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Simple Summary Tenodesmic injuries are key problems for sport horses. Several therapies have been developed over the years, including platelet-rich plasma (PRP), an autologous product that should stimulate tissue regeneration with its high concentration of growth factors. Nowadays, there are conflicting reports concerning the effect of PRP in tenodesmic lesions. The aim of our systematic review was to determine the effect of PRP on tendons and ligaments healing through a meta-analysis, a process to determine consensus from across published studies. The meta-analysis is the quantitative component of a systematic review, a statistical synthesis of the published data about a topic. We selected studies that evaluate PRP therapy in vitro or in vivo, most of which had a high risk of bias. The results found there is no evidence that PRP enhances the healing of tendon and ligament injuries. In the future, further unbiased, blinded, and controlled studies are needed to clarify the efficacy of this platelet concentrate in the treatment of equine tendon and ligament injuries. Abstract The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors independently extracted data and assessed each study’s risk of bias. Treatment effects were evaluated using risk ratios for dichotomous data, together with 95% CI. Data were pooled using the random-effects model. The quality of the evidence for each outcome was assessed using GRADE criteria. Twenty-four trials met inclusion criteria for systematic review, while fifteen studies were included in the meta-analysis. Results showed no significant differences in the outcomes between PRP and control groups. Finally, there is no definitive evidence that PRP enhances tendons and ligaments healing. Therefore, there is a need for more controlled trials to draw a firmer conclusion about the efficacy of PRP as a treatment for tenodesmic lesions in the horse.

Objective: To assess the ischemic threshold and stress-induced left ventricular dysfunction after high fat (HFM) and high carbohydrate (HCM) meals in patients with stable coronary disease. Methods: Twelve patients (68 +/- 7 years) underwent stress (treadmill exercise testing) echocardiography after fasting (8 h), after HFM and HCM (2 h). Time to 1 mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated. Before eating and just before exercise testing glucose, insulin, triglycerides, total cholesterol and FFA levels were measured. Results: Results are expressed as medians (Q1-Q3). HFM did not affect exercise variables compared to fasting, whereas HCM reduced the ischemic threshold [time to 1 mm from 376 (343-493) to 297 (180-420) s, p = 0.003]. Compared to fasting [1.47 (1.31-1.66)], stress WMSI was higher after HCM [1.56 (1.44-1.69)] (p = 0.04) but not after HFM [1.56 (1.30-1.63)]. Glycemia and insulinemia were significantly higher after HCM, compared to fasting and HFM. Conclusions: In patients with coronary disease, exercise testing after a high carbohydrate meal results in a lower ischemic threshold and greater ischemia magnitude. Conversely, compared to fasting, a high fat meal does not induce additional detrimental effects. Hyperglycemia and hyperinsulinemia were the only metabolic determinants identified as potential metabolic mechanisms of this phenomenon. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Neuroendocrine/inflammatory and endothelial functions have been indicated as crucial for heart failure (HF) patients. We evaluated relation in HF patients among cytokines and asymmetric dimethylarginine (ADMA) and left ventricular ejection fraction (LVEF) at baseline and after long-term administration of carvedilol. Interleukin 10 (IL-10), interleukin 18 (IL-18), and ADMA were measured in 22 NYHA class II to IV HF patients at baseline and after 40 +/- 14 months of carvedilol treatment. Patients were divided into 2 groups according to whether, after treatment with carvedilol, LVEF had increased at least 5% (responders) or less than 5% (non-responders). In responders (11 of 22 patients), LVEF increased from 38 +/- 6% to 50 +/- 7%, (P < 0.001); in non-responders, it decreased from 36 +/- 9% to 31 +/- 6%, (P = 0.02); NYHA class significantly decreased in both groups. IL-18 decreased in responders (from 586.4 +/- 128 to 183.13 +/- 64.4 pg/mL; P < 0.001) and in non-responders (from 529.3 +/- 116.25 to 142.4 +/- 58.9 pg/mL; P < 0.001). IL-10 increased in responders (from 0.49 +/- 0.25 to 2.01 +/- 1.01 pg/mL; P < 0.001) and in non-responders (from 0.64 +/- 0.31 to 1.33 +/- 0.59 pg/mL; P < 0.001). Conversely, ADMA levels decreased only in responders (from 0.67 +/- 0.16 to 0.44 +/- 0.15 micromol/L; P < 0.001), and an inverse correlation was observed between basal ADMA levels and changes in LVEF after treatment. In HF patients, carvedilol appears to reduce symptoms and the expression of inflammation, regardless of the LV functional response. In those patients showing improvement of LVEF, the reduction of inflammation is paralleled by a reduction of ADMA. We surmise that carvedilol could be effective at various independent levels as a result of possible pleiotropic effects of this agent.

