Treatment of acute myocardial infarction with intracoronary administration of autologous bone marrow cells

Modern reperfusion strategies and medical treatment reduce myocardial necrosis and have improved prognosis after acute myocardial infarction. However, some patients still develop extensive myocardial infarctions and are at risk of congestive heart failure, and these patients have a poor prognosis. Accordingly, there is a need for new treatment options to regenerate the human heart. In experimental models and in small clinical studies, administration of bone marrow cells have improved cardiac function, and some studies have indicated that bone marrow cells can generate new myocardium in a process called transdifferentiation. In the larger ASTAMI study, 100 patients with acute myocardial infarction were randomized to intracoronary administration of their own bone marrow cells, or to a control group. All patients received best medical therapy, and were followed for 12 months. The primary aim was to investigate whether bone marrow cell therapy improved myocardial function compared with standard therapy only, as measured by nuclear imaging, echocardiograpy and magnetic resonance imaging. There was a similar improvement in cardiac function in both groups. Results were consistent, since none of the imaging modalities revealed differences between groups for left ventricular ejection fraction, end-diastolic volume or infarct size. The treatment group improved exercise time significantly more than the control group. However, this was likely a placebo-effect, since there was a similar improvement in peak oxygen consumption. After 12 months, all patients were alive, and the number of adverse events were similar in the groups. Lunde and colleagues conclude that with the methods used, intracoronary administration of autologous bone marrow cells in patients with acute myocardial infarction was safe, but did not improve cardiac funtion to a clinically significant degree

Bruk av internett-informasjon for å veilede voldelige innsatte i å simulere god tilpasning og underrapportere aggresjon på MMPI-2 og Rorschach

Bakgrunn: Personer som utredes med psykologiske tester i rettslige sammenhenger kan ha betydelig motivasjon for å simulere god tilpasning og underrapportere aggresjon. På internett finnes informasjon om MMPI-2 og Rorschach som kan være en trussel for testenes robusthet mot positiv simulering. Det finnes lite forsking på slik internettinformasjon påvirker testenes sårbarhet. Denne oppgaven ønsker å undersøke nærmere om voldelige fengselsinnsatte klarer å underrapportere psykopatologi og aggresjon på MMPI-2 og Rorschach, med og uten internettinformasjon. Metode: Vi benyttet et mellom-gruppe design med 77 deltakere fordelt på fire grupper: voldelig innsatte som fikk standardinstruksjoner, voldelige innsatte som fikk instruksjon om å simulere uten internett-veiledning, voldelige innsatte som fikk instruksjon om å simulere med internett-veiledning og studenter som fikk standardinstruksjon. De statistiske analysene MANOVA, ANOVA og post-hoc analyse (LSD) ble gjennomført for å undersøke gruppeforskjeller Resultat: Voldelige innsatte som ble instruert om å simulere positivt, med og uten internett-veiledning, underrapporterte og fikk skårer i normalområdet på MMPI-2s kliniske skalaer. Simuleringsgruppen som ikke fikk veiledning ble i større grad avslørt av underrapporteringsskalaen L enn gruppen som fikk internett. Begge simuleringsgruppene hadde utslag på F og Pd, som indikerer at de ikke klarte å underrapportere all psykopatologi og aggresjon. På Rorschach fikk de voldelige innsatte som ble instruert til å simulere fikk ikke skårer i normalområdet på Rorschachs determinantvariabler og kognitive variabler, men de klarte å underrapportere og fikk skårer i normalområdet på innholdsvariablene Ag% og TCI. Internett-veiledning så ut til å ha størst effekt på MMPI-2. Konklusjon: Våre resultater indikerer at MMPI-2 og Rorschach er rimelig sårbar for simulering, men at de voldelige innsatte ikke klarte å underrapportere all psykopatologi og aggresjon. Rorschach er mer robust for simulering og veiledning, men alle fengselsgruppene hadde ikke-valide protokoller

Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis

Aims The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. Methods and results We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (−3.17 mL/m², 95% CI: −4.86 to −1.47, P < 0.001; −2.60 mL/m², 95% CI −3.84 to −1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. Conclusion Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therap

