Safety and efficacy of drug-eluting stents and bare metal stents in acute coronary syndrome

Compared with medical therapy, percutaneous coronary intervention has been shown to reduce the rates of death and recurrent ischemia in patients presenting with acute coronary syndromes (ACS). In the current interventional era, both drug-eluting stents (DES) and bare-metal stents (BMS) have been widely used, despite the fact that the use of DES in the context of ACS was initially an “off-label” indication and that ACS has been associated with stent thrombosis (ST). In contrast to the wealth of data available for the use of DES in patients with ST-elevation myocardial infarction, data regarding the performance of DES in non–ST-elevation ACS is restricted to a handful of registries with conflicting data. The aim of this review was to summarize the safety and efficacy of DES in the entire spectrum of ACS.     

Is there a correlation between time of delivery and newborn cord pH?

Purpose: Since more senior and attending physicians work in labor wards during morning shifts, we expect a better delivery outcome during that time period.

Materials and methods: A retrospective study was conducted between 1/2005 and 12/2014. Records of 56 428 singleton deliveries from a tertiary hospital in which cord blood pH was routinely measured at birth were analyzed. Time of birth was divided into shifts: 7 AM–3?PM (morning shift), 3?PM–11?PM (afternoon shift), and 11?PM–7 AM (night shift). Additional stratification compared weekdays and weekend deliveries.

Results: 19?601, 18?429, and 18?398 neonates were born during morning, afternoon, and night shifts, respectively. There was no significant difference in maternal age, neonatal weight, or mean 5-min Apgar score among the three shift periods. Furthermore, there was no correlation between shift time of delivery and newborn acidosis with respect to cord pH less than 7 (0.1% in each time periods, p?=?0.67). Despite the above, instrumental deliveries and cesarean sections were more common in the morning shift compared to the afternoon and night shift, respectively (p?=?0.001 each).

Conclusions: Although shift time of delivery was found to be related to mode of delivery it was not related to either 5-min Apgar score or newborn acidosis as reflected by cord pH.     

Involvement of the Pta-AckA pathway in protein folding and aggregation

Acetyl phosphate is a central metabolite involved in a broad range of versatile cellular functions. Recently it was observed that in Escherichia coli the acetyl phosphate pathway is required for efficient ATP-dependent proteolysis. Deletion of the operon coding for acetyl phosphate metabolism (ΔackApta) results in a very low cytoplasmic level of acetyl phosphate and impaired proteolysis. Here we show that the ΔackApta mutation affects additional components of the protein quality control system. Thus, this deletion is accompanied by a decrease in protein refolding and rescue from aggregates. These results indicate the involvement of the acetyl phosphate pathway in chaperone capabilities, in addition to their effect on proteolysis.     

Interplay between the heat shock response and translation in Escherichia coli

It is widely accepted that the heat shock response is critical for quality control of mature proteins. This function is carried out mainly by chaperones and proteases. Recently, a new group of conserved heat shock proteins essential for growth at high temperature has been characterized. These proteins are involved in regulating and maintaining efficient translation under heat shock.     

Thiazide diuretics and the risk for hip fracture

Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion.     

Use of ceramic water filtration in the prevention of diarrheal disease: a randomized controlled trial in rural South Africa and zimbabwe

To determine the effectiveness of ceramic filters in reducing diarrhea, we conducted a randomized controlled trial in Zimbabwe and South Africa, in which 61 of 115 households received ceramic filters. Incidence of non-bloody and bloody diarrhea was recorded daily over 6 months using pictorial diaries for children 24-36 months of age. Poisson regression was used to compare incidence rates in intervention and control households. Adjusted for source quality, intervention household drinking water showed reduced Escherichia coli counts (relative risk, 0.67; 95% CI, 0.50-0.89). Zero E. coli were obtained for drinking water in 56.9% of intervention households. The incidence rate ratio for bloody diarrhea was 0.20 (95% CI, 0.09-0.43; P < 0.001) and for non-bloody diarrhea was 0.17 (95% CI, 0.08-0.38; P < 0.001), indicating much lower diarrhea incidence among filter users. The results suggest that ceramic filters are effective in reducing diarrheal disease incidence.     

Two-year outcome of patients treated with sirolimus- versus paclitaxel-eluting stents in an unselected population with coronary artery disease (from the REWARDS Registry)

Multiple studies comparing sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with coronary artery disease have been performed. Despite these comparisons, it remains uncertain whether a differential in long-term efficacy and safety exists. Unselected patients treated exclusively with 1 drug-eluting stent type were enrolled in the Registry Experience at the Washington Hospital Center with Drug-Eluting Stents. There were 2,099 patients (3,766 lesions) treated with SES and 1,079 patients (1,850 lesions) treated with PES. Patients were followed at 30 days, 1 year, and 2 years for the clinical endpoints of death, myocardial infarction, target vessel revascularization, and definite and definite/probable stent thrombosis. Patients in the SES group had more dyslipidemia, history of congestive heart failure, and ostial lesions; patients treated with PES had more previous coronary artery bypass surgery, unstable angina, and type C lesions. At 2 years, unadjusted major adverse cardiac events (MACE) (22.6% vs 21.1%, p = 0.3) and target vessel revascularization (13.3% vs 11.2%, p = 0.1) were comparable. The incidence of definite stent thrombosis was higher in the SES group (1.8% vs 0.9%, p = 0.05) driven by early events. Similar results were seen after adjustment for baseline differences: MACE (hazard ratio 1.1, 95% confidence interval [CI] 0.9 to 1.3, p = 0.5), definite stent thrombosis (hazard ratio 2.3, 95% CI 1.0 to 5.2, p = 0.05), and target vessel revascularization (hazard ratio 1.1, 95% CI 0.9 to 1.4, p = 0.4). The incidence and rate of late stent thrombosis (>30 days) were similar (0.7% vs 0.5%, p = 0.4 and 0.24%/year, both groups, respectively). In conclusion, no major differential in long-term safety or efficacy was detected between SES and PES; both stent types were efficacious in reducing revascularization but were limited by a small continual increase in late stent thrombosis.