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Journal Club. NEWS.

Добавлено: Сб фев 16, 2008 9:33 am
Предлагаю обмениваться краткими новостями в этом разделе.

Плохие новости.
Мало того, что курить вредно:

Acute coronary events fall after smoking ban introduced in Italy
The incidence of acute coronary events including myocardial infarction dropped significantly after the ban on smoking in public places was introduced in Italy, research shows.
Circulation 2008; Advance online publication

Так и пить надо только для запаха:

One alcoholic drink relaxes but two stress circulation
One drink of alcohol results in vasodilation and reduces cardiac output, but a second cancels out these beneficial effects, increasing the heart rate, cardiac output, and sympathetic nervous activity, a Canadian study reveals.
Am J Physiol Heart Circ Physiol 2008; 294: H605-H612

И летать надо днем и бесшумно:

Night-time aircraft, traffic noise raises BP even during sleep
Noise from aircraft or traffic at night increases a person's blood pressure while they are sleeping, even if it does not wake them up, research findings show.
Eur Heart J 2008; Advance online publication

Re: Journal Club. NEWS.

Добавлено: Сб фев 16, 2008 12:39 pm
Абугов писал(а): И летать надо днем и бесшумно:
И низЭнько.

Добавлено: Вс фев 17, 2008 8:10 am
Igor Bulatov
"Younger women who drink two or three alcoholic beverages a week have a lower risk of developing high blood pressure than women who do not consume alcohol." -- Reuters
Researchers Say Alcohol Affects Women's Blood Pressure, Researchers' Interest

Cambridge, Mass. (SatireWire.com) Update — According to a new study on female alcohol use and blood pressure, young women who consume two or three alcoholic drinks a week are much more fun to do research on than women who do not consume alcohol.

Oh, and the report also found that women who have a few drinks each week are less likely to develop high blood pressure. Whatever.

The report, published in the Archives of Internal Medicine, studied drinking patterns and blood pressure among 70,000 nurses between the ages of 25 and 42.

Dr. Eric Shinauer, who headed the study for Harvard's School of Public Health, put the findings in perspective. "Alcohol, 70,000 nurses, and us," he said. "Is that cool or what?"

Shinauer and his colleagues — Dr. Andrew Sporata and Dr. Chandra Palava — conceded their initial grant was to study salt consumption. However, upon reflection, the trio decided that adjusting the parameters would dramatically heighten their interest in the research.

Explained Palava: "What it came down to was, did we want to say, 'Here young lady, have some salt and let's see what happens,' or, 'Here young lady, have a drink and let's see what happens.'"

"We're scientists, but we're not dead," he added.

In fact, Shinauer theorized there would be much more interest in studying women's health issues if alcohol were involved. Reaction to his study seems to bear this out, as already, several leading universities say they will attempt to verify the group's findings.

At Stanford University, epidemiologist Bruce Cawthorn said his department is very interested in testing Shinauer's conclusion that women who have more than 10 alcoholic drinks a week increase their risk of developing high blood pressure by 30 percent. But more importantly, he added, his staff is "totally stoked" by the concomitant finding that these same women were also, statistically speaking, a blast.

Shinauer, however, insisted their most valuable conclusion was that researchers could do variations on this type of study for years. "We could do how alcohol affects blood pressure among female flight attendants, or how alcohol affects blood pressure among female strippers. We are so golden."

Palava, meanwhile, said he is working on "the Holy Grail" for this area of study — a report on how drinking among young women affects drinking among young women. "We just have to figure out some statistically significant reason for doing it," he said.

Palava bristled, however, at the suggestion that researchers should also study the effect of alcohol on young men. "Jesus, we're not gay," he said.

Добавлено: Вс фев 17, 2008 10:17 am
Igor Bulatov писал(а):"should also study the effect of alcohol on young men. "Jesus, we're not gay," he said.
Еffect of alcohol сподручнее изучать на young men , проживающих в посёлке Ум-Рева , Мошковского район , Новосибирской обл. Вот там Jesus, we're not gay.
PS.Younger women тоже.

Добавлено: Пн фев 18, 2008 12:50 am
американские коллеги предлагают перестать с умным видом смотреть на часики, отсчитывая время от начала ОИМ, а тупо закатывать пациентов в операционную.

Late PCI After Infarction Still Improves Survival Over Medical Therapy
Even after more than 12 hours following an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI) offers improved survival and cardiac remodeling over medical therapy, according to a paper published online February 7, 2008, in the Journal of the American College of Cardiology.

Researchers led by George W. Vetrovec, MD, of Virginia Commonwealth University (Richmond, VA), performed a meta-analysis of 10 trials and a total of 3,560 patients who had been randomized to receive PCI of the infarct related artery (IRA) or medical management more than 12 hours and up to 60 days after AMI. Median time from AMI to randomization was 12 days, and average follow-up lasted for 2.8 years.

