Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction.

BACKGROUND: Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. METHODS & RESULTS: Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5-10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3-17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. CONCLUSIONS: ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

Rheum officinale (a traditional Chinese medicine) for chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a major public health issue worldwide. Standard therapies to delay CKD progression include dietary protein restriction and administration of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) to help control blood pressure and confer additional renoprotective effects. Despite such interventions, CKD incidence and mortality rates continue to increase. Rheum officinale (Da Huang) a medicinal herb used widely in China to treat CKD has been reported to offer a range of pharmacological properties that may delay disease progression. OBJECTIVES: To assess the benefits and harms of Rheum officinale for preventing the progression of CKD. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register and CENTRAL (Issue 4, 2011), MEDLINE, EMBASE, the Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), VIP (Chongqing VIP Chinese Science and Technology Periodical Database), and Wanfang Data. We also handsearched reference lists of articles. We applied no restrictions on language of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that assessed the benefits and harms of Rheum officinale for preventing the progression of CKD regardless of dosage, type, maturity, mode of administration, duration of treatment, or storage time before use. DATA COLLECTION AND ANALYSIS: Two authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We expressed results for dichotomous outcomes (need for renal replacement therapy, all-cause mortality, quality of life) as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes (glomerular filtration rate (GFR), serum creatinine (SCr), creatinine clearance (CrCl), blood urea nitrogen (BUN)) were expressed as mean differences (MD) with 95% CIs. MAIN RESULTS: We identified nine studies that enrolled 682 participants. None of the studies reported blinding or group allocation methods. Seven studies were judged to be at low risk of incomplete outcome reporting; three studies were judged to be a low risk of selective reporting (protocols were available and/or all outcomes relevant to the this review were reported); and two studies were judged free of other potential biases.Seven studies compared Rheum officinale with no treatment and two made comparisons with captopril, an angiotensin-converting enzyme inhibitor (ACEi). Compared with no treatment, Rheum officinale had a positive effect on SCr (MD -87.49 µmol/L, 95% CI -139.25 to -35.72) and BUN (MD -10.61 mmol/L, 95% CI -19.45 to -2.21). Compared with captopril, a statistically significant difference was not demonstrated in relation to Rheum officinale for any outcome (BUN, CrCl, or patients' capacity to undertake work). No data were available on all-cause mortality or cost of treatment. Only minor adverse events were reported in association with Rheum officinale. AUTHORS' CONCLUSIONS: Currently available evidence concerning the efficacy of Rheum officinale to improve SCr and BUN levels in patients with CKD is both scant and low quality. Although Rheum officinale does not appear to be associated with serious adverse events among patients with CKD, there is no current evidence to support any recommendation for its use.

Oxygen therapy for pneumonia in adults.

