Summary Background Percutaneous coronary intervention (PCI) with drug-eluting stents is the standard of care for treatment of native coronary artery stenoses, but optimum treatment strategies for ...bare metal stent and drug-eluting stent in-stent restenosis (ISR) have not been established. We aimed to compare and rank percutaneous treatment strategies for ISR. Methods We did a network meta-analysis to synthesise both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, and Embase for randomised controlled trials published up to Oct 31, 2014, of different PCI strategies for treatment of any type of coronary ISR. The primary outcome was percent diameter stenosis at angiographic follow-up. This study is registered with PROSPERO, number CRD42014014191. Findings We deemed 27 trials eligible, including 5923 patients, with follow-up ranging from 6 months to 60 months after the index intervention. Angiographic follow-up was available for 4975 (84%) of 5923 patients 6–12 months after the intervention. PCI with everolimus-eluting stents was the most effective treatment for percent diameter stenosis, with a difference of −9·0% (95% CI −15·8 to −2·2) versus drug-coated balloons (DCB), −9·4% (–17·4 to −1·4) versus sirolimus-eluting stents, −10·2% (–18·4 to −2·0) versus paclitaxel-eluting stents, −19·2% (–28·2 to −10·4) versus vascular brachytherapy, −23·4% (–36·2 to −10·8) versus bare metal stents, −24·2% (–32·2 to −16·4) versus balloon angioplasty, and −31·8% (–44·8 to −18·6) versus rotablation. DCB were ranked as the second most effective treatment, but without significant differences from sirolimus-eluting (–0·2% 95% CI −6·2 to 5·6) or paclitaxel-eluting (–1·2% –6·4 to 4·2) stents. Interpretation These findings suggest that two strategies should be considered for treatment of any type of coronary ISR: PCI with everolimus-eluting stents because of the best angiographic and clinical outcomes, and DCB because of its ability to provide favourable results without adding a new stent layer. Funding None.
The efficacy of durable polymer drug-eluting stents (DES) is delivered at the expense of delayed healing of the stented vessel. Biodegradable polymer DES aim to avoid this shortcoming and may ...potentially improve long-term clinical outcomes, with benefit expected to accrue over time. We sought to compare long-term outcomes in patients treated with biodegradable polymer DES vs. durable polymer sirolimus-eluting stents (SES).
We pooled individual patient data from three large-scale multicentre randomized clinical trials (ISAR-TEST 3, ISAR-TEST 4, and LEADERS) comparing biodegradable polymer DES with durable polymer SES and assessed clinical outcomes during follow-up through 4 years. The efficacy endpoint of interest was target lesion revascularization and the safety endpoint of interest was definite stent thrombosis. Out of 4062 patients included in the present analysis, 2358 were randomly assigned to treatment with biodegradable polymer DES (sirolimus-eluting, n= 1501; biolimus-eluting, n= 857) and 1704 patients to durable polymer SES. No heterogeneity across the trials was observed in analyses of the primary and secondary endpoints. At 4 years, the risk of target lesion revascularization was significantly lower among patients treated with biodegradable polymer DES vs. durable polymer SES (hazard ratio 0.82, 95% CI 0.68-0.98, P= 0.029). In addition, the risk of stent thrombosis was significantly reduced with biodegradable polymer DES vs. durable polymer SES (hazard ratio 0.56, 95% CI 0.35-0.90, P= 0.015), driven by a lower risk of very late stent thrombosis (hazard ratio 0.22, 95% CI 0.08-0.61, P= 0.004). In keeping with this, in landmark analysis between 1 and 4 years, the incidence of myocardial infarction was lower for patients treated with biodegradable polymer DES vs. durable polymer SES (hazard ratio 0.59, 95% CI 0.73-0.95, P= 0.031).
Biodegradable polymer DES improve safety and efficacy compared with durable polymer SES during long-term follow-up to 4 years.
State of the art: coronary artery stents - past, present and future Stefanini, Giulio G; Byrne, Robert A; Windecker, Stephan ...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,
08/2017, Volume:
13, Issue:
6
Journal Article
Peer reviewed
The first percutaneous coronary intervention (PCI) was performed in September 1977 by Andreas Grüntzig using a rudimentary balloon angioplasty catheter mounted on a fixed wire. PCI was immediately ...recognised as a potential breakthrough in cardiovascular medicine, but uptake in clinical practice was limited by unpredictable acute outcomes and a need for surgical standby. The introduction of bare metal stents (BMS) in the 1980s improved procedure reproducibility and clinical outcomes through a permanent scaffolding of the coronary vessel, preventing abrupt occlusion and acute recoil. It was the introduction of drug-eluting stents (DES) at the beginning of this century, however, that allowed PCI to become one of the most frequently performed therapeutic interventions in medicine, primarily by addressing the issue of in-stent restenosis. DES technology has improved considerably since, with iterative developments of the stent metallic backbone, the polymer coating, and the released antiproliferative agents impacting on the safety and efficacy profile of these devices in a meaningful way. Overall, the impressive technological advances in metallic coronary stents have revolutionised the treatment of ischaemic heart disease over the last 40 years. The aim of the present article is to provide an overview of past, present, and future aspects of coronary stent technologies.
