Abstract Background Stem cell–based therapy has emerged as a potential therapy in acute myocardial infarction (AMI). Although various approaches have been studied, intracoronary injection of bone ...marrow autologous mononuclear cells (BMMC) and the ability of granulocyte colony-stimulating factor (G-CSF) to mobilize endogenous cells have attracted the most attention. Objectives This study compares, for the first time, the efficacy of BMMC injection, G-CSF mobilization, and the combination of both with standard treatment. Methods On Day 1 after primary percutaneous coronary intervention, 120 patients were randomized to a 1) intracoronary BMMC injection; 2) mobilization with G-CSF; 3) both (BMMC injection plus G-CSF); or 4) conventional treatment (control group). G-CSF, 10 μg/kg/day subcutaneously, was started Day 1 and maintained for 5 days. BMMC injection was performed on Days 3 to 5. Our primary endpoint was absolute change in 12-month left ventricular ejection fraction (LVEF) and left ventricular end-systolic volume (LVESV) relative to baseline measured by cardiac magnetic resonance. Results The mean change in LVEF between baseline and follow-up for all patients was 4 ± 6% (p = 0.006). Change in LVEF and LVESV over time did not differ significantly among the 4 groups. Patients actively treated with any stem cell approach showed similar changes in LVEF and LVESV versus control subjects, with a small but significant reduction in infarct area (p = 0.038). Conclusions In our study, 3 different bone marrow–derived stem cell approaches in AMI did not result in improvement of LVEF or volumes compared with standard AMI care (Trial of Hematopoietic Stem Cells in Acute Myocardial Infarction TECAM; NCT00984178 )
Summary We assessed differences in the patterns of expression of matrix metalloproteases and their inhibitors (tissue inhibitors of metalloproteases) in ductal carcinoma in situ alone and admixed ...with invasive ductal carcinomas (n = 40), as well as in pure invasive ductal carcinomas (n = 40), immunohistochemically and using tissue arrays. The invasive ductal carcinoma components showed higher expression of matrix metalloprotease–9 and –13 than did the admixed ductal carcinoma in situ, whereas stromal fibroblasts of the invasive components showed higher expression of matrix metalloprotease–2, –7, –9, –13, and –14 and tissue inhibitor of metalloprotease–1 and –3 than did fibroblasts around the neoplastic ducts of the admixed ductal carcinoma in situ. Expression of matrix metalloprotease–14 and tissue inhibitor of metalloprotease–3 was significantly higher in the mononuclear inflammatory cells of the invasive components. By contrast, matrix metalloprotease–1 expression was significantly higher in stromal cells of the ductal carcinoma in situ admixed with invasive ductal carcinoma. The pure invasive ductal carcinomas had significantly higher expression of matrix metalloprotease–1, –9, –11, and –14 and tissue inhibitor of metalloprotease–1 and –3 than the invasive ductal carcinomas admixed with ductal carcinoma in situ. Our findings indicate a significant association of matrix metalloprotease expression by the periductal stromal cells of the ductal carcinoma in situ component of mixed tumors and the occurrence of distant metastasis. Our data suggest that the molecular matrix metalloprotease/tissue inhibitor of metalloprotease profile can contribute to better characterization of early breast carcinomas.
Abstract Background Synthetic tissue adhesives (TA) are sometimes used in hernia repair surgery. This study compares the use of a new, non-commercial, long-chain cyanoacrylate (n-octyl) TA and ...Ifabond® for mesh fixation. Materials and methods In two implant models in the rabbit, ePTFE meshes were fixed to the parietal peritoneum using a TA or tacks (intraperitoneal model), or polypropylene meshes used to repair partial abdominal wall defects were fixed with a TA or sutures (extraperitoneal model). Animals were euthanized 14 or 90 days postsurgery when implant specimens were processed for microscopy, labeling of macrophages and apoptotic cells, cytokines (IL-6 and TNFα) in peritoneal fluid and biomechanical strength testing. Results Mesothelial cell deposition on the intraperitoneal implants fixed using the new TA and Ifabond® was adequate and similar IL-6 and TNFα levels were detected in these implants. Intraperitoneal meshes fixed with tacks showed IL-6 overexpression. Three months after surgery, macrophage and apoptotic cell rates were higher for the intraperitoneal implants fixed with Ifabond® versus the new TA or tacks. In the extraperitoneal model, reduced macrophage and cell damage responses were observed in the meshes fixed with sutures versus both TA. Tensile strengths were greater for the tacks versus TA in the intraperitoneal implants and similar for the sutures and TA in the extraperitoneal implants (90 days). Conclusions Both TA showed a good cell response in both models. Their use in an intraperitoneal location resulted in reduced tensile strength compared with the tacks. However, strengths were comparable when extraperitoneal implants were fixed with these adhesives or sutures.
This study sought to document the safety of a new accelerated dobutamine-atropine stress echocardiography protocol and to analyze its complications.
Dobutamine-atropine stress echocardiography ...studies were performed using an incremental dobutamine infusion protocol from 20 to 40 microg/kg/min in 3-minute stages and followed by atropine.
A total of 962 patients were included. Mean age was 64 +/- 11 years and 584 were male (61%). Mean ejection fraction was 62 +/- 10%. Complications included hypertensive responses in 66 patients (7%), arrhythmias in 26 (2.7%), and symptomatic hypotension in 16 (1.7%). No patient developed heart failure, acute myocardial infarction, ventricular fibrillation, or died. The independent predictors of hypertensive responses were age, baseline systolic blood pressure, and treatment with nitrates. The independent predictors of arrhythmias were history of hypertension, previous coronary artery disease, and baseline heart rate.
This accelerated dobutamine-atropine stress echocardiography protocol is safe in a low-risk population and has a rate of complications similar to that reported for the standard protocol.
Background The aim of the study was to examine the causes of the death of patients with heart failure (HF) and evaluate the differences in this respect between patients with and without depression of ...left ventricular ejection fraction (LVEF). Method All patients hospitalized with HF between 1995 and 2002 in the cardiology service of a tertiary hospital were assessed. LVEF was evaluated by echocardiography during hospitalization and was considered normal when it was ≥50%. After a mean follow-up time of 3.7 ± 2.8 years, 615 cases had terminated in death. Results The most common cause was refractory HF, both in the whole group (39%) and in both the subgroups defined with respect to LVEF (normal and depressed). There was no statistically significant difference between the normal and depressed subgroups as regard the distribution of deaths, although the depressed group showed a somewhat greater incidence of sudden death (21% as against 16% in the normal group) and a somewhat smaller incidence of death due to refractory HF (37% as against 47%). However, in the depressed LVEF group, the cumulative risk of death due to acute myocardial infarction in the first 1.5 years first increased rapidly and then more slowly, whereas the reverse pattern was held in the normal left ventricular systolic function group, in which it was the cumulative risks of death from noncardiovascular or vascular noncardiac causes that initially increased more rapidly than later. Conclusions The spectrum of causes of death among patients with HF who have been hospitalized is independent of LVEF in the long term. In the short term, there are differences between patients with normal LVEF and depressed LVEF as regard the dynamics of the risks of death from acute myocardial infarction, noncardiac vascular causes, and noncardiovascular causes. These results may help orient the short-term and long-term management of HF, especially for patients with normal LVEF, for whom there is still no well-established consensus strategy.
Summary To analyze the expression and prognostic value of matrix metalloproteases and their tissue inhibitors in luminal A and basal-like breast carcinomas, an immunohistochemical study was performed ...on cancer specimens from 93 randomly selected patients with invasive primary ductal tumors of the breast (46 with and 47 without distant metastasis) and with luminal A (n = 48) (ER+, HER2−) or basal-like (HER2−, ER−, PgR−) (n = 45) lesions. Luminal B cases were too few to analyze. Specimens were also studied using tissue microarrays and specific antibodies against matrix metalloproteases 1, 2, 7, 9, 11, 13, and 14 and tissue inhibitors 1, 2, and 3. There were no significant differences in matrix metalloprotease or tissue inhibitor expression in the 2 phenotypes of tumors. In basal-like carcinomas, high scores for matrix metalloproteases 9 and 11 were significantly associated with a high distant metastasis rate. Likewise, data showed associations between matrix metalloprotease/tissue inhibitor expression by either stromal fibroblasts or mononuclear inflammatory cells and distant relapse-free survival in both tumor phenotypes. In addition, in infiltrating luminal A and basal-like tumors, we identified a prometastatic phenotype of mononuclear inflammatory cells, showing a high matrix metalloprotease/tissue inhibitor molecular profile. Expression of matrix metalloproteases and tissue inhibitors is related to the characteristics of breast tumor cells. As prognostic factors in breast carcinomas of both luminal A and basal-like phenotypes, our results point to the importance of the expression of matrix metalloproteases and tissue inhibitors by the stromal cells.
