No abstract

Background: Late percutaneous coronary intervention (PCI) of a totally occluded infarct‐related artery (IRA) in stable patients is currently not recommended based on the lack of clear clinical benefits in randomized controlled trials. We sought to perform a systematic review and meta‐analysis of randomized controlled trials comparing PCI with optimal medical therapy in patients with IRA occlusion more than 12 hr after onset of acute myocardial infarction (AMI), focusing on left ventricular function and remodeling. Methods and Results: PubMed, CENTRAL, and mRCT were searched for eligible studies. Studies were included in the analysis if they were randomized controlled trials comparing conservative medical management with PCI performed at least 12 hr after the onset of symptoms of AMI, and data on left ventricular ejection fraction (LVEF) at baseline and follow‐up were available. Studies were excluded if randomization occurred less than 12 hr after symptom onset, or if patients were hemodynamically unstable. Change in LVEF was the primary outcome of interest, with changes in left ventricular end‐diastolic volume index (LVEDVI) and end‐systolic volume index (LVESVI) analyzed as secondary endpoints. We retrieved five studies in which baseline and follow up LVEF data were available enrolling a total of 648 patients: 342 patients randomized to PCI and 306 to medical treatment. There was a statistically significant difference in LVEF changes over time favoring PCI (+3.1%, 95% CI +1.0 to +5.2, P = 0.0004). In addition, there were statistically significant differences changes in both LVEDVI (−5.1 ml in favor of PCI, 95% CI of −9.4 to −0.8, P = 0.020) and LVESVI (−5.3 ml in favor in PCI, 95% CI of −8.3 to −2.4, P = 0.0005). Conclusions: This meta‐analysis suggests that late revascularization of an occluded IRA may improve left ventricular systolic function and remodeling, supporting the “open artery hypothesis.” The reason why these changes have not resulted in clinical benefits in large clinical trials is subject to debate. © 2008 Wiley‐Liss, Inc.

Purified dinitrophenyl S-glutathione (DNP-SG) ATPase was reconstituted into artificial liposomes prepared from soybean asolectin. Electron micrography confirmed the formation of unilamellar vesicles with an average radius of 0.25 micron. Intravesicular volume estimated by incorporation of radiolabled inulin into the vesicles was found to be 19.7 +/- 1.3 microL/mL reconstitution solution. Accumulation of the glutathione-conjugate of CDNB, DNP-SG, and of doxorubicin (DOX) in the proteoliposomes was increased in the presence of ATP as compared to equimolar ADP or adenosine 5'-[beta,gamma-methylene]triphosphate tetralithium. ATP-dependent transmembrane movement of DOX and DNP-SG into DNP-SG ATPase-reconstituted vesicles was saturable with respect to time, sensitive to the osmolarity of the assay medium, and temperature dependent. The energy of activation was found to be 12 and 15 kcal/mol for DNP-SG and DOX, respectively. Optimal temperature for transport was 37 degrees C. Saturable transport was demonstrated for DNP-SG (Vmax of 433 +/- 20 nmol/min/mg of protein, KmATP = 2.4 +/- 0. 3 mM and KmDNP-SG = 36 +/- 5 microM) as well as DOX (Vmax = 194 +/- 19 nmol/min/mg of protein, KmATP = 2.5 +/- 0.6 mM and KmDOX = 2.4 +/- 0.7 microM). The kinetic data for both DNP-SG and DOX transport were consistent with a random bi-bi sequential reaction mechanism. DOX was found to be a competitive inhibitor of DNP-SG transport with Kis of 1.2 +/- 0.2 microM and DNP-SG was found to be a competitive inhibitor of DOX transport with Kis of 13.3 +/- 2.6 microM.

Object. This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. Methods. A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. Conclusions. These findings provide corroborating clinical evidence for the existence of a newly recognized mid-line posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.

Syncope with and without convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convwithout convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convwithout convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convulsive movement, other complex convulsive phenomena occurred, some simulating epileptic seizure. No statistical difference in changes of pulse or blood pressure was found between subjects with convulsive versus nonconvulsive syncope. Similarly, no difference was found between subjects with tonic spasm and those with other convulsive phenomena, nor between those with "early" and those with "delayed" reactions. Marked individual variation may exist in the susceptibility of the central nervous system to ischemia. Some individuals appear to be predisposed to development of seizures in situations of global cerebral ischemia such as occur in hypotension and bradycardia.

This clinical experience indicates that rFVIIa may be safe and effective as the initial hemostatic agent for rapid reversal of orally administered anticoagulation medications in patients who require urgent neurosurgical intervention.

This article argues that parental mediation theory is rooted in television studies and must be refined to accommodate the fast-changing media landscape that is populated by complex and intensively used media forms such as video games, social media, and mobile apps. Through a study of parental mediation of children's video game play, we identify the limitations of parental mediation theory as applied to current trends in children's media use and suggest how it can be enhanced. This study seeks to improve parental mediation theory's descriptive and explanatory strength by identifying and outlining the specific activities that parents undertake as they impose their media strategies. We explain how restrictive, co-use, and active mediation are constituted by gatekeeping, discursive, diversionary, and investigative activities.

Cancer pain management among prison inmates is an emerging problem. To examine the obstacles to cancer pain management in inmates, surveys of inmates with cancer pain (IPs) (n = 102) and primary care practitioners (PCPs) (n = 74) in Texas state prisons were conducted. IPs were assessed using the Brief Pain Inventory and Pain Management Index (PMI). PCPs were assessed with a modified Clinic Staff Survey of Cancer Pain Management. Eighty-three IPs (81%) reported severe worst pain; 51 (49%) reported severe average pain. Thirty-three IPs (32%) reported no pain relief with prescribed analgesics. PMI was negative in 65 IPs (64%), indicating undertreatment. Of the PCPs, 20/65 (31%) felt that IPs were undertreated. Most frequently cited barriers to pain management were drug misuse/diversion and lack of inmate credibility. Practitioner problems and systemic barriers also were cited frequently. These results indicate the existence of unique barriers to undertreatment of cancer pain in IPs. A multidisciplinary approach involving prison authorities and practitioners is required to improve pain management in prison populations.