Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial.
Centre for Complementary Health Studies, University of Exeter, Exeter, Devon, UK. firstname.lastname@example.org
OBJECTIVES To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI). DESIGN Partially randomised, partially blinded placebo-controlled, exploratory clinical study. SETTING Coronary Care Unit, Torbay Hospital, Torquay, Devon. PARTICIPANTS A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI. INTERVENTION The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure. OUTCOME MEASURES (1) Incidence of post-MI nausea and/or vomiting,(2) severity of symptoms,(3) use of antiemetic drugs, over 24h. RESULTS There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant. CONCLUSIONS Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.
Department of Physiotherapy, Grantham Hospital, China.
Increased heart rate (HR) and reduced blood pressure (BP) are common consequences of cardiac surgery. This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points (Acu-TENS) on HR, BP, rate pressure product (RPP) and nausea and vomiting score after open-heart surgery. After open heart surgery, 40 patients were randomly allocated to either an Acu-TENS group, which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1-5, or a Placebo-TENS group, which received identical electrode placement but with no electrical output from the TENS unit, despite an output indicator light appearing activated. HR, systolic and diastolic BPs (SBP and DBP) were recorded and RPP computed. Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention. Daily HR, BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group. A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days, with all variables returning to preoperative values by Day 4 (P >.2). In the Placebo-TENS and Control groups the HR remained higher (P <.0001), BP lower (P <.05) and RPP higher (P =.01) than respective preoperative values at Day 4. The dose of Maxolon required was lowest in the Acu-TENS group (P =.038). We concluded that Acu-TENS facilitated an earlier return to preoperative BP, HR and RPP values in patients after acute heart surgery.
Department of Physiology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, 16 Nanxiaojie, Dongzhimennei, Beijing 100700, China.
AIM To observe the effect of electroacupuncture (EA) of "Neiguan"(PC6) and "Gongsun"(SP4) on pathological changes of the heart and stomach in rats with acute myocardial ischemia (AMI), and to explore its underlying mechanism. METHODS Fifty Wistar rats were randomized into control, model, PC6, SP4 and PC6 + SP4 groups (n = 8 each group). An AMI model was established by occlusion of the descending anterior branch (DAB) of the left coronary artery. ECG-ST of cervico-thoracic lead and electrogastrogram (EGG) were recorded. EA was applied to PC6, SP4 and PC6 + SP4 groups, respectively. At the end of experiments, the rats were transcardically perfused with 4% paraformaldehyde, and the heart base myocardium, gastric antrum and duodenum tissues were sampled, sectioned and stained with a reduced form of nicotinamide-adenine dinucleotide phosphate (NADPH)-diaphorase histochemical method for displaying nitric oxide synthase (NOS) activity. RESULTS After AMI, ECG-ST values elevated. After EA, the elevated ECG-ST values at 20 min in PC6 group, at 30 min in PC6 + SP4 and SP4 groups had no significant differences in comparison with their respective basal values before AMI. Following AMI, the amplitude and frequency of slow waves of EGG decreased remarkably (P < 0.05). At 30 min after EA, the mean amplitude and frequency of slow waves of EGG in the three EA groups had no marked differences compared with their individual basal levels and those in the control group. After AMI, the mean integral grey values of NOS-positive product in myocardium, gastric antrum and duodenum tissues in the model group increased remarkably in comparison with the control group, while those in three EA groups were lower than those in the model group. No significant differences were found in ECG-ST and EGG improvement among the three EA groups. However, EA of PC6 had a better effect on ECG-ST and EA of PC4 had a better effect on EGG, respectively. CONCLUSION EA of PC6, SP4 and PC6 + SP4 can significantly promote the recovery of cardiac and gastric electrical activities after AMI, and up-regulate NOS expression in myocardium, gastric antrum and duodenum tissues.
Explore (NY). ;2 (6):543-6 17113497
Integrating tuina acupressure and traditional Chinese medicine concepts into a holistic nursing practice.
