Stent implantation in acute myocardial infarction using a heparin-coated stent: a pilot study as a preamble to a randomized trial comparing balloon angioplasty and stenting

Preliminary experience with primary stenting in myocardial infarction has suggested a greater benefit in clinical outcome than has been obtained with direct balloon angioplasty. However, subacute thrombosis (SAT) remains a limitation for this new mode of therapy. In the BENESTENT II Pilot and main trials, the incidence of SAT with the heparin-coated Palmaz-Schatz stent was only 0.15%. Therefore, as a preamble to a large randomized trial, the feasibility and safety of the use of the Heparin-Coated Palmaz-Schatz trade mark Stent in Acute Myocardial Infarction (AMI) was tested in 101 patients enrolled between April and September 1996 in 18 clinical centres. In 101 stent-eligible AMI patients, as dictated by protocol, a heparin-coated stent was implanted. The primary objectives were to determine the in-hospital incidence of major adverse cardiac events (MACE: death, MI, target lesion revascularization) and bleeding complications, while the secondary objectives were the procedural success rate and the MACE, the restenosis and reocclusion rates at 6.5 months. Stent implantation (n 3 129 stents) was successful in 97 patients of the 101 who were included in this trial. During their hospital stay, two patients died and no patient experienced re-infarction, ischaemia prompting re-PTCA or CABG. Four patients suffered a bleeding complication, three major and one minor, of whom three required surgical repair. At 210 days follow-up, 81% of the patients were event free. At 6.5 months restenosis was documented in 18% of the 88 patients who underwent follow-up angiography, including three total occlusions. The results, both with respect to QCA and the occurrence of MACE, compare favourably with studies using elective stenting in both stable and unstable angina patients. As a result of this pilot study, a large randomized trial comparing direct balloon angioplasty with direct stenting in 900 patients with AMI was initiated in December 1996.     

Genetic conflict outweighs heterogametic incompatibility in the mouse hybrid zone?

Background  

The Mus musculus musculus/M. m. domesticus contact zone in Europe is characterised by sharp frequency discontinuities for sex chromosome markers at the centre of wider clines in allozyme frequencies.     

D-Alanine substitution of teichoic acids as a modulator of protein folding and stability at the cytoplasmic membrane/cell wall interface of Bacillus subtilis

The extracytoplasmic folding of secreted proteins in Gram-positive bacteria is influenced by the microenvironment of the compartment into which they are translocated, namely the negatively charged matrix of the cell wall polymers. In this compartment, the PrsA lipoprotein facilitates correct post-translocational folding or prevents misfolding of secreted proteins. In this study, a secretion mutant of B. subtilis (prsA3) encoding a defective PrsA protein was mutagenized and screened for restored secretion of the AmyQ alpha-amylase. One mini-Tn10 insertion, which partially suppressed the secretion deficiency, was found to interrupt dlt, the operon involved in the d-alanylation of teichoic acids. The inactivation of dlt rescued the mutant PrsA3 protein from degradation, and the increased amount of PrsA3 was shown to enhance the secretion of PrsA-dependent proteins. Heterologous or abnormal secreted proteins, which are prone to degradation after translocation, were also stabilized and secreted in increased quantities from a dlt prsA(+) strain. Furthermore, the dlt mutation partially suppressed the lethal effect of PrsA depletion, suggesting that the dlt deficiency also leads to stabilization of an essential cell wall protein(s). Our results suggest that main influence of the increased net negative charge of the wall caused by the absence of d-alanine is to increase the rate of post-translocational folding of exported proteins.     

The auration of 2-hydroxy-pyridine (2-pyridone): preparative and structural studies and a comparison with reactions of related aliphatic O,N-donors

In a study of the isolobal analogy between the proton H⁺ and the ligand-backed gold(I) cations [(R₃P)Au]⁺, the reaction of the mixture of 2-pyridone/2-hydroxy-pyridine tautomers with [(Ph₃P)Au]BF₄ has been investigated. It affords the 1:1 complex with the gold atom N-bonded to the 2-hydroxy-pyridine tautomer: {(Ph₃P)Au[NC₅H₄-(OH-2)]}⁺BF₄ ⁻, which is related to known salts with the 2-hydroxy-pyridinium cation such as [HNC₅H₄(OH-2)]⁺Cl⁻. The structure was derived from analytical and spectroscopic data and from a comparison with the salt [(Ph₃P)Au(pyr)]BF₄, prepared and investigated structurally as a reference compound. An analogue was also prepared with 2-dimethylamino-ethanol as a substrate, which also affords the N-bonded complex [(Ph₃P)Au([Me₂NCH₂CH₂OH)]⁺BF₄ ⁻, the structure of which has been determined. The OH group is not attached to the gold atom but engaged in hydrogen bonding with the counterion. By contrast, in the complex [(Ph₃P)Au(Me₂NCH₂CH₂NMe₂)]⁺BF₄ ⁻ synthesized similarly with tmeda and crystallized as the dichloromethane solvate, one nitrogen atom is bonded firmly to the metal atom, but the second nitrogen atom is also weakly engaged in coordinative bonding. The compound is fluxional in solution, where a site exchange is observed which is rapid on the NMR time scale. The reaction of two equivalents of [(Ph₃P)Au]BF₄ with an alkali 2-pyridinolate, prepared from the above tautomeric mixture and sodium metal or a potassium alkoxide, yields the diaurated product {N,O-[(Ph₃P)Au]₂(NC₅H₄-O-2)}BF₄. In the crystal structure determination of a sesqui-solvate with dichloromethane it has been shown that one gold atom is attached solely to the nitrogen atom and the other solely to the oxygen atom. The dinuclear cations are associated into cyclic dimers through head-to-tail aurophilic bonding. From the geometrical characteristics of the core unit of the cations the ligand can be assigned a 2-pyridinolate form featuring pyridine and phenolate donor sites.     

Resistance to clofentezine and hexythiazox inPanonychus ulmi from apples in Australia

The ovicides clofentezine and hexythiazox have been used in Australia againstPanonychus ulmi (Koch) since 1984 and 1987, respectively. Failure of clofentezine in the field againstP. ulmi was first reported in early 1988. In 1988–89, laboratory bioassays were carried out against susceptible reference strains, and discriminating doses for clofentezine and hexythiazox established. Suspected resistant strains were tested, as were randomly collected strains.Panonychus ulmi from 23 apple orchards in eastern Australia were found to be resistant to clofentezine, and 19 of these strains were also resistant to hexythiazox. In all cases, a total of four or more ovicide sprays had been used. Of 15 samples ofP. ulmi from blocks where less than four ovicides had been used, none were resistant to either clofentezine or hexythiazox. A survey of orchards in the Orange district of New South Wales found that 30% had received four or more ovicide sprays and were likely to experience resistance problems. The control problems with clofentezine and hexythiazox means the few remaining acaricides will be subject to extreme selection pressure.