Background The aim of this study was to evaluate feasibility and accuracy of a videophone-based system for remote cardiopulmonary examination of patients with heart failure. Methods and Results Fifty patients were examined by 2 cardiologists, 1 with a conventional stethoscope and 1 remotely with a videophone-based method, employing an electronic stethoscope and transmitting through an integrated services digital network line. During both sessions, the cardiologists filled out a 27-item questionnaire, which was then compared; concordance between standard and remote examination was evaluated. In 92% of patients, electronic and acoustic auscultation concurred. Only in 3 patients (4%) did teleauscultation not permit a correct interpretation of lung examination. In one patient, bilateral fine crepitant rales were not detected during teleauscultation. Conversely, in the second, patient bilateral fine crepitant rales were recognized during teleauscultation, which were not confirmed during real-life auscultation. In the third nonconcordant patient, moderate-degree wheezing was not detected during teleauscultation. Fine crepitant rales were present at the lungs lower fields in 12 and wheezing in 3 additional patients, and were always correctly identified during teleauscultation. Overall, sensitivity, specificity, positive, and negative predictive value of remote lung auscultation were 88%, 97%, 94%, and 94%, respectively. Conclusions Remote cardiopulmonary examination appears as a feasible method for assessing patients with heart failure. Telestethoscopy can therefore be reliably used in the context of comprehensive telecare programs.

We describe the case of an 82 year old woman developing severe respiratory functional impairment after open heart surgery and subsequent surgical pericardial drainage inducing diaphragmatic spasm and successfully treated with gabapentin. (c) 2005 Elsevier Ireland Ltd. All rights reserved. We describe the case of an 82 year old woman developing severe respiratory functional impairment after open heart surgery and subsequent surgical pericardial drainage inducing diaphragmatic spasm and successfully treated with gabapentin. (c) 2005 Elsevier Ireland Ltd. All rights reserved. RI Corti, Angelo/F-7046-2012

Background: Previous studies provide evidence for a significant reduction of coronary flow reserve after ingestion of meals of different compositions. A possible role of hyperinsulinemia and increased free fatty acid levels, which are deleterious during acute myocardial ischemia and reperfusion, has been hypothesized. We assessed in patients with stable coronary disease the effects of high-fat meals (HFMs) and high-carbohydrate meals (HCMs) on ischemic threshold and stress left ventricular function on placebo and after partial fatty acid inhibition by trimetazidine (TMZ). Methods: Ten patients (9 men, age 68 ± 7 years) were allocated to placebo and TMZ (40 mg TID), both administered in the 24 hours preceding testing, according to a randomized double-blind study design. All patients underwent stress (treadmill exercise testing according to the Bruce protocol) echocardiography after fasting (8 hours) and after an HFM and HCM (2 hours) either on placebo or on TMZ. Time to 1-mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated. Results: An HFM did not affect exercise variables compared with fasting, whereas an HCM resulted in a reduction of the ischemic threshold (time to 1 mm from 402 ± 141 to 292 ± 123 seconds, P = .025). Compared with placebo, TMZ improved time to 1 mm after fasting, HFM, and HCM (432 ± 153 vs 402 ± 141, 439 ± 118 vs 380 ± 107, 377 ± 123 vs 292 ± 123, F1,9 = 26.91, P = .0006). Compared with placebo, on TMZ, stress WMSI decreased from 1.55 ± 0.25 to 1.29 ± 0.14 after fasting, from 1.57 ± 0.10 to 1.39 ± 0.28 after HFM, and from 1.64 ± 0.21 to 1.39 ± 0.21 after HCM (F1,9 = 37.04, P = .0002). Interestingly, stress WMSI on TMZ was never different from rest WMSI on placebo. Conclusions: In patients with coronary disease, exercise testing after an HCM results in more severe myocardial ischemia compared with that after an HFM. The observed beneficial effects of the partial fatty acid inhibitor TMZ seem to be unrelated to meal composition and are possibly caused by the better glucose use induced by the drug. © 2006 Mosby, Inc. All rights reserved

