<p>Validerat; 20101217 (root)</p>

Clinical and preclinical studies revealed that heart failure induces depression. Injury of myocardial tissue initiates an inflammation cascade that extends to the CNS and might contribute to depression following myocardial infarction (MI). Sex differences were noticed in the progression of heart failure and depression in clinical studies. We hypothesized that depression-like behavior induced by HF post-MI is influenced by sex through modulation of inflammation pathway. First, we evaluated sex differences in depression-like behavior in male and female rats at 8-10 weeks post-MI, as well as circulating cytokines, the extent of inflammation in the PFC, PVN, and amygdala, and mBDNF levels in the PFC and amygdala that are affected by neuroinflammation. Then we evaluated the effect of ovariectomy (OVX) and whether estrogen replacement with 17β-estradiol (E2) prevents post-MI induced depression-like behavior through inhibiting neuroinflammation. Thirdly we evaluated the role of inflammation for cardiac dysfunction and development of depression-like behavior in OVX female rats post-MI by oral treatment with pentoxifylline (PTX). Male rats developed depression-like behavior by ten weeks post-MI but not females as assessed by sucrose preference test (SPT) and forced swim test (FST). Both developed similar cardiac dysfunction and a comparable increase in plasma and PVN cytokine levels, but cytokine levels increased and mBDNF levels decreased only in the PFC of male rats post-MI. OVX per se decreased sucrose consumption and induced passive behavior assessed by SPT and FST, respectively.The combination of MI and OVX aggravated depression-like behvaiour. E2 treatment prevented the development of mild depression-like behavior in OVX and severe symptoms in OVX female rats post-MI. E2 had no effect on cardiac dysfunction in OVX female rats at 10 weeks post-MI. Despite the similar increase in circulating cytokines in OVX ± E2 at 10 weeks post-MI, E2 decreased the proinflammatory cytokines and increased IL-10 (anti-inflammatory cytokine) in the PFC. Finally, we evaluated the role of neuroinflammation in depression-like behavior in OVX female rats post-MI through inhibiting cytokine production by administering oral PTX. PTX prevented depression-like behavior in OVX female rats post-MI and reduced cytokines levels in plasma, PVN and PFC. However, PTX did not affect the progression of cardiac dysfunction at 10 weeks post-MI. Sex determines the development of depression-like behavior in HF post-MI and neuroinflammation appears to play a critical pathway that is affected by sex and can be inhibited by hormonal replacement or anti-inflammatory agents.

Successful treatment of myocardial infarction requires anearly and accurate diagnosis. Recent studies have shown thatacute myocardial scintigraphy has a high predictive value forprognosis of myocardial events. Three dimensional (3D)perfusion data obtained with SPECT are however very rare in theemergency department (ED). We have developed a mobile tomographic system for myocardialscintigraphy, which can be used in the ED. The objectives ofthe studies presented were:     To develop software and hardware for a mobile tomographicgamma camera system: the Cardiotom     To demonstrate that a mobile tomographic system can beused in a clinical situation     To evaluate the limitations of Ectomography when usingfiltered back projection for reconstruction     To develop a method of reconstruction that compensatesfor the incomplete data acquisition associated with theacquisition geometry of Ectomography Three prototypes of a mobile tomographic gamma camera systemhave been designed and built at the Division of MedicalEngineering, which all have been used in a clinical setting.The systems are based on Ectomography, a limited view anglemethod, also developed by us. Instead of rotating the entiregamma camera detector around the patient as in SPECT, a slanthole collimator is rotated in front of a stationary detector.Since short imaging times are important in the ED and the heartonly occupies a small area of the detector, system sensitivityhas been increased by dividing the collimator into segmentswith different projection directions. In myocardial imaging, 4segments are used and within 10 minutes from the start ofacquisition, reconstructed short axis view sections areavailable for interpretation. Using the Cardiotom in an experimental animal study, weverified that the system could be used to quantify myocardialarea at risk and final infarct size. This conclusion was madefrom a comparison of images obtained from the Cardiotom andpathological staining of the myocardium, analysedpost-mortem. Inherent limitations of Ectomography were evaluated withboth phantom studies and computer simulated data, reconstructedusing filtered back-projection Results show that moderatedeviation from optimal position of the detector with respect tothe myocardium will have little or no influence on thediagnostic information when assessed from short axis sectionimages and polar tomograms. However, long axis section imagesappear elongated when reconstructed using filteredback-projection. We have shown that this elongation distortion can besuppressed using iterative reconstructions techniques, and wehave implemented such an algorithm, called three-dimensionalTotal Variation Expectation Maximisation (3DTV-EM). Resultswere that elongation distortion was reduced and depthresolution improved. The reconstruction technique was alsoevaluated for SPECT reconstruction and was found to decreasethe noise in reconstructed images, when compared to thetwo-dimensional TV-EM algorithm. Noise pattern were also foundto be more uniform for the 3DTV-EM algorithm compared totwo-dimensional TV-EM. In conclusion, we have shown that the Cardiotom may beuseful in a clinical acute setting, providing valuablediagnostic information. Rapid positioning is possible, sincemoderate deviation from optimal positioning will cause few orno artefacts. Image quality can be improved if iterativetechniques are used for image reconstruction instead offiltered back-projection. <b>Keywords</b>: acute studies, myocardial infarction,scintigraphy, mobile gamma camera, tomography.

