Stent Thrombosis is the Primary Cause of ST-Segment Elevation Myocardial Infarction following Coronary Stent Implantation: A Five Year Follow-Up of the SORT OUT II Study

Background

The widespread use of coronary stents has exposed a growing population to the risk of stent thrombosis, but the importance in terms of risk of ST-segment elevation myocardial infarctions (STEMIs) remains unclear.

Methods

We studied five years follow-up data for 2,098 all-comer patients treated with coronary stents in the randomized SORT OUT II trial (mean age 63.6 yrs. 74.8% men). Patients who following stent implantation were readmitted with STEMI were included and each patient was categorized ranging from definite- to ruled-out stent thrombosis according to the Academic Research Consortium definitions. Multivariate logistic regression was performed on selected covariates to assess odds ratios (ORs) for definite stent thrombosis.

Results

85 patients (4.1%), mean age 62.7 years, 77.1% men, were admitted with a total of 96 STEMIs, of whom 60 (62.5%) had definite stent thrombosis. Notably, definite stent thrombosis was more frequent in female than male STEMI patients (81.8% vs. 56.8%, p = 0.09), and in very late STEMIs (p = 0.06). Female sex (OR 3.53 [1.01–12.59]) and clopidogrel (OR 4.43 [1.03–19.01]) was associated with increased for definite stent thrombosis, whereas age, time since stent implantation, use of statins, initial PCI urgency (STEMI [primary PCI], NSTEMI/unstable angina [subacute PCI] or stable angina [elective PCI]), and glucose-lowering agents did not seem to influence risk of stent thrombosis.

Conclusion

In a contemporary cohort of coronary stented patients, stent thrombosis was evident in more than 60% of subsequent STEMIs.     

Merleau-Ponty’s Concept of Nature and the Ontology of Flesh

The essay attempts to delineate how Maurice Merleau-Ponty’s phenomenology of perception can be applied to theories of sign processes, and how it reworks the framework of the phenomenalist conception of communication. His later philosophy involved a reformulation of subjectivity and a resolution of the subject/object dualism. My claim is that this non-reductionist theory of perception reveals a different view of nature as we experience it in an expressive and meaningful interaction. The perspective that another living being has and communicates entails a form of depth, the invisible dimension of the visible or audible. These two aspects of perception and dialogue are intertwined in a dialectic of presence and absence, so that sense arises in the perceptual field rather than in subjectivity. This, I argue, is the most fundamental result of his theory. The origination of meaning in the workings of the chiasm of visible and invisible in perception opens up an objective sense of intersubjective nature. The essay also deals with the role of the phenomenological reduction; a suspension of beliefs and existence claims in experience. The reduction enables us to take a step back and look more closely at our understanding of nature in light of the historical and cultural influence on our thinking.     

Cutting edge: virus selectively primes human langerhans cells for CD70 expression promoting CD8+ T cell responses

The two outermost compartments of skin are populated by different Ag-presenting dendritic cell types. Epidermal Langerhans cells (LCs) are evolutionarily adapted to the continuous presence of harmless skin commensals by the selective lack of cell surface TLRs that sense bacteria. In this article, we analyze the ability of LCs and dermal dendritic cells (DDCs) to respond to virus infection. Live virus and intracellular TLR3-agonist dsRNA commit LCs more effectively than DDCs to stimulate naive CD8(+) T cell expansion and their differentiation into effector cells. This potent CD8(+) T cell-promoting capacity of LCs is causally related to high levels of virus-induced CD70 expression but not to IL-12 production. These data suggest a remarkable specialization of LCs in the induction of pathogen class-specific adaptive immunity. Whereas LCs ignore bacteria, they are superior to DDCs to initiate effective CD70-mediated CD8(+) T cells in response to virus stimulation.     

Early Impact of a National Multi-Faceted Road Safety Intervention Program in Mexico: Results of a Time-Series Analysis

Background

In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León.

Methods

An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999–2011 with dummy variables representing each intervention phase.

Results

In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city.

Conclusion

These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.     

Long distance dispersal in the assembly of floras: A review of progress and prospects in North America

Here, we review progress and prospects to explicitly test for long distance dispersal biogeographic events. Long distance dispersal represents a “jump” across some kind of barrier, such as a topographic feature or a zone of unsuitable climate and may include repeated jumps, or stepping‐stone dispersals. Long distance dispersals were considered integral for explaining the organization of biodiversity at large and small scales by early biogeographers, such as Darwin and Wallace. Darwin, Wallace, and others envisioned that long distance dispersals were predictable events because the vectors for dispersal, such as animals, winds, and currents, behaved in non‐random ways. However, these early biogeographers found that dispersal was hard to observe, and, later, with the advent of the theory of Continental Drift, vicariance became regarded as a better scientific explanation for the arrangement of biodiversity, because it represented a falsifiable hypothesis. Thus, long distance dispersal was reduced to a nuisance parameter in biogeography; a random possibility that could never fully be ruled out in a scenario in which evidence supported vicariance. Today, there is strong interest to more fully integrate long distance dispersal into understanding the assembly and organization of biodiversity on earth. In this review, we discuss progress and prospects for explicitly testing long distance dispersal hypotheses including through uses of molecular, morphological, paleontological, and informatics methods. We focus on hypothesis testing of long distance dispersals involved in the assembly of the flora of North America, which is a robust preliminary study system on account of its extant and extinct biodiversity being well‐catalogued.     

Paclobutrazol and Its Use in Fruit Production: A Review

There are documentary records referring to paclobutrazol (PBZ) as a growth bioregulator that inhibits the gibberellin synthesis and its application increases yields in fruit and vegetable crop productions. Its agronomic management includes it as an emerging technology to reduce vigour, promote flower induction and flower development in fruit trees with increased economic returns. Its use is banned in some countries because of concerns about residues that can cause harmful effects on the environment. Therefore, the aim of this article was to collect, analyse and summarise relevant information on the use of PBZ in fruit tree production and its possible risks to the environment. The results obtained indicated that the application of PBZ can be effective in solving some problems related to flowering if it is applied in the right amount and at the right time. However, it is necessary to elucidate the physiological processes with which it is associated and its response to be taken into account to increase yield. PBZ is currently used in fruit trees such as mango, lime, apple and guava, increasing their productivity. However, some studies have shown its residual effect on the environment. Therefore, PBZ is a viable strategy, because it presents a series of advantages in the production of fruit trees. However, it is vital to generate protocols that seek its regulation with a rational and sustainable approach.