Among the patients who received PCI, 112 (6.3%) died, as opposed to 149 (8.4%) in the medical therapy group (P=0.03). This survival benefit was associated with improvements in cardiac remodeling, including a 4.4% increase in left ventricular ejection fraction for PCI patients (95% CI 1.1-7.6).

“The findings of a beneficial effect of late PCI proposes that revascularization of the IRA by means of PCI occurring late and beyond the window of myocardial salvage can be favorable in terms of post-AMI cardiac remodeling and all-cause mortality,” the study authors concluded, arguing that such findings have significant clinical implications because “the number of patients treated within 12 hours of the onset of symptoms is still disappointing.”

In an editorial accompanying the study, Manel Sabaté, MD, PhD, of Saint Paul University Hospital (Barcelona, Spain), commended the researchers for shedding light on this “controversial topic.”

“This meta-analysis fully addressed the open artery hypothesis with an adequate final sample size and a long enough clinical follow-up,” Dr. Sabaté wrote. “This hypothesis suggests that survival after MI depends on the effect of mechanical recanalization to improve left ventricular modeling and healing, to enhance electrical stability, and to cause myocardial perfusion rather than to reduce the infarct size (that is, myocardial salvage).”

He noted that the benefit of PCI was more obvious in those trials with a median follow-up of more than 4 years, supporting the idea that restoration of blood flow may interrupt “progression to apoptosis of hibernating myocardium and prevent the development of cardiomyopathy.”

А сонные стентировать тоже не вредно . . .

Добавлено: Пн фев 18, 2008 5:26 pm
А сонные стентировать тоже не вредно . . .

Effect of Carotid Artery Stenting on Cognitive Function in Patients With Carotid Artery Stenosis: Preliminary Results
A.S. Turk, I. Chaudrya, V.M. Haughtona, et all

Departments of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis

BACKGROUND AND PURPOSE:Stenosis of the carotid artery may be a cause of reduced cognitive performance that can be ameliorated with placement of a stent. The goal of this study was to measure cognitive performance and speed of psychomotor performance prospectively before and after carotid stent placement.

MATERIALS AND METHODS:Patients referred for stent placement for a unilateral carotid artery stenosis were enrolled in the study. Neuropsychologic testing was performed with a Mini-Mental State Examination, an extended mental status examination, a subjective cognitive status measure, and a psychomotor performance test for speed. The severity of the stenosis was measured on angiograms performed before stent placement. Three months after stent placement, CT angiograms were performed and the neuropsychologic testing was repeated. Differences in neuropsychologic test scores before and after stent placement were calculated and tested for significance with a Student t test.

RESULTS:Seventeen patients with a single unilateral carotid stenosis of more than 50% completed the study. Stenosis of the carotid artery averaged 80% before treatment and 18% after treatment. After stenting, the scores from the extended mental status examination improved significantly. The scores from the subjective cognitive status measure also improved. No significant change was noted in the scores from the Mini-Mental State Examination or in the speed of psychomotor performance.

CONCLUSION:Carotid stent placement in patients with a unilateral stenosis of the carotid artery resulted in significant improvement in cognitive test scores in this highly selected patient group. Further studies are needed to confirm these preliminary observations.


Добавлено: Вт фев 19, 2008 1:01 am
Сахарный диабет 2 типа надо лечить активно, но не зацикливаться на глюкозе

http://public.nhlbi.nih.gov/newsroom/ho ... px?id=2551

В исследовании ACCORD попытка добиться снижения гликозилированного гемоглобина ниже 6,0% привела к увеличению смертности, в связи с чем эта ветвь исследования была приостановлена и больных стали лечить так, как в группе сравнения: добиваясь снижения гликозилированного гемоглобина до 7--7,9%.

Вместе с тем, в исследовании STENO-2 (http://content.nejm.org/cgi/content/abstract/358/6/580) у больных с сахарным диабетом 2 типа и микроальбуминурией активное лечение сразу по нескольким направлениям (снижение гликозилированного гемоглобина < 6,5%, снижение общего холестерина < 4,5 ммоль/л, поддержание оптимального АД, ингибиторы АПФ независимо от АД, физические нагрузки и диета) позволило добиться снижения смертности по сравнению с менее активным лечением. Активное лечение позволило за 13,3 лет снизить смертность на 20% (в абсолютном выражении).

Таким образом, сахарный диабет надо лечить активно, но помнить, что сахарный диабет -- это не только высокий уровень глюкозы, и не слишком усердствовать в ее снижении.

Добавлено: Ср фев 20, 2008 12:03 am
Не кардиология, но интересно.