University of Texas Health Science Center at Houston, School of Nursing, Houston, TX, USA. Pamela.Shiao@uth.tmc.edu
OBJECTIVE Using metaanalysis to examine the effects of acustimulations on nausea and vomiting symptoms (NVS) in postoperative adult populations. METHODS Metaanalyses of effects of various acupoints stimulations (AS)(including acupuncture, acupressure, and electrical stimulation) on NVS in postoperative adult populations were performed. Thirty-three quality randomized controlled trials (RCT) published over the past three decades were identified by evaluating the quality of randomization and treatment methods, and results were pooled using a fixed effects model. RESULTS Twenty-four trials were pooled for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics, with AS compared with placebo or controls. Two additional trials did not have control groups but compared AS to medication groups. Compared with the controls, AS (all modalities) reduced nausea (relative risk [RR]= 0.60, 95% confidence interval [CI]: 0.54-0.67, P <.0001), vomiting (RR = 0.51, 95% CI: 0.45-0.57, P <.0001), and use of rescue antiemetics (RR = 0.63, 95% CI: 0.54-0.74, P < 0001). All AS modalities were effective in reducing NVS. Korean hand acupressure stimulations (two trials) had the best impact on reducing vomiting. There were no significant differences on pooled RRs for nausea (five trials) and vomiting (eight trials) between medication and AS groups, but medication groups had increased use of rescue antiemetics (two trials, RR = 2.27, 95% CI: 1.48-3.49, P =.0002). There was a placebo effect when compared with controls in reducing nausea (four trials, RR = 0.67, 95% CI: 0.50-0.90, P =.0069) and vomiting (three trials, RR = 0.39, 95% CI: 0.19-0.80, P =.0106). CONCLUSIONS This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations.
Other papers by authors:
Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: face-to-face interviews with 515 users of herbal remedies.
AIMS: To determine whether adverse drug reactions (ADRs) to herbal remedies would be reported differently from similar ADRs to conventional over-the-counter (OTC) medicines by herbal-remedy users. METHODS: Face-to-face interviews (using a structured questionnaire) with 515 users of herbal remedies were conducted in six pharmacy stores and six healthfood stores in the UK. The questionnaire focused on the likely course of action taken by herbal-remedy users after experiencing an ADR associated with a conventional OTC medicine and a herbal remedy. RESULTS: Following a 'serious' suspected ADR, 156 respondents (30.3%) would consult their GP irrespective of whether the ADR was associated with the use of a herbal remedy or a conventional OTC medicine, whereas 221 respondents (42.9%) would not consult their GP for a serious ADR associated with either type of preparation. One hundred and thirty-four respondents (26.0%) would consult their GP for a serious ADR to a conventional OTC medicine, but not for a similar ADR to a herbal remedy, whereas four respondents (0.8%) would consult their GP for a serious ADR to a herbal remedy, but not for a similar ADR to a conventional OTC medicine. Similar differences were found in attitudes towards reporting 'minor' suspected ADRs. CONCLUSIONS: Consumers of herbal remedies would act differently with regard to reporting an ADR (serious or minor) to their GP depending on whether it was associated with a herbal remedy or a conventional OTC medicine. This has implications for herbal pharmacovigilance, particularly given the increasing use of OTC herbal remedies. The finding that a high proportion of respondents would not consult their GP or pharmacist following ADRs to conventional OTC medicines is also of concern.
Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study.
Centre for Complementary Health Studies, University of Exeter, Devon.
