X-sizer for thrombectomy in acute myocardial infarction improves ST-segment resolution: results of the X-sizer in AMI for negligible embolization and optimal ST resolution (X AMINE ST) trial

OBJECTIVES: We sought to compare, in a prospective randomized multicenter study, the effect of adjunctive thrombectomy using X-Sizer (eV3, White Bear Lake, Minnesota) before percutaneous coronary intervention (PCI) versus conventional PCI in patients with acute myocardial infarction (AMI) for <12 h and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 to 1. The primary end point was the magnitude of ST-segment resolution after PCI. BACKGROUND: Despite a high rate of TIMI flow grade 3 achieved by PCI in patients with AMI, myocardial reperfusion remains relatively low. Distal embolization of thrombotic materials may play a major role in this setting. METHODS: We conducted a prospective, randomized, multicenter study in patients with AMI <12 h and initial TIMI flow grade 0 to 1 who were treated with primary PCI. The magnitude of ST-segment resolution 1 h after PCI was the primary end point. RESULTS: A total of 201 patients were included. Treatment groups were comparable by age (61 +/- 13 years), diabetes (22%), previous MI (8%), anterior MI (52%), onset-to-angiogram (258 +/- 173 min), and glycoprotein IIb/IIIa inhibitor use (59%). The magnitude of ST-segment resolution was greater in the X-Sizer group compared with the conventional group (7.5 vs. 4.9 mm, respectively; p = 0.033) as ST-segment resolution >50% (68% vs. 53%; p = 0.037). The occurrence of distal embolization was reduced (2% vs. 10%; p = 0.033) and TIMI flow grade 3 was obtained in 96% vs. 89%, respectively (p = 0.105). Myocardial blush grade 3 was similar (30% vs. 31%; p = NS). Six-month clinical outcome was comparable (death, 6% vs. 4% and major adverse cardiac and cerebral events, 13% vs. 13%, respectively). By multivariate analysis, independent predictors of ST-segment resolution >50% were: younger age, non-anterior MI, use of the X-Sizer, and a short time interval from symptom onset. CONCLUSIONS: Reducing thrombus burden with X-Sizer before stenting leads to better myocardial reperfusion, as illustrated by a reduced risk of distal embolization and better ST-segment resolution.     

Eimeria tenella: quantitative in vitro and in vivo studies on the effects of mouse polyclonal and monoclonal antibodies on sporozoites

Murine, polyclonal and monoclonal antibodies, raised against sporozoites of Eimeria tenella, were tested for their ability to neutralize sporozoite infectivity in vitro and in vivo. Neutralization was effected via three mechanisms. Firstly, sporozoites fixed complement, at low titres, and lysis occurred by the alternative pathway of complement activation. Secondly, in the absence of complement activity, the murine heat-inactivated, hyperimmune antiserum neutralized sporozoites at relatively low titres. At high titres, even though sporozoites were agglutinated, neither the heat-inactivated hyperimmune antiserum nor the monoclonal antibody neutralized sporozoites. Finally, in the presence of complement and specific antibodies, at titres which by themselves would not neutralize sporozoites, neutralization was effected due to lysis via the classical pathway of complement activation.     

Targeting Gonadotropin-releasing Hormone Receptor Inhibits the Early Step of Ovarian Cancer Metastasis by Modulating Tumor-mesothelial Adhesion

