El estudio PEACE (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investiga por primera vez si un balón recubierto de sirolimus (BRS) (Magic Touch, ...Concept Medical, India) deriva en resultados diferentes según se utilice en síndromes coronarios agudos (SCA) o crónicos (SCC).
Este es un análisis post-hoc del registro EASTBOURNE (NCT03085823). De los 2.083 pacientes inscritos, se utilizó un BRS para tratar a 968 (46,5%) pacientes con SCA y a 1.115 (53,5%) con SCC. El objetivo primario es la revascularización de la lesión diana a los 12 meses; las variables secundarias son el éxito angiográfico y los eventos cardiovasculares adversos mayores.
Las características demográficas iniciales, el diámetro medio del vaso de referencia y la longitud media de la lesión son similares en ambos grupos. Es importante destacar que la predilatación se realiza con mayor frecuencia en SCA que en SCC (p=0,007). Los BRS se inflan a una presión estándar en ambos grupos, con una ligera tendencia hacia un tiempo de inflado más largo en SCA. El éxito angiográfico es alto en ambos grupos (el 97,4% en SCA frente al 97,7% en SCC; p=0,820) con un limitado uso de stents de rescate, y a los 12 meses la incidencia acumulada de revascularización de la lesión diana es similar en SCA y SCC (el 6,6% en SCA frente al 5,2% en SCC; p=0,258). Por el contrario, los eventos cardiovasculares adversos mayores son más frecuentes en SCA (el 10,4% frente al 8,3% en SCC; p=0,009) debido a su mayor número de recaídas. La reestenosis intrastent muestra una mayor proporción de revascularización de la lesión diana y eventos cardiovasculares adversos mayores que las lesiones nuevas, independientemente del tipo de presentación en el procedimiento inicial.
Este BRS muestra buenos resultados agudos y a un año, independientemente de la presentación clínica.
The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS).
This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events.
Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure.
This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
Drug-coated balloons (DCB) represent 1 of the most promising innovations in interventional cardiology and may represent a valid alternative to drug-eluting stents. Currently, some sirolimus-coated ...balloons (SCB) are being investigated for several coronary artery disease applications.
This study sought to understand the role of a novel SCB for the treatment of coronary artery disease.
EASTBOURNE (All-Comers Sirolimus-Coated Balloon European Registry) is a prospective, multicenter, investigator-driven clinical study that enrolled real-world patients treated with SCB. Primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints were procedural success, myocardial infarction (MI), all-cause death, and major adverse clinical events (a composite of death, MI, and TLR). All adverse events were censored and adjudicated by an independent clinical events committee.
A total population of 2,123 patients (2,440 lesions) was enrolled at 38 study centers in Europe and Asia. The average age was 66.6 ± 11.3 years, and diabetic patients were 41.5%. De novo lesions (small vessels) were 56%, in-stent restenosis (ISR) 44%, and bailout stenting occurred in 7.7% of the patients. After 12 months, TLR occurred in 5.9% of the lesions, major adverse clinical events in 9.9%, and spontaneous MI in 2.4% of the patients. The rates of cardiac/all-cause death were 1.5% and 2.5%, respectively. The primary outcome occurred more frequently in the ISR cohort (10.5% vs 2.0%; risk ratio: 1.90; 95% CI: 1.13-3.19). After multivariate Cox regression model, the main determinant for occurrence of the primary endpoint was ISR (OR: 5.5; 95% CI: 3.382-8.881).
EASTBOURNE, the largest DCB study in the coronary field, shows the safety and efficacy of a novel SCB in a broad population of coronary artery disease including small vessels and ISR patients at mid-term follow-up. (The All-Comers Sirolimus-Coated Balloon European Registry EASTBOURNE; NCT03085823)
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The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, ...Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS).
This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events.
Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure.
