Presentation and clinical course of pediatric-onset versus adult-onset Takayasu arteritis—a systematic review and meta-analysis

Clinical Rheumatology - Takayasu arteritis (TAK) is a less common large-vessel vasculitis which can occur in either children or adults. However, differences between pediatric-onset and adult-onset...     

Twelve-month outcomes with a paclitaxel-eluting stent transitioning from controlled trials to clinical practice (the WISDOM Registry)

The WISDOM Registry tracked clinical outcomes in patients receiving a slow-release, polymer-based, paclitaxel-eluting stent during the transition from randomized trials to commercial use in everyday interventional cardiology practice. Although randomized trials of drug-eluting stents have demonstrated the safety and effectiveness of these devices in less complicated, de novo lesions, observation of long-term clinical outcomes is required to monitor safety as use of this revolutionary technology expands to broader patient populations. In total, 778 patients were enrolled at 22 sites in 9 countries where the TAXUS paclitaxel-eluting stent first received market approval. Patients with de novo or restenotic coronary lesions eligible for stenting were enrolled. Clinical follow-up was conducted by telephone at 3, 6, 9, and 12 months after the procedure to capture reported stent thrombosis and major cardiac events (death, myocardial infarction, and reintervention on the target lesion). Clinical follow-up at 12 months was completed for 92% of patients. The 12-month rate of physician-reported major cardiac events was 5.2%, with a target lesion reintervention rate of 2.0%. The low overall stent thrombosis rate of 0.6% included no stent thromboses >30 days after the index procedure. Low target lesion reintervention rates were also observed in the high-risk subgroups: patients with diabetes (4.0%), vessels <2.5 mm (2.5%), lesions >20 mm (3.6%), and multiple stents in a lesion (1.4%). In conclusion, the paclitaxel-eluting TAXUS slow-release stent exhibits long-term safety and efficacy in uncomplicated and higher risk patients and lesions seen in everyday clinical practice.     

Impact of catheter sizes and intracoronary glyceryl trinitrate on the TIMI frame count when digital angiograms are acquired at lower frame rates during elective angiography and PCI

The TIMI frame count (TFC) is a useful measure of coronary flow. To be widely applicable, the effect of different catheter sizes and the use of intracoronary glyceryl trinitrate (ICGTN) must be determined when films are acquired at lower acquisition rates (12.5 frames/s, f/s). METHODS: We compared 6F versus 5F diagnostic catheters (n = 44), 6F versus 7F diagnostic catheters (n = 45) and 6F diagnostic versus 7F guide catheters (n = 44). In the nitrate angiography group (n = 141), coronary angiography was performed before and after 200 micrograms of ICGTN. In the nitrate percutaneous coronary intervention (PCI) group (n = 48), coronary angiography was performed before and after 200 micrograms of ICGTN after the completion of the elective PCI procedure. RESULTS: The mean difference in the uncorrected TFC using 6F and 5F was 0.02 (95 % CI -0.5, 0.6; P = 0.9); using 6F and 7F diagnostic catheters it was 0.3 (95% CI -0.49, 1.1; p = 0.4); and using 6F diagnostic and 7F guide catheters it was 0.4 (95% CI -2.6, 3.4; P = 0.7) respectively. In the nitrate angiography group, the uncorrected TFC before and after ICGTN was 13.1+/-6.2 and 15+/-7.5 (equivalent to 31.4+/-14.9 and 36+/-2 at 30 f/s), with a mean difference of 1.9 (95% CI 1.3, 2.5; P = or <0.0001). In the nitrate PCI group, the uncorrected TFC before and after ICGTN administration was 9.2+/-3.7 and 10.3+/-4.2 (equivalent to 22.6+/-9.6 and 25.2+/-11 at 30 f/s) respectively with a mean difference between the two injections of 1.2 (95% CI -0.4, 1.9; P = 0.003). CONCLUSION: We have demonstrated that the catheter sizes did not significantly affect the TFC when angiography was performed at 12.5f/s. The use of ICGTN significantly increased the TFC in both normal and diseased coronary arteries. This effect was also observed when ICGTN was administered into the culprit vessels after the completion of the elective PCI procedure. This effect must be considered when investigating the impact of specific treatments or drugs on coronary flow.     

Lower Frequency and Diversity of Antibiotic-Producing Fluorescent Pseudomonads in Rhizosphere of Indian Rapeseed–Mustard (<Emphasis Type="Italic">Brassica juncea</Emphasis> L. Czern.)

Fluorescent pseudomonads are one of the most important microbial communities which play a key role in rhizosphere to enhance plant growth-promotion and protection. The diverse groups of antibiotics viz. 2,4-diacetylphloroglucinol (DAPG), phenazine-1-carboxylic acid (PCA) and pyoluteorin (PLT) are produced by fluorescent pseudomonads inhibiting growth of fungal pathogens which results in health upliftment of plants. The present study, discusses about frequency and diversity of 138 antibiotic-producing fluorescent pseudomonads isolated from eight genotypes of rapeseed mustard rhizosphere (Brassica juncea L. Czern.). The plant growth promoting traits and antibiotics (DAPG, PCA and PLT) production of isolates were examined by using polymerase chain reaction (PCR), thin layer chromatography (TLC) and dot blot-hybridization. Among 138 isolates, 47, 25 and 9 % of isolates were positive in indole production, phosphate solubilization and antagonism potential against Sclerotinia sclerotiorum (causal agent of white mold disease in rapeseed mustard), respectively. PCR amplifications showed that none of the isolates had phlD (DAPG) and phzC (PCA) genes, but four isolates (UKA-2, UKA-8, UKA-11, UKA-66) had pltB (PLT) gene, which was further confirmed by TLC and DNA dot-blot hybridization. BOX profiles of pltB positive isolates were distinct, showing unique genetic diversity in the small population. The four pltB positive fluorescent pseudomonad isolates could be used as promising bio-control and plant growth-promoting inoculants for Indian rapeseed mustard.     