Eighty-two subjects with chronic arthritic pain were randomly assigned for 2 months without cross-over to either Reumalex, a licenced over-the-counter (OTC) herbal medicine, or a placebo. Entry characteristics were determined by a previous survey of arthritic customers at pharmacy and healthfood shop outlets. The AIMS2 questionnaire was completed at monthly intervals throughout and for 2 months prior to the trial, and a modified Ritchie Index provided clinical scores. Subjects also completed diary recordings of their use of self-prescribed analgesics and events they considered significant. There was a small but statistically significant improvement in pain symptoms, less so in sufferers from osteoarthritis. There were no other significant changes in any other measures nor in the use of other self-prescribed analgesics. There were few side-effects noted. It is concluded that Reumalex has a mild analgesic effect in chronic arthritis at a level appropriate to self-medication.
Parenting quality, DRD4, and the prediction of externalizing and internalizing behaviors in early childhood.
Center for Developmental Science, University of North Carolina-Chapel Hill, CB# 8115, 100 East Franklin Street, Chapel Hill, NC 27599-811, USA. email@example.com
Recent research has found that the dopamine D4 receptor (DRD4) gene and maternal insensitivity may interact to predict externalizing behavior in preschoolers. The current study attempted to replicate and extend this finding in a sample of 18-30-month-old children. The current study examined two distinct dimensions of parenting (warm-responsive and negative-intrusive) as predictors of childhood externalizing and internalizing behavior. Further, race was investigated as a moderator of gene-environment relationships. Results revealed that high warm-responsive parenting was associated with decreased externalizing behavior only for African American children possessing the short polymorphism of DRD4. The data indicate that children may be differentially susceptible to different aspects of parenting depending on their genotype, and it is important to consider differences in racial composition when studying these relationships.
Paths to child social adjustment: parenting quality and children's processing of social information.
Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA. firstname.lastname@example.org
BACKGROUND The purpose of this research was to examine the manner in which multiple influences on child social adjustment operated together to predict differential outcomes for young children. Specifically, this study was designed to (i) examine the role of social cognitive and emotional factors in parents' observed and self-reported behaviour towards their children, and (ii) investigate the impact of parenting and children's social information processing (SIP) patterns on children's subsequent social adjustment in the school setting. METHODS A model of children's peer social adjustment was evaluated using a group of 166 children, over-sampled for history of physical child abuse. Assessment of constructs was multi-method, including parent and child self-reports as well as teacher reports of child adjustment and observations of parent-child and child-peer interactions. RESULTS Using structural equation modelling, support was found for our theoretical model. Specifically, parents' negative child-related beliefs and clinical elevations in emotional distress were predictors of harsh, insensitive parenting, which in turn predicted children's SIP operations and social maladjustment 6 months later. However, children's SIP did not significantly predict their social adjustment above and beyond the impact of parenting. CONCLUSIONS Results indicated that the quality of parenting that children received was more central to subsequent adjustment in peer interactions than were children's SIP operations. Furthermore, the quality of parenting children experienced was closely linked to parents' beliefs about their children and parents' mental health status. Directions for future research and potential implications for clinical practice are discussed.
Department of Cardiology, OPD3, New Royal Infirmary of Edinburgh at Little France, Edinburgh. email@example.com
BACKGROUND Secondary prevention of coronary artery disease is effective in reducing morbitiy and mortality. Our aim was to assess lipid management following non-attendance to a hospital based secondary prevention clinic. METHODS Data were collected over 5 years on statin usage and total cholesterol levels for patients with coronary artery disease following attendance at a cardiac nurse led outpatient clinic. Lipid levels were taken from a central laboratory database, for both patients discharged from clinic and non-attenders. RESULTS From 935 inpatients discharged from hospital, 248 (29%) defaulted from outpatient follow up. Lipid lowering drug usage was similar (72% vs. 74% for non-attenders, p=NS). Attenders at the nurse led outpatient clinic were more likely to achieve a total cholesterol <5 mmol/L at discharge than non-attenders (70% vs. 43%; p < 0.001), with a lower mean total cholesterol (4.75 +/- 0.06 mmol/L vs. 5.33 +/- 0.08 mmol/L; p < 0.001). Non-attenders subsequently had a greater number of cholesterol measurements than those who were discharged from the hospital based clinic (range 0-12, c2 23.8 on 12 df p < 0.005). Lipid profiles in hospital non-attenders remained inferior with fewer achieving a total cholesterol <5 mmol/L (61% vs. 78%; p < 0.001), and having greater mean total cholesterol levels (4.85 +/- 0.06 mmol/L vs. 4.52 +/- 0.05 mmol/L; p < 0.001). CONCLUSIONS Patients defaulting from hospital follow up have higher total cholesterols with fewer at target level compared to attenders. Though non-attenders receive subsequent lipid measurement, inferior lipid profiles persist compared to patients who completed hospital follow up to be discharged. Further implementation strategies are needed with regard to lipid management in this patient group.
