Effectiveness of "Centaurea behen" root on quality of life in patients with systolic heart failure: A randomized clinical trial.

Introduction: The effect of Centaurea behen (Cb) on patients with systolic heart failure is not known academically. This study was conducted to evaluate the effect of Cb on improving the quality of life (QoL) and echocardiographic and biochemical blood parameters in patients with systolic heart failure. Methods: This study was a parallel double-blind, placebo-controlled randomized trial of 60 patients with systolic heart failure, was conducted from May 2018 up to August 2019. Intervention group received 150 mg twice daily Cb capsules for two months + Guideline directed medical therapy (GDMT), and control group received GDMT + placebo capsules for two months. The main aim of the present study were to assess the QoL based on the 6-minute walk test (6MWT) and the Minnesota living with heart failure questionnaire (MLHFQ). Independent T-test, paired T-test, and ANOVA were used for the analysis. Results: At the beginning of the present study there were no significant differences between study groups in terms of QoL and clinical results. After treatment, the average values of QoL based on MLHFQ and 6MWT instruments were significantly improved 15.5 and 36.18, respectively (P<0.05). Conclusion: Based on the MLHFQ, and 6MWT tests, the consumption of Centaurea behen root extract was associated with significant improvement in the quality of life of patients with systolic heart failure.

Synthesis of physically crosslinked PAM/CNT flakes nanocomposite hydrogel films via a destructive approach.

Carbon nanotube (CNT)-based hydrogels have recently found a wide variety of applications due to the unique physical and chemical properties of CNTs. CNTs can be used as a nanofiller and/or crosslinker to produce nanocomposite hydrogels with good mechanical and structural properties. In this research, a novel method was reported for producing polyacrylamide (PAM)/oxidized-multiwalled carbon nanotube (O-MWCNT) flakes nanocomposite hydrogel films without using any organic cross-linker or surfactant. Through a mechanism dependent on the reactive oxygen species (ROS), some O-MWCNTs were broken down in situ into small flakes in the aqueous solutions containing acrylamide (AM) and sodium persulfate (NaPS) at the temperature range of 85-90 °C. Simultaneously, in situ polymerization of the AM monomers occurred using free radicals, which resulted in the formation of PAM chains. The flakes acted as crosslinkers by forming hydrogen bonds with PAM chains and formed a hydrogel network after 48 h at room temperature. The hydrogels were characterized by different techniques (FT-IR, Raman, FE-SEM, TEM, TGA, tensile test). The porous structure of the hydrogel films as well as micro-network structures with unique morphologies were observed by SEM. The O-MWCNT flakes and some undegraded O-MWCNTs in the hydrogel network were also observed by TEM. The results showed that PC2I2H hydrogel film, as an evolved hydrogel, has excellent swelling performance in aqueous solutions at different pH and temperatures. In addition, this hydrogel showed a tensile strength of 103 MPa in the dry state and an elongation of 703% in the swollen state.

Anticancer DOX delivery system based on CNTs: Functionalization, targeting and novel technologies.

Carbon nanotubes (CNTs) have attracted significant attention as promising nanocarriers in the field of drug delivery, due to their properties such as ultrahigh length-to-diameter ratio and excellent cellular uptake. The unique conjugated structure of CNTs suits their surface for π-π stacking interactions with many drugs and therapeutic molecules with aromatic rings, including anthracyclines. Doxorubicin(DOX), as an anthracycline anticancer drug, can be easily adsorbed onto the surface of CNTs via π-π stacking, making the CNTs-DOX conjugation, as the basis of CNT-based drug delivery systems(DDSs) for the delivery of DOX to cancer cells. In this review article, the delivery of DOX using various CNT-based DDSs is presented. In addition, the current progress of in vitro and in vivo research on the design of DOX loaded CNT-based DDSs, including the functionalization and targeting of CNTs, has been reviewed, focusing particularly on emerging technologies and techniques to date for DOX delivery by CNT-based DDSs.

