A Dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, for the Degree of Master of Science. / Serotonin (5-Hydroxytryptamine, 5-HT) mediates vasoconstriction and vasodilation in the normal coronary circulation of various animal species. In the presence of coronary artery disease serotonin may inhibit coronary collateral formation and stimulate predominantly vasoconstriction. This study tested the effect of ketanserin, a selective 5-HT2 receptor antagonist and platelet aggregation inhibitor, on ischaemic myocardium blood flow and coronary collateral formation following coronary artery occlusion in primates. / IT2018

Myocardial infarction is the most common cause of heart failure and remains one of the leading causes of morbidity and mortality in humans. Stem cells are important in the maintenance and repair of adult tissues. Hoechst effluxing cells, termed side population cells are a rare subset of cells found in adult tissues that are highly enriched for stem and progenitor cell activity. Recent studies have suggested that Sca-1+/CD31- cardiac side population cells are capable of differentiation into cardiomyocytes in vitro. However, the response of cardiac side population cells to myocardial injury remains unknown in vivo. In this study, we directly transplanted Sca-1+/CD31- cardiac side population cells into an acutely infarcted mouse heart. After two weeks, the transplanted cells were found to express cardiomyocyte or endothelial cell markers. Importantly, when these cells were transplanted into a remote nonischemic part of the heart after MI, they were able to migrate to the damaged myocardium. Consistent with these cells homing property, we found that SDF-1α, a chemotactic chemokine and its receptor, CXCR4 were up-regulated in the damaged myocardium and on Sca-1+/CD31- cardiac SP cells respectively following an acute myocardial infarction. We further showed that SDF-1α was able to induce migration of Sca-1+/CD31- cardiac side population cells in vitro. Our results have therefore suggested that Sca-1+/CD31- cardiac side population cells are able to migrate to damaged myocardium from non-ischemic myocardium and differentiate into cardiomyocytes as well as endothelial cells in the acutely infarcted mouse heart. We postulate that the SDF-1α/CXCR4 interaction may play an important role in the migration of these cells. Understanding and enhancing these processes may hold enormous potential possibilities for therapeutic myocardial regeneration for the treatment of cardiovascular disease.

Thesis (Ph. D.)--University of Wyoming, 2006. / Title from PDF title page (viewed on Dec. 17, 2007). Includes bibliographical references (p. 94-118).

<p>I Sverige har insjuknandet och överlevnanden i hjärtinfarkt förbättrats de senaste åren. Levnadsvanor och livsstil har betydelse. Människor som drabbas av hjärtinfarkt blir utskrivana från sjukhuset allt tidigare idag mot förut. Detta bidrar till att patienter och anhöriga/närstående får ta ett större ansvar efter utskrivningen. Informationsbehovet kring livsstilsförändringar är därför stort. Syftet var att beskriva människors erfarenhet av vad som underlättar respektive försvårar att göra de livsstilsförändringar de fått rekommendation om efter en diagnostiserad hjärtinfarkt. Metoden var en beskrivande studie med kvalitativ ansats. Öppna intervjuer genomfördes med sex informanter. Data analyserades med innehållsanalys. Av informanterna framkom information om hur de upplevt tiden efter insjuknandet gällande de rekommenderade livsstilsförändringarna. Huvudresultatet visade att det som dominerade bland svaren och vad som underlättat att genomföra livsstilsförändringar var den egna motivationen till en förändrad livsstil. Vad som ansågs försvårande var den sociala begränsningen informanterna upplevde. Slutsatsen är att det är viktigt med information till sjukvårdspersonal om vilka faktorer som underlättar livsstilsförändring och att den informationen når ut till patienterna.</p><p>Nyckelord: Livsstilsförändring, hjärtinfarkt. upplevelser</p>

The literature has demonstrated that depression is a significant predictor of morbidity and mortality for individuals who have experienced an acute myocardial infarction (AMI). Despite this robust relationship, few studies have systematically examined the demographic, psychosocial, neuroimmunological and hormonal predictors of depression amung post-AMI individuals in a longitudinal design...

I Sverige har insjuknandet och överlevnanden i hjärtinfarkt förbättrats de senaste åren. Levnadsvanor och livsstil har betydelse. Människor som drabbas av hjärtinfarkt blir utskrivana från sjukhuset allt tidigare idag mot förut. Detta bidrar till att patienter och anhöriga/närstående får ta ett större ansvar efter utskrivningen. Informationsbehovet kring livsstilsförändringar är därför stort. Syftet var att beskriva människors erfarenhet av vad som underlättar respektive försvårar att göra de livsstilsförändringar de fått rekommendation om efter en diagnostiserad hjärtinfarkt. Metoden var en beskrivande studie med kvalitativ ansats. Öppna intervjuer genomfördes med sex informanter. Data analyserades med innehållsanalys. Av informanterna framkom information om hur de upplevt tiden efter insjuknandet gällande de rekommenderade livsstilsförändringarna. Huvudresultatet visade att det som dominerade bland svaren och vad som underlättat att genomföra livsstilsförändringar var den egna motivationen till en förändrad livsstil. Vad som ansågs försvårande var den sociala begränsningen informanterna upplevde. Slutsatsen är att det är viktigt med information till sjukvårdspersonal om vilka faktorer som underlättar livsstilsförändring och att den informationen når ut till patienterna. Nyckelord: Livsstilsförändring, hjärtinfarkt. upplevelser

