Development and course of heart failure after a myocardial infarction in younger and older people

BackgroundAcute 心肌的梗塞(AMI ) 是心失败(HF ) 的一个普通原因，它能此后不久开发 AMI 并且可以晚坚持或解决或发展。在 MI 以后的 HF 是死亡的主要来源。在在不同年龄组的 MI 以后的 HF 的累积发生，流行和决定糟糕被描述。在 AMI 从医院记录在 1998 期间根据有 AMI 的 age.MethodsPatients 被识别以后，这研究描述 HF 的自然历史。HF 与环利尿剂被定义为症状的治疗和 HF 的症状并且如果没有症状的复发，环利尿剂治疗能被停止，被认为决定了。病人们 &#x0003c 被分成那些；65 年， 65-75 年，和 &#x0003e；75 years.ResultsOf 896 个病人， 311， 297 和 288 被变老 &#x0003c；65， 65-75 和 &#x0003e； 75 年并且谁 24% ， 57% 和 82% 由 2005 年 12 月分别地死了。这些死亡， 24 (8%) ， 68 (23%) 并且(37%) 107 发生在索引承认期间，与尖锐 HF 联系的许多。A 推进 37 (12%) ， 63 (21%) 并且(29%) 82 开发了坚持了直到分泌物， 15， 44 和 62 随后死于的 HF。在分泌物以后， 53 (24%) ， 55 (40%) 并且 37 (47%) 病人们第一次开发了 HF，谁 26% ， 62% 和 76% 随后死了。死亡被 HF 的发展在 35 先于(70%) ， 93 (91%) 并且 107 (85%) 在年老的 &#x0003c；65 年， 65-75 年和 &#x0003e； 75 年，开发 HF 并且在 MI 以后死的 respectively.ConclusionsThe 风险与年龄日益增多地增加。不管年龄，在 MI 以后的大多数死亡被 HF 的发展先于。

Differential effects of atrial and brain natriuretic peptides on human pulmonary artery:An in vitro study

BACKGROUND The prevalence of cardiovascular diseases,especially heart failure,continues to rise worldwide.In heart failure,increasing levels of circulating atrial natriuretic peptide(ANP)and brain natriuretic peptide(BNP)are associated with a worsening of heart failure and a poor prognosis.AIM To test whether a high concentration of BNP would inhibit relaxation to ANP.METHODS Pulmonary arteries were dissected from disease-free areas of lung resection,as well as pulmonary artery rings of internal diameter 2.5–3.5 mm and 2 mm long,were prepared.Pulmonary artery rings were mounted in a multiwire myograph,and a basal tension of 1.61gf was applied.After equilibration for 60 min,rings were pre-constricted with 11.21μmol/L PGF2α(EC80),and concentration response curves were constructed to vasodilators by cumulative addition to the myograph chambers.RESULTS Although both ANP and BNP were found to vasodilate the pulmonary vessels,ANP is more potent than BNP.pEC50 of ANP and BNP were 8.96±0.21 and 7.54±0.18,respectively,and the maximum efficacy(Emax)for ANP and BNP was-2.03 gf and-0.24 gf,respectively.After addition of BNP,the Emax of ANP reduced from-0.96gf to-0.675gf(P=0.28).CONCLUSION BNP could be acting as a partial agonist in small human pulmonary arteries,and inhibits relaxation to ANP.Elevated levels of circulating BNP could be responsible for the worsening of decompensated heart failure.This finding could also explain the disappointing results seen in clinical trials of ANP and BNP analogues for the treatment of heart failure.

Acute coronary syndromes： an old age problem

在老年的增加的人口将导致他们的更大的数字与急性冠的症候群(交流) 介绍。这在全球保健资源上有含意并且为基于证据的治疗要求更好的管理和选择。老比更年轻的交流是有更重要的治疗好处的一个高风险组。不过，在交流的相关不平等在乎的年龄被认出并且坚持。到某程度，在照顾的这差异被不正常、推迟的演讲的更高的频率在表示在老、不太诊断的心电图解释，加强在交流的延期诊断。在死亡风险在的评价下面由于为生理的脆弱，合作病态，认知 / 心理的缺陷和物理残疾的有限考虑老，由心病学专家和 randomised 的缺乏的更少的输入，指导管理在的控制试用数据老可以进一步使照顾的不平等惊讶。当这些不平等存在时，在那里仍然是一个实质的机会改进年龄相关交流结果。为特定的治疗和药政体的老病人的选择是未答复的。对 randomised 有成长需要，人口更代表性并且与合作病态先进年龄注册那些的控制试用数据。不利事件报导的缺乏，张贴冠的 angiography 例如肾的缺陷，在老进一步的限制风险利益决定。在老交流病人的照顾的实质的改进被要求并且应该被倡导。最终，这些改进是可能的导致更好的结果柱子交流。然而，在结果的改进不是无限的并且将由年龄相关的风险的非可修改的因素有限。

