Paclitaxel-coated balloon treatment for functionally nonsignificant residual coronary lesions after balloon angioplasty

There is limited data on the efficacy of paclitaxel-coated balloon (PCB) compared to stents for de novo coronary lesions. The purpose of this study was to compare the efficacy of PCB treatment with stent implantation for de novo coronary lesions after successful plain old balloon angioplasty (POBA) guided by fractional flow reserve (FFR). In 200 patients scheduled for elective percutaneous coronary intervention (PCI) for de novo lesions, FFR was measured after POBA (POBA–FFR). If POBA–FFR was ≥?0.75, patients were treated with PCB (PCB group, n?=?78) or stent (Stent group, n?=?73). If POBA–FFR was <?0.75, stent was implanted as planned (Reference group, n?=?42). The primary endpoint was late lumen loss at 9 months and the secondary endpoint was adverse cardiac events (cardiac death, myocardial infarction, target lesion thrombosis, or repeat revascularization) at 12 months follow-up. There was no between-group differences in the POBA–FFR (0.87?±?0.05 in PCB, 0.89?±?0.06 in stent, p?=?0.101). At 9 months, late lumen loss was significantly lower in the PCB group compared to the Stent group (0.05?±?0.33 vs. 0.59?±?0.76 mm, p?<?0.001). Adverse cardiac events were not different between the PCB, Stent and Reference groups (2.6, 5.5, and 9.5% respectively; p?=?0.430 for PCB vs. Stent group; p?=?0.229 for the reference vs. both other groups). PCB treatment guided by POBA–FFR showed excellent 9 months angiographic and functional results, as well as comparable 12 months clinical outcomes, compared with stent implantation for de novo coronary lesions.     

Anatomical Morphometric Study of the Cervical Uncinate Process and Surrounding Structures

Objective

The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery.

Methods

Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots.

Results

The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4°. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side.

Conclusion

These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.     

The outcome of labor at the University Teaching Hospital (CHU), Yaounde, Cameroon

The University Teaching Hospital, Yaounde, Cameroon became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from casenotes, annual reports, delivery and operation registers. The maternal mortality rate (MMR) is one of the lowest in Africa. The perinatal mortality is low but could be improved upon. The reasons for the low MMR is discussed. It is possible to reduce the appalling MMRs of developing countries without sophisticated technologies.     

The management of pre-invasive cervical lesions using cryotherapy in Yaounde, Cameroon.

Cervical cancer is the commonest gynaecological malignancy in developing countries. The pre-invasive lesion often starts more than a decade before it becomes overt cancer. In this study most patients were in their third or fourth decade of life and had been pregnant at least once. Cryotherapy has been shown in this study to be an effective method of treating pre-invasive lesions. The cure rate after 1 year follow-up following single treatment was 93.1%. Follow-up visits are important and can improve the results to near perfection if patients are properly selected for such conservative management. The complication rate of cryotherapy is low and mainly involves excessive mucoid discharge which lasts for a few weeks. It is our opinion that the technique be popularised in developing countries, as a cost-effective method for the management of pre-invasive lesions.     

3D‐QSAR studies of cytotoxic heterocyclic quinones using calculated reduction potential

Most quinones with 2–4 fused aromatic rings exhibit cytostatic activity via DNA intercalation that causes enzyme blockade and reading errors during the replication process. The redox activity of quinones plays a role in the DNA cleavage mediated by oxygen or sulfur radicals. To develop novel anticancer agents based on nitrogen‐containing heterocyclic quinones, pharmacophore models of representative molecules with high activity were generated using Genetic Algorithm with Linear Assignment of Hypermolecular Alignment of Database (GALAHAD). A series of compounds were aligned to the selected pharmacophore model and the 3D‐quantitative structure activity relationships (QSAR) were analyzed using comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA), resulting in q² values of 0.734 and r² of 0.951, and q² of 0.803 and r² of 0.917, respectively, in each study. In addition, the potentials for the one‐electron reduction of quinones were calculated from LUMO energies using the semi‐empirical Austin Model 1 (AM1) method. These also showed a good correlation (r² of 0.816) with the cytotoxic activities of the quinones. Drug Dev Res 2009. © 2009 Wiley‐Liss, Inc.     

Ketorolac amide prodrugs for transdermal delivery: stability and in vitro rat skin permeation studies

Various amide prodrugs of ketorolac were synthesized and their rat skin permeation characteristics were determined. The solubility of the prodrugs in propylene glycol (PG) was determined at 37 degrees C while lipophilicity was obtained as 1-octanol/water partition coefficient (logP) and capacity factor (k') using HPLC. Stability of the prodrugs in rat skin homogenate, plasma and liver homogenate was investigated to observe the enzymatic degradation. Rat skin permeation characteristics of the prodrugs saturated in PG were investigated using the Keshary-Chien permeation system at 37 degrees C. The logP value of the prodrugs increased up to 4.28 with the addition of various alkyl chain to ketorolac which has a logP of 1.04. Good linear relationship between logP and capacity factor was observed (r(2)=0.89). Amide prodrugs were converted to ketorolac only in rat liver homogenate. However, the skin permeation rate of amide prodrugs did not significantly increase, probably due to their low aqueous solubility. Chemical modification of the ketorolac amide prodrug and/or the selection of proper vehicle to increase aqueous solubility would be necessary for an effective transdermal delivery of ketorolac.