Mindin (Spondin 2) is a highly conserved extracellular matrix protein of the Mindin-F-spondin family and a regulator of host innate immunity. Despite its expression in the heart, its role in cardiac stress response is unknown. The objective of this study was to determine the role of mindin following myocardial infarction (MI). C57/BL6 wild-type (mindin+/+) or mindin knockout (mindin-/-) mice were randomized to permanent left anterior descending (LAD) coronary artery ligation or sham operation. Mindin expression level increased maximally on day 7 post MI, but returned to baseline by day 28. Mindin-/- mice showed reduced mortality, rupture rate, cardiac MMP-9/-2 activities, NF-kB activation, cytokines and macrophage recruitment. We concluded that mindin is a significant contributor to mortality and acute adverse remodeling post MI, partly through its unique attributes of innate immune regulator and inhibitor of angiogenesis. Mindin may function as a potential biomarker or therapeutic target post MI.

Mindin (Spondin 2) is a highly conserved extracellular matrix protein of the Mindin-F-spondin family and a regulator of host innate immunity. Despite its expression in the heart, its role in cardiac stress response is unknown. The objective of this study was to determine the role of mindin following myocardial infarction (MI). C57/BL6 wild-type (mindin+/+) or mindin knockout (mindin-/-) mice were randomized to permanent left anterior descending (LAD) coronary artery ligation or sham operation. Mindin expression level increased maximally on day 7 post MI, but returned to baseline by day 28. Mindin-/- mice showed reduced mortality, rupture rate, cardiac MMP-9/-2 activities, NF-kB activation, cytokines and macrophage recruitment. We concluded that mindin is a significant contributor to mortality and acute adverse remodeling post MI, partly through its unique attributes of innate immune regulator and inhibitor of angiogenesis. Mindin may function as a potential biomarker or therapeutic target post MI.

Background Myocardial Infarction (MI) is one of the major diseases which cause death in the world nowadays. In Hong Kong, 27.7 persons per 100,000 population died from AMI during the years 2007 to 2009. The rate for recurrent MI is also very high and the mortality rate is even higher for recurrent MI cases than first MI attack. Meanwhile, modern lifestyles and convenience brought about by advancements in technology have led to unhealthy lifestyles which is a risk factor for recurrent MI. Prevention of recurrent MI has become highly important and a worldwide public health issue. Patient education is the process by which health professionals provide information to patients or the public aiming to enhance their awareness and, therefore, alter their unhealthy behavior in order to improve their health status. Even nowadays, patient education is a common approach to disease prevention and health promotion in developed countries. Currently, many developed countries use patient education for disease prevention and health promotion. Many studies have investigated the effect of patient education on recurrent MI prevention resulting from proper behavioral change, and some decreases have resulted in recurrent MI after giving patient education. However, there is a gap in the current literature regarding the specialized meta-analysis in the evaluation of effectiveness of patient education conducted within three months or earlier. In other words, the efficiency of patient education to prevent recurrent MI has seldom been assessed. Although there have been a few systemic reviews about patient education in the past, the focus of these studies was not on recurrent MI, but obesity and diabetes. In addition, they discuss the issues in a qualitative manner, and omit calculations of the relative risk or summarized odds ratio. Therefore, this meta-analysis aims to generate statistics on the evaluation of the positive impact resulting from early patient education on recurrent MI prevention. Aim The current study aimed to assess the effect of early post-MI education in preventing the recurrence of myocardial infarction. Objective The current systematic review aimed to evaluate the relation between the occurrence of recurrent MI, which is evidenced by hospitalization, in addition to consultation with medical professionals, and the provision of early patient education. Method Studies were identified through searching e-databases including MEDLINE (Ovid), PUBMED, Cochrane library and EMBASE. Two reviewers searched the databases independently. Keywords included “recurrent heart attack”, “recurrent myocardial infarction”, “post MI education”, “prevention of myocardial infarction”, “cardiac rehabilitation on MI” when searching the databases. Only studies fulfilling the inclusion criteria were chosen in this meta-analysis. Randomized control trials were selected and included in meta-analysis after the screening and filtering process. Other study methods such as case control study and cohort study were not included in this meta-analysis. All studies selection included in this meta-analysis had to follow strictly the PRISMA 2009 guideline. Quality assessments were also performed by using CONSORT 2010 checklists. Results Eight randomized controlled trials were selected for this meta-analysis. The meta-analysis evaluated the effect of receiving early patient education on prevention of future recurrence of MI by comparing with control subjects. Patients who received early patient education showed a reduction of risk of recurrent myocardial infarction by 3% to 100%; the summarized relative risk of the interventional group was 0.80compared with the control group. This means there resulted a 20% reduction in recurrent MI. Conclusion Early patient education was shown to have a positive effect on the prevention of recurrent MI in this meta-analysis. Compared with the usual care in today’s hospital and medical system, we should provide more early patient education to patients with myocardial infarction for recurrent MI prevention. In light of this meta-analysis, I recommend the government to invest more funds and manpower in patient education at both hospital and clinical levels. / published_or_final_version / Public Health / Master / Master of Public Health

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