Hosp Med. 2005 Mar ;66 (3):186-7 15791885
M Willoughby, J Williams, D Proctor, J Lovley, M Hall, R Shaw, C Nyman, A M Davies, H Hassan, J Boulton, D Read, M Collins, L Hill
Coronary Care Unit, Pilgrim Hospital, Boston.
Department of Cardiology, Ninewells Hospital, Dundee, UK. firstname.lastname@example.org
BACKGROUND Secondary prevention of coronary artery disease is effective in reducing morbidity and mortality, but deficiencies in implementation and prescription bias have been identified. Aim: To assess progress in secondary prevention measures for coronary heart disease and whether there was a difference between patient subgroups with angina, post myocardial infarction or revascularization. DESIGN Retrospective analysis. METHODS Between 1997 and 2001, data were collected on prophylactic prescribing, demographic and lifestyle information, at baseline and 1 year following attendance at a hospital-based, cardiac-nurse-led out-patient clinic. RESULTS Patients (n = 945) were entered into the database at hospital discharge and 619 (72%) attended at 1 year. Aspirin and statin prescribing increased, though ACE inhibitor use was less. Mean total cholesterol at baseline reduced to 4.92 +/- 0.11 mmol/l (p < 0.001) in 2000, with a further reduction to 4.59 +/- 0.08 mmol/l at the 1-year visit in 2001 (p < 0.001). The proportion of patients with total cholesterol < 5 mmol/l increased to 38% in 2000, reaching 70% in 2001. Smokers at baseline were similar at around 30%, although this had reduced to 10% in 2001 (p < 0.001). No change in weight was seen for patients with BMI >or=30 (p = NS). No significant differences were seen between patient subgroups (p = NS). DISCUSSION Secondary prevention measures are improving, especially in prophylactic prescribing, lipid management and smoking cessation, although scope for further improvement remains. No difference was seen between the patient subgroups. Lifestyle measures need to be addressed to gain maximum benefit in addressing overall cardiovascular risk.
ESCOP Secretary, Argyle House, Gandy Street, Exeter, Devon EX4 3LS, UK.
Complementary Health Studies, School of Education and Lifelong Learning, University of Exeter, Exeter, Devon, UK.
Tayside Hospitals, University Trust, Dundee.
Pericardial cysts are rare mediastinal cysts, which are commonly asymptomatic. We report the case of a middle-aged lady, with a previous short history of chest pain, who was found to have a focal pericardial density, felt to have been a consequence of haemorrhage into such a cyst.
Latest similar papers:
Klin Padiatr. 2012 Mar ;224 (2):72-5 21815129
Ernst-Moritz-Arndt-University, Pediatrics, Greifswald, Germany. email@example.com
OBJECTIVE Acupuncture is successfully used to alleviate vomiting in children after general anesthesia. However there is no data on treatment of vomiting in children with gastroenteritis (GE) and pneumonia (PM). METHODS Descriptive analysis of 18 cases, where acupuncture was used as an individual therapy attempt to treat vomiting in children with GE or PM before starting the conventional antiemetic therapy. Feasibility and acceptance by patients and parents as well as the incidence of vomiting and use of antiemetic drugs after acupuncture were recorded. RESULTS Acupuncture was feasible in all children and application of the indwelling needles was tolerated without fear. Side effects were not observed. 13 patients stopped vomiting immediately after the insertion of acupuncture needles, none of the patients required conventional antiemetic medication. CONCLUSION Acupuncture for the treatment of vomiting is feasible and acceptable. Suggested antiemetic effect should be examined in a randomized multicenter controlled trial.
