Timing of intervention in high-risk non-ST-elevation acute coronary syndromes in PCI versus non-PCI centres

Aims

To compare the effect of timing of intervention in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in percutaneous coronary intervention (PCI) versus non-PCI centres.

Methods and results

A post-hoc sub-analysis was performed of the ELISA III trial, a randomised multicentre trial investigating outcome of early (< 12 h) versus late (> 48 h) angiography and revascularisation in 542 patients with high-risk NSTE-ACS. 90 patients were randomised in non-PCI centres and tended to benefit more from an early invasive strategy than patients included in the PCI centre (relative risk 0.23 vs. 0.85 [p for interaction = 0.089] for incidence of the combined primary endpoint of death, reinfarction and recurrent ischaemia after 30 days of follow-up). This was largely driven by reduction in recurrent ischaemia. In non-PCI centres, patients randomised to the late group had a 4 and 7 day longer period until PCI or coronary artery bypass grafting, respectively. This difference was less pronounced in the PCI centre.

Conclusions

This post-hoc analysis from the ELISA-3 trial suggests that NSTE-ACS patients initially hospitalised in non-PCI centres show the largest benefit from early angiography and revascularisation, associated with a shorter waiting time to revascularisation. Improved patient logistics and transfer between non-PCI and PCI centres might therefore result in better clinical outcome.     

Weed vegetation (wild flora) of long established organic versus conventional cereal fields in Denmark

The vegetation of weeds was sampled in matched pairs of long established organic and contemporary conventional cereal fields in summer 1987, and in spring and summer 1988, with an extended Raunkiaer circle at distances up to 50 m from the field boundary. In spring 1988, the number of plants were also counted. Species density, plant density, a proxy measure of plant density (accumulated Frequency Sum), crop and weed biomass, and occurrence of plants assigned to functional groups, are compared between farming systems. The plants were assigned to functional groups according to: (i) herbivore associations to broad-leaved taxa and (ii) flower location in the canopy, i.e. visibility and availability to flying insects. Furthermore, crop margin and mid-field were compared concerning species density and accumulated Frequency Sum. All variables that differed among the two farming systems had highest values - often several times higher - in the organic system with four exceptions: total biomass, biomass of crop, proportion of a single broad-leaved taxon and of grasses. The differences between the two systems were largest mid-field due to a pronounced pre-herbicide spraying gradient in species and plant density from crop margin to mid-field in conventional fields. A similar gradient was not found in the organic fields.     

Characterisation of footpad lesions in organic and conventional broilers

Recent data suggest that organic broilers often score worse on footpad lesions than conventional broilers but also that the current scoring of organic broiler feet may be misleading. In order to characterise footpad lesions in organic broilers, this study assessed and compared footpad lesions in a sample of 2987 conventional and 3578 organic broiler feet obtained from a large Danish abattoir during summer and winter. The feet were scored according to two scoring systems: the modified Danish surveillance scoring system and a histopathology-based new scoring system specifically developed to target the ability to differentiate between broiler feet with hyperkeratosis and ulcers. For both systems, all broiler feet with visible lesions were cross-sectionally incised. Significant differences between the two production systems were found for both scoring systems (χ² = 710; P < 0.001 and χ² = 247; P < 0.001 for the new and the surveillance systems, respectively), showing that a larger proportion of the organic feet compared to conventional feet – summer and winter – exhibited signs of hyperkeratosis. In addition, a smaller fraction of the organic feet than of the conventional feet were given the outermost scores, that is, normal or ulcerated; 13.4% v. 25.3% broiler feet were given score 0 for organic v. conventional production systems, respectively (χ² = 152; P < 0.001), and 18.4% v. 23.8% feet were given score 4 for organic v. conventional production systems, respectively (χ² = 308; P < 0.001). Thus, the results suggest that surveillance scoring systems such as the one used in Denmark are useful for the examination of footpad lesions in broilers from both types of production systems. However, the results have also raised attention to a typical characteristic of the feet of organic broilers, that is, profound hyperkeratosis, which may underlie potential misclassifications in surveillance scoring systems like the one used in Denmark. Among the possible solutions to this challenge to the correctness and fairness of the scoring system are improved procedures (such as mandatory incision), training of technicians and calibration of results (especially for the organic footpads).     

