SUMMARYIntroduction: Reperfusion injury reduces the benefits of early reperfusion therapies after acute ST-elevation myocardial infarction (STEMI). Cyclosporine-A (CsA) is a potent inhibitor of opening of the mitochondrial permeability transition pore, which has been shown to play a key role in myocardial reperfusion injury. The impact of this treatment on clinical outcomes of acute STEMI remains unknown. Our aim was to investigate the clinical outcomes of using this drug in patients with acute anterior STEMI receiving thrombolytic treatment (TLT). Methods: In this double-blinded randomized clinical trial, 101 patients with acute anterior STEMI who were candidate for TLT, were enrolled and randomly assigned into treatment or control groups. Patients in the treatment group received an intravenous bolus injection of 2.5 mg/kg of CsA immediately before TLT. The patients in the control group received an equivalent volume of normal saline. Infarct size, occurrence of major arrhythmias, heart failure, left ventricular ejection fraction (LVEF), TLT-related complications, in-hospital and 6-month mortality rates were investigated. Results: There were no significant differences among the demographics, myocardial enzyme release, occurrence of major arrhythmias [9 (18%) vs. 12 (23.5%), P = 0.80], heart failure [18 (36%) vs. 19 (38.3%), P = 0.83], LVEF at first day [34.7 ± 9.9% vs. 33.5 ± 8.1%, P = 0.50] or at discharge [37.7 ± 10% vs. 36.1 ± 8.2%, P = 0.43], and in-hospital [4 (8%) vs. 6 (11.8%), P = 0.74] or 6-month mortality rates [9 (18%) vs. 10 (19.6%), P = 0.99] between the CsA vs. the control group. Conclusion: In this study, the prethrombolytic administration of CsA was not associated with a reduction in the infarct size or any improvement in clinical outcomes.
Supplemental oxygen, a therapy that has been used for more than a century, is recommended in all practice guidelines in the management of hypoxemic (peripheral oxygen saturation <90% to 94% or partial arterial oxygen pressure <60 mm Hg) patients with acute heart failure, but its use in normoxemic patients is controversial. Several pre-clinical and early clinical studies have shown the detrimental effects of oxygen therapy and subsequent hyperoxia in patients with normal oxygen saturation levels. These effects are suggested to be gauged by the increased production of reactive oxygen species and the related oxidative stress and by the reductions in coronary blood flow and myocardial oxygen consumption resulting from hyperoxia-induced vasoconstriction in the cerebral, coronary, and systemic vasculature. Considering these findings, recent practice guidelines are diverging from the previous consensus that oxygen should be administered routinely in patients with cardiac disease, but this new direction is also based on expert opinions rather than evidence such as well-designed trials. In this review, the authors summarize current evidence regarding the cardiovascular effects of supplemental oxygen therapy, particularly evidence from the field of acute heart failure, and delineate knowledge gaps in the field and future directions in research.
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.
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