The incidence of stroke and re-infarction is noticeably high in the first few days following acute myocardial infarction. This finding has raised questions whether the systemic inflammatory reaction secondary to myocardial necrosis is involved. The inflammation might affect the activation of platelets leading to insufficient effect of the antiplatelet treatment given. Furthermore, the importance of platelet reactivity and inflammation in terms of long-term prognosis is not fully understood. The prognostic importance of C-reactive protein (CRP) in relation to clinical variables also needs to be clarified. The present studies are aimed at describing the dynamics of platelet function during the first days of an acute myocardial infarction, in relation to diabetes and inflammation. We also investigated whether increased platelet reactivity or the increased concentration of CRP in blood were related to a worse outcome. Finally, we examined if CRP levels contributed to a predictive model using clinical variables known to affect outcome in patients with AMI.  We used two novel platelet function tests to measure platelet reactivity; the PA-200 (a laser light aggregometer) and the PFA-100 (measures primary haemostasis in whole blood). Platelet aggregation increased during the initial course of an acute myocardial infarction. The increase in platelet aggregation was most pronounced in diabetics and in patients showing higher systemic inflammatory reaction, assessed by measuring the concentration of CRP in blood. The pronounced platelet aggregation occurred despite ongoing antiplatelet and antithrombotic treatment. There was a significant association between the levels of CRP and the degree of platelet reactivity. However, while the CRP levels were associated with a worse outcome (AMI, stroke and death), the results of the platelet function tests were not. The importance of CRP in predicting prognosis depended on which adjustments were made for confounding factors. CRP and prognostic variables in a statistical model predicting death, however, showed that CRP was excluded. Thus CRP did not predict outcome beyond clinical prognostic variables. The results of these studies reinforce the importance of clinical variables such as heart failure, age, atrial fibrillation, smoking status, diabetes and impaired kidney function - all of which were associated with worse prognosis in multivariable analysis.

Optical methods can provide useful tissue characterization tools. For this project, two-photon microscopy and polarized light examinations (polarimetry) were used to assess the organizational state of myocardium in healthy, infarcted, and stem-cell regenerated states. Two-photon microscopy visualizes collagen through second-harmonic generation and myocytes through two-photon excitation autofluorescence, providing information on the composition and structure/organization of the tissue. Polarimetry measurements yield a value of linear retardance that can serve as an indicator of tissue anisotropy, and with a dual-projection method, information about the anisotropy axis orientation can also be extracted. Two-photon microscopy results reveal that stem-cell treated tissue retains more myocytes and structure than infarcted myocardium, while polarimetry findings suggest that the injury caused by temporary ligation of a coronary artery is less severe and more diffuse that than caused by a permanent ligation. Both these methods show potential for tissue characterization.