Пробиотики не так безопасны, как принято считать

В двойном слепом рандомизированном исследовании пробиотики достовено повышали смертность у больных с тяжелым панкреатитом.

Probiotics Raise Mortality Risk in Patients with Severe Pancreatitis

Using probiotic therapy to reduce infectious complications in severe pancreatitis actually increases mortality, according to a study released early by Lancet.

Dutch researchers randomized some 300 patients with first episodes of acute pancreatitis who were judged to be at risk for severe disease. Patients received a 28-day course of either placebo or a combination of Lactobacillus, Lactococcus, and Bifidobacterium species via feeding tube or later ingested orally. Treatment assignments were double-blinded.

By follow-up at 90 days, rates of infectious complications between the groups did not differ. However, those on probiotic therapy had mortality rates twice as high as those on placebo, and nine suffered bowel ischemia.

The authors speculate that increased oxygen demands of the infused bacteria may have led to the ischemia. Regardless of the cause, they conclude that "probiotics can no longer be considered to be harmless adjuncts to enteral nutrition, especially in critically ill patients."

Lancet article (Free abstract; full text requires subscription) http://click.jwatch.org/cts/click?q=227 ... WCoxuk4%3D

Добавлено: Ср фев 20, 2008 9:26 am
Igor Bulatov
Decellularized Human Heart Valve (CryoValve SG) for Native Pulmonary Valve Replacement

On February 7, the FDA granted 510(k) clearance for a decellularized human heart valve (CryoValve SG, CryoLife, Inc) for the replacement of diseased, damaged, malformed, or malfunctioning native pulmonary valves. An estimated 60,000 heart valve replacements are performed in the United States each year.

Heart valve tissue is recovered from human cadavers and is inspected, cleaned, and decontaminated as preparation for implantation. However, although traditional preparation of tissue leaves the allograft product otherwise unchanged, the new product undergoes an additional step that removes tissue cells and cellular debris, leaving only the scaffold of connective tissue. The step does not compromise the integrity of the valve but may lower the risk of tissue rejection.

According to the manufacturer, the device can be used in conjunction with the right ventricular outflow tract reconstruction procedures commonly performed in children with congenital heart defects and in the Ross procedure to replace the native pulmonary valve

Добавлено: Ср фев 20, 2008 10:19 pm
Близко к теме топика Стеноз РАV. Ретроградный кровоток..
According to the manufacturer, the device can be used in conjunction with the right ventricular outflow tract reconstruction procedures commonly performed in children with congenital heart defects and in the Ross procedure to replace the native pulmonary valve(с)
Интересно, в каком возрасте предполагается, или , скажем, предпочтительнее оперировать этих 60 000 детей.

Добавлено: Ср фев 20, 2008 10:50 pm
С ACCORD не так однозначно

Ситуация следующая: при 2 типе человечество долго не принимало идею близконормальных сахаров,довольствуясь безжалобной жизнью ( аналог терапевтической идеи "рабочего давления" ) но UKPDS доказало, что гликогемоглобин 7,5 % у этих больных дает основания расчитывать на снижение микрососудистых осложнений ( напомню, что при 2 типе НА момент диагностики у половины микро- или макрососудистые осложения ), но НЕ снижает статистически значимо ( прошло различие в 16% при p ( если не изменяет память ) 0,052 ( sic!) макрососудистых осложнений

Идей было две - во - первых, дибет 2 типа это еще и гиперлипидемия и артериальная гипертензия, и во вторых может, еще чуть - чуть снизить сахар? ( у здорового HbA1c будет меньше 6 % - не будем углубляться в дебри методик, тут свои заморочки)

Словом, какое -то время сосредоточились на лечения по всем фронтам ( нормогликемия + целевое АД с целевым гликогемоглобином до 7% )- даже дисциплинированые скандинавы получили 10 %( тоже могу соврать, но не сильно) достижения всех трех целевых уровней ( STENO) причем цены немалые на эту коррекцию ..

Тогда возник вновь вопрос об эффективном и экономичном управлении диабетом : уже сейчас в мире 260 млн больных диабетом ( это больше, чем полторы России) , а к 2025 году будет 300 млн ( или 360 ) - не хило..

