Discharge Policy and Reperfusion Therapy in Acute Myocardial Infarction

Treatment of patients with acute myocardial infarction (MI) has improved over time and the duration of hospital stay has considerably decreased. Early hospital discharge after MI has been promoted for over 25 years. However, the meaning of “early” evolved over time. In the early eighties, before the widespread introduction of reperfusion therapy, patients were hospitalised for approximately 3 weeks and early discharge implemented a reduction to 7 days. Nowadays, the average hospital stay in the Netherlands amounts up to 8 days and “early” discharge is after 3-5 days. Evidently, in a cost-conscious environment hospitalisation should not be extended beyond the patient’s clinical needs. Still, evidence exists that further reduction in length of hospital stay can be achieved compared to current practice. In particular, after primary PCI that nowadays is the choice of reperfusion therapy especially in the Netherlands, when coronary anatomy and left ve! ntricular function are known, discharge can be safely effectuated after a few days. In particular, because early hospital discharge has been associated with improved physical and psychological outcome, especially in elderly subjects. We developed and validated different early discharge strategies in unselected patients with acute myocardial infarction in different patient cohorts. Over time reperfusion therapy changed and we evaluated the consequences for discharge policy and validated our allocation model of reperfusion therapy with 10 years of follow-up. Furthermore, we investigated the psychological impact of early discharge

EACVI appropriateness criteria for the use of cardiovascular imaging in heart failure derived from European National Imaging Societies voting

This paper presents the first European appropriateness criteria for the use of cardiovascular imaging in heart failure, derived from voting of the European National Imaging Societies representatives. The paper describes the development process and discusses the results

Risk factors and mechanisms of stroke in young adults: The FUTURE study

Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30–40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as “unknown etiology”. Risk factors of 656 young stroke patients (aged 18–50) of the FUTURE study were categorized according to the “International Pediatric Stroke Study” (IPSS), with stratification on gender, age and stroke of “unknown etiology”. Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as “stroke of unknown etiology” using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly. This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: de Leeuw is supported by a clinical established investigator grant of the Dutch Heart Foundation (grant no. 2014 T060), and by a VIDI innovational grant from The Netherlands Organisation for Health Research and Development ZonMw (grant no. 016-126-351) and has also received research support from the “Dutch Epilepsy Fund” (grant no. 2010-18); Loes Rutten-Jacobs (LR-J) is supported by a British Heart Foundation Immediate Research Fellowship (FS/15/61/31626) (www.bhf.org.uk)

Observational Dutch Young Symptomatic StrokE studY (ODYSSEY): Study rationale and protocol of a multicentre prospective cohort study

Background: The proportion of strokes occurring in younger adults has been rising over the past decade. Due to the far longer life expectancy in the young, stroke in this group has an even larger socio-economic impact. However, information on etiology and prognosis remains scarce.Methods/design: ODYSSEY is a multicentre prospective cohort study on the prognosis and risk factors of patients with a first-ever TIA, ischemic stroke or intracerebral hemorrhage aged 18 to 49 years. Our aim is to include 1500 patients. Primary outcome will be all cause mortality and risk of recurrent vascular events. Secondary outcome will be the risk of post-stroke epilepsy and cognitive impairment. Patients will complete structured questionnaires on outcome measures and risk factors. Both well-documented and less well-documented risk factors and potentially acute trigger factors will be investigated. Patients will be followed every 6 months for at least 3 years. In addition, an extensive neuropsychological assessment will be administered both at baseline and 1 year after the stroke/TIA. Furthermore we will include 250 stroke-free controls, who will complete baseline assessment and one neuropsychological assessment.Discussion: ODYSSEY is designed to prospectively determine prognosis after a young stroke and get more insight into etiology of patients with a TIA, ischemic stroke and intracerebral hemorrhage in patients aged 18 to 49 years old in a large sample size

Patient-reported burden of intensified surveillance and surgery in high-risk individuals under pancreatic cancer surveillance

In high-risk individuals participating in a pancreatic cancer surveillance program, worrisome features warrant for intensified surveillance or, occasionally, surgery. Our objectives were to determine the patient-reported burden of intensified surveillance and/or surgery, and to assess post-operative quality of life and opinion of surgery. Participants in our pancreatic cancer surveillance program completed questionnaires including the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). For individuals who underwent intensified surveillance, questionnaires before, during, and ≥ 3 weeks after were analyzed. In addition, subjects who underwent intensified surveillance in the past 3 years or underwent surgery at any time, were invited for an interview, that included the Short-Form 12 (SF-12). A total of 31 high-risk individuals were studied. During the intensified surveillance period, median CWS scores were higher (14, IQR 7), as compared to before (12, IQR 9, P = 0.007) and after (11, IQR 7, P = 0.014), but eventually returned back to baseline (P = 0.823). Median HADS scores were low: 5 (IQR 6) for anxiety and 3 (IQR 5) for depression, and they were unaff

Glucosylated cholesterol in mammalian cells and tissues: formation and degradation by multiple cellular β-glucosidases

The membrane lipid glucosylceramide (GlcCer) is continuously formed and degraded. Cells express two GlcCer-degrading β-glucosidases, GBA and GBA2, located in and outside the lysosome, respectively. Here we demonstrate that through transglucosylation both GBA and GBA2 are able to catalyze in vitro the transfer of glucosyl-moieties from GlcCer to cholesterol, and vice versa. Furthermore, the natural occurrence of 1-O-cholesteryl-β-D-glucopyranoside (GlcChol) in mouse tissues and human plasma is demonstrated using LC-MS/MS and 13C6-labelled GlcChol as internal standard. In cells the inhibition of GBA increases GlcChol, whereas inhibition of GBA2 decreases glucosylated sterol. Similarly, in GBA2-deficient mice GlcChol is reduced. Depletion of GlcCer by inhibition of GlcCer synthase decreases GlcChol in cells and likewise in plasma of inhibitor-treated Gaucher disease patients. In tissues of mice with Niemann-Pick type C, a condition characterized by intralysosomal accumulation of cholesterol, marked elevations in GlcChol occur as well. When lysosomal accumulation of cholesterol is induced in cultured cells, GlcChol is formed via lysosomal GBA. This illustrates that reversible transglucosylation reactions are highly dependent on local availability of suitable acceptors. In conclusion, mammalian tissues contain GlcChol formed by transglucosylation through β-glucosidases using GlcCer as donor. Our findings reveal a novel metabolic function for GlcCer.Bio-organic SynthesisMedical Biochemistr

Auditory word recognition is not more sensitive to word-initial than to word-final stimulus information

Several accounts of human recognition of spoken words a.!!llign special importance to stimulus-word onsets. The experiment described here was d~igned to find out whether such a word-beginning superiority effect, which ill supported by experimental evidence of various kinds, is due to a special sensitivity of the word recognition process to word-initial stimulus information, or rather to the special importance of word onsets for the proper alignment of stimuli with word candidates. To this end 28 polysyllabic monomorphematic test words were selected, all having the special characteristic that their leCt,..to-right and right-to-Ieft recognition points coincided in the same phoneme. These words were synthesilled from diphones, and of each word four versions were prepared: a. without noise, b. with liaise-masking segment perception in the word-initial fragment, c. with noise-masking segment perception in the word-final fragment, d . with noise masking the whole word. These stimuli were, appropriately blocked, distributed over four stimulus tapes together with a number of filler words, and presented to four groups of twelve subjects for word r