Regional myocardial function after intracoronary bone marrow cell injection in reperfused anterior wall infarction - a cardiovascular magnetic resonance tagging study

<p>Abstract</p> <p>Background</p> <p>Trials have brought diverse results of bone marrow stem cell treatment in necrotic myocardium. This substudy from the Autologous Stem Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI) explored global and regional myocardial function after intracoronary injection of autologous mononuclear bone marrow cells (mBMC) in acute anterior wall myocardial infarction treated with percutaneous coronary intervention.</p> <p>Methods</p> <p>Cardiovascular magnetic resonance (CMR) tagging was performed 2-3 weeks and 6 months after revascularization in 15 patients treated with intracoronary stem cell injection (mBMC group) and in 13 controls without sham injection. Global and regional left ventricular (LV) strain and LV twist were correlated to cine CMR and late gadolinium enhancement (LGE).</p> <p>Results</p> <p>In the control group myocardial function as measured by strain improved for the global LV (6 months: -13.1 ± 2.4 versus 2-3 weeks: -11.9 ± 3.4%, p = 0.014) and for the infarct zone (-11.8 ± 3.0 versus -9.3 ± 4.1%, p = 0.001), and significantly more than in the mBMC group (inter-group p = 0.027 for global strain, respectively p = 0.009 for infarct zone strain). LV infarct mass decreased (35.7 ± 20.4 versus 45.7 ± 29.5 g, p = 0.024), also significantly more pronounced than the mBMC group (inter-group p = 0.034). LV twist was initially low and remained unchanged irrespective of therapy.</p> <p>Conclusions</p> <p>LGE and strain findings quite similarly demonstrate subtle differences between the mBMC and control groups. Intracoronary injection of autologous mBMC did not strengthen regional or global myocardial function in this substudy.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00199823">NCT00199823</a></p

Semi-automated quantification of left ventricular volumes and ejection fraction by real-time three-dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>Recent studies have shown that real-time three-dimensional (3D) echocardiography (RT3DE) gives more accurate and reproducible left ventricular (LV) volume and ejection fraction (EF) measurements than traditional two-dimensional methods. A new semi-automated tool (4DLVQ) for volume measurements in RT3DE has been developed. We sought to evaluate the accuracy and repeatability of this method compared to a 3D echo standard.</p> <p>Methods</p> <p>LV end-diastolic volumes (EDV), end-systolic volumes (ESV), and EF measured using 4DLVQ were compared with a commercially available semi-automated analysis tool (TomTec 4D LV-Analysis ver. 2.2) in 35 patients. Repeated measurements were performed to investigate inter- and intra-observer variability.</p> <p>Results</p> <p>Average analysis time of the new tool was 141s, significantly shorter than 261s using TomTec (<it>p </it>< 0.001). Bland Altman analysis revealed high agreement of measured EDV, ESV, and EF compared to TomTec (<it>p </it>= <it>NS</it>), with bias and 95% limits of agreement of 2.1 ± 21 ml, -0.88 ± 17 ml, and 1.6 ± 11% for EDV, ESV, and EF respectively. Intra-observer variability of 4DLVQ vs. TomTec was 7.5 ± 6.2 ml vs. 7.7 ± 7.3 ml for EDV, 5.5 ± 5.6 ml vs. 5.0 ± 5.9 ml for ESV, and 3.0 ± 2.7% vs. 2.1 ± 2.0% for EF (<it>p </it>= <it>NS</it>). The inter-observer variability of 4DLVQ vs. TomTec was 9.0 ± 5.9 ml vs. 17 ± 6.3 ml for EDV (<it>p </it>< 0.05), 5.0 ± 3.6 ml vs. 12 ± 7.7 ml for ESV (<it>p </it>< 0.05), and 2.7 ± 2.8% vs. 3.0 ± 2.1% for EF (<it>p </it>= <it>NS</it>).</p> <p>Conclusion</p> <p>In conclusion, the new analysis tool gives rapid and reproducible measurements of LV volumes and EF, with good agreement compared to another RT3DE volume quantification tool.</p

Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study

Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18–35 years during the period 2008–2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention