Drug-eluting stent supported percutaneous coronary intervention for unprotected left main disease.

OBJECTIVES: This study sought to determine the clinical and angiographic outcomes of unselected patients receiving drug-eluting stents for unprotected left main disease. BACKGROUND: The results of several series of percutaneous coronary intervention (PCI) for left main disease in the pre-drug-eluting stent era have arisen concerns on the safety and mid-term efficacy of PCI. METHODS: Consecutive patients with unprotected left main disease were considered eligible for drug-eluting stent supported PCI. The surgical risk score (risk of death within 1 month) of each patient was calculated according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. RESULTS: One-hundred and one patients with unprotected left main disease underwent PCI. The mean EuroSCORE was 19 +/- 23. Successfully left main stenting was performed in 98 patients (primary success rate 97%). The overall 1-month mortality rate was 9.9%. The 1-month mortality rate was 50% in patients with acute myocardial infarction (AMI) on presentation, and 4.5% in patients without AMI on presentation. The 1-month mortality rate of patients with a risk score <13 was 3%, while it was 21% in patients with a risk score >or=13. At 6 months, the mortality rate of the entire cohort of patients increased to 12.8%, and the one of the non-AMI patients to 7.8%. Survival rate was 86% +/- 4% (mean follow-up 295 +/- 175 days). Target vessel revascularization was performed in 14 patients (16%). The 6-month in-segment restenosis rate was 16%. CONCLUSION: Drug-eluting stent supported PCI may provide early and mid-term outcomes comparable or superior to those expected from coronary artery surgery. (c) 2006 Wiley-Liss, Inc.     

Overlapping syndromes in laminopathies: a meta-analysis of the reported literature

Mutations on the LMNA gene are responsible for an heterogeneous group of diseases. Overlapping syndromes related to LMNA gene alterations have been extensively reported. Study scope is to perform a systematic analysis of the overlapping syndromes so far described and to try to correlate the clinical features to the associated genetic alterations. We evaluated all the dominant overlapping syndromes reported by means of a PubMed search and by the analysis of the main databases containing the pathogenic LMNA gene variations and the associated diseases.Metabolic alterations in association to skeletal and/or cardiac alterations proved to be the most frequent overlap syndrome. Overlapping syndromes are mostly associated to inframe mutations in exons 1, 2, 8 and 9. These data further improve the understanding of the pathogenesis of laminopathies.Key words: Lamin A/C, laminopathies, LMNA overlapping syndromes     

A comparison of the half-life of inorganic and organic tin in the mouse.

Tin-113-labeled bis-tributyltin oxide, TBTO, has been prepared from metallic ¹¹³Sn. The half-life of the organotin has been compared with inorganic tin in the mice using a whole-body counter. The biological half-life of inorganic tin, 29 days, was not changed by injection of an excess of unlabeled tin. During the first several days TBTO was cleared rapidly from the body of the mouse. At later times the turnover rate of TBTO in the mice appeared to become asymptotic to that of inorganic tin.     

The receptor for tumor necrosis factor on murine astrocytes: Characterization,intracellular degradation,and regulation by cytokines and theiler's murine encephalomyelitis virus

Oligodendrocytes were studied in the anterior medullary velum (AMV) of the rat using the monoclonal antibody Rip, an oligodendrocyte marker of unknown function. Confocal microscopic imaging of double immunofluorescent labelling with antibodies to Rip and carbonic anhydrase II (CAII) revealed two biochemically and morphologically distinct populations of oligodendrocyte which were either Rip + CAII + or Rip + CAII−. Double immunofluorescent labelling with Rip and myelin basic protein (MBP) or glial fibrillary acidic protein (GFAP) provided direct evidence that Rip-labelled cells were phenotypically oligodendrocytes and confirmed that Rip did not recognise astrocytes. Oligodendrocytes which were Rip+CAII+ supported numerous myelin sheaths for small diameter axons, whilst Rip+CAII− oligodendrocytes supported fewer myelin sheaths for large diameter axons. Morphologically, Rip+CAII+ oligodendrocytes corresponded to types I or II of classical nomenclature, whilst Rip+CAII− oligodendrocytes corresponded to types III and IV. The results demonstrated a biochemical difference between oligodendrocytes which myelinated small and large diameter fibres. © 1995 Wiley-Liss, Inc.     