Optical methods can provide useful tissue characterization tools. For this project, two-photon microscopy and polarized light examinations (polarimetry) were used to assess the organizational state of myocardium in healthy, infarcted, and stem-cell regenerated states. Two-photon microscopy visualizes collagen through second-harmonic generation and myocytes through two-photon excitation autofluorescence, providing information on the composition and structure/organization of the tissue. Polarimetry measurements yield a value of linear retardance that can serve as an indicator of tissue anisotropy, and with a dual-projection method, information about the anisotropy axis orientation can also be extracted. Two-photon microscopy results reveal that stem-cell treated tissue retains more myocytes and structure than infarcted myocardium, while polarimetry findings suggest that the injury caused by temporary ligation of a coronary artery is less severe and more diffuse that than caused by a permanent ligation. Both these methods show potential for tissue characterization.

Syfte: Syftet med studien var att kartlägga förekomst och undersöka samband mellan stress och depression hos patienter som genomgått en hjärtinfarkt. Syftet var även att undersöka eventuella skillnader mellan män och kvinnors upplevelser av stress och depression vid hjärtinfarkt. Metod: Patienter som vårdats på en hjärtavdelning för hjärtinfarkt i Mellansverige och är svensktalande inkluderades i studien. Enkäterna Vardagslivets Stress och MADRS-S användes som mätinstrument. Resultat: Antalet inkluderade deltagare i studien var 20 stycken. Förekomsten av självskattad depression uppgick till 5 % efter en hjärtinfarkt. Förekomst av självskattad stress sågs hos totalt 20 % av deltagarna, av dessa var det 5 % som hamnade i den högsta kategorin av stress. Inget samband konstaterades mellan depression och stress (r=0,15), signifikans (p=0,52). Skillnader mellan män och kvinnors upplevelser av stress och depression vid hjärtinfarkt kunde ej bestämmas i denna studie. Slutsats: Denna studie är relativt liten och omfattar endast 20 deltagare. För att kunna dra giltiga slutsatser, krävs en mer omfattande studie som inkluderar fler deltagare och har en jämnare könsfördelning. / Purpose: The purpose of this study was to evaluate the prevalence and to examine the correlation between stress and depression among patients that have had a myocardial infarction. The purpose was also to examine differences between men and women and their experiences of stress and depression due to myocardial infarction. Methods: Patients who received treatment at a cardiac department in the central parts of Sweden and spoke the Swedish language were included in the study. The questionnaires Everyday Life Stress and MADRS-S were used as measurements. Results: 20 participants were included in the study. The prevalence of self-rated depression was 5 %. Self-rated stress was found among 20 % of the participants, and of these 5 % fell into the highest category of stress. No correlation could be found between depression and stress (r=0.15), significance (p=0,52). Differences in experiences between men and women regarding stress and depression due to myocardial infaction could not be determined. Conclusion: This study is relatively small and covers only 20 participants. In order to reach valid conclusions, a more comprehensive study should be made that includes more participants and with better gender balance.

