B-scan measurements of intraocular tumor heights intraoperatively, before and after radioactive plaque application: A comparative prospective study.

PURPOSE: To assess the difference in intraocular tumors height measurements intraoperatively before and after radioactive plaque application. METHODOLOGY: Twenty-four eyes of 24 patients with intraocular tumors, candidates for radioactive therapy, were included. Each tumor was measured at the same setting before and after plaque application independently by 3 sonographers, using a 20-MHz B-scan transducer. Mean pre-plaque and post-plaque measurements were calculated and recorded. An A-scan vector aided in identification of the inner and outer tumor surfaces. RESULTS: Each patient was examined independently three times by three experienced ultrasonographers within the same setting to assess interobserver variability. There was no statistically significant difference between the 3 examiners' readings, with P-value 0.99 for pre-plaque height and 0.97 for post-plaque height. Mean pre-plaque height was 5.16±2.11mm, while post-plaque height was 5.51±2.1mm (P-value 0.001). The Spearman correlation test showed that initial tumor height was negatively correlated with the difference between both heights, but with no statistical significance. CONCLUSION: Intraocular tumor height measurement differs significantly before and after plaque application. Use of the pre-plaque height is advised until further studies are performed to assess the effect of this difference on treatment outcomes.

A review of transgenic animal techniques and their applications.

Nowadays, breakthroughs in molecular biology are happening at an unprecedented rate. One of them is the ability to engineer transgenic animals. A transgenic animal is one whose genome has been changed to carry genes from another species or to use techniques for animal genome editing for specific traits. Animal features can be changed by purposefully altering the gene (or genes). A mouse was the first successful transgenic animal. Then pigs, sheep, cattle, and rabbits came a few years later. The foreign-interested genes that will be used in animal transgenic techniques are prepared using a variety of methods. The produced gene of interest is placed into a variety of vectors, including yeast artificial chromosomes, bacterial plasmids, and cosmids. Several techniques, including heat shock, electroporation, viruses, the gene gun, microinjection, and liposomes, are used to deliver the created vector, which includes the interesting gene, into the host cell. Transgenesis can be carried out in the gonads, sperm, fertilized eggs, and embryos through DNA microinjection, retroviruses, stem cells, and cloning. The most effective transgenic marker at the moment is fluorescent protein. Although transgenesis raises a number of ethical concerns, this review concentrates on the fundamentals of animal transgenesis and its usage in industry, medicine, and agriculture. Transgenesis success is confirmed by the integration of an antibiotic resistance gene, western and southern blots, PCR, and ELISA. If technology solves social and ethical problems, it will be the most promising in the future.

A comparison of several methodologies of selection index for productive and reproductive characteristics in Egyptian buffaloes.

Data on Egyptian buffalo first lactation records (n = 1167) available at Mehalet Mousa Farm (between 2002 and 2015) of the Animal Production Research Institute (APRI), Cairo, Egypt, were used to analyse the genetic parameters of total milk yield (TMY), lactation time (LP), and age at first calving (AFC). Additionally, four selection indices were created by using a single phenotypic standard derivation as relevant economic values. The data were evaluated using multiple-trait derivative-free restricted maximum likelihood (MTDFREML). The estimated heritabilities for TMY, LP, and AFC were 0.22, 0.17, and 0.08 respectively and the phenotypic and genetic correlations between TMY and LP were 0.76 and 0.56, respectively, and between AFC with TMY and LP were nеgаtivеs. Using a selection index that incorporates TMY, LP, and AFC (RIH = 0.68) looks to be optimum for increased genetic gain and a shorter generation interval; as a result, selection should thus be exercised near the end of the first lactation.

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study.

INTRODUCTION: Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV. METHODS: This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism. RESULTS: Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD. CONCLUSION: These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

Rasmussen aneurysm: A forgotten complication of tuberculosis in the COVID-19 era.