One possible control strategy against the olive fly, Bactrocera oleae, the most serious olive crop pest, is the Sterile Insect Technique (SIT) application. However, a number of problems associated ...with this method remain that decrease the effectiveness of SIT, including the quality of reared insects. Taking the importance of the relationship between the olive fly and bacteria into consideration, the effects of probiotic diets enriched with Pseudomonas putida on B. oleae longevity and fecundity were evaluated. First, we found that the probiotic bacterium, P. putida, is conveyed from diets to the oesophageal bulb as well as to the fly midgut after feeding on the probiotic diet. Subsequently, B. oleae adults fed on either: (a) a standard full protein and sugar diet; (b) a sugar only diet; (c) a probiotic standard full protein and sugar diet; or (d) a probiotic sugar diet. Flies fed on probiotic diets were supplied with an inoculated gel containing P. putida; non‐inoculated gel was provided to the flies fed on non‐probiotic diets. B. oleae males and females that fed on sugar diets did not survive as long as those that fed on protein diets. A comparison of the longevity of adults fed on full diet and sugar with their respective probiotic diets revealed no significant difference. Males fed on the sugar only diet survived longer than males fed on probiotic sugar diet, and females fed on the full protein and sugar diet survived much longer than females fed on the full probiotic diet. As regarding fecundity, both full diets resulted in a higher number of eggs laid per female. Females fed on the probiotic sugar diet laid a higher number of eggs than females that fed on sugar only. The inoculated gel of the probiotic sugar diet contained a significantly higher quantity of leucine, isoleucine and proline than the non‐inoculated gel of the sugar only diet. The possible role of dietary bacteria in relation to functional aspects of olive fly physiology is discussed.
Abstract Quantum tunnelling plays a crucial role in heavy-ion fusion reactions at sub-barrier energies, especially in the context of nuclear physics and astrophysics. The nuclear structure of the ...colliding nuclei and nucleon transfer processes represent intrinsic degrees of freedom. They are coupled to the relative ion motion and, in general, increase the probability of tunnelling. The influence of couplings to nucleon transfer channels relatively to inelastic excitations, on heavy-ion fusion cross sections, is one of the still open problems in this field. We present a new analysis of several systems, based on the combined observation of the energy-weighted excitation functions $$E\sigma $$ E σ in relation to their first energy derivatives $$d(E\sigma )/dE$$ d ( E σ ) / d E . The relation between $$d(E\sigma )/dE$$ d ( E σ ) / d E and $$E\sigma $$ E σ removes the basic differences due to the varying Coulomb barrier when comparing different systems. We show that, depending on the nuclear structure and/or the presence of strong transfer channels, this representation reveals characteristic features below the barrier. The possible presence of cross section oscillations makes this analysis less clear for light- or medium-light systems.
The hippocampal CA2 region is essential for social memory. To determine whether CA2 activity encodes social interactions, we recorded extracellularly from CA2 pyramidal neurons (PNs) in male mice ...during social behavior. Although CA2 neuronal firing showed only weak spatial selectivity, it accurately encoded contextual changes and distinguished between a novel and a familiar mouse. In the Df(16)A
mouse model of the human 22q11.2 microdeletion, which confers a 30-fold increased risk of schizophrenia, CA2 social coding was impaired, consistent with the social memory deficit observed in these mice; in contrast, spatial coding accuracy was greatly enhanced. CA2 PNs were previously found to be hyperpolarized in Df(16)A
mice, likely due to upregulation of TREK-1 K
current. We found that TREK-1 blockade rescued social memory and CA2 social coding in Df(16)A
mice, supporting a crucial role for CA2 in the normal encoding of social stimuli and in social behavioral dysfunction in disease.
The evaluation for European Union market approval of coronary stents falls under the Medical Device Directive that was adopted in 1993. Specific requirements for the assessment of coronary stents are ...laid out in supplementary advisory documents. In response to a call by the European Commission to make recommendations for a revision of the advisory document on the evaluation of coronary stents (Appendix 1 of MEDDEV 2.7.1), the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) established a Task Force to develop an expert advisory report. As basis for its report, the ESC-EAPCI Task Force reviewed existing processes, established a comprehensive list of all coronary drug-eluting stents that have received a CE mark to date, and undertook a systematic review of the literature of all published randomized clinical trials evaluating clinical and angiographic outcomes of coronary artery stents between 2002 and 2013. Based on these data, the TF provided recommendations to inform a new regulatory process for coronary stents. The main recommendations of the task force include implementation of a standardized non-clinical assessment of stents and a novel clinical evaluation pathway for market approval. The two-stage clinical evaluation plan includes recommendation for an initial pre-market trial with objective performance criteria (OPC) benchmarking using invasive imaging follow-up leading to conditional CE-mark approval and a subsequent mandatory, large-scale randomized trial with clinical endpoint evaluation leading to unconditional CE-mark. The data analysis from the systematic review of the Task Force may provide a basis for determination of OPC for use in future studies. This paper represents an executive summary of the Task Force's report.
The study of fusion reactions at extreme sub-barrier energies has seen an increased interest in recent years, although difficult to measure due to their very small cross sections. Such reactions are ...extremely important for our understanding of the production of heavy elements in various environments. In this article, the status of the field is reviewed covering the experimental techniques, the available data, and the theoretical approaches used to describe such reactions. The fusion hindrance effect, first discovered in medium-mass systems, has been found to be relevant also for lighter systems. In some light systems, resonance structures are found to be important, while for heavy systems, the fission process plays an important role. In the near barrier region, couplings to collective excitations in the fusion participants and transfer reactions have been found to give a good description of the measured fusion cross sections and it results in a distribution of fusion barrier heights. New physics ingredients, related to the overlap process of the two projectiles, have to be introduced to describe the hindrance behavior. In addition, it has recently been found that the fusion cross section in both near-barrier and sub-barrier regions can be described very well in many cases using simple, analytical forms of the barrier-height distributions or a modified version of the classic Wong formula.
Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in ...the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.
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