Effect of corrective or palliative procedures on arterial to end-tidal carbon dioxide pressure difference in pediatric cardiac surgery.

BACKGROUND: The normal small difference (3-5 mmHg) between arterial (partial pressure of carbon dioxide [PaCO2]) and end-tidal carbon dioxide pressure (ETPCO2) increases in children with congenital heart disease. The present study was conducted to evaluate the effect of corrective or palliative cardiac surgery on this difference (known as DPCO2). PATIENTS AND METHODS: In a prospective study, 200 children (aged <12 years old) candidate for corrective or palliative cardiac surgery were studied. Using arterial blood gas measurement and simultaneous capnography, DPCO2 was calculated at various intra- and postoperative periods. DPCO2 values were compared within and between corrective or palliative procedures. RESULTS: Corrective and palliative procedures were carried out on 154 and 46 patients, respectively. Initial DPCO2 was higher than normal values in corrective or palliative procedures (15.50 ± 13.1 and 10.75 ± 9.1 mmHg, respectively). DPCO2 was higher in patients who underwent palliative procedure, except early after procedure. The procedure did not have any effect on the final DPCO2 in palliative group. Although DPCO2 decrease was significant in the corrective group, it did not return to normal values. Operation time was longer, and the need to inotropic support was higher in corrective procedures; however, longer periods of ventilatory support were needed in the palliative group. Complication rate and Intensive Care Unit stay time were the same in two operation types. CONCLUSIONS: DPCO2 did not change after palliative cardiac procedures. DPCO2 decreased after corrective procedures; however, it did not return to normal values at early postoperative period. Thus, DPCO2 may not have any clinical value in monitoring the quality of corrective or palliative procedures.

The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery.

INTRODUCTION: Over the past decades, it has been recommended that preoperative assessment mainly relies on history and physical examination rather than unnecessary laboratory tests. In Iranian hospitals, erythrocyte sedimentation rate (ESR) has been routinely measured in most of the patients awaiting major surgery, which has in turn exacted heavy costs on the health system. Therefore, the aim of the present study was to assess the preoperative routine measurement of ESR in such patients. MATERIALS AND METHODS: This is a retrospective study, in which we evaluated the medical files of 620 patients. Patients older than 18 years, who had undergone elective heart surgery in our hospital in 2014, were included in the study. The data associated with demography, heart disease diagnosis, type of surgery, significant preoperative tests, delay or postponing of surgery and the reason for it, type and characteristics of the subspecialty consultation, and finally, postoperative complication and mortality rate were collected and analyzed. The patients were categorized into four groups according to ESR value: normal (<15 mm/h in females or <20 mm/h in males), moderately increased (<40 mm/h), severely increased (≥40 mm/h), and not measured. RESULTS: Of the 620 patients' files, 402 were of males and 218 were of females. Demographic values and preoperative characteristics were similar in the four groups. A total of 105 consultations were given to 79 patients preoperatively, where only in five cases, the elevation in ESR was the main reason for consultation. In no other cases did the consultations result in new diagnoses. Overall, postoperative complication and mortality rate were the same in all four groups; in severely increased ESR group, on the other hand, the need for long periods of intensive care unit (ICU) and hospital stays was higher than that of other groups. CONCLUSION: It is concluded that elevated preoperative ESR does not cancel or defer the surgery, nor does it help diagnose a new, previously undiagnosed disease. Furthermore, it does not generally affect postoperative morbidity or mortality rate unless increased to ≥40 mm/h, where it can increase postoperative ICU and hospital stay. Ultimately, routine preoperative ESR measurement in patients is not conducive to elective heart surgery.

Comparative effect of grape seed extract (Vitis vinifera) and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery.