Итого, NIH начала исследование для уточнения стратегии управления диабетом 2 типа ( это не единственное, и два других из других центров и с другими , но сходными дизайнами идут- ADVANCE, нпрм)

Больных было включено 10251 человек

Были две группы - с принятым на сегодня + практически приемлемым ( 7,0 -7,9 % ) целевым гликогемоглобином и " как у здоровых "- меньше 6,0%
Исследование многоцентровое / рандомизация начато в 2001 году, помимо контроля гликемии , включали еще и статины только или фибраты со статинами и АД сист ( ниже 120 или ниже 140 как цель)
Cпустя 4 года ветвь гликогемоглобина "как у здоровых" была закрыта : больше смертей -257/ на 5128 участников при 203/5123 на стандартном на сегодня гликогемоглобине

Анализ данных на сегодня не выявил причин повышения смертности - это не гипогликемии и не росиглитазон ( два основных потенциальных обвиняемых на вскидку )

Любопытно, что в группе жесткого контроля оказалось на 10 % меньше ( ТАК !!! ) нефатальных кардиальных исходов

Информация полная ( включая анализ гиполипидемической и гипотензивной терапии) будет получена к концу 2009 года, так что мы пока ответа не знаем - это шутки статистики или какой-то неизвестный нам факт, но эти даные не подрывают сегодняшнюю тактику ведения и не отрицают контроль до 7 % гликогемоглобина ..

Добавлено: Чт фев 21, 2008 7:15 am
Igor Bulatov
Igor писал(а):Близко к теме топика Стеноз РАV. Ретроградный кровоток..
According to the manufacturer, the device can be used in conjunction with the right ventricular outflow tract reconstruction procedures commonly performed in children with congenital heart defects and in the Ross procedure to replace the native pulmonary valve(с)
Интересно, в каком возрасте предполагается, или , скажем, предпочтительнее оперировать этих 60 000 детей.
60 тысяч -это подразумевается всего операций по поводу клапанных дефектов у всех пациентов (взрослых и детей),выполняемых ежегодно в США.Детей же с врожденными пороками сердца оперируется порядка 35 тысяч в год.Из них лишь достаточно небольшая часть подвергается клапанным операциям.Из которых,в свою очередь,еще меньшая часть получает клапанные гомографты описанного выше типа.Механические клапаны устанавливаются детям исключительно редко.Операция Росса заключается в замещении дефектного аортального клапана легочным клапаном пациента.А на место легочного клапана устанавливается клапанный графт вышеописанного типа.Наши хирурги предпочитают восстанавливать (repair)дефектный аортальный (и все другие) клапан у маленьких детей.В тех случаях,когда repair невозможно,легочный гомографт (подобный разрешенному FDA)устанавливается вместо аортального. А после достижения подросткового возраста делается операция Росса.

Добавлено: Чт фев 21, 2008 11:48 am
Igor Bulatov писал(а):[ А после достижения подросткового возраста делается операция Росса.
Теперь ясно :!:

Добавлено: Пт фев 22, 2008 11:11 pm
Еще два гвоздя в гробовую крышку трасилола.

Aprotinin under fire: Two new observational studies point to mortality risk .
Boston, MA - More fuel for the aprotinin controversy this week: two large, observational studies appearing in the February 21, 2008 issue of the New England Journal of Medicine (NEJM) point to an increased risk of mortality in patients given the drug—used to reduce bleeding risk during CABG—as compared with patients given other drugs or no antifibrinolytic [1,2].

Schneeweiss S, Seeger JD, Landon J, Walker AM. Aprotinin during coronary-artery bypass grafting and risk of death. N Engl J Med 2008; 358:771-783.
Shaw AD, Stafford-Smith M, White WD, et al. The effect of aprotinin on outcome after coronary-artery bypass grafting. N Engl J Med 2008; 358:784-793.

Добавлено: Сб фев 23, 2008 7:41 pm
Есть новости плохие, а есть ужасные:

Marijuana users have increased mortality after MI
Marijuana users who survive a myocardial infarction are at increased risk for dying after the event, preliminary study findings suggest.
Am Heart J 2008; 155: 465-470

Как всегда - стенты намазываем:

DES versus BMS 'moderately' reduces revascularization in Type 2 diabetics
Using drug-eluting stents rather than bare-metal stents only "moderately" reduces 2-year risk for target vessel revascularization in Type 2 diabetic patients undergoing coronary stenting, say Italian researchers who analyzed registry data.
Circulation 2008; 117: 923-930

Не дай Бог жить в Канаде - плавикса не допросишься:

Restricted clopidogrel access linked to increased mortality after PCI
Medical insurance restricting access to clopidogrel can delay or stop patients receiving treatment with the drug after percutaneous coronary intervention with stenting, which in turn may increase their risk for dying, a Canadian study suggests.
Can Med Assoc J 2008; 178: 413-420

А вот это уже нападки на уважаемого Евгения Николаевича:

Perfusion CMR 'alternative to SPECT' for CAD detection
Cardiac magnetic resonance stress perfusion imaging may offer a valuable alternative to single-photon emission computed tomography for the detection of coronary artery disease, results of a large, multicenter trial indicate.
Eur Heart J 2008; 29: 480-489