[Therapy for replenishing qi, nourishing yin and promoting blood circulation in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a randomized controlled trial].
Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital University of Medical Sciences, Beijing 100010, China.
BACKGROUND No-reflow phenomenon after reperfusion treatment of acute myocardial infarction (AMI) is becoming more recognized today. The effective treatment for no-reflow has not been reported. OBJECTIVE To observe the effects of traditional Chinese medicine (TCM) therapy for replenishing qi, nourishing yin, and promoting blood circulation on AMI patients undergoing percutaneous coronary intervention (PCI). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This study was conducted from January 2005 to March 2006 using a double-blinded, randomized method. Thirty-five AMI patients (Killip I-II) were first diagnosed as ST segment elevation AMI and obtained primary PCI. They were recruited from People's Hospital, Peking University. All patients' symptoms accorded with qi-yin deficiency syndrome and blood stasis syndrome. They were randomly and double blindly divided into control group (18 cases) and treatment group (17 cases). The patients in the control group received Western medicine treatment, and the patients in the treatment group were treated with Western medicine plus American ginseng and Salviae miltiorrhizae preparations. They were all treated for 3 months. MAIN OUTCOME MEASURES Before and after 3-month treatment, the TCM symptoms were observed and scored. At the state of baseline and dobutamine stress, left ventricular ejection fraction (LVEF), wall motion score (WMS), WMS index and normal cardiac muscle percentage (NCMP), and the myocardial contrast echocardiography index k, which reflects myocardium microcirculation perfusion, were detected. RESULTS After 3-month treatment, the TCM symptoms in the treatment group were improved as compared with the control group (X(2)=4.118, P=0.042). At the state of dobutamine stress, LVEF in the treatment group after treatment was higher than those in the control group (t=2.130, P=0.041) and before treatment (t=2.345, P=0.032). Although the number of the segments with increased k value was more than that in the control group, there was no significant difference. CONCLUSION TCM therapy for replenishing qi, nourishing yin and promoting blood circulation can improve the clinical symptoms and quality of life of the AMI patients undergoing PCI, and is beneficial to myocardium microcirculation. Thus, it may be an alternative cardioprotective treatment strategy for successful myocardial microcirculation in AMI patients after reperfusion.
Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial.
Paul Erne, Andreas W Schoenenberger, Dieter Burckhardt, Michel Zuber, Wolfgang Kiowski, Peter T Buser, Paul Dubach, Therese J Resink, Matthias Pfisterer
Division of Cardiology, Kantonsspital Luzern, Luzern, Switzerland. Paul.Erne@ksl.ch
CONTEXT The effect of a percutaneous coronary intervention (PCI) on the long-term prognosis of patients with silent ischemia after a myocardial infarction (MI) is not known. OBJECTIVE To determine whether PCI compared with drug therapy improves long-term outcome of asymptomatic patients with silent ischemia after an MI. DESIGN, SETTING, AND PARTICIPANTS Randomized, unblinded, controlled trial (Swiss Interventional Study on Silent Ischemia Type II [SWISSI II]) conducted from May 2, 1991, to February 25, 1997, at 3 public hospitals in Switzerland of 201 patients with a recent MI, silent myocardial ischemia verified by stress imaging, and 1- or 2-vessel coronary artery disease. Follow-up ended on May 23, 2006. INTERVENTIONS Percutaneous coronary intervention aimed at full revascularization (n = 96) or intensive anti-ischemic drug therapy (n = 105). All patients received 100 mg/d of aspirin and a statin. MAIN OUTCOME MEASURES Survival free of major adverse cardiac events defined as cardiac death, nonfatal MI, and/or symptom-driven revascularization. Secondary measures included exercise-induced ischemia and resting left ventricular ejection fraction during follow-up. RESULTS During a mean (SD) follow-up of 10.2 (2.6) years, 27 major adverse cardiac events occurred in the PCI group and 67 events occurred in the anti-ischemic