It remains unclear whether there are differences in the safety and efficacy outcomes between everolimus-eluting stents (EES) and sirolimus-eluting stents (SES) in contemporary practice.
We ...prospectively enrolled 6166 consecutive patients who received EES (3081 patients) and SES (3085 patients) between April 2008 and June 2010, using data from the Interventional Cardiology Research In-Cooperation Society-Drug-Eluting Stents Registry. The primary end point was a composite of death, nonfatal myocardial infarction (MI), or target-vessel revascularization (TVR). At 2 years of follow-up, the 2 study groups did not differ significantly in crude risk of the primary end point (12.1% for EES versus 12.4% for SES; HR, 0.97; 95% CI, 0.84-1.12, P=0.66). After adjustment for differences in baseline risk factors, the adjusted risk for the primary end point remained similar for the 2 stent types (HR, 0.96; 95% CI, 0.82-1.12, P=0.60). There were also no differences between the stent groups in the adjusted risks of the individual component of death (HR, 0.93; 95% CI, 0.67-1.30, P=0.68), MI (HR, 0.97; 95% CI, 0.79-1.18, P=0.74), and TVR (HR, 1.10; 95% CI, 0.82-1.49, P=0.51). The adjusted risk of stent thrombosis also was similar (HR, 1.16; 95% CI, 0.47-2.84, P=0.75).
In contemporary practice of percutaneous coronary intervention procedures, the unrestricted use of EES and SES showed similar rates of safety and efficacy outcomes with regard to death, MI, sent thrombosis, and TVR. Future longer-term follow-up is needed to better define the relative benefits of these drug-eluting stents.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01070420.
Among members of the tumor necrosis factor receptor (TNFR) superfamily, 4-1BB, CD27, and glucocorticoid-induced tumor necrosis
factor receptor family-related gene (GITR) share a striking homology in ...the cytoplasmic domain. Here we report the identification
of a new member, activation-inducible TNFR family member (AITR), which belongs to this subfamily, and its ligand. The receptor
is expressed in lymph node and peripheral blood leukocytes, and its expression is up-regulated in human peripheral mononuclear
cells mainly after stimulation with anti-CD3/CD28 monoclonal antibodies or phorbol 12-myristate 13-acetate/ionomycin. AITR
associates with TRAF1 (TNF receptor-associated factor 1), TRAF2, and TRAF3, and induces nuclear factor (NF)-κB activation
via TRAF2. The ligand for AITR (AITRL) was found to be an undescribed member of the TNF family, which is expressed in endothelial
cells. Thus, AITR and AITRL seem to be important for interactions between activated T lymphocytes and endothelial cells.
The genus Alexandrium includes organisms of interest, both for the study of dinoflagellate evolution and for their impacts as toxic algae affecting human health and fisheries. Only partial large ...subunit (LSU) rDNA sequences of Alexandrium and other dinoflagellates are available, although they contain much genetic information. Here, we report complete LSU rDNA sequences from 11 strains of Alexandrium, including Alexandrium affine, Alexandrium catenella, Alexandrium fundyense, Alexandrium minutum, and Alexandrium tamarense, and discuss their segmented domains and structure. Putative LSU rRNA coding regions were recorded to be around 3,400bp long. Their GC content (about 43.7%) is among the lowest when compared with other organisms. Furthermore, no AT-rich regions were found in Alexandrium LSU rDNA, although a low GC content was recorded within the LSU rDNA. No intron-like sequences were found. The secondary structure of the LSU rDNA and parsimony analyses showed that most variation in LSU rDNA is found in the divergent (D) domains with the D2 region being the most informative. This high D domain variability can allow members of the diverse Alexandrium genus to be categorized at the species level. In addition, phylogenetic analysis of the alveolate group using the complete LSU sequences strongly supported previous findings that the dinoflagellates and apicomplexans form a clade.
We performed the long-term follow-up of a large cohort of patients in a multicenter study receiving left main coronary artery (LMCA) revascularization.
Limited information is available on long-term ...outcomes for patients with unprotected LMCA disease who underwent coronary stent procedure or coronary artery bypass grafting (CABG).
We evaluated 2,240 patients with unprotected LMCA disease who received coronary stents (n = 1,102; 318 with bare-metal stents and 784 with drug-eluting stents) or underwent CABG (n = 1,138) between 2000 and 2006 and for whom complete follow-up data were available for at least 3 to 9 years (median 5.2 years). The 5-year adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction MI, or stroke; and target vessel revascularization TVR) were compared with the use of the inverse probability of treatment weighted method and propensity-score matching.
After adjustment for differences in baseline risk factors with the inverse probability of treatment weighting, the 5-year risk of death (hazard ratio HR: 1.13; 95% confidence interval CI: 0.88 to 1.44, p = 0.35) and the combined risk of death, Q-wave MI, or stroke (HR: 1.07; 95% CI: 0.84 to 1.37, p = 0.59) were not significantly different for patients undergoing stenting versus CABG. The risk of TVR was significantly higher in the stenting group than in the CABG group (HR: 5.11; 95% CI: 3.52 to 7.42, p < 0.001). Similar results were obtained in comparisons of bare-metal stent with concurrent CABG and of drug-eluting stent with concurrent CABG. In further analysis with propensity-score matching, overall findings were consistent.
During 5-year follow-up, stenting showed similar rates of mortality and of the composite of death, Q-wave MI, or stroke but higher rates of TVR as compared with CABG for patients with unprotected LMCA disease.
Abstract Objective To clarify the association of serum calcium level with metabolic syndrome (MetS) and diabetes in middle-aged and elderly Korean subjects. Design and patients We conducted a ...population-based, cross-sectional survey of 1329 participants aged over 40 years (median age 65.8) in a rural area of Chungju, Korea, in 2007. Measurements Serum level of albumin, calcium, 25-hydroxy-vitamin D and intact parathyroid hormone were measured in a central laboratory. Results The prevalence of MetS increased progressively with elevated serum albumin-corrected calcium levels ( P < 0.001 for trend). After adjusting for various covariates, subjects in the highest quintile group (2.45–2.99 mmol/L) compared with the lowest quintile group (2.05–2.24 mmol/L) of serum calcium levels had an odds ratio (OR) for having MetS of 3.11 (95% confidence intervals, CI, 1.95–4.97; P for trend <0.001). Excluding the subjects with hypocalcemia and hypercalcemia ( n = 1064) did not alter this significant association. After multiple adjustment, subjects with serum calcium levels in the fourth to fifth quintiles had a 2.0- to 3.0-fold increased OR of having diabetes (first quintile reference, fourth quintiles OR 2.38; 95% CI 1.32–4.28, fifth quintiles OR 3.32; 95% CI 1.87–5.88; P for trend <0.001).The associations of serum calcium levels with the incidences of MetS or diabetes were unchanged after adjustment for 25(OH)D and PTH levels. Conclusions Altered calcium homeostasis was associated with an increased risk of having MetS and diabetes in this demographic group.
We investigated the ability of multidetector spiral computed tomography (MDCT) to detect atherosclerotic plaque in nonstenotic coronary arteries.
In 22 patients without significant coronary stenoses, ...contrast-enhanced MDCT (0.75-mm collimation, 420-ms rotation) and intravascular ultrasound (IVUS) of one coronary artery were performed. A total of 83 coronary segments were imaged by IVUS (left main, 19; left anterior descending, 51; left circumflex, 4; right coronary, 9). MDCT data sets were evaluated for the presence and volume of plaque in the coronary artery segments. Results were compared with IVUS in a blinded fashion. For the detection of segments with any plaque, MDCT had a sensitivity of 82% (41 of 50) and specificity of 88% (29 of 33). For calcified plaque, sensitivity was 94% (33 of 36) and specificity 94% (45 of 47). Coronary segments containing noncalcified plaque were detected with a sensitivity of 78% (35 of 45) and specificity of 87% (33 of 38), but presence of exclusively noncalcified plaque was detected with only 53% sensitivity (8 of 15). If analysis was limited to the 41 proximal segments (segments 1, 5, 6, and 11 according to American Heart Association classification), sensitivity and specificity were 92% and 88% for any plaque, 95% and 91% for calcified plaque, and 91% and 89% for noncalcified plaque. MDCT substantially underestimated plaque volume per segment as compared with IVUS (24+/-35 mm3 versus 43+/-60 mm3, P<0.001).
The results indicate the potential of MDCT to detect coronary atherosclerotic plaque in patients without significant coronary stenoses. However, further improvements in image quality will be necessary to achieve reliable assessment, especially of noncalcified plaque throughout the coronary tree.
