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Myocardial dysfunction is a major determinant of mortality after cardiac arrest, yet the molecular events driving post-resuscitation injury remain incompletely understood. Nitric oxide (NO) has been proposed as a cardioprotective adjunct during extracorporeal life support (ECLS), but its mechanistic impact on myocardial recovery is unclear. We investigated whether NO supplementation during ECLS modulates oxidative stress, metabolic pathways, and apoptotic signaling in the post–cardiac arrest heart. Male Sprague Dawley rats underwent hypothermic cardiac arrest followed by ECLS resuscitation with or without NO supplementation (20 ppm). Myocardial tissue was analyzed using bulk RNA sequencing, quantitative RT-PCR, oxidative stress assays (MDA, 3-nitrotyrosine, total oxidant/antioxidant status), and TUNEL staining to characterize pathway-level alterations. NO supplementation markedly increased cardiomyocyte apoptosis (46
Lipid management is a key component of secondary prevention after acute coronary syndrome (ACS), but guideline adherence is variable. Adjunctive lipid-lowering therapies (LLTs) beyond statins are available, yet eligibility in the real-world setting is not well-described. We aimed to improve local post-ACS lipid management, and evaluate eligibility for LLTs. Consecutive admissions of patients with ACS to a district general hospital from April to June 2022 were assessed for: inpatient lipid-profile assessment, inpatient LLT management, and outpatient repeat lipid profiles. A structured intervention, including updating blood testing panels, education, and reference resources, was implemented. We re-audited admissions in April-June 2024, where eligibility for adjunctive LLTs was assessed. There were 97 (cycle 1) and 102 (cycle 2) patients identified. While performance was suboptimal in cycle 1, we observed improvements in cycle 2 (baseline full lipid profile testing from 10% to 75%; appropriate LLT management 65% to 78%; post-discharge repeat testing 37% to 63%). At one year post-ACS, 35% of patients remained subtherapeutic, but medication changes were rare. In conclusion, through use of a structured intervention, we were able to improve post-ACS lipid management. Many patients fail to achieve therapeutic lipid lowering. Strategies to address this are urgently required.
Aim Distal biceps tendon repair may be performed using cortical button (CB) alone or combined with an interference screw (CBIS), however direct clinical comparison remains limited. We aimed to compare clinical and functional outcomes between these techniques.Methods Patients with acute distal biceps tendon rupture managed with CB or CBIS were identified from 2019 to 2024 at a single institution. Treatment allocation was based exclusively on surgeon preference, with each of the two operating surgeons consistently using a single technique throughout the study period. Outcomes were recorded at minimum 12 months using Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Visual Analogue Scale scores, and patients were assessed for complications and return to activity.Results Fifty-five patients were included (CB n = 27, CBIS n = 28) with similar baseline demographics. Mean follow-up was 21.6 months (CB) and 19.8 months (CBIS). Mean MEPS and Q-DASH scores were 96.3 and 2.8 versus 97.1 and 2.2 respectively. No statistically significant differences were found between groups in any outcome measure.Conclusions Both techniques provided excellent short- to mid-term clinical and functional outcomes. No statistically significant or clinically meaningful difference was detected between groups, though the study may be underpowered to detect small between-group differences. Within the context of surgeon-specific practice patterns, CB fixation alone appears sufficient for routine acute distal biceps tendon repair.Level of evidence Level III, retrospective comparative study.