drug therapy group (adjusted hazard ratio, 0.33; 95% confidence interval, 0.20-0.55; P<.001), which corresponds to an absolute event reduction of 6.3% per year (95% confidence interval, 3.7%-8.9%; P<.001). Patients in the PCI group had lower rates of ischemia (11.6% vs 28.9% in patients in the drug therapy group at final follow-up; P =.03) despite fewer drugs. Left ventricular ejection fraction remained preserved in PCI patients (mean [SD] of 53.9%[9.9%] at baseline to 55.6%[8.1%] at final follow-up) and decreased significantly (P<.001) in drug therapy patients (mean [SD] of 59.7%[11.8%] at baseline to 48.8%[7.9%] at final follow-up). CONCLUSION Among patients with recent MI, silent myocardial ischemia verified by stress imaging, and 1- or 2-vessel coronary artery disease, PCI compared with anti-ischemic drug therapy reduced the long-term risk of major cardiac events. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00387231.
A randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of tegaserod in patients from China with chronic constipation.
San-Ren Lin, Mei-Yun Ke, Jin-Yan Luo, Yao-Zong Yuan, Ji-Yao Wang, Shelley diTommaso, Verena Walter, Jiaqing Huang
The 3rd Hospital, Beijing Medical University, China.
AIM To evaluate the efficacy and safety of tegaserod, 6 mg twice daily (b.i.d.), in men and women with chronic constipation (CC) from China. METHODS This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatment-free baseline period, patients were randomized to receive either tegaserod (6 mg b.i.d.) or placebo (b.i.d.) for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements (CSBMs) during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients' daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events (AEs). RESULTS A total of 607 patients were randomized to receive either tegaserod (n = 304) or placebo (n = 303). Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo (1.39 vs 0.91, P = 0.0002). A statistically significant difference in favor of tegaserod was also observed for a mean increase > or = 1 CSBM/wk over wk 1-4 (47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018) and for the absolute number of > or = 3 CSBMs/wk over wk 1-4 (25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021). Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod (3.6%) compared with placebo (1.7%). CONCLUSION Tegaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.
Antiplatelet therapy and progression of coronary artery disease: a placebo-controlled trial with angiographic and clinical follow-up after myocardial infarction.
Hendrik-Jan Dieker, John K French, Irene C Joziasse, Marc A Brouwer, John Elliott, Teena M West, Bruce J Webber, Freek W A Verheugt, Harvey D White
Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
INTRODUCTION In patients after ST-elevation myocardial infarction (STEMI), antiplatelet therapy reduces subsequent cardiac events, which are often attributed to recurrent thrombosis with (sub)total occlusion in the infarct-related artery. Whether antiplatelet therapy influences the often subclinical process of coronary disease progression in noninfarct arteries has not been reported. METHODS Quantitative coronary angiography of noninfarct arteries was performed on paired cine-angiograms of 149 patients from fibrinolytic trials who had a patent infarct-related artery 3 to 4 weeks following STEMI and who were randomized to either continue the daily combination of 50-mg aspirin and 400-mg dipyridamole or to matching placebo. Follow-up angiography was scheduled at 1 year. RESULTS On a per-patient basis, the change in minimal luminal diameter (MLD) was 0.00 mm in the aspirin/dipyridamole group (n = 76) and was 0.01 mm in the placebo group (n = 73). There was no difference between these groups in the changes in MLD (-0.02 mm; 95% CI -0.09 to 0.05), neither were there significant differences in mean luminal diameter and diameter stenosis. Progression (1 segment/patient with > or = 0.40 mm decrease in MLD) was seen in two thirds of patients and did not independently predict long-term death and/or reinfarction. CONCLUSION In this placebo-controlled trial after STEMI, the combination of aspirin and dipyridamole did not affect noninfarct artery disease progression. Progression did not predict long-term clinical outcome.
