Thrombus aspiration in patients with ST elevation myocardial infarction : meta-analysis of 16 randomized trials

Objective: The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone. Methods: Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke. Results: Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups. Conclusion: This meta-analysis is the first updated analysis after publishing the 1-year result of the “Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction” trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke. (Anatol J Cardiol 2015; 15: 175-87)Objective: The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone. Methods: Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke. Results: Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups. Conclusion: This meta-analysis is the first updated analysis after publishing the 1-year result of the “Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction” trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke. (Anatol J Cardiol 2015; 15: 175-87

Prevalence of IgE-mediated kiwi allergy: a population-based study in a region where it is cultivated

World Allergy and Asthma Congress of the European-Academy-of-Allergy-and-Clinical-Immunology and World-Allergy-Organization -- JUN 22-26, 2013 -- Milan, ITALYWOS: 000325142906162....European Acad Allergy & Clin Immunol, World Allergy Or

Kalp Yetersizliği Hastalarında Depresyonun Sol Ventrikül Mekanikleri Üzerine Etkisi

AmaçKalp yetersizliği (KY) dünya genelinde morbidite ve mortalitenin önde gelen nedenlerinden biridir. Bir çok çalışmada KY ve depresyonun sıklıkla birlikte olduğu ve depresyonun KY semptomları ile bağlantılı olduğu gösterilmiştir. Bu çalışmamızda 2 boyutlu speckle tracking ekokardiyografi kullanılarak depresif semptomların derecesiyle sol ventrikül global longitüdinal strain (GS) değerlerini karşılaştırmayı amaçladık.Gereç ve YöntemÇalışmamız  Aralık 2012 ile  Şubat 2016 tarihleri arasında kardiyoloji kliniğine başvuran KY (EF<%35) tanısı olan 135 hastanın dahil edildiği kesitsel bir çalışmadır. Depresif semptomlar Beck Depression Inventory-II ile değerlendirildi. Mental olarak normal olmayanlar ve diğer nörolojik problemi olan hastalar ve onam formunu imzalayamayan hastalar çalışma dışı bırakıldı. Depresyon hastaları şu şekilde sınıflandırıldı: skor 0-13 arasında olanlar minimal (grup 1),  skor 14-19 arasında olanlar hafif (grup 2), skor 20-28 arasında olanlar orta (grup 3) ve skoru 29-63 arasında olanlar ciddi (grup 4). İkiboyutlu speckle tracking ekokardiyografide GS değerlendirilmesi için sol ventrikül apikal uzun,4 ve 2 boşluk görüntüleri bazal,mid-papiller ve apikal seviylerden frame rate  40 and 80 frames/s arasındayken görüntüler alındı.Bulgular Çalışma popülasyonda ortalama yaş  64±10 yıl (%54.8 kadın) idi. Gruplar arasında yaş ve cinsiyet açısından fark yoktu. Grup 4’teki hastaların ortanca New York Heart Association değerleri grup 1, 2 ve 3’teki hastalara göre istatiksel olarak anlamlı şekilde daha yüksek idi. Gruplar arasında yapılan analizde GS değerleri açısından, gruplar arasında istatiksel olarak anlamlı fark bulundu (p<0.001). Yapılan post-hoc analizde bu farkın grup 4’ten kaynaklandığı izlendi, grup 4’te diğer gruplara kıyasla GS değerleri anlamlı olarak daha düşüktü (sırasıyla, 19.1±2.3, 17.5±3.1, 17.1±2.3 ve 15.2±3.9, p<0.001).SonuçDepresyon KY olan hastalarda klinik öneme sahiptir. KY olan hastalarda bozulmuş GS depresyon ciddiyeti ile ilişkili olabilir

Does hyperbaric oxygen therapy reduce the effects of ischemia on colonic anastomosis in laparoscopic colon resection?

BACKGROUND: An increase in intra-abdominal pressure causes a decrease in the splanchnic blood flow and the intramucosal pH of the bowel, as well as increasing the risk of ischemia in the colon. The aim of the present study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the ischemia caused by laparoscopy in colonic anastomosis in an experimental model of laparoscopic colonic surgery. MATERIALS AND METHODS: We divided 30 male Wistar albino rats into three groups: Group A was the control (open colon anastomosis); Group B received LCA (laparoscopic colon anastomosis); while Group C received both LCA. and HBOT. Each group contained ten animals. We placed Group C (LCA and HBOT) in an experimental hyperbaric chamber into which we administered pure oxygen at 2.1 atmospheres absolute 100% oxygen for 60 min for ten consecutive days. RESULTS: The anastomotic bursting pressure value was found to be higher in the open surgery group (226 +/- 8.8) (Group A). The result for Group C (213 +/- 27), which received HBOT, was better than that for Group B (197 +/- 27). However, there was no statistically significant difference between Group B and Group C. Group A showed better healing than the other groups, while significant differences in the fibroblast proliferation scores were found between Groups A and B. In terms of tissue hydroxyproline levels, a significant difference was found between Groups A and B and between Groups A and C, but not between Groups B and C. CONCLUSIONS: HBOT increases the oxygen level in the injured tissue. Although HBOT might offer several advantages, it had only a limited effect on the healing of colonic anastomosis in rats with increased intra-abdominal pressure in our study