Syftet med föreliggande litteraturstudie var att beskriva vad som framkommer om socialt stöd och livsstilsförändringar efter hjärtinfarkt. Studien är en beskrivande litteraturstudie som innefattar tio vetenskapliga artiklar vilka har granskats av författarna och därefter kvalitetsbedömts. Resultatet visade att livsstilsförändringar inte var lätta att genomföra. Det sociala stödet var viktigt för att de olika livsstilsförändringarna skulle klaras av och att stödets utformning skulle vara anpassat efter den hjärtinfarktdrabbades behov. För mycket eller för litet stöd hade negativ inverkan på hur patienten lyckades med livsstilsförändringarna. Personalen på sjukhuset hade stor inverkan på hur lyckad livsstilsförändringarna skulle bli. Sjukvårdspersonalen behövde stödja både hjärtinfarktdrabbade och anhöriga för att rehabiliteringen skulle bli lyckad. De slutsatser som dragits från föreliggande studie är, att socialt stöd påverkar hjärtinfarktdrabbades möjlighet att genomföra livsstilsförändringar. Det sociala stödet kan få både en positiv och negativ inverkan på livsstilsförändringar. Det har visat sig vara viktigt att sjuksköterskan samarbetar med den hjärtinfarktdrabbade. Att anpassa situationen och informationen till respektive individ kan förbättra stödet från sjukvården. / The purpose of this study was to describe what is found about social support and lifestyle changes after a myocardial infarction. The study is a descriptive literature review that includes ten scientific articles that have been reviewed and qualitatively evaluated by the authors. The results showed that lifestyle changes were not easy to conduct. Social support was essential to cope with lifestyle changes and it was important that the aid was designed to match each individual. Too much or too little support had adverse effects on the lifestyle changes that needed to be made. The hospital staff had a major impact on how successful lifestyle changes would be. The hospital staff needed to support both myocardial infarction victims and relatives to make the rehabilitation a success to assure a full recovery. The conclusions drawn from this study is that social support affects myocardial infarction victims and their opportunity to conduct lifestyle changes. Social support can have both positive and negative effects on lifestyle changes. It has also proved to be of great importance that the nurse is collaborating with the myocardial infarction victim. Adjustment to the situation and information to each individual could change the support from the healthcare.

Syftet med den föreliggande litteraturstudien var att beskriva kvinnors respektive mäns livskvalitet efter insjuknande i hjärtinfarkt och de copingstrategier som användes i hanteringen av vardagen. En deskriptiv litteraturstudie genomfördes utifrån sex kvalitativa samt åtta kvantitativa studier med övervägande delen hög kvalitet. Publikationsåren för de inkluderade artiklarna var mellan 2000 och 2010. Artikelsökningen genomfördes i databaserna MedLine (PubMed) samt Cinahl med följande sökord: Hjärtinfarkt, anpassning, psykologisk, livskvalitet och coping. Sammanfattningsvis var vanligt förekommande problem under den första tiden efter insjuknande i hjärtinfarkt fysiska symtom och emotionell utmattning där tillfredsställande behandling och god sjukdomsinsikt kunde leda till välbefinnande. Följande faktorer såsom stress, oro, ångest, nedstämdhet, depression samt kronisk trötthet hade negativ inverkan på den upplevda livskvaliteten, liksom alltför omfattande livsstilsförändringar. Att återgå till sitt arbete hade däremot positiva effekter ur de fysiska och psykologiska aspekterna på livskvaliteten. Likaså hade det sociala nätverket inverkan på välbefinnandet där män i huvudsak sökte stöd från sin partner medan kvinnor även sökte sympati från övriga anhöriga. Optimistiska copingstrategier var vanligast bland både kvinnor och män, dock använde sig kvinnor av fler copingstrategier och hade svårare att hantera sin vardag än vad män hade. För ytterligare evidens i copingstrategier och genusskillnader krävs ytterligare forskning av komparativ design. / The purpose of this study was to describe perceived quality of life and used coping in daily life of women and men after myocardial infarction, which is described in the literature review included studies and methodological quality. A descriptive literature review was conducted based on six qualitative and eight quantitative studies of high quality nature. In conclusion, the year of publication of the studies was between the years of 2000 and 2010. The databases MedLine (Pubmed) and Cinahl were used in the searching of scientific articles with the following keywords: Myocardial infarction, Adaptation, Psychological, Quality of life and Coping. Furthermore, the findings in satisfaction of treatment and good insight in illness was increased in terms of well-being. Return to work appeared to bring positive outcomes of the physical and psychological aspects in quality of life. By the same token, social network had an impact in terms of well-being, since men mainly perceived available support trough their partner as women in larger extension perceived available support from other relatives than men did. Optimistic coping was the most frequently used strategy by both women and men, however, women practiced several strategies of coping. Also, difficulties were found in women managing their daily life compared to men. Regarding coping strategies as well as gender differences, further research is to claim.

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