Inflammation in various stages of coronary heart disease

Inflammation plays a key role in atherosclerosis and acute myocardial infarction (AMI), and circulating levels of inflammatory substances may reflect the ongoing process. Lately, transplantation of stem cells from the bone marrow has been suggested as a treatment option in AMI. The aim of the present thesis was to examine inflammation in patients with various stages of coronary heart disease (CHD) and during various treatment modalities, including the effects of intracoronary injection of autologous bone marrow cells (mBMC) on left ventricular function in AMI. We found reduced levels of pro-inflammatory markers in patients treated with aspirin 160 mg daily compared to warfarin for up to 4 years after an acute MI. However, these findings were not reflected in the incidence of clinical end-points after 4 years. In patients with stable CHD 1 year treatment with aspirin 160 mg daily and clopidogrel 75 mg daily induced similar reduction in the levels of TNFα and MCP-1, possibly by different mechanisms. In patients with acute ST-segment elevation myocardial infarction treated with PCI a marked short term increase in circulating levels of IL-6 and CRP as well as of IL-10 compared to similarly treated patients with stable angina pectoris appeared. The PCI procedure per se also induced an increase in IL-6 levels in patients with stable angina pectoris. The myocardial infarction induced a systemic inflammatory reaction that overwhelmed the inflammatory response induced by the PCI procedure. No effects on global left ventricular function after 6 months were obtained in patients with AMI treated with intracoronary injection of autologous mBMC 6 days after acute PCI. A short-term pro-inflammatory response that may be unfavourable, and a slightly reduced inflammatory response after 3 months that may be beneficial, were noted in the stem cell treated patients

Training auscultatory skills: computer simulated heart sounds or additional bedside training? A randomized trial on third-year medical students

<p>Abstract</p> <p>Background</p> <p>The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3^rdyear medical students at Oslo University Medical School.</p> <p>Methods</p> <p>In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student's t-test.</p> <p>Results</p> <p>At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training.</p> <p>Conclusions</p> <p>Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training.</p

Helikoptertopping og -kvisting av trær langs kraftlinjer

Kapping og beskjæring av tretopper langs kraftlinjer med sag fra helikopter reduserer risikoen for trefall på kraftlinja og kan være et kostnadseffektivt tiltak med få ulemper for skogeier. Topping eller kvisting med helikopter gir mindre sjanse for vindfall, toppbrekk og snøbøy, dels ved at trærne får mindre vindfang og mindre snølast, og dels ved at vektarmen som kraften virker på blir kortere.publishedVersio

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