COVID-19 pandemic has led to an overwhelming healthcare system causing a delay in management of other infectious diseases such as tuberculosis. Rasmussen aneurysm (RA) appears in chronic cavitary tuberculosis. We report here, three cases of pulmonary tuberculosis complicated by RA admitted to Department 1 of Abderrahmane Mami hospital in Tunisia. Data were collected from June 2020 to September 2021. All patients presented with hemoptysis. Sputum was positive for the acid-fast bacilli. Computed tomographic pulmonary angiography showed RA. Only one patient underwent emergent glue embolization. These cases give an insight into the importance of timely therapeutic care for tuberculosis.

Genetic evaluation of semen traits in Friesian bulls raised in Egypt.

A total of 14696 semen records were collected from Friesian bulls, kept at International Livestock Management Training Center belonging to Animal Research Institute, Ministry of Agriculture, Dokki, Cairo. Traits studied were volume, motility, livability and sperm concentrates in other to construct selection indexes by using all combination between different traits of semen to improve semen traits in a herd of Friesian bull cattle. Data were analysed by using four traits repeatability model and includes effects of the following fixed factors: the age of animal at semen collection, the combined effect of the month and year of semen collection, and the number of times semen were collected per month. Semen motility, volume and livability were highly influenced (p < 0.001) by all the fixed factors. Heritability estimates for semen traits were moderate and ranged from 0.29 to 0.33. All phenotypic and genetic correlations between different traits are positive and ranged from 0.09 to 0.67 for phenotypic correlations and from 0.02 to 0.68 for genetic correlations, while permanent environmental correlations ranged from -0.69 to 0.12. Estimated Breeding Values ranged from -0.68 to 0.78 ml for semen volume, from -13.17 to 7.34% for motility, from -259.42 × 10-6 to 239.64 × 10-6 for concentrates and from -6.83 to 6.09% for livability. Eleven selection indexes were calculated, selection Indexes not including livability showed a reduced accuracy. This study demonstrated that selection index (I3) which includes sperm volume, motility and livability or selection index (I8) which includes sperm volume and livability are the best and both are recommended for Friesian bulls' selection.

Genetic parameters, phenotypic and genetic trends of litter size on different breeds of goats in Egypt.

Data of 475 goats (242 Zaraibi, 84 Baladi, and 149 Damascus) kept at Sakha Farm, belonging to Animal Production Research Institute (APRI), Ministry of Agriculture, Dokki, Cairo, Egypt, from the period of 2011 to 2017 were used to estimate direct (additive) and maternal genetic effects for litter size at birth (LSB). Three animal models were used. Model 1 includes the fixed effects of breed, season, year of kidding, age of doe, and direct genetic effect. Model 2 is similar to model 1 beside the permanent environmental effect. Model 3 is similar to model 2 and includes the maternal genetic, covariance between direct and maternal genetic effects. The effects of breed, season, year of kidding, and age of doe were significant on LSB. Heritability estimates for LSB are 0.19±0.050, 0.19±0.160, and 0.06±0.007, as estimated from models 1, 2, and 3, respectively. Maternal heritability estimate using model 3 was 0.05±0.006. The removal of additive genetic maternal effect and covariance between direct and maternal effects from the model increased heritability of direct genetic effect by 0.13. Annual phenotypic trends for LSB in Zaraibi, Baladi, and Damascus goat breeds are negative. Annual genetic trends for LSB for the three breeds of goats are positive, significant, and being 0.10±0.01, 0.25±0.02, and 0.01±0.001 litter/year for Zaraibi, Baladi, and Damascus, respectively. The present results indicated that selection for LSB will take a long time. The speed and efficiency of selection is expected to increase by use of molecular markers in selection.

Removal of hexavalent chromium by electrospun PAN/GO decorated ZnO.

A novel composite nanofibers material have fabricated by using electrospinning technique followed by chemical cross-linking with zinc oxide (ZnO). The surface sensitization and morphology changes of the fabricated composite nanofibers were studied by using X-Ray Diffraction (XRD) analysis, Scanning Electron Microscopy (SEM) and transmission electron microscope (TEM). The effect of operating parameters includes the amount of ZnO, initial solution PH, and hexavalent chromium concentration on adsorption were investigated. The maximum adsorption capacity was found to be 690 mg/g at pH 6, which is much higher than most of the reported adsorbents. The adsorption equilibrium reached within 25 and 180 min as the initial solution concentration increased from 10 to 300 mg/L, and the data fitted well using nonlinear pseudo first order model with determination coefficient (R2) in between 0.97 and 0.99. Adsorption isotherms correlate the data on equilibrium adsorption with different mathematical models to describe the behaviour of an adsorption process and provide valuable information for optimizing the design of an adsorption system.