MCP-1和VEGF与冠心病患者冠脉病变程度的关系及介入前后的变化和意义

目的:探讨单核细胞趋化蛋白1(MCP-1)和血管内皮生长因子VEGF与冠心痛患者冠脉病变程度的关系及介入前后的变化和意义.方法:选择经冠状动脉造影确诊的冠心痛患者105例,根据病变程度分为单支病变组(A组)、双支病变组(B组)和多支病变组(C组),同时选择经冠状动脉造影确诊的正常时照组35例(D组),采用双抗体夹心ELISA法洲定术前术后血清MCP-1和VEGF水平.结果:1.血清MCP-1水平测定结果冠心病组明显高于正常对照组,三支病变组高于双支病变组,双支病变组高于单支病变组,支架置入术后显著高于术前,差异均有统计学意义(P<0.01),对照组术前术后相比差异无统计学意义(P>0.05).2血清VEGF水平测定结果显示:冠心病组明显高于正常对照组,三支病变组高于双支病变组和单支病变组,差异均有统计学意义(P<0.01),双支病变组与单支病变组间差异无统计学意义(P>0.05),支架置入术后较术前显著降低(P<0.01),术后冠心病组与对照组相比差异无统计学意义(P>0.05),对照组术前术后差异无统计学意义(P>0.05).结论:冠心病患者血清MCP-1、VEGF水平与冠脉病变程度密切相关,介入治疗可影响冠心病患者血清MCP-1水平的升高和VEGF水平降低,监测血清中MCP-1和VEGF水平变化可了解治疗效果和炎症程度.     

Real-time PCR versus conventional PCR for malaria parasite detection in low-grade parasitemia

We have optimized a faster and cheaper real-time PCR and developed a conventional genus specific PCR based on 18S rRNA gene to detect malaria parasites in low-grade parasitemias. Additionally, we compared these PCRs to the OptiMAL-IT test. Since there is no consensus on choice of standard quantitative curve in real-time assays, we decided to investigate the performance of parasite DNA from three different sources: "genome", amplicon and plasmid. The amplicon curve showed the best efficiency in quantifying parasites. Both PCR assays detected 100% of the clinical samples tested; the sensitivity threshold was 0.5 parasite/mul and no PCR positive reaction occurred when malaria parasites were not present. Conversely, if OptiMAL-IT were employed for malaria diagnosis, 30% of false-negative results could be expected. We conclude that PCR assays have potential for detecting malaria parasites in asymptomatic infections, in evaluation of malaria vaccine molecule candidates, for screening blood donors, especially in endemic areas, or even in monitoring malaria therapy.     

Considerations of specimen damage for the transmission electron microscope, conventional versus scanning

We have previously shown that the transmission scanning electron microscope is capable of giving a resolving power equal to that of a conventional electron microscope, that it can be used to provide all the same contrast modes, but that it offers the advantage of new forms of contrast and can provide direct numerical outputs (Crewe &; Wall, 1970a,b; Crewe et al. 1970; Crewe, 1970).One question that we have not previously discussed is that of specimen damage, but in view of the similarity in performance between the two types of machine it has become important to do so.Recent remarks of Scherzer (1971) have been widely misinterpreted as indicating that the scanning microscope causes more specimen damage. However, he has confined his attention to the highest conceivable resolution of 0·4 Å, where we agree with his general conclusion (barring advances in scanning microscope technology). As we will demonstrate, the conclusion is not valid for normally attainable resolutions.     

A role for IFNgamma in differential superantigen stimulation of conventional versus plasmacytoid DCs