Characterization of optimal resting tension in human pulmonary arteries

AIM To determine the optimum resting tension(ORT) for in vitro human pulmonary artery(PA) ring preparations.METHODS Pulmonary arteries were dissected from disease free sections of the resected lung in the operating theatre and tissue samples were directly sent to the laboratory in Krebs-Henseleit solution(Krebs).The pulmonary arteries were then cut into 2 mm long rings.PA rings were mounted in 25 m L organ baths or 8 m L myograph chambers containing Krebs compound(37 ℃,bubbled with 21% O_2:5% CO_2) to measure changes in isometric tension.The resting tension was set at 1-gram force(gf) with vessels being left static to equilibrate for duration of one hour.Baseline contractile reactions to 40 mmol/L KCl were obtained from a resting tension of 1 gf.Contractile reactions to 40 mmol/L KCl were then obtained from stepwise increases in resting tension(1.2,1.4,1.6,1.8 and 2.0 gf).RESULTS Twenty PA rings of internal diameter between 2-4 mmwere prepared from 4 patients.In human PA rings incrementing the tension during rest stance by 0.6 gf,up to 1.6 gf significantly augmented the 40 mmol/L KCl stimulated tension.Further enhancement of active tension by 0.4 gf,up to 2.0 gf mitigate the 40 mmol/L KCl stimulated reaction.Both Myograph and the organ bath demonstrated identical conclusions,supporting that the radial optimal resting tension for human PA ring was 1.61 g.CONCLUSION The radial optimal resting tension in our experiment is 1.61 gf(15.78 m N) for human PA rings.

Pancreatic cancer:A model cancer for the study of the therapeutic effects of anticoagulants

Cancer-related thromboembolic disease is a well recognized syndrome since first described by Armand Trousseau in 1865.Preventing the morbidity and mortality related to thromboembolism in these patients is becoming a priority research area with the advent of new anti-coagulants.It is only recently that randomized trials of improved quality are been undertaken to study this question.Many of these trials however are still not accounting for the heterogeneity of "cancer" in terms of anatomical site,histology,stage and treatment.This editorial review highlights why pancreatic cancer may serve as a model malignancy to study this question.

Review of the adaptation of skeletal muscle in intermittent claudication

Background: Despite awareness about the impact of intermittent claudication (IC) on mobility, balance and quality of life;the underlying pathophysiology and alterations in muscle architecture secondary to the disease are often overlooked. This review aimed to summarize the pathophysiological muscle changes present secondary to IC. Methods: The electronic databases, Medline, EMBASE, Cinahl and AMED, were searched for studies from 1967 to August 2011. Search terms included exercise, intermittent claudication and muscle. Studies about IC which were focused on muscle histology, muscle architecture, blood flow or changes with exercise were included. Results: Of 434 studies identified, 135 unique results were found. Only 78 of these were suitable from abstract review, of which 15 were unobtainable and a further nine were identified from hand-searching references. Studies in animal models demonstrated a predominance of type II muscle fibres and an improvement in animal exercise tolerance secondary to training. Exercise alone was never able to improve distances to that of healthy controls, however a lower limb fistula along with exercise did. Lower limb blood flow was demonstrated to be affected regionally, and most evident during exercise with a prolonged return to normal in patients with IC. At a cellular level, the myocytes metabolism increased in those with IC, but returned to normal post-revascularization. Conclusion: Treatment for claudicants includes either revascularization or exercise. Successful revascularization has demonstrated a return to normal muscle metabolism;the underlying physiological improvement secondary to exercise still requires clarification.

Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma

Background: The pancreas is an uncommon but recognizable site for metastases from renal cell carcinoma (RCC). Isolated pancreatic RCC metastases are still rarer and often present years after initial nephrectomy. Surgical resection has been the treatment of choice because of superior patient survival compared with traditional immunotherapy. In recent years, the advent of targeted therapy has transformed the outcomes of patients with metastatic RCC although little evidence is available on its effectiveness on this subset of patients. We report our experience of 6 patients with pancreatic RCC metastases. Patients and Methods: Between 2007 and 2012, 6 patients (2 men, 4 women;median age 78 years) were diagnosed to have pancreatic RCC metastases at our institute. The clinical features, treatment and outcomes were examined. Results: All 6 patients had a primary RCC of clear cell type. The median interval between initial curative nephrectomy and re-presentation with pancreatic metastases was 12.5 years. Four patients were asymptomatic at the time of diagnosis, one presented with obstructive jaundice and another with acute gastrointestinal bleed. Four patients had extra-pancreatic disease. All were deemed unsuitable or unfit for surgical metastasectomy. Five patients had a Memorial Sloan-Kettering Cancer Center (MSKCC) score of 1 (moderate risk) and the other patient had a score of 0 (good risk). Two patients were commenced on Sunitinib, one received Pazopanib and one received Temsirolimus. Two patients did not undergo further treatment. Of the 4 patients who underwent targeted therapy, the median follow up was 33 months with a median progression free survival of 16 months. One achieved complete response but recurred soon after treatment was stopped. Targetted therapy was recommenced and the disease remained stable. A second patient had long period of stable disease before disease progression. A third achieved partial response since started on targeted therapy and a fourth had disease progression despite treatment. Of the four patients who underwent systemic therapy, three are still alive at the time of this report. Conclusion: Pancreatic metastasis from RCC is a unique subgroup of disease which runs an indolent course, and a higher incidence in an elderly population. Our results demonstrate that targeted therapy can be efficacious in some patients where surgical resection is not suitable or possible.

Developments in Simulation Bronchoscopy Training

Flexible bronchoscopy is a common procedure. Training in bronchoscopy is a complex process involving learning technical skills, understanding indications and contraindications, risks and benefits of the procedure, working within the team and communicating with patients. It is expected that a competent bronchoscopist is able to maneuver the scope through the anatomically complex bronchial tree, take samples, manage the sedated patient and communicate with nursing staff. Learning the complex procedural skills in the clinical setting can be stressful, therefore current bronchoscopic training methodology should blend a number of learning methods including didactic lectures, web-based material, high and low fidelity simulators as well as supervised apprenticeship training. Simulation-based bronchoscopy training therefore has been explored as a mode of training bronchoscopy skills. In this article, the role of simulation-based bronchoscopy training is reviewed. The low fidelity and high fidelity virtual reality bronchoscopy models are described together with the evidence available to support the use of simulation for bronchoscopy training.

合理检查多尿的检查

多尿是一级医院门诊的常见症状，鉴别诊断困难，需要仔细斟酌。本文为此提供了结构化的、逻辑性的鉴别诊断思路，强调了各项相关检查的重要性，并且对何时进行专科转诊给出了建议。

Reproductive Challenges in Young Female Cancer Patients

The last three decades have seen a significant improvement and advancement in both the diagnostic and therapeutic modalities with improved surgical technique, chemoradio and supportive therapy in cancer treatment. This has produced a correspondingly increase in the 5-year relative survival rate for many cancers and for all races. However, the chemo-radiotherapy which is often gonadotoxic, has a substantial impact on quality of life issues especially that of reproduction in young female patients on account of increasing survival rates and delayed childbearing in the western hemisphere. This case based discussion paper using two real life case scenarios from our department focuses on the negative impact of cancer treatments on fertility and various options available for fertility preservation and / or fertility preservation measures. It is concluded that a lot of variables have to be considered when deciding upon fertility preservation treatments including patient＇s age, cancer stage, proposed treatment regime and time before it is initiated, availability of partner sperm and issues of individual patients. The latter include surgical complications, ovarian hyperstimu-lation syndrome, delay in cancer treatment and reintroduction of cancer cells, cost, low success rates and experimental nature of these treatments and the disposition of gametes in the event that the patient does not survive her cancer. It is very important for physician to advise patients of all these factors so that they can make an informed decision regarding the fertility preservation options and each case is unique and requires a different strategy of fertility preservation.

An odyssey through Fitz-Hugh Curtis syndrome

Acute fibrinous perihepatitis due to genital tract infection has attracted sparse and fluctuating interest. The recent increase in the incidence of sexually transmitted disease and the recognition of Chlamydia trachomatis as a causative organism in both pelvic inflammatory disease （PID） and extra pelvic manifestation of PID have brought about the renewed interest in perihepatitis. This is likely to ensure that the clinical features of perihepatitis will now become widely recognised. This paper examines the evolution, clinical features, diagnosis and management of this interesting syndrome and emphasises the need to explore the upper abdomen during laparoscopic gynaecological surgery.