BACKGROUND: This study aimed to test the beneficial effect of grape seed extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary artery bypass surgery. PATIENTS AND METHODS: In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surgery included. The patients were randomly assigned into three groups (n = 29 each): (1) Control group with no treatment, (2) GSE group who received the extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C group who received 25 mg/kg Vitamin C through CPB during surgery. Blood samples were taken from coronary sinus at (T1) just before aortic cross clamp; (T2) just before starting controlled aortic root reperfusion; and (T3) 10 min after root reperfusion. Some clinical parameters and biochemical markers were compared among the groups. RESULTS: There were significant differences in tracheal intubation times, sinus rhythm return, and left ventricular function between treatment groups compared with control (P < 0.05). Total antioxidant capacity was higher (P < 0.05) in both grape seed and Vitamin C groups at T2 and T3 times. In reperfusion period, malondialdehyde level was increased in control group; however, it was significantly lower for the grape seed group (P = 0.04). The differences in the mean levels of superoxide dismutase and glutathione peroxidase among the three groups were not significant (P > 0.05 in all cases). CONCLUSIONS: In our patients, GSE and Vitamin C had antioxidative effects and reduced deleterious effects of CPB during coronary artery bypass grafting surgery.

The combination of breast necrosis and chylothorax following the OPCAB.

Due to long term patency, the internal mammary artery is considered as a conduit of choice for revascularization of the left anterior descending coronary artery. The internal mammary artery and its accessory branches in addition to perfusing the chest wall structures also contributes to supplying, part of the female breast arteries. In addition, due to the accompaniment of thoracic duct branches with the left internal mammary artery, harvesting may be associated with injury to these branches and contribute to chylothorax. We report a rare case of chylothorax and the breast necrosis following the coronary artery bypass grafting. The chylothorax was started in the second postoperative day and ceased gradually in the 12th day of operation. The breast necrosis appeared in the 3th weeks of operation with pain, and tenderness and black skin color change. The patient underwent total mastectomy in the 4th weeks of operation.

Correlation of Serum Levels of Vitronectin, Malondialdehyde and Hs- CRP With Disease Severity in Coronary Artery Disease.

INTRODUCTION: Vitronectin (VN), malondialdehyde (MDA) and high-sensitivity C-reactive rotein (hs-CRP) are cooperative agents involved in the atherosclerosis process. The study was conducted to assess the correlation of VN, MDA and hs-CRP with the severity of coronary artery disease (CAD). METHODS: Parameters such as serum VN, MDA and hs-CRP were measured in 250 subjects including 200 patients with angiographically diagnosed CAD (50 subjects with non-significant CAD, 50 with single vessel disease, 50 with double vessel disease, and 50 with triple vessel disease) and 50 CAD-free subjects as a control group. Serum VN was measured with ELISA; MDA was measured based on reaction with thiobarbituric acid (TBA); and hs-CRP level was measured by a Commercial Kit by Immunoturbidimetry. RESULTS: Serum VN, MDA and hs-CRP were significantly higher in patient groups compared to control group (P < .05). The mean value of MDA between 1 vessel and 3 vessel groups had significant difference (P = .01), also mean value of MDA between 2 vessel and control group and normal group showed significant difference (P < .001). The difference of MDA between 3 vessel and normal and 1 vessel and control group was significant (P < .001). CONCLUSION: The association and correlation between VN, MDA and hs-CRP indicate their involvement in the atherosclerosis process that may lead to progression of CAD. Also, these findings suggested that serum levels of VN, MDA and hs-CRP can help as diagnostic and monitoring markers in CAD patients and as markers of disease severity.

Effects of Ramadan Fasting on Serum Amyloid A and Protein Carbonyl Group Levels in Patients With Cardiovascular Diseases.