The incidence of diabetes mellitus is becoming progressively more frequent. The majority of diabetic patients will develop cardiovascular complications, among which coronary artery disease and diabetic cardiomyopathy are the most frequent and insidious. Apart from a meticulous metabolic control of diabetes, cardiac and vascular complications should be aggressively treated using the usual drugs at present effectively employed for their treatment in the general population. Additionally, the possibility of modifying cardiac substrate metabolism of the diabetic heart appears particularly attractive. Specifically, the possibility of increasing glucose metabolism rate and, accordingly, reducing free fatty acid oxidation, appears to be a very attractive therapeutic approach. Indeed, among traditional pharmacological tools, there is growing evidence that specific metabolically active drugs, the so-called partial free fatty acid inhibitors, of which the most studied is trimetazidine, will play an increasing role in the treatment of diabetic patients with coronary artery disease and cardiomyopathy. The property of these drugs is to facilitate myocardial utilization of glucose instead of free fatty acids which, in the context of ischemic and dysfunctional myocardial cells, appears to be deleterious. Similarly to other compounds that stimulate pyruvate dehydrogenase activity thereby facilitating glucose oxidation and inhibiting free fatty acid oxidation, such as dichloroacetate, trimetazidine has been shown to improve left ventricular function in diabetic patients with heart failure. Prospective studies in large clinical trials would produce more objective and definitive insights into the specific value of these new therapeutic concepts in the treatment of diabetic patients with cardiac diseases.

Background Capsaicin has been shown to exert direct vasodilating effects through increased calcitonin gene-related peptide (CGRP) release. However, no data exist on its effect following systemic administration in humans. Methods Twelve male patients with stable coronary disease and a persistently positive exercise were selected for study. According to a double blind, placebo-controlled, cross-over study, patients were randomized to placebo or 3 g oleic capsaicin-containing patches, on 2 different days and with a 2-day interval between treatments. Patients performed treadmill exercise testing according to the Bruce protocol. Time to 1 mm ST segment depression and to peak exercise, maximal ST segment depression, and the number of ECG leads showing diagnostic changes were also measured. Blood samples for nitric oxide (NO) and CGRP were drawn at baseline, 2, 6, and 24 hours after exercise. Results On placebo, all patients had a positive ECG during exercise test. Only 1 patient experienced angina, on both treatments. With capsaicin, 1 patient had a negative exercise, while 8 patients significantly increased time to 1 mm ST depression from 328 +/- 167 to 401 +/- 174 seconds (P = 0.01). Of the remaining patients, 1 did not show any changes and 2 showed a worse ischemic threshold when on capsaicin. CGRP levels were not significantly different between placebo and capsaicin treatment. Conversely, when on capsaicin, NO significantly increased at 6 hours. Conclusions Transdermal capsaicin may improve ischemic threshold in patients with stable coronary disease, probably through arteriolar vasodilation. Increased capsaicin-induced NO availability could represent the principal mechanism of action.