here is the actual xhtml file and problem is it parse the whole file while i am trying only for title node.
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et al. 41 (1): 1 -- Journal of the American College of
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<h4>CLINICAL STUDY: MYOCARDIAL INFARCTION AND ACUTE CORONARY
SYNDROME</h4>
<h2>Association between hyperglycemia and the no-reflow phenomenon
inpatients with acute myocardial infarction</h2>
<nobr>Katsuomi Iwakura, MD<sup>*</sup></nobr>, <nobr>Hiroshi Ito,
MD, FACC<sup>*</sup><sup>,*</sup></nobr>, <nobr>Masashi Ikushima,
MD<sup>*</sup></nobr>, <nobr>Shigeo Kawano, MD<sup>*</sup></nobr>,
<nobr>Atsushi Okamura, MD<sup>*</sup></nobr>, <nobr>Katsuaki Asano,
MD<sup>*</sup></nobr>, <nobr>Tadashi Kuroda, MD<sup>*</sup></nobr>,
<nobr>Koji Tanaka, MD<sup>*</sup></nobr>, <nobr>Tohru Masuyama,
MD<sup><img
alt="{dagger}"
src="journalacc_files/dagger.gif"
border="0" /></sup></nobr>, <nobr>Masatsugu Hori, MD<sup><img
alt="{dagger}"
src="journalacc_files/dagger.gif"
border="0" /></sup></nobr> and <nobr>Kenshi Fujii,
MD<sup>*</sup></nobr>
<p><sup>*</sup> Division of Cardiology, Sakurabashi Watanabe
Hospital, Osaka University, Osaka, Japan<br />
<sup><img
alt="{dagger}"
src="journalacc_files/dagger.gif"
border="0" /></sup> Department of Internal Medicine and
Therapeutics, Graduate School of Medicine, Osaka University, Osaka,
Japan</p>
<p>Manuscript received August 13, 2002; revised manuscript received
September 12, 2002, accepted September 20, 2002.</p>
<p><sup>*</sup> <b>Reprint requests and correspondence:</b> Dr.
Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital,
2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan. <sup></sup><br />
<span
id="em0">itomd{at}osk4.3web.ne.jp</span>
<script
type="text/javascript">
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</p>
<p>OBJECTIVES: We investigated the association between
hyperglycemia and the <sup></sup>no-reflow phenomenon in patients
with acute myocardial infarction <sup></sup>(AMI). <sup></sup></p>
<p>BACKGROUND: Hyperglycemia is associated with increased risks of
heart failure, <sup></sup>cardiogenic shock, and death after AMI,
but its underlying mechanism <sup></sup>remains unknown.
<sup></sup></p>
<p>METHODS: A total of 146 consecutive patients with a first AMI
were studied <sup></sup>by intracoronary myocardial contrast
echocardiography (MCE) <sup></sup>after successful reperfusion
within 24 h after symptom onset. <sup></sup>Two-dimensional
echocardiography was recorded on day 1 and three <sup></sup>months
later to determine the change in the wall motion score
<sup></sup>(<img
alt="{Delta}"
src="journalacc_files/Delta.gif"
border="0" />WMS; sum of 16 segmental scores; dyskinesia = 4 to
normokinesia <sup></sup>= 0). <sup></sup></p>
<p>RESULTS: The no-reflow phenomenon was found on MCE in 49 (33.6%)
of 146 <sup></sup>patients; their glucose level on hospital
admission was significantly <sup></sup>higher than that of patients
who did not exhibit this phenomenon <sup></sup>(209 ± 79 vs.
159 ± 56 mg/dl; p < 0.0001). <sup></sup>There was no
difference in glycosylated hemoglobin or in the
<sup></sup>incidence of diabetes mellitus between the two subsets.
The <sup></sup>no-reflow phenomenon was more often observed in the
75 patients <sup></sup>with hyperglycemia (<img
alt="≥"
src="journalacc_files/ge.gif"
border="0" />160 mg/dl) than in those without hyperglycemia
<sup></sup>(52.0% vs. 14.1%; p < 0.0001). Patients with
hyperglycemia <sup></sup>had a higher peak creatine kinase level
(2,497 ± 1,603 <sup></sup>vs. 1,804 ± 1,300 IU/l; p =
0.005) and a lower <img
alt="{Delta}"
src="journalacc_files/Delta.gif"
border="0" />WMS (3.7 <sup></sup>± 4.8 vs. 5.7 ±
4.3; p = 0.01) than did those <sup></sup>without hyperglycemia. The
blood glucose level was an independent <sup></sup>prognostic factor
for no reflow, along with age, gender, absence <sup></sup>of
pre-infarction angina, complete occlusion of the culprit
<sup></sup>lesion, and anterior AMI. <sup></sup></p>
<p>CONCLUSIONS: Hyperglycemia might be associated with impaired
microvascular <sup></sup>function after AMI, resulting in a larger
infarct size and worse <sup></sup>functional recovery.
<sup></sup></p>
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