Noninvasive Assessment of Plaque Morphology and Composition in Culprit and Stable Lesions in Acute Coronary Syndrome and Stable Lesions in Stable Angina by Multidetector Computed Tomography
Udo ...Hoffmann, Fabian Moselewski, Koen Nieman, Ik-Kyung Jang, Maros Ferencik, Ayaz M. Rahman, Ricardo C. Cury, Suhny Abbara, Hamid Joneidi-Jafari, Stephan Achenbach, Thomas J. Brady
With contrast-enhanced submillimeter 16-slice multidetector computed tomography (MDCT), we noninvasively assessed morphology and composition of 40 culprit and stable coronary lesions. Culprit lesions in patients with acute coronary syndrome (ACS) had significantly greater plaque area and a higher remodeling index than stable lesions both in patients with ACS and in patients with stable angina (p = 0.02 and p = 0.04; respectively). Lesion composition was also different between the three groups. This study introduces the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS, emphasizing the potential of MDCT to improve noninvasive risk stratification in patients with acute chest pain.
The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT).
Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain.
Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined.
We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 ± 5.9 mm2vs. 9.1 ± 4.8 mm2vs. 13.5 ± 10.7 mm2, p = 0.02; and 1.4 ± 0.3 vs. 1.0 ± 0.4 vs. 1.2 ± 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina.
We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.
Polymer electrolyte membrane fuel cell (PEMFC) stacks in a fuel cell vehicle can be inevitably exposed to harsh environments such as cold weather in winter, causing water flooding by the direct flow ...of condensed water to the electrodes. In this study, anode flooding was experimentally investigated with condensed water generated by cooling the anode gas line during a long-term operation (∼1600 h). The results showed that the performance of the PEMFC was considerably degraded. After the long-term experiment, the thickness of the anode decreased, and the ratio of Pt to carbon in the anode increased. Moreover, repeated fuel starvation of the half-cell severely oxidized the carbon surface due to the high induced potential (>1.5 VRHE). The cyclic voltammogram of the anode in the half-cell experiments indicated that the characteristic feature of the oxidized carbon surface was similar to that of the anode in the single cell under anode flooding conditions during the long-term experiment. Therefore, repeated fuel starvation by anode flooding caused severe carbon corrosion in the anode because the electrode potential locally increased to >1.0 VRHE. Consequently, the density of the tri-phase boundary decreased due to the corrosion of carbons supporting the Pt nanoparticles in the anode.
•Anode flooding can occur by direct flow of condensed water in humidified fuel.•Anode flooding induces local fuel starvation and high potential in the anode.•High potential locally present in the anode results in anode carbon corrosion.•Anode carbon corrosion plays a key role in MEA degradation by anode flooding.
Purpose The aim of this study was to investigate the effects of regular treadmill exercise on skeletal muscle Rictor-Akt and mTOR-Raptor-S6K1 signaling pathway in high-fat diet-induced obese mice. ...Subjects and Methods Four- week-old C57BL/6 mice were adopted and classified into normal diet group (ND, n = 10), normal diet and training group (NDT, n = 10), high-fat diet group (HF, n = 10), and high-fat diet and training group (HFT, n = 10). The exercise program consisted of a treadmill exercise provided at low intensity for 1–4 weeks, and moderate intensity for 5–8 weeks. Results The Western blot method was used to measure the expression of mTOR, Raptor, S6K1, Rictor, and Akt proteins in the soleus muscle. mTOR levels were significantly higher in the HF group than in the ND and NDT groups. Raptor/mTORC1 and S6K1 levels were significantly higher in the HF group than in all the other groups. Akt levels were significantly lower in the HF group than in the NDT group. The risk of obesity may be associated with the overactivation of the mTOR-Raptor-S6K1 signaling pathway and a decrease in Akt levels. Conclusion This study also indicates that performing aerobic exercise may be associated with the downregulation of the mTOR-Raptor-S6K1 pathway.
Purpose We investigated the effect exercise training has on cardiac autonomic nervous system (ANS) and cardiovascular risk profiles in children with type 1 diabetes mellitus (DM). Subjects Fifteen ...type 1 DM children (all boys; 13.0±1.0 years of age) were enrolled in the study. Methods The subjects received exercise training three times a week in a 12-week program. Each child was asked to walk on a treadmill to achieve an exercise intensity of VO2max 60%. ANS activity was measured by power spectral analysis of the electrocardiogram (ECG). Blood samples were obtained for serum lipid profiles. To evaluate Doppler-shifted Fourier pulsatility index (PI) analysis, a 5-MHz continuous wave Doppler (VASCULAB D10) set was used to measure forward blood flow velocity (FLOW) in the radial artery. Results Total and low-frequency (LF) power of heart rate variability increased significantly after exercise intervention. Total cholesterol (TC) levels were significant lower after exercise intervention. Total and high-frequency (HF) power were significantly correlated with higher TC levels, but diastolic blood pressure and HF was significantly correlated with lower TC levels. Conclusion Regular exercise intervention should be prescribed for children with type 1 DM.
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