Steroid-free immunosuppression regime reduces both long-term cardiovascular morbidity and patient mortality in renal transplant recipients

The aim of this retrospective study was to assess the impact of steroid therapy on cardiovascular disease (CVD) and patient mortality, in 486 on-CsA renal transplant recipients, with a follow-up of 9.5 +/- 4.3 yr. Two hundred and one patients had their steroids permanently withdrawn at sixth month after transplantation (G1); 285 patients did not (G2) as they were unable (acute rejection after suspension) or unsuitable (because of clinical criteria or immunosuppressive protocols). The CVD considered were coronary artery disease diagnosed by angiography and myocardial infarction. G1 and G2 patients were well-matched regarding CVD risk factors, except for age (G1: 44 +/- 14 yr; G2: 40 +/- 12 yr; p < 0.003), incidence of male (G1: 62%; G2: 72%, p < 0.02) incidence of acute rejection (G1: 39%; G2: 83%, p < 0.0001). Both CVD and deaths occurring during the first year of transplantation were excluded from the analysis. At 20 yr, the cumulative probability of developing a CVD, was 3.8% in G1; 23.8% in G2 (p < 0.0005). Patient survival rate was 95% in G1; 62% in G2 (p < 0.003). Mortality caused by CVD was higher in G2 (4.2% vs. 0.5%; p < 0.03). The Cox analysis identified in steroid therapy the main independent risk factors for both CVD (hazard ratio 9.56 p < 0.0001) and patient mortality (hazard ratio 5.99, p < 0.0001). At 10th and 15th year after transplantation, the mean-daily dose of steroids was 4.2 mg. In the long-term, steroid therapy, even in low-doses, increases significantly both the rate of CVD and patient mortality. This retrospective study suggests that steroid-free regime should always be recommended for the prevention of post-transplant CVD. This relevant statement should be followed by a long-term prospective study.     

Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy

CONTEXT: Although the prognosis of papillary thyroid microcarcinoma (PTMC) is usually excellent, the optimal follow-up strategy has never been investigated. OBJECTIVE: The objective of the study was to investigate the role of neck ultrasonography (US), whole-body scintigraphy (WBS), and serum thyroglobulin levels (Tg) after recombinant human (rh) TSH in the follow-up of very low-risk PTMC patients. DESIGN: The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy. SETTING: The study population consisted of ambulatory patients. PATIENTS: Eighty consecutive patients diagnosed with PTMC, who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies, were included. MAIN OUTCOME MEASURES: WBS and Tg after both rhTSH and neck US were measured. RESULTS: rhTSH-Tg was 1 ng/ml or less in 45 (Tg-) and more than 1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in two Tg (+) and one Tg (-) patients. rhTSH-Tg levels positively correlated with thyroid bed iodine uptake (r = 0.40, P < 0.0001). To date (32 +/- 13 months after surgery), all node-negative patients have undetectable Tg levels on LT(4) treatment and negative US. CONCLUSIONS: For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment: 1) WBS is useless; 2) US is highly sensitive in detecting node metastases; and 3) detectable rhTSH-Tg levels mainly depend on small normal tissue remnants. In this subgroup of PTMC patients, neck US might be regarded as a primary tool for the initial follow-up.     

Hyperbaric oxygen therapy and promoting neurological recovery following nerve trauma

There is a constant search for new techniques that induce more extensive and rapid wound healing. Hyperbaric oxygen therapy (HBO2T) involves placing a patient in a sealed chamber and elevating its pressure several-fold above ambient air pressure while the patient breathes 100% oxygen. HBO2T induces a number of physiological actions, and which wounds are selected for HBO2T depends on the specific actions of HBO2T relative to the wound's healing requirements. Although nerve traumas are not yet indicated for HBO2T, there are many animal and clinical examples showing the benefits of HBO2T in inducing neurological recovery following nerve trauma. This review examines the general mechanisms required to induce wound healing and the actions of HBO2T which meet these requirements. It then examines the requirements for inducing axon regeneration and how many are met by HBO2T. Finally, we discuss anecdotal evidence that HBO2T enhances the rate and extent of axon regeneration in both animal models and clinically. Weconclude that HBO2T triggers most of the mechanisms required to induce axon regeneration.