Ovarian cancer has a clear predilection to metastasize to the peritoneum, which represents one of the most important prognostic factors of poor clinical outcome. Gonadotropin-releasing hormone (GnRH) receptor is significantly overexpressed during the malignant progression of human ovarian cancer. Here, using lentiviral-based small interfering RNA (siRNA) technology to downregulate GnRH receptor in metastatic ovarian cancer cells, we show that GnRH receptor is an important mediator of ovarian cancer peritoneal metastasis. GnRH receptor downregulation dramatically attenuated their adhesion to the peritoneal mesothelium. By inhibiting the expression of GnRH receptor, we showed decreased expression of α2β1 and α5β1 integrin and adhesion to specific extracellular matrix (ECM) proteins. This was also associated with a reduction of P-cadherin. Furthermore, adhesion of ovarian cancer cells to different ECMs and the mesothelium were abrogated in response to β1 integrin and P-cadherin reduction, confirming that the effects were β1 integrin- and P-cadherin–specific. Using a mouse model of human ovarian cancer metastasis, we found that the inhibition of GnRH receptor, β1 integrin, and P-cadherin significantly attenuated tumor growth, ascites formation, and the number of metastatic implants. These results define a new role for GnRH receptor in early metastasis and offer the possibility of novel therapeutic targets.     

Cross-species bone marrow transplantation: evidence for recognition of skin-specific antigens across a species barrier (rat----mouse).

We have developed a model to study cross-species bone marrow transplantation and the associated donor-specific transplantation tolerance induced using fully xenogeneic chimeras. Reconstitution of lethally irradiated B10 mice with untreated F344 rat bone marrow cells results in fully xenogeneic chimerism (F344 rat----B10 mouse). Survival of recipients is excellent (greater than 80% at 100 days) and stable rat lymphoid and multilineage chimerism are present throughout the life of the chimeras. Recipients are specifically tolerant to donor-type skin xenografts yet are competent to reject major histocompatibility complex (MHC)--disparate third party strain rat xenografts. Although prolonged, donor-specific skin xenografts underwent chronic rejection which had its onset at approximately 40 days following skin graft placement. We have now examined these chimeras by serial flow cytometry typing to determine whether this is due to skin-specific antigens expressed on skin, but not on the bone marrow elements to which the chimeras were rendered tolerant. In all animals examined, lymphopoietic chimerism persisted unchanged even after the onset of inflammation in the grafts, suggesting the presence of skin specific antigens. This model may provide a method to study tissue and organ specific antigens recognized across a species barrier.     

Risk management issues related to the use of contrast agents

The authors reviewed retrospectively 2,100 claims filed over an 11-year period in 12 hospitals in a large metropolitan area covered by a single insurance carrier. One hundred cases (5%) involved radiologists, and 10 of these were related to the use of contrast media. Four of the cases reached financial settlement before trial, three were dropped with no financial settlement before tribunal or trial, one was dropped after a tribunal finding for the defendants, and two were decided in favor of the defendants at trial. Multiple issues were raised by the plaintiffs in all 10 cases. The questions of quality of care and of informed consent were raised in 10 and nine cases, respectively. In the four cases that reached a financial settlement, quality of care was thought to be an important issue in three, whereas informed consent was not a key issue in any. Conversely, adequate informed consent was an important consideration in three of the six cases that were dropped. Screening of patients and documentation of risk factors, adverse events, treatment, and follow-up were also important factors in determining outcome. The authors conclude that legal claims relating to use of contrast agents are unusual, most often involve non-life-threatening outcomes, and in most cases do not result in trial or a financial settlement.     

Anthropometric Studies of Human Subjects Susceptible to Malignant Hyperpyrexia

Height, weight, and skinfold thickness were measured on 82 patients prior to muscle biopsy which was performed to determine their susceptibility to malignant hyperpyrexia. Percentage body fat was calculated from the skinfold measurements. Using AP photographs six coronal diameters of the left thigh. equally spaced between the lower border of the patella and the perineum, were measured on another group of 90 patients referred for biopsy. The subjects were then divided into those who were susceptible to malignant hyperpyrexia (MHS) and those who were normal and acted as controls. Each group was separated into males and females. There was no significant difference in age between the MHS and the control groups. There was no difference between MHS and controls in height or weight but the percentage body fat in the MHS males was significantly lower than in the controls (P<0.02). The upper three thigh diameters in the MHS females were significantly greater than in the control group (P<0.05). There appears to be a difference in the leanness/fatness relationship and in the development of the thigh in MHS subjects compared with controls, but these differences are subtle and appear to vary with sex.