[Prognostic factors of advanced stage non-small-cell lung cancer]. / Facteurs pronostiques du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. AIM: To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. METHODS: A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. RESULTS: The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. CONCLUSION: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC.

Long term outcomes in 46, XX adult patients with congenital adrenal hyperplasia reared as males.

Patients with Congenital Adrenal Hyperplasia (CAH) owing to 21-hydroxylase deficiency and whose karyotype is 46, XX are usually assigned to the female gender. Reported herein are the long term outcomes in three patients with CAH whose karyotype is 46, XX and who were reared as males. A retrospective review of three CAH patients with a 46, XX karyotype who were reared as males was conducted. Gender assignment, clinical and biochemical data, pre and post-genitoplasty genital examinations were reviewed. Gender identity was tested by an extensive questionnaire. Gender role, sexual preference, marital status and sexual satisfaction were evaluated by interview. The three patients were genotyped for the CYP21A2 gene confirming the diagnosis of CAH. Owing to genital virilization, cultural preferences for male gender and the lack of newborn screening programs the three patients reported herein were assigned to the male gender at birth before the diagnosis of CAH was established. In adulthood the patients remained significantly virilized. Thorough psychosexual assessments in adulthood revealed well established male gender identities compatible with their male gender assignments at birth. In all three patients, gender role and behavior were consistent with male gender identity including sexual intercourse with female partners. The three patients reported herein revealed that male gender assignment to CAH patients with a 46, XX karyotype may have a successful outcome providing there is strong parental support and expert endocrine care. No standard guidelines have been published for the gender assignment of CAH patients with a 46, XX karyotype and genital ambiguity. More studies concerning gender assignment in CAH patients with a 46, XX karyotype reared as males are needed.

Synthesis and characterization of nanosilver-silicone hydrogel composites for inhibition of bacteria growth.

PURPOSE: Nanosilver-silicone hydrogel (NAgSiH) composites for contact lenses were synthesized to asses the antimicrobial effects. METHODS: Silicone hydrogel (SiH) films were synthesized followed by impregnation in silver nitrate solutions (10, 20, 30, 40, 60, 80ppm) and in-situ chemical reduction of silver ions using sodium borohydride (NaBH4). The silver nano particles (AgNPS) were identified by UV-vis absorption spectroscopy, Energy-dispersive X-ray spectroscopy (EDX) mapping and EDX spectrum. Physico-mechanical and chemical properties of NAgSIH films were studied. The antimicrobial effect of the hydrogels against Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis and Staphylococcus aureus was evaluated. The numbers of viable bacterial cells on NAgSiH surface or in solution compared to control SiH were examined. RESULTS: The NAgSiH films were successfully synthesized. FTIR results indicated that AgNPS had no effect on the bulk structure of the prepared SiH films. From TGA analysis, NAgSiH(R80) and SiH(R0) films had the same maximum decomposition temperature (404°C). UV-vis absorption spectroscopy and EDX mapping and spectrum emphasized that AgNPS were in spherical shape. The maximum absorption wavelength of NAgSiH films were around 400nm. The light transmittance decreased as the concentration of AgNPS increased, but still greater than 90% at wavelength around 555nm. The Young's modulus increased gradually from 1.06MPa of SiH(R0) to highest value 1.38MPa of NAgSiH(R80). AgNPS incorporated into SiH films reduced the bacterial cell growth and prevented colonization. Groups NAgSiH(R60,R80) demonstrated an excellent reduction in bacterial viability in solution and on the SiH surface. CONCLUSIONS: NAgSiH composites were successfully synthesized and possessed an excellent antimicrobial effects.

