Blood Cardioplegia with N-Acetylcysteine May Reduce Coronary Endothelial Activation and Myocardial Oxidative Stress

Objectives: The aim of this prospective study was to compare the efficacy of intermittent antegrade blood cardioplegia with or without n-acetylcysteine (NAC) in reducing myocardial oxidative stress and coronary endothelial activation. Methods: Twenty patients undergoing elective isolated coronary artery bypass graft surgery were randomly assigned to receive intermittent antegrade blood cardioplegia (32 degrees C-34 degrees C) with (NAC group) or without (control group) 300 mg of NAC. For these 2 groups we compared clinical outcome, hemodynamic evolution, systemic plasmatic levels of troponin I, and plasma concentrations of malondialdehyde (MDA) and soluble vascular adhesion molecule 1 (sVCAM-1) from coronary sinus blood samples. Results: Patient demographic characteristics and operative and postoperative data findings in both groups were similar. There was no hospital mortality. Comparing the plasma levels of MDA 10 min after the aortic cross-clamping and of sVCAM-1 30 min after the aortic cross-clamping period with the levels obtained before the aortic clamping period, we observed increases of both markers, but the increase was significant only in the control group (P=.039 and P=.064 for MDA; P=.004 and P=.064 for sVCAM- 1). In both groups there was a significant increase of the systemic serum levels of troponin I compared with the levels observed before cardiopulmonary bypass (P<.001), but the differences between the groups were not significant (P=.570). Conclusions: Our investigation showed that NAC as an additive to blood cardioplegia in patients undergoing on-pump coronary artery bypass graft surgery may reduce oxidative stress and the resultant coronary endothelial activation.

Grainger as an interpreter of Grieg

Piano performances; Grieg's Piano Concerto in A minor; Op. 16 (Music); Norwegian Bridal Procession, Op. 19 no. 2 (Music)

An analysis of why telehealth systems in Australia have not always succeeded

Telehealth programmes are rather similar to humans in the way that they are planned, develop, grow and ultimately die or disappear. To achieve good life expectancy for a telehealth programme there appear to be three major needs: nurturing, which includes the provision of money, ideas, education, training and innovation; experience, which involves an integrated management process, the achievement of long and wide patterns of usage, the development of updated policies and procedures and the involvement of multiple disciplines; success, which involves evidence of outcomes, evaluation and research, and, most important, the sharing of information through scientific and popular press publications, and conferences and collaborations with internal and external groups. The future of telehealth in Australia is at a watershed. There are now a substantial number of programmes, and there has been a large amount of financial and human investment in telehealth around the nation. There is, however, no forum for national leadership, no national association and little support at federal government level.