Clinical Outcome in Elderly Patients on Chronic Peritoneal Dialysis: A Retrospective Study from a Single Center in China

♦ Objectives: We aimed to evaluate clinical outcomes and identify the predictors of mortality in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD).♦ Methods: This retrospective cohort study included all incident CAPD patients treated at our center from 2006 to 2009. Demographic and clinical data on initiation of CAPD and clinical events during the study period were collected. Survival probabilities were generated using the Kaplan-Meier method, and risk factors for mortality were evaluated using Cox proportional hazards models.♦ Results: Of 805 patients on CAPD, the elderly group (≥65 years; mean age: 71.3 ± 4.3 years) consisted of 148 patients, and the younger group (<65 years; mean age: 43.1 ± 12.2years) consisted of 657 patients. The 1-, 2-, 3-, and 5-year patient survival rates were 97%, 92%, 88%, and 73% for the younger group, and 79%, 67%, 56%, and 30% for elderly group. The patient survival rates were significantly lower for the elderly group than for the younger group (p = 0.000). However, technique survival did not significantly differ between the groups (p = 0.559). In the patients overall, the independent predictors of death were old age (p = 0.003), diabetes (p = 0.000), cardiovascular disease (p = 0.006), lower hemoglobin (p = 0.010), and lower serum albumin (p = 0.024). Mortality in the elderly patients was associated with advanced age [relative risk (RR): 1.088; 95% confidence interval (CI): 1.027 to 1.153; p = 0.004], diabetes (RR: 2.064; 95% CI: 1.236 to 3.445; p = 0.006), and lower serum albumin (RR: 0.940; 95% CI: 0.897 to 0.985; p = 0.010).♦ Conclusions: The elderly patients on CAPD experienced technique survival comparable with that of younger patients, but their patient survival was lower. In elderly patients, mortality was determined predominantly by greater age, diabetes, and lower serum albumin. Our results indicate that chronic peritoneal dialysis is a viable dialysis option for elderly patients with end-stage renal disease. Better management of hypoalbuminemia and comorbid conditions might improve survival in elderly PD patients.Key words: ESRD, elderly patients, patient survival, technique survivalChronic kidney disease is a serious public health problem associated with an increasing prevalence, rising health care costs, and high rates of mortality from comorbid conditions. The world’s population is aging. Currently, it is estimated that people more than 65 years of age represent approximately 420 million (about 7%) of the global population (1). According to recent data from the US Renal Data System, the end-stage renal disease (ESRD) population reached a new high in 2010, with 594 374 patients under treatment (2, Vol. 2, p. 166). Since 2000, the adjusted ESRD incidence rate has grown by 12.2% for patients 75 years of age and older, to 1773 per million population (pmp) in 2010 (2, Vol. 2, p. 219). China experienced a significant increase in ESRD patients on maintenance hemodialysis (HD) or peritoneal dialysis (PD), with an estimated prevalence at the end of 2007 of 51.7 pmp that grew to 79.1 pmp by the end of 2008 (3).Most studies have shown the superiority of PD over HD for elderly ESRD patients (4-6). The problems well known to occur during HD (hypo- or hypertension, arrhythmia, angina pectoris, and variations in volume) can, especially in the elderly, lead to a marked deterioration in clinical condition that can be prevented by prescribing PD for elderly ESRD patients. When medical teams face the choice of dialysis therapy in elderly patients, PD is frequently considered because PD better preserves residual renal function, avoids large volume and electrolyte shifts, provides better cardiovascular stability, and avoids the need for vascular access (4). However, findings concerning outcomes in elderly patients on continuous ambulatory PD (CAPD) are still discordant. Reports about elderly patients on CAPD are still scarce, and no study of this kind has been conducted in patients from Mainland China, although a few reports from Hong Kong are available. We therefore retrospectively analyzed a cohort of elderly PD patients to determine clinical outcomes and identify the factors influencing patient survival.     

Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: a 30-day follow-up study.

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost-effective, small-molecule GP IIb/IIIa blocker with a shorter half-life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 microg/kg 10 min apart and a 24-hr infusion of 2 microg/kg/min). Clinical outcomes were evaluated at 30 days after the procedure. The angiographic patency of the vessel with TIMI flow rates, TIMI myocardial perfusion (TMP) grade, and corrected TIMI frame counts were assessed at the end of procedure and before hospital discharge. At 30 days, the primary endpoint, a composite of death, myocardial infarction, and urgent target vessel revascularization (TVR) was seen in 12.7% of patients. The TIMI 3 and TMP grade 3 flow, which was seen in 93% and 86% of patient, respectively, at the end of the procedure, declined to 86% and 78%, respectively (P < 0.05) before hospital discharge. Corrected TIMI frame counts also decreased from 25.7 +/- 7.2 to 22.9 +/- 6.8 (P < 0.05). There were five (9.1%) instances of subacute thrombosis (SAT) presenting as AMI, needing urgent TVR in all, within 3-5 days of the primary procedure. No excessive bleeding complication, directly attributable to the use of eptifibatide, was observed. The study was terminated prematurely because of an unacceptable SAT rate. Administration of eptifibatide along with primary stenting for AMI is associated with a high TIMI 3 and TMP grade 3 flow acutely. However, these flows decline significantly before hospital discharge and lead to a high rate of SAT. The dosage and duration of infusion of eptifibatide in this setting needs further evaluation.