BACKGROUND: Oxygen therapy is widely used in the treatment of lung diseases. However, the effectiveness of oxygen therapy as a treatment for pneumonia is not well known. OBJECTIVES: To determine the effectiveness and safety of oxygen therapy in the treatment of pneumonia in adults older than 18 years. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 4, part of The Cochrane Library, www.thecochranelibrary.com (accessed 9 December 2011), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1948 to November week 3, 2011) and EMBASE (1974 to December 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) of oxygen therapy for adults with community-acquired pneumonia (CAP) and nosocomial (hospital-acquired) pneumonia (HAP or NP) in intensive care units (ICU). DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed abstracts and assessed data for methodological quality. MAIN RESULTS: Three RCTs met our inclusion criteria. The studies enrolled 151 participants with CAP or immunosuppressed patients with pulmonary infiltrates. Overall, we found that non-invasive ventilation can reduce the risk of death in the ICU, odd ratio (OR) 0.28, 95% confidence interval (CI) 0.09 to 0.88; endotracheal intubation, OR 0.26, 95% CI 0.11 to 0.61; complications, OR 0.23, 95% CI 0.08 to 0.70; and shorten ICU length of stay, mean duration (MD) -3.28, 95% CI -5.41 to -1.61.Non-invasive ventilation and standard oxygen supplementation via a Venturi mask were similar when measuring mortality in hospital, OR 0.54, 95% CI 0.11 to 2.68; two-month survival, OR 1.67, 95% CI 0.53 to 5.28; duration of hospital stay, MD -1.00, 95% CI -2.05 to 0.05; and duration of mechanical ventilation, standard MD -0.26, 95% CI -0.66 to 0.14. Some outcomes and complications of non-invasive ventilation were varied according to different participant populations. We also found that some subgroups had a high level of heterogeneity when conducting pooled analyses. AUTHORS' CONCLUSIONS: Non-invasive ventilation can reduce the risk of death in the ICU, endotracheal intubation, shorten ICU stay and length of intubation. Some outcomes and complications of non-invasive ventilation were varied according to different participant populations. Other than the oxygen therapy, we must mention the importance of standard treatment by physicians. The evidence is weak and we did not include participants with pulmonary tuberculosis and cystic fibrosis. More RCTs are required to answer these clinical questions. However, the review indicates that non-invasive ventilation may be more beneficial than standard oxygen supplementation via a Venturi mask for pneumonia.

Prostaglandin E1 for preventing the progression of diabetic kidney disease.

BACKGROUND: Diabetic kidney disease (DKD) is one of the major chronic microvascular complications in diabetes mellitus, and may progress to end-stage kidney disease (ESKD). There are no definitely effective approaches for preventing, delaying or treating DKD. Small studies have shown that Prostaglandin E1 (PGE1) can improve renal blood circulation and decrease proteinuria and albuminuria. OBJECTIVES: To assess the benefits and harms of PGE1 for preventing the progression of DKD. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedicine Database (CBM) and reference lists of articles with no language restriction. SELECTION CRITERIA: All randomised controlled trials (RCTs) or quasi-RCTs comparing any PGE1 agent used for preventing the progression of DKD, regardless of dosage, mode of administration, addition of cointerventions or duration of treatment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. For dichotomous outcomes (all-cause mortality, ESKD), results were expressed as relative risk (RR) with 95% confidence intervals (CI). Continuous outcomes (microalbuminuria, proteinuria, albuminuria, doubling of serum creatinine, serum creatinine) were expressed as mean difference (MD) with 95% CI. MAIN RESULTS: Six studies (271 patients) were included. Five studies investigated PGE1 with or without fosinopril/losartan versus fosinopril/losartan or no treatment and one compared PGE1 versus Xueshuantong (a Chinese medicinal herb). There was a significant decrease in urinary albumin excretion rate (UAER) in patients treated with PGE1 (MD -48.28 microg/min, 95% CI -75.29 to -21.28), other outcomes also showed a significant decrease in the patients with PGE1 (albuminuria: MD -143.66 mg/24 h, 95% CI -221.48 to -65.84; proteinuria: MD -300 g/24 h, 95% CI -518.34 to -81.66). PGE1 had a positive effect on albuminuria (MD -660 mg/24 h, 95% CI -867.07 to -452.93) in clinical DKD (CDN, III stage of DN) compared with Xueshuantong. No data on incidence of ESKD, all-cause mortality or quality of life were available. AUTHORS' CONCLUSIONS: PGE1 may have positive effects on DKD by reducing UAER, decreasing albuminuria and lessening proteinuria, with no obvious serious adverse events. However, limited by the poor methodological quality of the included studies and the small number of participants, there is currently insufficient evidence for determining if PGE1 could be used for preventing the progression of DKD. Large, properly randomised, placebo-controlled, double-blind studies are urgently needed.

[Study on the accuracy of dual source computed tomography coronary angiography in detection of coronary artery stenoses in old patients].

