In-stent restenosis (ISR) remains the most common cause of stent failure after percutaneous coronary intervention (PCI). Recent data suggest that ISR-PCI accounts for 5-10% of all PCI procedures ...performed in current clinical practice. This State-of-the-Art review will primarily focus on the management of ISR but will begin by briefly discussing diagnosis and classification. We then move on to detail the evidence base underpinning the various therapeutic strategies for ISR before finishing with a proposed ISR management algorithm based on current scientific data.
Objective
Methotrexate has shown efficacy for the treatment of several diseases, especially rheumatoid arthritis (RA). Methotrexate has also been implicated as a causative agent in interstitial lung ...disease. Patients with RA may develop pulmonary manifestations of their disease and are at increased risk of respiratory infection. The aim of this study was to evaluate the relative risk (RR) of pulmonary disease among patients with RA treated with methotrexate.
Methods
We searched the PubMed and Cochrane databases (publication dates January 1, 1990 to February 1, 2013) for double‐blind, randomized, controlled trials of methotrexate versus placebo or active comparator agents in adults with RA. Studies with <100 subjects or with a duration of <24 weeks were excluded. Two investigators independently searched both databases, and all of the investigators reviewed the selected studies. We compared differences in the RR using the Mantel‐Haenszel random‐effects method.
Results
A total of 22 studies with 8,584 participants met the inclusion criteria. Heterogeneity across studies was not significant (I2 = 3%), allowing combination of the trial results. Methotrexate was associated with an increased risk of all adverse respiratory events (RR 1.10, 95% confidence interval 95% CI 1.02−1.19) and respiratory infection (RR 1.11, 95% CI 1.02−1.21). Patients treated with methotrexate were not at increased risk of death due to lung disease (RR 1.53, 95% CI 0.46−5.01) or noninfectious respiratory events (RR 1.02, 95% CI 0.65−1.60). A subgroup analysis of studies in which pneumonitis was described revealed an increased risk associated with methotrexate (RR 7.81, 95% CI 1.76−34.72).
Conclusion
Our study demonstrated a small but significant increase in the risk of lung disease in patients with RA treated with methotrexate compared with other disease‐modifying antirheumatic drugs and biologic agents.
An ion mobility spectrometer (IMS) with an electrospray ion source is used to investigate photo and thermal isomerization of photoactive molecules in the electrospray syringe. A light emitting diode ...adjacent to the syringe establishes a photostationary state that relaxes thermally toward the more stable isomer once illumination ceases. The arrangement is demonstrated by measuring Z–E thermal isomerization rates for several azoheteroarene compounds. The IMS technique has a distinct advantage over UV–vis spectrophotometry for measuring isomer populations in situations where there are multiple isomers with overlapping absorption profiles. In another development, an LED array adjacent to the silica capillary connecting the syringe to the electrospray ion source, is used to activate photochromic molecules, and investigate sequential photoswitching events.
Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.Data sources PubMed, Cochrane ...central register of controlled trials, and Embase to 9 January 2014.Study selection Double blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with psoriatic arthritis, psoriasis, or inflammatory bowel disease. Studies with fewer than 50 participants or of less than 12 weeks’ duration were excluded.Data synthesis Two investigators independently searched both databases. All authors reviewed selected studies. We compared relative risk differences using the Mantel-Haenszel random effects method to assess total respiratory adverse events, infectious respiratory adverse events, non-infectious respiratory adverse events, interstitial lung disease, and death.Results Seven studies met our inclusion criteria, six with placebo as the comparator. Heterogeneity across the studies was not significant (I2=0%), allowing combination of trial results. 504 respiratory adverse events were documented in 1630 participants. Methotrexate was not associated with an increased risk of adverse respiratory events (relative risk 1.03, 95% confidence interval 0.90 to 1.17), respiratory infections (1.02, 0.88 to 1.19), or non-infectious respiratory events (1.07, 0.58 to 1.96). No pulmonary deaths occurred.Conclusions Findings suggested that there was no increased risk of lung disease in methotrexate treated patients with non-malignant inflammatory diseases. Given the limitations of the study, however, we cannot exclude a small but clinically important risk.
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