A double-blind randomized placebo-controlled trial with short-term beta-glucuronidase therapy in children with chronic rhinoconjunctivitis and/or asthma due to dust mite allergy.
Research Center San Pietro, Fatebenefratelli Hospital, AfaR, Rome, Italy. firstname.lastname@example.org
BACKGROUND: Enzyme potentiated desensitization, in which beta-glucuronidase (BG) is administered with low doses of mixed allergens, was proposed in the 1970s for specific immunotherapy. The BG currently commercially available in a purified and standardized preparation devoid of any allergen has been suggested as a regulator in the allergic immune response, acting on the cytokine-network of type 2 helper T cells. A double-blind trial with a single-dose of BG proved effective in preventing symptoms in adult patients with rhinoconjunctivitis due to grass pollens. OBJECTIVE: The aim of this randomized double-blind placebo-controlled trial was to confirm the safety and effectiveness of double-dose intradermal BG immunotherapy in preventing symptoms in children suffering from chronic rhinoconjunctivitis and/or asthma due to dust mite. METHOD: We randomized 125 children with dust-mite related chronic rhinoconjunctivitis and/or asthma to the BG treated group (67) or the placebo group (58). All patients were screened before treatment (TO), at BG or placebo administration (T1 and T3), and at 3 and 9 months after T1 (T2 and T4). Drug intake and bronchial, nasal and ocular symptoms were recorded in a diary. RESULTS: Patients in both groups completed the study and BG treatment was well tolerated without side effects. Significant differences in symptoms were observed, in particular for conjunctivitis (P=.008). The total drug intake for allergic symptoms was significantly lower in the treated group than in the placebo group (P<. 01). CONCLUSIONS: BG immunotherapy is efficacious, safe, and well tolerated in allergic children. Moreover, good compliance with the administration of 2 doses per year and the lack of significant side effects makes the benefit/risk ratio of this treatment particularly favorable.
Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial.
Guy Amit, Carlos Cafri, Sergei Yaroslavtsev, Shmuel Fuchs, Ora Paltiel, Akram Abu-Ful, Jean M Weinstein, Arik Wolak, Reuben Ilia, Doron Zahger
Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
BACKGROUND The aim of this study was to test whether nitroprusside (NTP) injected intracoronary immediately before primary angioplasty for acute ST-elevation acute myocardial infarction (STEMI) prevents no-reflow and improves vessel flow and myocardial perfusion. METHODS Ninety-eight patients presenting with STEMI were evenly randomized to receive either NTP (60 microg) or placebo. The drug was selectively injected into the infarct-related artery, distal to the occlusion, in a double-blind manner. The primary end points were postintervention angiographic corrected thrombolysis in myocardial infarction frame count and the proportion of patients with complete (>70%) ST-segment elevation resolution. Secondary end points included myocardial blush score and clinical outcome at 6 months follow-up. RESULTS Mean (+/-SD) age was 62 (+/-12) years, and 87% were men. Baseline characteristics (excluding sex) did not differ between groups. The corrected thrombolysis in myocardial infarction frame count after angioplasty was 20.8 (+/-18.6) and 20.3 (+/-21.3) in patients given NTP and placebo, respectively (P =.78). Complete ST-segment resolution was achieved in 61.7% and 61.2% of NTP and placebo subjects, respectively (P =.96). The distribution of myocardial blush score did not differ between groups. At 6 months, the rate of target lesion revascularization, myocardial infarction, or death occurred in 6.3% of the NTP group and 20.0% of the placebo group (P =.05). CONCLUSIONS In patients with STEMI, selective intracoronary administration of a fixed dose of NTP failed to improve coronary flow and myocardial tissue reperfusion but improved clinical outcomes at 6 months.