INTRODUCTION: Serum amyloid-A (SAA) and protein carbonyl group are rigorously related with cardiovascular diseases (CVDs) as a sensitive marker of an acute inflammatory state and as an important index of oxidative stress, respectively. Moreover, diet is one of the main factors that can modify cardiovascular risks. Therefore, this study aimed to investigate the effects of Ramadan fasting on SAA and protein carbonyl group levels in patients with CVDs. METHODS: Twenty-one patients (21 male; mean age 52±9 years old) with CVDs (coronary artery disease, cerebrovascular, or peripheral arterial diseases) were participated in this study. Biochemical parameters were measured in patients 2 days before and 2 days after Ramadan fasting. SAA levels were assessed using enzyme-linked immunosorbent assay and Cayman's protein carbonyl colorimetric assay was provided for measuring protein carbonyl groups. RESULTS: According to the findings of the study, post-Ramadan levels of inflammatory biomarker, SAA was decreased significantly in patients with CVDs in comparison with the baseline before-fasting values (16.84±8.20 vs. 24.40±6.72 µg/ml, P = 0.021). In addition, Ramadan fasting significantly reduced the levels of protein carbonyl group in patients as compared with those of baseline values (33.08±15.31 vs. 43.65±16.88 nmol/ml, P = 0.039). CONCLUSION: Ramadan fasting has impressive effects on modulating CVDs by decreasing inflammation and oxidative stress markers. However, to get a clear conclusion with more results, further investigation is warranted.

Electrochemical synthesis of ultrafast and gram-scale surfactant-free tellurium nanowires by gas-solid transformation and their applications as supercapacitor electrodes for p-doping of graphene transistors.

We herein report a gas-solid transformation mechanism for the surfactant-free synthesis of Te NWs at room temperature by electrolysis of bulk Bi2Te3 using H2Te gas. Te NWs, with an average diameter below 20 nm, grow along the [001] direction due to the unique spiral chains in the crystal structure and show an enhanced Raman scattering effect, a broad absorption band over the range of 350-750 nm and an emission band over the range of 400-700 nm in the photoluminescence spectrum. In terms of device applications, we demonstrate how Te NWs can be directly applied as a p-type dopant source in order to shift the Dirac point in ambipolar field effect graphene transistors. Finally, the favorable capacitive properties of Te NWs are established as supercapacitor electrodes with negligible internal resistance and excellent electrochemical reversibility and a specific capacitance of 24 F g(-1).

Microwave-assisted fabrication of titanium implants with controlled surface topography for rapid bone healing.

Morphological surface modifications have been reported to enhance the performance of biomedical implants. However, current methods of introducing graded porosity involves postprocessing techniques that lead to formation of microcracks, delamination, loss of fatigue strength, and, overall, poor mechanical properties. To address these issues, we developed a microwave sintering procedure whereby pure titanium powder can be readily densified into implants with graded porosity in a single step. Using this approach, surface topography of implants can be closely controlled to have a distinctive combination of surface area, pore size, and surface roughness. In this study, the effect of various surface topographies on in vitro response of neonatal rat calvarial osteoblast in terms of attachment and proliferation is studied. Certain graded surfaces nearly double the chance of cell viability in early stages (∼one month) and are therefore expected to improve the rate of healing. On the other hand, while the osteoblast morphology significantly differs in each sample at different periods, there is no straightforward correlation between early proliferation and quantitative surface parameters such as average roughness or surface area. This indicates that the nature of cell-surface interactions likely depends on other factors, including spatial parameters.

Fabrication of large-scale single-crystal bismuth telluride (Bi2Te3) nanosheet arrays by a single-step electrolysis process.

Nanolizing of thermoelectric materials is one approach to reduce the thermal conductivity and hence enhance the figure of merit. Bismuth telluride (Bi2Te3)-based materials have excellent figure of merit at room temperature. For device applications, precise control and rapid fabrication for the nanostructure of thermoelectric materials are essential issues. In the present study, we demonstrate a one-step electrolysis process to directly form Bi2Te3 nanosheet arrays (NSAs) on the surface of bulk Bi2Te3 with controllable spacing distance and depth by tuning the applied bias and duration. The single sheet of NSAs reveals that the average thickness and electrical resistivity of single crystalline Bi2Te3 in composition are 399.8 nm and 137.34 µΩ m, respectively. The formation mechanism of NSAs has been proposed. A 1.12% efficiency of quantum dot-sensitized solar cells with Bi2Te3 NSAs for counter electrode has been demonstrated, indicating that Bi2Te3 NSAs from top-down processing with a high ratio of surface area to volume are a promising candidate for possible applications such as thermoelectrics, dye-sensitized solar cells (DSSCs), and lithium-ion batteries.

Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation: immediate and intermediate-term results.

OBJECTIVES: This study sought to evaluate the outcomes of endovascular treatment with covered versus bare Cheatham-platinum stents (NuMed, Hopkinton, New York) in coarctation of aorta (CoA) patients. BACKGROUND: Covered stenting has been newly recognized as a useful therapeutic method for patients with native CoA, but there has been no study comparing the use of covered stents with bare stents for treating CoA. METHODS: In this randomized clinical trial, 120 patients with a mean age of 23.60 ± 10.99 years (range 12 to 58 years, 79 men), with post-ductal, short-segment, severe native CoA underwent implantation of bare Cheatham-Platinum (bCP) (n = 60) or covered Cheatham-Platinum (cCP) (n = 60) stents. Patients were followed clinically at 1, 3, 6, and 12 months after the stenting and yearly thereafter. During follow-up, multislice computed tomography (64 slices) was scheduled to assess any complications. RESULTS: The procedural success rate was 100% in both groups. Patients were followed for 31.1 ± 19.2 months. Although recoarctation was seen only in the bCP group during follow-up, the difference between groups did not reach statistical significance (6.7% vs. 0%; p = NS). Two cases of pseudoaneurysm (3.3%) occurred in the cCP group, but none was observed in the bCP group (p = NS). Normotensive status significantly increased during follow-up in both groups (from 15% to 73.3% in the bCP group and 16.7% to 78.3% in the cCP group, p < 0.001 for each group and not significant between groups). CONCLUSIONS: Implanting bCP and cCP stents have very high success rates with remarkable hemodynamic effects in severe native CoA patients. Patients undergoing cCP stent implantation experienced a nonsignificantly lower recoarctation rate and a higher occurrence of pseudoaneurysm formation with respect to bCP stenting during follow-up. These findings indicate that CoA stenting is a safe procedure. (Endovascular Stenting With Covered CP Stent Compared With Bare CP Stent for Adult Patients With Coarctation: The Initial and Intermediate-Term Follow-Up Results; IRCT201012045311N1).

A study on the mortality and complication rates following percutaneously adjustable pulmonary artery banding.

INTRODUCTION: Pulmonary artery (PA) banding is a procedure associated with high morbidity and mortality rates. It however can effectively palliate several forms of congenital heart lesions with increased pulmonary flow. Occasionally, to obtain an optimal degree of banding following operation, readjustment of the band is inevitable. We describe the technique of adjustable PA banding to prevent this problem. METHODS: From June 2007 to 2008, 21 patients with congenital cardiac abnormalities including Single ventricle (1), transposition of great arteries (TGA) (4) and ventricular septal defect (VSD) (16) were operated via percutaneously adjustable PA banding in Madani Hospital (Tabriz, Iran). RESULTS: The mean age and the mean weight of the patients were 12±.8 months and 61±.7 kg respectively. Seventeen (81%) patients survived the operation. Cause of death was heart failure in 2 (9.5%) patients, and arrhythmia in 2 (9.5%) patients. Later, patients were followed up for 6 months. Satisfactory band gradient was achieved between 48 and 240 hours. Mean PA gradient before and 1 and 6 months after adjusting was (55.3±7.1 mmHg), (54.7±5.1 mmHg), and (53.2±5.4 mmHg) respectively. In the follow up period, there were 2 deaths, one caused by aspiration pneumonia and one caused by poor mixing. Postoperative complications were observed in 28.5% of the cases including cardiac (10%), pulmonary (pneumothorax, pneumonia) (10%) and infectious complications (9%). CONCLUSION: The technique of percutaneously adjustable PA banding is simple and inexpensive and allows easy band adjustments without the need for multiple reoperations. Moreover, our assessment reveals that created gradient is constant and did not decrease with time.

Factors influencing prolonged ICU stay after open heart surgery.