Superantigens (SAgs) are known to play a role in food poisoning, toxic shock syndrome and have been identified as a potential mediator of autoimmunity. Although much is known about the effects of SAgs on T cells, by comparison few studies have investigated how SAgs influence innate immune cells. In particular no study has examined how SAgs affect murine plasmacytoid dendritic cells (pDC). We report that in vivo administration of staphylococcal enterotoxin A (SEA) increased the number of pDCs in secondary lymphoid organs, and induced CD86 and CD40 expression. Similar to SEA activation of conventional DCs (cDCs), pDCs relied on T cells, but not on CD40. Nonetheless, pDCs strictly required IFNgamma for upregulation of CD86 and CD40, but cDCs did not depend upon IFNgamma for activation. Further, even though IFNgamma deficient pDCs were not activated by SEA, they were still capable of producing wild-type levels of IFNalpha in response to CpG oligodeoxynucleotide (ODN). The source of IFNgamma for pDC activation was not T cells, nor did pDCs themselves have to synthesize or bind IFNgamma, but the presence of IFNgamma was essential. After SEA stimulation, IFNgamma deficient mice fail to induce expression of the pDC dependent chemokines CXCL9, and demonstrated a defect in recruitment of pDCs to marginal zones of lymphoid organs. Thus, SEA exerts its combined effect on pDC activation, recruitment and chemokine induction through the action of IFNgamma. This fundamental dichotomy of the effects of SAgs on pDCs versus cDCs show how a non-PAMP from bacteria, can selectively and indirectly stimulate innate cell subpopulations much in the same way that differential TLR expression influences cells of the innate immune system.     

Position of intragastric balloons in global initiative for obesity treatment

Obesity is chronic disease with multiple health consequences and among the most severe health problems worldwide. According to public health records around 65% of population in Croatia are overweight and 20% obese. National physicians chamber with support of Health and Social Welfare Ministry gave recommendations on diagnosing and treating of obesity in form of national consensus. Treatment of obesity is complex and enrolls multiple clinical specialties. Change of life style, strenuous physical activity and pharmacotherapy are part of conservative treatments. Patients are treated more efficiently by minimally invasive endoscopic procedures or bariatric surgery depending on starting body mass index score. Implantation of intragastric balloons is conceptually simple method of obesity treatment. Modern devices as Bio-Enterics intragastric balloons (BIB), (Inamed Health, USA) are gaining wide popularity among both patients and physicians. BIB intragastric offers the best gains with individuals ranging BMI from 35 to 40. Efficiency has relative timeline dependance from 85% at 6 months to 24% at 36 months. BIB offers substantial ameliorative influence on obesity comorbidities, particularly cardiovascular risk. Treatment with BIB is also efficient but transient treatment modality in morbidly and superobese individuals to reduce preoperative risks of general and bariatric surgery. Obesity treatment with BIB is well tolerated and safe, offering better quality of life. Nevertheless, due to relative poor results of conservative obesity treatments on long-term follow up further investigations defining new clinical parameters for solving treatment resistance. In order to provide resourcefully individualized approach modern perspectives are focused on endocrine constitutes of obesity. Hormonal effects of BIB treatment in compare to bariatric surgery are potentially interesting for the prospect studies.     

Cost comparison of molecular versus conventional screening of relatives at risk for retinoblastoma.

To compare costs of molecular and conventional screening of retinoblastoma relatives, we evaluated the direct health care costs. With variables set at the most likely values (baseline), the expected cost (in 1994 Canadian dollars) of conventional screening was $31,430 for a prototype family consisting of seven at-risk relatives (three clinic exams and eight examinations under anaesthetic over the first 3 years of life for each relative). For the molecular strategy that involves looking for the RB1 gene mutation in the proband, testing the relatives for that mutation, and clinical follow-up similar to conventional strategy for relatives with mutation, the expected cost was $8,674, using baseline variables. Sensitivity analysis over the range of values for each variable revealed a significant saving of health care dollars by the molecular route, indicating the benefit of redirecting economic resources to molecular diagnosis in retinoblastoma.     