OBJECTIVE: To investigate the accuracy of dual source computed tomography (DSCT) coronary angiography in detecton of coronary artery stenoses in patients older than 60 years. METHODS: The study was performed in 102 patients older than 60 years who were suspected of coronary artery stenoses, and without any contraindications to CT Scan and iodnated contrast agents. These patients underwent DSCT, as well as selective coronary angiography (SCA). All the data of DSCT were compared with the results of SCA which were regarded as gold standard to assess the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DSCT in classifying coronary artery stenoses in old patients. RESULTS: In these 102 patients, DSCT indicated 56 patients with coronary artery stenoses and SCA indicated 52 patients. DSCT correctly classified 51 patients out of 52 patients who had significant coronary artery stenoses. The sensitivity of DSCT was 98.1%, specificity was 90.0%, positive predictive value was 91.1%, negative predictive value was 97.8%, and accuracy was 94.1%. DSCT also assessed and measured 408 lesions in all the patients. The sensitivity of DSCT was 95.8%, specificity was 96.2%, positive predictive value was 88.5%, negative predictive value was 98.7%, and accuracy was 96.1%. CONCLUSION: DSCT appears to be a useful method for the detection of coronary artery stenoses with a high accuracy in elder patients more than 60-year.

[The feasibility exploration of cultured newborn rat ventricular myocyte taking the place of acutely enzymatic isolated myocardium for study in electrophysiology of pacemaker current].

OBJECTIVE: To investigate the feasibility of cultured rat ventricular myocytes taking the place of acutely enzymatic isolated myocardia for study in the pacemaker current electrophysiology. METHODS: By using patch-clamp technique, the whole-cell pacemaker currents were recorded to study the difference of pacemaker current electrophysiology between neonatal rat ventricular myocytes isolated acutely and maintained in cell culture. RESULTS: The cell membrane capacitances (Cm) were significantly decreased in myocardia even upon short term of cell culture. The Cm of myocardia cultured 1-3 day were (43 +/- 3) pF, with decreased 23% compared to acute enzymatic isolated cells C(56+/-7) pF, P<0. 013. It seemed like the Cm increased slightly upon cell cultured time, but no significant difference appearing among various culture stages (P > 0. 05) . No significant difference of pacemaker current electrophysiological character, such as reverse potential, current density, active threshold and V0.5, was detected from different cell group (P>0. 05). CONCLUSION: The cultured myocardium can take place of acute enzymatic isolated myocardium used to study in pacemaker current. The cells cultured no more than one week may be more suitable to this kind of electrophysiological experiment.

[Social functions of the longevous elderly population in Dujiangyan].

OBJECTIVE: To describe the social functions of the longevous elderly population in Dujiangyan. METHODS: A questionnaire survey was undertaken in Dujiangyan in 875 elderly people who were over 90 years old. RESULTS: Poor social economic status was prevalent in the longevous elderly population. The elderly people had limited social contacts except from their families. The daily lives of 65. 0% of the longevous elderly were taken care of by their families. More than 81. 8% of the longevous elderly people were financially supported by their families. About 89. 2% of the longevous elderly people had accessed to spiritual supports in difficult circumstances, among 88. 7% came from families. CONCLUSION: Thanks to the family supports, the longevous people in Dujiangyan have maintained good social functions.

Effects of autologous stem cell transplantation on ventricular electrophysiology in doxorubicin-induced heart failure.

To investigate whether stem cell transplantation affects ventricular electrophysiology in vivo, either autologous bone marrow mesenchymal stem cells or skeletal myoblast cells were transplanted via a catheter into a doxorubicin-treated failing heart. Four weeks after transplantation, electrophysiological investigation showed that transplantation of either cell type prolonged the local activation time and increased the activation time dispersion. In the stem cell transplantation groups, a positive correlation was demonstrated between activation time dispersion and the number of stem cell-derived cells in the pacing site. It is concluded that transplantation of either mesenchymal stem cells or skeletal myoblast cells might exacerbate abnormalities of local ventricular conduction in the doxorubicin-treated failing heart.