BACKGROUND: There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. OBJECTIVES: The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay in a large referral hospital. PATIENTS AND METHODS: We conducted a case-control study to determinate causes of prolonged ICU stay in 280 adult patients undergoing cardiac surgery in a tertiary care center for cardiovascular patients, Tehran, Iran. These patients were divided into two groups according to ICU stay ≤ 96 and > 96 hours. We evaluated perioperative risk factors of ICU stay > 96 hours. RESULTS: Among the 280 patients studied, 184 (65.7%) had stayed ≤ 96 hours and 96 (34.3%) had stayed > 96 hours in ICU. Frequency of prolonged ICU stay was 34.2% in patients undergoing coronary artery bypass graft (CABG), 30.8% in patients with valve surgery, and 44.8% in patients with CABG plus valve surgery. Patients with > 96 hours of ICU stay received more blood transfusion and intravenous inotropes. They also had longer anesthesia, cardiopulmonary bypass, and postoperative intubation time. There were higher incidence of postoperative tamponade, re-exploration, re-intubation, hemodialysis, and hypotension in this group (P < 0.05 for all comparisons). CONCLUSIONS: In this study, about one-third of patients had prolonged ICU stay. Factors influencing prolonged ICU stay were medical and some non-medical factors. In the present study, up to 30% of the patients had a prolonged ICU stay of > 96 hours. Additional data from well-designed investigations are needed for further assessment of the factors influencing prolonged ICU stay after cardiac surgery.

Evaluation of Early and Intermediate Outcomes of Cryo-MazeProcedure for Atrial Fibrillation.

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with mitral valve disease affecting 50% of patients undergoing mitral valve surgery, contributing to increased risks of systemic embolization, anticoagulant- related hemorrhage and mortality. The maze procedure is an effective way to treat AF. Over the last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, few studies have been carried out to evaluate the results of cryoablation surgery. In the present study we evaluated the results of this procedure. METHODS: In this cross sectional study, 47 AF patients were treated with Cryo-Maze surgery method. Rhythm assessment using electrocardiographic and echocardiographic survey was performed in all patients before surgery, during the patients' hospital stay, on discharge and after six months. RESULTS: Survival rate of the studied patients at six months was 93.6%. Sinus rhythm restoration rate in Cryo-Maze patients was 72.1% on discharge and 76.7% six months after their operation. CONCLUSION: The present study revealed that Cryo-Maze procedure is an effective and safe therapeutic modality in AF while normal sinus rhythm can be achieved in patients following this intervention.

Evaluation of cardiovascular diseases and their risk factors in hospitalized patients in East azerbaijan province, northwest iran: a review of 18323 cases.

BACKGROUND: Coronary artery disease (CAD) is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. METHODS: Data on 18.323 patients hospitalized due to cardiovascular diseases were collected to evaluate the diseases and their risk factors in 15 hospitals in the East Azerbaijan Province, northwest Iran. We assessed the main diagnosis of cardiovascular disease on admission in each hospital. Also, types of interventional and surgical procedures were assessed and all these variables were compared between men and women. RESULTS: The study population consisted of 56.6% male and 43.4% female patients. The median and range between quartile 1 and 3 (Q1-Q3) ages of the males and females were 59 (49-70) and 62 (51-71) years, respectively. Ischemic heart diseases were diagnosed in 68.4%, electrophysiological disorders in 6.5%, and valvular heart diseases in 4.5% of the patients. The frequencies of the studied risk factors were as follows: cigarette smoking (47.5%); hypertension (66.95%); diabetes mellitus (35.9%); and history of cerebrovascular accident (16.4%) and renal disease (13.4%). Medical therapy was performed in 79.23%, surgery in 6.28%, and cardiovascular interventional therapy in 13.99% of the patients. The in-hospital mortality rate was 1.57% (1.42% in the males and 1.76% in the females; p value = 0.009). CONCLUSION: The most frequent known risk factors in the hospitalized patients were smoking, alcohol consumption, and diabetes. In the northwest of Iran, age at hospitalization due to cardiovascular diseases is slightly lower than that in the Western populations; however, sex distribution, diagnoses, and treatment modalities are not significantly different from those reported in Western countries.