Infectious bacterial pathogens, parasites and pathological correlations of sewage pollution as an important threat to farmed fishes in Egypt.

This paper is a part of a multi-disciplinary research "Application of Decentralized On-Site Water Treatment System in Egypt for Use in Agriculture and Producing Safe Fish and Animal Proteins". The project aimed to investigate the environmental impact of implementing sewage water before and after treatment using the effluent of the on-site decentralized Japanese' Johkasou system, in agriculture and producing fish protein. The aim is to establish such system in Egypt to strengthen the sanitary conditions of water resources. In the present study, the impact of the sewage pollution in some fish farms at El-Fayyum, Port Said and El-Dakahlia governorates in Egypt was carried out. Water and fish (Oreochromis niloticus and Mugil cephalus) samples were collected from private fish farms of such localities. Bacteriological and chemical examination of water samples revealed the existence of coliforms and many other bacterial species of significant human health hazards. The chemical parameters of water showed a marked deviation from normal levels while examination of fish flesh specimens indicated contamination with Streptococcus Sp., Staphylococcus Sp., and Salmonella in all examined localities. Other bacterial isolates of human health importance (Morganella morganii, Pseudomonas cepacia and Enterococcos durans) were identified. The parasitological examination revealed the presence of encysted metacercariae (EMC); Diplostomatidae, Prohemistomatidae and Heterphyidae. Moreover, two protozoan parasites (Mxyoboulus tilapiae and Ichthyophthirius multifilis) were also recorded. The histopathological examination revealed mild tissue reaction in case of bacterial infection and severe pathological lesions in different organs in case of EMC infection. Lamellar hyperplasia and mononuclear cell infiltration in branchial tissue was common findings. In skeletal muscles, atrophy of muscle fibres, myolysis and myophagia were detected.

The effects of proton pump inhibitors on autonomic tone in patients with erosive and non-erosive esophagitis.

BACKGROUND: Reduction in autonomic tone as measured by heart rate variability (HRV) has been associated with various inflammatory conditions including reflux disease. The nature of and permanence of this damage have not been fully assessed. METHODS: Fourteen individuals with non-erosive reflux disease (NERD) and 10 individuals with erosive reflux disease (ERD) as identified on endoscopy were assessed for HRV prior to starting a course of proton pump inhibitor (PPI) therapy and 8 weeks from the start of PPI therapy. KEY RESULTS: Reflux symptoms were significantly improved by PPI therapy (p = 0.001), with no significant difference in reflux symptoms between the NERD and ERD groups either before (p = 0.45) or following therapy (p = 0.17). The ERD group displayed reduced HRV prior to PPI therapy as compared with a non-symptomatic group. There was significant improvement of HRV resulting from PPI therapy in the ERD group as measured by inspiration/expiration ratio on forced breathing (p = 0.02), Valsalva ratio (p = 0.03), and extended metronome-guided breathing at 6 breaths per minute (p = 0.03). While a similar pattern was seen in the NERD group, the effects were not as strong and did not reach statistical significance. CONCLUSIONS & INFERENCES: The results are consistent with a growing body of evidence that cardiac autonomic neuropathy as measured by HRV is associated with gastro-esophageal reflux disease and also suggest that successful treatment of the inflammation can lead to reversal of the deterioration of autonomic tone associated with that inflammation.

Complement activation in primiparous women from a malaria endemic area is associated with reduced birthweight.

The hallmark of placental malaria (PM) due to Plasmodium falciparum infection is the accumulation of mature-stage parasites, monocytes and macrophages in the maternal vascular bed of the placenta. The mechanisms leading to morbidity and mortality in PM are incompletely understood. However, an inflammatory response in the placenta has been related to both severe anemia in the mother and low birthweight (<2500 g) in the newborn. In this study we analyzed whether complement activation as a mediator of inflammation could contribute to poor pregnancy outcome in PM. The concentrations of the soluble terminal complement complex (TCC) were measured as an indicator of complement activation in placental, cord and peripheral blood samples from 146 women from a malaria endemic area. Placental and cord plasma samples of primiparous women, a group vulnerable to PM, showed significantly higher levels of TCC than multiparous women. Additionally, in women with malaria history during pregnancy or placental infection by P. falciparum at delivery, the TCC levels in the corresponding placental and cord plasma samples were significantly higher than in the malaria negative group. In multiple regression analysis parity was shown to be the main determinant of TCC levels. Placental plasma samples corresponding to babies weighing less than 2700 g had significantly higher levels of TCC than babies carrying more weight. In conclusion, both primiparity and P. falciparum infection were related to a local increase of complement activation in the placentas. Association between reduced birthweight and higher levels of TCC in placental blood suggests a role for complement activation in influencing the pregnancy outcome in malaria exposed women.