Percutaneous intervention of a coronary graft is the treatment of choice when the graft fails. The objective is to report the long-term results of drug-eluting stents (DES) in mammary artery grafts ...(MAG). Patients who had been treated with DES for MAG in 27 centers were selected. The baseline and procedural clinical data were included prospectively, and the follow-up was performed with the patients, families, and medical records. Two hundred and sixty-eight patients were included: age 65.5 ± 10.1 years, diabetes 47.8%, ejection fraction 55.5 ± 14.9%. Indication: stable angina 28.4%, unstable angina 38.1%, non–ST-elevation myocardial infarction 21.6%, ST-elevation myocardial infarction 5.3%, and heart failure 6.7%; 1.19 ± 0.59 stents/patient were implanted measuring 18.8 ± 8.8 mm in length and 2.68 ± 0.35 mm in diameter. Rapamycin was used in 78 cases (29.1%), paclitaxel in 77 (28.7%), everolimus in 70 (26.1%), zotarolimus in 34 (12.7%), and biolimus in 9 (3.4%). All cases were successful except for 1 in which the patient died 30 minutes after the procedure. There were no other inhospital events. After a follow-up of 41 months (Q25 : 23.7 to Q75 : 57.8), 24 patients (9%) died of heart-related causes and 20 (7.5%) of noncardiac causes. Repeat revascularization was necessary in 31 cases, and in 1 additional patient, there was total occlusion, which was not treated. These 32 patients represented 11.9% of the total. In conclusion, the implantation of DES in MAG shows very high procedural success and also low long-term event rates.
Background
Ricinus communis (castor bean) is a species included into the Euphorbiaceae family, common to all the warm regions of the world. Although the allergenicity of its seed is well known, ...references are scarce regarding the role played by its pollen as a pneumo‐allergen.
Objectives
To carry out an aerobiological study of this pollen in the Málaga area (southern Spain); describe the physicochemical characteristics of its most relevant allergens; and to demonstrate the existence of patients with respiratory allergy due to this pollen.
Methods
A Burkard spore trap was used for the aerobiological study from 1992 to 1996. Skin prick tests with castor bean pollen extract were performed to 1946 patients with rhinitis and/or asthma. Specific IgE levels were measured in castor bean‐positive SPT patient sera. Immunochemical characterization of the most relevant allergens was performed using electrophoretic techniques. In vitro cross‐reactivity studies using positive patient sera were carried out. Nasal challenge tests were done in 32 subjects randomly selected from the sensitized patient group.
Results
Castor bean is a perennial pollen with total annual pollen levels never exceeding 1%. One hundred and eighteen (7.7%) patients showed positive prick test (74 rhinitis, 36 rhinitis and asthma, eight asthma). Nine were monosensitized. Specific IgE levels were ≥ 0.35 PRU/mL in 39 (33%) of patient sera. Nasal challenge test: 10 subjects presented non‐specific nasal hyperactivity, 15 were positive and seven negative. The molecular masses and isoelectric points of the main IgE‐binding proteins, ranged from ≈ 67–15.5/14.5 kDa and ≈ 4.5–5.5, respectively. Profilin of the extract was purified by poli‐ L‐proline‐Sepharose chromatography and it appeared as one of the most frequent allergens.
Conclusion
Castor bean pollen is an allergen which causes respiratory (mainly nasal) symptoms.
We present the first case of foreign body granuloma in the cervical (submandibular) region as a result of migration of noninjected aluminium silicate particles from the oral mucosa. This migration ...can be explained by macrophage phagocytosis and transport through the local lymphatic network and surgical disruption of fascial layers. The appearance of foreign body granulomas in distant sites may appear several weeks after the local event in a specific disposition according with the migration route. This entity must be born in mind in differential diagnosis of multiple nodules, pigmentation, or persistent swelling in the cervical-orofacial region.
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