Pharmacokinetics of stealth versus conventional liposomes: effect of dose

Liposomes which substantially avoid uptake into the mononuclear phagocyte system (MPS), termed Stealth liposomes, have recently been formulated (Allen, T.M. and Chonn, A., (1987) FEBS Lett. 223, 42-46). The pharmacokinetics of stealth liposomes as a function of liposome dose and a comparison to conventional liposome pharmacokinetics, was the subject of the present study. We have examined the tissue distribution of two different formulations of stealth liposomes, i.e., sphingomyelin:egg phosphatidylcholine:cholesterol:monosialoganglioside GM1 (SM:PC:CHOL:GM1) 1:1:1:0.2 and SM:PC:CHOL:polyethylene glycol distearoylphosphatidylethanolamine (PEG(1990)-DSPE) 1:1:1:0.2, and compared them with the tissue distributions seen for a liposomal formulation which is avidly removed from circulation by the cells of the MP system (PC:CHOL, 2:1). Tissue distribution in mice was examined over a 100-fold concentration range (0.1 to 10 mumol phospholipid/mouse) and at several time points over a 48 h time period. Liposome size ranged from 92-123 nm in diameter for all compositions. Clearance from blood of PC:CHOL liposomes following intravenous administration showed a marked dose dependence (i.e., saturation-type or Michaelis-Menten kinetics), with MPS uptake decreasing and % of injected dose in blood increasing as dose increased, over the entire dosage range. Injection of stealth liposomes, on the other hand, resulted in % of injected doses of liposomes in MPS, blood and carcass which were dose-independent and log-linear (first order kinetics) over the entire dosage range. The doses of stealth liposomes containing PEG(1900)-DSPE required for MPS saturation was higher than 10 mumol phospholipid/mouse or 400 mumol/kg. The dosage-independence of the pharmacokinetics of stealth liposomes and their lack of MPS saturation within the therapeutic dose range are two more assets, in addition to the prolonged circulation half-lives, leading towards their eventual use as drug delivery systems in the clinic.     

TaqMan real-time PCR versus four conventional PCR assays for detection of apple proliferation phytoplasma

A recently developed TaqMan real-time PCR assay for detection of apple proliferation phytoplasma was evaluated in comparison to four conventional PCR-based methods with the aim to assess its potential for research and routine applications. All five protocols were tested in parallel on the same DNA isolates obtained from orchard trees. The performance of the methods was evaluated by means of sensitivity, specificity, susceptibility to inhibition, handling effort, testing time, assay expenses, and potential risk for operator and environment. Compared to the conventional PCR methods, the TaqMan real-time PCR procedure combined the highest test sensitivity with the highest test specificity and was, above all, not susceptible to PCR inhibition. Furthermore, TaqMan real-time PCR had the simplest and fastest testing process, involving a minimum of handling steps. Its disadvantage is the high cost of consumables and reagents, exceeding that of a standard PCR procedure up to four-fold. However, the higher material costs could be compensated by considerably lower personnel costs and by saving expenses for hazardous waste disposal. Due to the simple testing procedure and the output of results as numeric data the TaqMan real-time PCR assay has a high potential for automation, and seems to represent the currently most suitable method for large-scale testing procedures.     

Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography

Background

Computed tomography angiography (CTA) is required in the work-up for transcatheter aortic valve implantation (TAVI). However, CTA may cause contrast-induced acute kidney injury (CI-AKI). We hypothesised that a short (1?h, 3?ml/kg/h sodium bicarbonate) hydration protocol is not inferior to conventional (24?h, 1?ml/kg/h saline) hydration in avoiding a decline in renal function in patients with impaired renal function.

Methods and results

Single-centre randomised non-inferiority trial in patients with impaired renal function who underwent pre-TAVI CTA. Patients were randomised on a 1:1 ratio to short hydration (SHORT; 1?h sodium bicarbonate, 3?ml/kg/h) or conventional hydration (CONV; 24?h saline, 1?ml/kg/h). Outcomes included percentage change in serum creatinine until 2–6 days after CTA with a non-inferiority margin of 10% and an increase on the Borg dyspnoea scale ≥1 point. Seventy-four patients were included. Increase in creatinine was 6?µmol/l (95% CI 2.5–9.3) in the SHORT versus 2?µmol/l (95% CI-1.4 to 6.3) in the CONV arm (p?=?0.167). The percentage change was 4.6% (95% CI 2.0–7.3%) in the SHORT arm versus 2.5% (95% CI: 0.8 to 5.8%) in the CONV arm. The difference in percentage increase in creatinine between the two arms was 2.1% (95% CI: 2.0–6.2%; p-value non-inferiority: <0.001). CI-AKI and a need for dialysis were not observed. An increase of ≥1 point on the Borg scale (dyspnoea scale ranging from 1 (lowest) to 10 (highest)) was seen in 1 patient in the SHORT arm versus 5 patients in the CONV arm (2.9% vs 16.1%, p?=?0.091).

Conclusion

For patients with impaired renal function undergoing pre-TAVI CTA, a short 1?h, low-volume hydration protocol with sodium bicarbonate is not inferior to conventional 24-h, high-volume saline hydration.