The posterior glottis: structural and clinical considerations.

Despite the presence of a number of good publications during the past two decades, the posterior glottis (PG) is still not clearly appreciated in clinical laryngological practice. This study focuses on searching the literature to find out the present day awareness of the PG, as well as highlighting some of its clinical features. The investigation proceeds with two main sections: (1) critical analysis of the literature on the PG during the last 50 years (2) describing the clinical appearance and behavior of the PG in 100 normal subjects. Results of section 1 illustrate the limited awareness in the literature of the existence of PG as a distinct part of the human larynx. Results of section 2 illustrate some misconcepts related to the PG as inter-arytenoid pachydermia, change of voice with lesions in the PG. Discussion elaborates on the significance of the findings and attempts to clarify certain misconcepts about the PG, its structure, function, and clinical features. In the light of the data collected from the literature regarding the dimensions of the PG, a set of recommendations were proposed regarding the optimal sizes of the endotracheal tubes in both sexes.

Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery.

BACKGROUND: Epistaxis is the most common complication encountered during nasotracheal intubation (NTI) in children. The aim of this study was to test the efficacy of prophylactic intranasal admixture of xylometazoline and local anaesthetic gel in reducing epistaxis after NTI in children. METHODS: Children presenting for dental procedures requiring NTI were randomly allocated into two groups: Group 1 (xylometazoline group, n=53) and Group 2 (control group, n=51). After sevoflurane inhalation induction, the more patent nostril in each subject was lubricated with lidocaine 2% (1 ml) jelly, followed by 0.6 ml of either xylometazoline hydrochloride 0.1% nasal drops (Group 1) or sodium chloride 0.9% (Group 2). The presence and extent of bleeding occurring during intubation, extubation, or both and navigability through the nasal passage were assessed. RESULTS: The incidence and severity of bleeding were significantly reduced between the study group (7.5%) compared with the control group (27.5%; P<0.01). Navigability was similar in both groups. CONCLUSIONS: Admixture of intranasal xylometazoline 0.1% drops and lidocaine 2% jelly reduced the incidence and severity of epistaxis after NTI in preschool children.

Drug-eluting stents: limitations of early generation and progress with newer generation devices.

The success of first generation drug-eluting stents, namely by reducing restenosis and the need of repeat revascularization procedures is hampered by some limitations affecting device safety. Intense research efforts helped to identify these shortcomings and direct research to develop newer generation drug-eluting stents with the potential to circumvent these drawbacks. This review will discuss limitations of early generation drug-eluting stents, focus on solutions provided by newer generation devices, and shed light on unresolved issues and potential future solutions.

Rotational atherectomy followed by drug-eluting stent implantation (Rota-DES): a rational approach for complex calcified coronary lesions.

Rotational atherectomy has been regaining interest over the last couple of years after it almost has disappeared from most interventional catheterization laboratories for several years due to failure to prove its original concept of improving long term results of percutaneous coronary interventions (PCI) as was repeatedly shown in studies in the 1990s. Its revival coupled the introduction of drug-eluting stents (DES); these devices have led to treating much more complex lesions and high-risk patients by PCI. However, real-world experience suggested that off-label use of DES is associated with a higher rate of early and late stent thrombosis. Therefore, more attention is now being paid to the initial implantation technique of DES including aggressive lesion preparation to facilitate stent delivery and expansion. The limited studies with rot-ablation and DES showed promising results with no long term safety concerns. In these studies, a subtle observation was made suggesting that rot-ablation prior to DES implantation in such lesions may have an add-on effect on long term outcome compared to DES alone. An ongoing multicenter study is investigating such effect among complex calcified coronary lesions. Even if this additive benefit does not prove true, rot-ablation remains an efficient tool for preparing certain lesions to facilitate effective and safe DES implantation. Therefore, interventional training programs should focus on this difficult technique to bridge the gap of experience which resulted from neglecting it for several years. In this regard, dedicated courses at experienced sites as well as medical simulation may be appropriate.