Prerequisites for electronic learning: Iranian postgraduate nursing students' points of view.

BACKGROUND: Nursing education is mostly conducted through electronic educational programs. We aimed at assessing the Iranian postgraduate nursing students' skills and attitudes regarding the electronic education. MATERIALS AND METHODS: Ninety-seven postgraduate nursing students were surveyed using questionnaires assessing their individual-social and educational characteristics, electronic education skills, and attitudes toward the electronic education. RESULTS: Scores of the students' skills in using computer and the Internet were significantly associated with gender and the number of hours working with computer and the Internet at home and work. CONCLUSION: Prerequisites for performing electronic education programs are present at moderate levels in Iran.

The value of serum osteoprotegerin levels in patients with angina like chest pain undergoing diagnostic coronary angiography.

BACKGROUND: Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily.Recent evidence supports a relationship between serum OPG level and atherosclerosis. The aim of this study was to evaluate the possible association of OPG with the presence of coronary artery disease (CAD), its severity and prognosis in patients with chest pain and suspected coronary stenosis. METHODS: In this cross-sectional analytic study, 180 candidates of elective coronary artery angiography were recruited. Serum level of OPG was measured by ELISA method in all patients and its relation with presence and severity of CAD based on a coronary atherosclerosis score (CAS) was assessed. Patients were followed for a mean period of about 24 ± 3.2 months and the relationship between OPG levels and future cardiac events were evaluated. RESULTS: The mean serum level of OPG was 1637 ± 226 pg/mL in those with CAD and 1295 ± 185 pg/mL (nonparametric p = 0.001) in those without it. There was a significant direct correlation between the level of serum OPG and CAS (rho = 0.225, p = 0.002). The optimalcut-off point for predicting a significant coronary artery obstruction was a serum level of≥ 1412 pg/mL with a sensitivity and specificity of 60% and 57.8%, respectively. Major adversecardiac events (MACE) including cardiovascular death, admission with acute coronary syndrome,or heart failure, was significantly higher in those with higher OPG levels (22 [34.3%]vs. 15 [16%], p = 0.012). CONCLUSIONS: There was a direct and significant correlation between the serum level of OPG and CAS. MACE occurred more commonly in those with higher baseline OPG levels.

Prophylactic high-dose oral-N-acetylcysteine does not prevent atrial fibrillation after heart surgery: a prospective double blind placebo-controlled randomized clinical trial.

AIMS: Postoperative atrial fibrillation (POAF) following cardiac surgery is a frequent complication with multifactorial etiologies. Recently inflammation due to enhanced oxidative stress has been implicated in its pathogenesis. N-acetylcysteine (NAC) is a promising and novel antioxidant agent. The purpose of this study was to evaluate the efficacy of high-dose oral-NAC for prevention of POAF. METHODS: Two hundred and forty patients were randomized in this prospective, double blind placebo-controlled trial to either 1,200-mg oral-NAC two times a day (n = 120) or placebo (n = 120) starting 48 hours before and up to 72 hours after open heart surgery. RESULTS: The mean age was about 60 years, and 75% were male. Patients in the NAC group were older, with higher percentage of acute coronary syndrome, hypercholesterolemia, and left internal mammary artery use. Coronary involvement and hypertension were more prevalent in the placebo group. All other baseline patient characteristics were similar between groups. Overall POAF developed in 13.8% of the patients. There was no difference in the incidence of POAF between the NAC vs placebo groups (11.7% vs 15.8%, respectively; P = 0.34). Postoperative hospital stay, morbidity, and mortality were similar in both groups. CONCLUSIONS: Prophylactic high-dose oral-NAC begun 2 days before open heart surgery and continued for 5 days, and had no significant effect on the incidence of POAF, in-hospital stay, and postoperative morbidity or mortality.