This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
Brain natriuretic peptide (BNP) levels were measured in 100 patients with coronary heart disease (CHD) who underwent myocardial stress thallium-201 single-photon emission computed tomography (30 with ...stable angina without basal electrocardiographic ischemia and no perfusion defects, 31 with angina with electrocardiographic ischemia and reversible perfusion defects, and 39 with myocardial infarction and irreversible defects) and in 42 controls. BNP levels progressively increased in patients with CHD and were significantly greater in patients with ischemia (p <0.01) and infarction (p <0.001) compared with controls and subjects with angina. BNP concentration was correlated positively (r = 0.923, p <0.001) with perfusion defect extent and inversely (r = −0.690, p <0.001) with the left ventricle ejection fraction (not different in the subjects examined).
Nearly 40% of patients requiring a hematopoietic stem cell transplant lack a suitable donor. However, virtually all these patients have a potential family donor with whom they share one HLA ...haplotype.
We report the rationale for making hematopoietic stem cell transplantation from haploidentical related donors feasible, as well as the method followed to achieve this. Two studies are reported, designed to overcome the problem of rejection and graft-versus-host disease after haploidentical stem cell transplantation. We describe how our total body irradiation-based, highly immuno- and myelosuppressive conditioning regimens were developed and how they have been modified over the years in an attempt to improve the clinical outcome of high-risk acute leukemia patients receiving large numbers of extensively T-cell-depleted hematopoietic stem cell transplantations from full-haplotype mismatched family donors.
A high engraftment rate and an extremely low incidence of graft-versus-host disease were obtained. Modifications of the pretransplant schedules allowed the reduction of transplant-related toxicity.
The main obstacles that limited the use of haploidentical stem cell transplantation have been overcome. The procedure is now a reality that should be recommended in high-risk acute leukemia patients who do not have a suitable matched donor.
...because of such problems, these drugs could not be used for more than 3 months. Furthermore, fenfluramine was withdrawn because of heart valve damage and pulmonary hypertension.1 Now GLP-1 ...analogues offer a new opportunity for effective weight control—and the first of these, liraglutide, has already been approved by regulatory agencies such as the US Food and Drug Administration and the European Medicines Agency for the treatment of obesity and overweight. ...the insulin response to nutrient ingestion in such people is increased, suggesting that, as with glucose and non-esterified fatty acids, the β cell might become more responsive to the effects of GLP-1 receptor agonists to modulate insulin secretion.2,3 GLP-1 receptor agonists such as liraglutide and semaglutide (both made by Novo Nordisk) stimulate postprandial insulin secretion, reduce glucagon secretion, delay gastric emptying, and induce weight loss through reduction of hunger and consequent food intake.
A
bstract
We construct a spinning particle that reproduces the propagation of the graviton on those curved backgrounds which solve the Einstein equations, with or without cosmological constant, i.e. ...Einstein manifolds. It is obtained by modifying the
N
= 4 supersymmetric spinning particle by relaxing the gauging of the full SO(4)
R
-symmetry group to a parabolic subgroup, and selecting suitable Chern-Simons couplings on the worldline. We test it by computing the correct one-loop divergencies of quantum gravity in
D
= 4.
Pentraxin 3 in Cardiovascular Disease Ristagno, Giuseppe; Fumagalli, Francesca; Bottazzi, Barbara ...
Frontiers in immunology,
04/2019, Letnik:
10
Journal Article
Recenzirano
Odprti dostop
The long pentraxin PTX3 is a member of the pentraxin family produced locally by stromal and myeloid cells in response to proinflammatory signals and microbial moieties. The prototype of the pentraxin ...family is C reactive protein (CRP), a widely-used biomarker in human pathologies with an inflammatory or infectious origin. Data so far describe PTX3 as a multifunctional protein acting as a functional ancestor of antibodies and playing a regulatory role in inflammation. Cardiovascular disease (CVD) is a leading cause of mortality worldwide, and inflammation is crucial in promoting it. Data from animal models indicate that PTX3 can have cardioprotective and atheroprotective roles regulating inflammation. PTX3 has been investigated in several clinical settings as possible biomarker of CVD. Data collected so far indicate that PTX3 plasma levels rise rapidly in acute myocardial infarction, heart failure and cardiac arrest, reflecting the extent of tissue damage and predicting the risk of mortality.
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