Plasma Brain Natriuretic Peptide (BNP) as an Indicator of Left Ventricular Function, Early Outcome and Mechanical Complications after Acute Myocardial Infarction

Aims This study investigated the prognostic value of B type natriuretic peptide (BNP) in acute myocardial infarction (AMI) patients and its relation with left ventricular function and post-myocardial infarction complications. Methods In this cross-sectional study, plasma BNP level was measured for 42 consecutive patients (mean ± SD: 61.6 ± 10.85 years old) with acute ST elevation myocardial infarction (MI) and 42 healthy, age and gender matched subjects. Result BNP level in AMI patients were significantly higher than control group (@ P < 0.001). Regarding to infarct location, the highest BNP level measured in inferoposterior MI (BNP = 4436.63 ± 6188.159 pg/ml) and the lowest one indicated in standalone inferior MI (BNP = 598.83 ± 309.867 pg/ml ( P = 0.071). There was significant reverse relation between BNP and EF ( P = 0.006, OR = −0.47) and a significant relationship between BNP and killip classification ( P = 0.036). There was no significant relation between diastolic and right-ventricular function and BNP level ( P = 0.61, P = 0.21). The highest BNP level was detected in LV septal rupture and false aneurysm ( P = 0.02) and in ventricular tachycardia, but without significant relationship ( P = 0.25). Conclusion After the onset of AMI, BNP blood level can be used as an important predictor for left ventricular dysfunction, killip classification, early mechanical complications and cardiac death

A review of system dynamics models applied in transportation

It is 20 years since Abbas and Bell [1994. “System Dynamics Applicability to Transportation Modeling.” Transportation Research Part A 28 (5): 373–390] evaluated the strengths and weaknesses of system dynamics (SD) as an approach for modelling in the transportation area. They listed 12 advantages of the approach and in particular suggested it was well suited to strategic issues and that it could provide a useful tool for supporting policy analysis and decision-making in the transport field. This paper sets out a review of over 50 peer-reviewed journal papers since 1994 categorising them by area of application and providing a summary of particular insights raised. The fields of application include the take-up of alternate fuel vehicles, supply chain management affecting transport, highway maintenance, strategic policy, airport infrastructure and airline business cycles and a set of emerging application areas. The paper concludes with recommendations for future application of the SD approach

Clinicopathological and prognostic significance of HER-2/neu and VEGF expression in colon carcinomas

<p>Abstract</p> <p>Background</p> <p>HER-2/neu and VEGF expression is correlated with disease behaviors in various cancers. However, evidence for their expression in colon cancer is rather contradictory both for the protein expression status and prognostic value. HER-2/neu is found to participate in VEGF regulation, and has known correlation with VEGF expression in some tumors. In this study, we investigated HER-2/neu and VEGF expression in Chinese colon patients and explored whether there was any correlation between their expression patterns.</p> <p>Methods</p> <p>HER-2/neu and VEGF were investigated immunohistochemically using tumor samples obtained from 317 colon cancer patients with all tumor stages. Correlation of the degree of staining with clinicopathological parameters and survival was investigated.</p> <p>Results</p> <p>Positive expression rates of HER-2/neu and VEGF in colon cancer were 15.5% and 55.5% respectively. HER-2/neu expression was significantly correlated with tumor size and distant metastases (<it>P </it>< 0.05), but was not an independent prognostic marker of survival <it>(P > 0.05)</it>. Expression of VEGF was significantly correlated with tumor size, tumor stage, lymph node metastases, and distant metastases (<it>P </it>< 0.05). The 5-year survival rate in patients with negative and positive VEGF expression was 70.2% and 61.9% respectively; the difference was not statistically significant <it>(P = 0.146)</it>. No correlation between HER-2/neu and VEGF expression was detected (<it>P = </it>0.151).</p> <p>Conclusions</p> <p>HER-2/neu and VEGF are not important prognostic markers of colon cancer. The present results do not support any association between HER2/neu and VEGF expression in this setting.</p

Designing Outcome-Based Performance Management Systems to Assess Policies Impacting on Caesarean Section Rate: An Analysis of the Sicilian Maternity Pathway

The reduction in Caesarean sections (CSs) is widely considered a priority in the public decision makers agenda. Though the World Health Organisation has strongly encouraged countries to implement policies to reduce CSs to 10\u201315%, after almost thirty years this goal appears still far from its achievement. The literature depicts CS as a multifaceted phenomenon whose causes involve different factors, ranging from the patient sphere to the health care level of services provided, and the societal preference of CS practice. Policy makers aiming to standardise cares and to reduce CSs often implement maternity pathways (MP). By investigating the MP introduced in the Sicilian region, the authors highlight the need to adopt an outcome-based performance management approach to assess the effectiveness of CS reduction policies. The suggested perspective also reveals the necessity to frame and coordinate the interdependencies between the different actors playing a crucial role in the MP