Three-year Follow-up of Patients With Bifurcation Lesions Treated With Sirolimus- or Everolimus-eluting Stents: SEAside and CORpal Cooperative Study

Introduction and objectives

To compare the 3-year incidence of major events in patients with bifurcation lesions treated with provisional sirolimus-eluting stents vs everolimus-eluting stents.

Methods

A pooled analysis of 2 prospective randomized trials with similar methodology (SEAside and CORpal) was performed. In these trials, 443 patients with bifurcation lesions were randomly assigned to treatment with either sirolimus-eluting stents or everolimus-eluting stents. The clinical follow-up was extended up to 3 years to assess major adverse cardiovascular events (death or acute myocardial infarction or target vessel revascularization).

Results

At 3 years, survival free of major adverse cardiovascular events was 93.2% vs 91.3% in the everolimus-eluting stent group vs the sirolimus-eluting stent group (P = .16). Exploratory land-mark analysis for late events (occurring after 12 months) showed significantly fewer major adverse cardiovascular events in the everolimus-eluting stent group: 1.4% vs 5.4% in the sirolimus-eluting stent group (P = .02).

Conclusions

Provisional stenting with either sirolimus-eluting stents or everolimus-eluting stents in bifurcation lesions is associated with low rates of major adverse events at 3-years’ follow-up. The results of a subanalysis of events beyond 1 year, showing a lower event rate with everolimus-eluting stents than with sirolimus-eluting stents, suggest that studies exploring the long-term clinical benefit of the latest generation of drug-eluting stents are warranted.     

Cerebral vein thrombosis in patients with Philadelphia‐negative myeloproliferative neoplasms An European Leukemia Net study

To investigate the characteristics and clinical course of cerebral vein thrombosis (CVT) in patients with myeloproliferative neoplasms (MPN) we compared 48 patients with MPN and CVT (group MPN‐CVT) to 87 with MPN and other venous thrombosis (group MPN‐VT) and 178 with MPN and no thrombosis (group MPN‐NoT) matched by sex, age at diagnosis of MPN (±5 years) and type of MPN. The study population was identified among 5,500 patients with MPN, from January 1982 to June 2013. Thrombophilia abnormalities were significantly more prevalent in the MPN‐CVT and MPN‐VT than in MPN‐NoT group (P = 0.015), as well as the JAK2 V617F mutation in patients with essential thrombocythemia (P = 0.059). Compared to MPN‐VT, MPN‐CVT patients had a higher rate of recurrent thrombosis (42% vs. 25%, P = 0.049) despite a shorter median follow‐up period (6.1 vs. 10.3 years, P = 0.019), a higher long‐term antithrombotic (94% vs. 84%, P = 0.099) and a similar cytoreductive treatment (79% vs. 70%, P = 0.311). The incidence of recurrent thrombosis was double in MPN‐CVT than in MPN‐VT group (8.8% and 4.2% patient‐years, P = 0.022), and CVT and unprovoked event were the only predictive variables in a multivariate model including also sex, blood count, thrombophilia, cytoreductive, and antithrombotic treatment (HR 1.97, 95%CI 1.05–3.72 and 2.09, 1.09–4.00, respectively). Am. J. Hematol. 89:E200–E205, 2014. © 2014 Wiley Periodicals, Inc.     

Cell sheets of human dental pulp stem cells for future application in bone replacement

Objectives

To analyze the potential of human dental pulp stem cells (hDPSCs) for maintaining their undifferentiated status and osteogenic differentiation capacity when arranged in cell sheets (CSs) for future application in bone replacement.

Materials and methods

CSs were formed after being induced for 10–15 days by clonogenic medium containing additional vitamin C (20 μg/ml). The cell viability of hDPSC4s in the CSs was followed until 96 h using the Live/Dead® assay. The cells of the CSs were enzymatically dissociated and then compared with the original hDPSC4s. The two cell types were characterized immunophenotypically by flow cytometry using specific mesenchymal stem cell-associated markers (CD105, CD146, CD44, STRO-1, and OCT3/4) and non-associated markers (CD34, CD45, and CD14). Osteogenic differentiation was analyzed with the Alizarin red assay.

Results

Living cells were observed until 96 h in the CSs. Both cell types exhibited osteogenic differentiation and expressed the specific undifferentiated MSC-associated markers. Cells spontaneously detached from the CSs attached and proliferated at the bottom of the culture dishes.

Conclusions

Cells in the hDPSC4s cell sheets survived for at least 96 h. Moreover, the cells in the cell sheets retained their stemness and their osteogenic differentiation potential.

Clinical relevance

Cell sheets of hDPSCs could be employed as natural tri-dimensional structures for treating bone loss. This technique would be useful particularly for critical bone defects or any type of bone defects in patients carrying diseases that impair bone regeneration, such as diabetes mellitus, medication-related osteonecrosis of the jaw (MRONJ), and osteoporosis.

     

From the Cover: Proton transfers are key elementary steps in ethylene polymerization on isolated chromium(III) silicates

Mononuclear Cr(III) surface sites were synthesized from grafting [Cr(OSi(O^tBu)₃)₃(tetrahydrofurano)₂] on silica partially dehydroxylated at 700 °C, followed by a thermal treatment under vacuum, and characterized by infrared, ultraviolet-visible, electron paramagnetic resonance (EPR), and X-ray absorption spectroscopy (XAS). These sites are highly active in ethylene polymerization to yield polyethylene with a broad molecular weight distribution, similar to that typically obtained from the Phillips catalyst. CO binding, EPR spectroscopy, and poisoning studies indicate that two different types of Cr(III) sites are present on the surface, one of which is active in polymerization. Density functional theory (DFT) calculations using cluster models show that active sites are tricoordinated Cr(III) centers and that the presence of an additional siloxane bridge coordinated to Cr leads to inactive species. From IR spectroscopy and DFT calculations, these tricoordinated Cr(III) sites initiate and regulate the polymer chain length via unique proton transfer steps in polymerization catalysis.Almost half of the world’s high-density polyethylene is produced by the Phillips catalyst, a silica-supported chromium oxide (CrO_x/SiO₂) (1). This catalyst is prepared by incipient wetness impregnation of a chromium salt on silica, followed by high temperature calcination. Contacting this material with ethylene forms the active reduced species in situ that polymerizes ethylene. The Phillips catalyst is active in the absence of activators that are typically required for polymerization catalysts (2). Despite 50 y of research, the catalytically active site and the initiation mechanism, particularly the formation of the first Cr–C bond, remain controversial. Numerous spectroscopic techniques [infrared (IR), ultraviolet-visible (UV-Vis), electron paramagnetic resonance (EPR), X-ray absorption spectroscopy (XAS), etc.] established that the Phillips catalyst contains a complex mixture of surface Cr species, of which only ∼10% are active in polymerization (3, 4). The low number of active sites is one of the main limiting factors in using spectroscopic methods to study this material because the spectroscopic signature mainly belongs to inactive species.Previous molecular approaches to determine the Phillips catalyst ethylene polymerization mechanism focused on systems containing preformed Cr–C bonds (5–7). We recently reported the preparation of well-defined silica-supported Cr(II) and Cr(III) dinuclear sites (8), where Cr(III) species are active polymerization sites, in contrast to Cr(II), which is consistent with extensive research on homogeneous chromium complexes (9–11). We proposed that these well-defined Cr(III) silicates initiate polymerization by the heterolytic cleavage of a C–H bond of ethylene on a Cr–O bond to form a Cr–vinyl species that is capable of inserting ethylene by a Cossee–Arlman mechanism (8). However, extensive studies on Phillips catalyst invoke mononuclear polymerization sites (12–18). Furthermore, direct evidence of the active site structure and the polymerization mechanism is critically needed. Here we investigate the preparation and the detailed characterization of isolated Cr(III) sites supported on silica, prepared by grafting [Cr^III(OSi(O^tBu)₃)₃(tetrahydrofurano; THF)₂] (19) on dehydroxylated silica and a subsequent thermal treatment under vacuum. These isolated Cr(III) sites are highly active in ethylene polymerization in the absence of coactivator. Computational investigations in combination with IR spectroscopy indicate that polymerization occurs on tricoordinate Cr(III) sites and involves two key proton transfer steps: (i) formation of the first Cr–C bond through the C–H activation of ethylene across a Cr–O bond and (ii) termination by the microreverse of the initiation step while chain growth occurs by classical Cossee–Arlman insertion polymerization (20, 21).