J M Ezzo, M A Richardson, A Vickers, C Allen, S L Dibble, B F Issell, L Lao, M Pearl, G Ramirez, Ja Roscoe, J Shen, J C Shivnan, K Streitberger, I Treish, G Zhang
James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland 21209, USA. email@example.com
BACKGROUND There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT(3) inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms. OBJECTIVES The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. SEARCH STRATEGY We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts. SELECTION CRITERIA Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both. DATA COLLECTION AND ANALYSIS Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes. MAIN RESULTS Eleven trials (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% confidence interval 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% confidence interval 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD =-0.19; 95% confidence interval -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. AUTHORS' CONCLUSIONS This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia. firstname.lastname@example.org
BACKGROUND The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with anti-acetylcholinesterase [corrected] effects, in patients with functional dyspepsia. METHODS Patients with functional dyspepsia were randomly assigned to receive either itopride (50, 100, or 200 mg three times daily) or placebo. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia (as assessed by the Leeds Dyspepsia Questionnaire), patients' global assessment of efficacy (the proportion of patients without symptoms or with marked improvement), and the severity of pain or fullness as rated on a five-grade scale. RESULTS We randomly assigned 554 patients; 523 had outcome data and could be included in the analyses. After eight weeks, 41 percent of the patients receiving placebo were symptom-free or had marked improvement, as compared with 57 percent, 59 percent, and 64 percent receiving itopride at a dose of 50, 100, or 200 mg three times daily, respectively (P<0.05 for all comparisons between placebo and itopride). Although the symptom score improved significantly in all four groups, an overall analysis revealed that itopride was significantly superior to placebo, with the greatest symptom-score improvement in the 100- and 200-mg groups (-6.24 and -6.27, vs.-4.50 in the placebo group; P=0.05). Analysis of the combined end point of pain and fullness showed that itopride yielded a greater rate of response than placebo (73 percent vs. 63 percent, P=0.04). CONCLUSIONS Itopride significantly improves symptoms in patients with functional dyspepsia.(ClinicalTrials.gov number, NCT00272103.).
[Plasma concentration of NT-proBNP in patients with acute coronary syndrome correlated with the severity of the diseases?].
People's Hospital of Beijing University, Beijing 100044, China.
OBJECTIVE To elucidate whether the plasma concentration of NT-proBNP in patients with acute coronary syndrome (ACS) correlated with severity of the diseases and whether NT-proBNP is a reliable biochemical marker correctly indicates the severity of ACS. METHODS Eighty-nine subjects came from CCU of Cardiology Department of People's Hospital Beijing University from October 2003 to June 2004 and aged 34-85 y (66.89 +/- 11.12 y). In this study the spectrum of ACS only included unstable angina pectoris (UA) and acute myocardial infarction (AMI). Patients with UA were separated into 3 groups by Braunwald classes and those with AMI were separated into 4 groups by Killip classes when their venous blood samples were collected. Plasma concentration of NT-proBNP was measured by enzyme linked immunoabsorbent assay. Data was estimated by SPSS. RESULTS The concentration of NT-proBNP in patients with ACS was dramatically correlative with the severity of the diseases: with the upgrading of Braunwald classes, the concentration of NT-proBNP in patients with UA increased gradually; in patients with AMI it also raised gradually with the upgrading of killip classes; furthermore, the plasma concentration of NT-proBNP in patients with AIM increased much more than that in patients with UA when they are at the similar NYHA functional class. CONCLUSION Plasma concentration of NT-proBNP in patients with ACS might be a reliable biochemical marker which can objectively indicate the degree of this diseases.