Evaluation of Current Termination of Pregnancy and Related Services at Grimsby(UK) and Recommendations for Service Improvement

Objective To develop local termination of pregnancy （TOP） dataset and to identify ＂hotspots＂ for highest activity and gaps in our fertility control services. Methods This was a retrospective analysis of 305 women who received TOP under section C of the Abortion Act 1967 over a period of 9 consecutive months from 1st March through to 31st October 2012. Results There were 275 （90.2%） British White （BW） and 30 non-BW women. Among 30 non-BW women, 10 （3.3%） were British Asian, 8 （2.6%） were Polish, 6 （2.0%） were British Black or Black, 5 （1.6%） were Chinese and i （0.3%） was White Latvian. The TOP rate was 8.9% in the under 18 years old and 27.9% in the over 30 years old. Totally 240 TOPs （78. 7%） occurred in 〈10 weeks and 276 TOPs （90.5%） occurred under 13 weeks of gestation. Eight-five women who received TOP-service have had one or more previous termination（s） in the last 3 years. The contraception use was low pre-TOP and none of the women were on long-acting reversible contraception （LARCs） pre- TOP, including those who had repeat terminations. Conclusion There are inequalities and gaps in the TOP and related services in Grimsby which must be addressed to reduce the rate of TOP. This is a major challenge involving multiple agencies. Provision of contraception across all age and ethnic groups, improving sex education, engaging with parents and women to improve their negotiation skills for safer sex, supporting vulnerable women, reducing risk factors e.g. alcohol and substance misuse and raising aspirations across the region will contribute to a reduction in termination rate.

Tumor heterogeneity and therapy resistance-implications for future treatments of prostate cancer

Aim:To develop new therapies for prostate cancer,disease heterogeneity must be addressed.This includes patient variation,multi-focal disease,cellular heterogeneity,genomic changes and epigenetic modification.This requires more representative models to be used in more innovative ways.Methods:This study used a panel of cell lines and primary prostate epithelial cell cultures derived from patient tissue.Several assays were used;alamar blue,colony forming assays,γH2AX and Ki67 immunofluorescence and comet assays.Ptychographic quantitative phase imaging(QPI),a label-free imaging technique,combined with Cell Analysis Toolbox software,was implemented to carry out real-time analysis of cells and to retrieve morphological,kinetic and population data.Results:A combination of radiation and Vorinostat may be more effective than radiation alone.Primary prostate cancer stem-like cells are more resistant to etoposide than more differentiated cells.Analysis of QPI images showed that cell lines and primary cells differ in their size,motility and proliferation rate.A QPI signature was developed in order to identify two subpopulations of cells within a heterogeneous primary culture.Conclusion:Use of primary prostate epithelial cultures allows assessment of therapies whilst taking into account cellular heterogeneity.Analysis of rare cell populations and embracing novel techniques may ultimately lead to identifying and overcoming treatment resistance.

Issues in the Mining of Heart Failure Datasets

This paper investigates the characteristics of a clinical dataset using a combination of feature selection and classification methods to handle missing values and understand the underlying statistical characteristics of a typical clinical dataset. Typically, when a large clinical dataset is presented, it consists of challenges such as missing values, high dimensionality, and unbalanced classes. These pose an inherent problem when implementing feature selection and classification algorithms. With most clinical datasets, an initial exploration of the dataset is carried out, and those attributes with more than a certain percentage of missing values are eliminated from the dataset. Later, with the help of missing value imputation, feature selection and classification algorithms, prognostic and diagnostic models are developed. This paper has two main conclusions: 1) Despite the nature of clinical datasets, and their large size, methods for missing value imputation do not affect the final performance. What is crucial is that the dataset is an accurate representation of the clinical problem and those methods of imputing missing values are not critical for developing classifiers and prognostic/diagnostic models. 2) Supervised learning has proven to be more suitable for mining clinical data than unsupervised methods. It is also shown that non-parametric classifiers such as decision trees give better results when compared to parametric classifiers such as radial basis function networks(RBFNs).

关节镜手术不能有效缓解膝关节骨性关节炎的疼痛或改善功能

问题:关节镜手术是否能有效缓解膝关节骨性关节炎患者的疼痛和改善关节功能? 设计 随机(隐匿分配)、盲法(患者和评价结果者)、安慰对照组的对照试验,随访2年。 地点 美国德克萨斯州休斯敦退伍军人医疗中心。的关节软骨,取出游离碎屑,修整撕裂的或变性的半月板部分。冲洗和清理都是全麻气管插管下进行。安慰对照组是在间断吸氧、短效镇静剂和阿片类药物作用下做3个1cm的皮肤切口。