Expression of Plasmodium falciparum 3D7 STEVOR proteins for evaluation of antibody responses following malaria infections in naïve infants.

Clinical immunity to Plasmodium falciparum malaria develops after repeated exposure to the parasite. At least 2 P. falciparum variant antigens encoded by multicopy gene families (var and rif) are targets of this adaptive antibody-mediated immunity. A third multigene family of variant antigens comprises the stevor genes. Here, 4 different stevor sequences were selected for cloning and expression in Escherichia coli and His6-tagged fusion proteins were used for assessing the development of immunity. In a cross-sectional analysis of clinically immune adults living in a malaria endemic area in Ghana, high levels of anti-STEVOR IgG antibody titres were determined in ELISA. A cross-sectional study of 90 nine-month-old Ghanaian infants using 1 recombinant STEVOR showed that the antibody responses correlated positively with the number of parasitaemia episodes. In a longitudinal investigation of 17 immunologically naïve 9-month-old infants, 3 different patterns of anti-STEVOR antibody responses could be distinguished (high, transient and low). Children with high anti-STEVOR-antibody levels exhibited an elevated risk for developing parasitaemia episodes. Overall, a protective effect could not be attributed to antibodies against the STEVOR proteins chosen for the study presented here.

Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience.

BACKGROUND: Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size. However, the safety and feasibility of such an approach has not been adequately established. METHODS: In this single-center prospective study we examined 73 consecutive patients who had an acute STEMI and at least one or more lesions > or = 70% in a major epicardial vessel other than the infarct-related artery. In the first 28 patients, forming the multi-vessel (MV) PCI group, all lesions were treated during the primary procedure. In the following 45 patients, forming the culprit-only (CO) PCI group, only the culprit lesion was treated during the initial procedure, followed by either planned-staged or ischemia-driven revascularization of the non-culprit lesions. Fluoroscopy time and contrast dye amount were compared between both groups, and patients were followed up for one year for major adverse cardiac events (MACE) and other significant clinical events. RESULTS: The two groups were well balanced in terms of clinical characteristics, number of diseased vessels and angiographic characteristics of the culprit lesion. In the MV-PCI group, 2.51 lesions per patient were treated using 2.96 +/- 1.34 stents (1.00 lesions and 1.76 +/- 1.17 stents in the CO-PCI group, both p < 0.001). The fluoroscopy time increased from 10.3 (7.2-16.9) min in the CO-PCI group to 12.5 (8.5-19.3) min in the MV-PCI group (p = 0.22), and the amount of contrast used from 200 (180-250) ml to 250 (200-300) ml, respectively (p = 0.16). Peak CK and CK-MB were significantly lower in patients of the MV-PCI group (843 +/- 845 and 135 +/- 125 vs 1652 +/- 1550 and 207 +/- 155 U/l, p < 0.001 and 0.01, respectively). Similar rates of major adverse cardiac events at one year were observed in the two groups (24% and 28% in multi-vessel and culprit treatment groups, p = 0.73). The incidence of new revascularization in both infarct- and non-infarct-related arteries was also similar (24% and 28%, respectively, p = 0.73). CONCLUSION: We may state from this limited experience that a multi-vessel stenting approach for patients with acute STEMI and multi-vessel disease is feasible and probably safe during routine clinical practice. Our data suggest that this approach may help to limit the infarct size. However, larger studies, perhaps using drug-eluting stents, are still needed to further evaluate the safety and efficiency of this procedure, and whether it is associated with a lower need of subsequent revascularization and lower costs.