Multicenter Pilot Study of a Serpentine Balloon-Expandable Stent (beStentTM): Acute Angiographic and Clinical Results

The beStent is a new stainless steel, balloon-expandable mesh stent which has a unique serpentine design. Rotation of the unique low stress junctions upon expansion leads to orthogonal locking of the wires, maximizing radial strength and assuring zero shortening. The stent has delineating gold markers which assure precise positioning. We aim to present the initial acute results in a pilot registry for stent evaluation. Two hundred eighty-four stents were used in a total of 217 patients (age 57.9 ± 3.10 years; 178 males; 39 females) in seven centers, for variable indications. Stents of 15-, 25-, and 35-mm length were used. The arteries treated were the left anterior descending (n = 112, 42%), circumflex (n = 54, 20.2%), right coronary (n = 95, 35.5%), left main (n = 1, 0.4%), and vein graft (n = 5, 1.9%). Lesion types were: A in 42 patients (16.5%); B1 in 53 patients (20.7%); B2 in 81 patients (31.8%); and C in 79 patients (31%). One hundred fifty-nine patients required one stent, 40 patients required two stents, and 18 patients required three or more stents. Anticoagulation protocol included procedural heparin with aspirin with/without ticlopidine. Smooth angiographie results were obtained in all cases with no plaque herniation. Acute angiographic success was obtained in 97% of the patients, and acute clinical success in 95% of the patients. Complications within 30 days were: 3 deaths (1.4%) (2 noncardiac); 2 (0.9%) myocardial infarctions; and 2 (0.9%) stent thromboses. Therefore, the beStent is useful in treatment of complex lesions of variable length and complexity, providing excellent acute results with a low complication rate, in spite of unfavorable basic clinical and angiographie characteristics.     

ESBRA-NORDMANN 1996 AWARD LECTURE: ETHANOL DRINKING BEHAVIOUR IN SARDINIAN ALCOHOL-PREFERRING RATS

Sardinian alcohol-preferring (sP) rats have been selectivelybred for high ethanol preference and consumption over 16 yearsand 39 generations. The present paper briefly reviews some recentstudies from this laboratory characterizing ethanol drinkingbehaviour in this rat line. Under the two-bottle regimen offree choice between 10% (v/v) ethanol and water, sP rats consumedaily >4 g of ethanol/kg and avoid water almost completely.Relevant features of ethanol drinking behaviour in sP rats are:(a) attainment of high ethanol intake from the first day ofexposure to ethanol, suggestive of an immediate disclosure andacquisition of ethanol reinforcement; (b) titration of dailyethanol intake in distinct binges during the nocturnal phaseof the light/dark cycle, indicative of their ability to regularizeboth ethanol dose and administration time; (c) achievement ofpharmacologically relevant blood ethanol levels at each drinkingepisode; (d) substitution of the calories provided by ethanolfor a part of those taken from food; (e) maintenance of constantethanol intake (in g/kg/day) in the presence of ethanol concentrationsvarying from 7 to 30% (v/v). These results suggest that voluntaryethanol intake in sP rats is sustained by the search for specificpharmacological effects of ethanol. Anxiolysis is likely tobe one of these effects; indeed, voluntarily consumed ethanolreversed the innate, high levels of anxiety in sP rats. Theseresults portray sP rats as a valid model for investigating theassociation between ethanol drinking and anxiety. Finally, thebreeding programme as well as results of neurochemical studiesare also described.     

DEVELOPMENT OF ANTHRALIN SHORT-CONTACT THERAPY IN PSORIASIS: SURVEY OF PUBLISHED CLINICAL TRIALS

In a survey of clinical trials concerning the efficacy of short-contact therapy with anthralin in psoriasis vulgaris, focusing principally on methodologic issues, twenty-four papers published between January 1982 and December 1989, in English, French, and Italian, were selected. Nine of 24 papers reported on more than one trial, giving a total of 37 clinical trials to be evaluated. A great heterogeneity was evident in many aspects of the design and conduct of these trials, making pooling of results impossible. Most trials suffered from flaws in general methodologic aspects such as randomization and blinding. Limitations in general applicability of results were discussed with reference to the popular use of self-control design and selection of composite indexes (e.g., PASI) as an outcome variable. Published trials are not a reliable guide to clinical decisions concerning short-contact therapy, and some methodologic observations we made could be of general interest in designing clinical trials of psoriasis.     

Hospital versus population controls in a retrospective study on diet and stomach cancer

The aim of the present study is to evaluate drawbacks and advantagesof the choice of hospital versus population controls in a casecontrol study on diet and cancer through the analysis of a retrospectivestudy on diet and gastric cancer (GC) conducted in Forli, Italy,involving 232 cases, 430 population controls and 252 hospitalizedcontrols. The present paper reports the comparison of resultson diet and GC risk obtained using the 2 types of controls.Population controls tended, in general, to eat all kinds offoods slightly more frequently (bread, pasta, cold cuts, freshfish, seasoned cheeses, legumes, garlic, onions and preservedfruits), with the exception of cooked vegetables, which werereported less frequently by population than by hospital controls.ORs for specific foods adjusted for confounders and other foodswere consistent in the separate models including populationand hospital controls respectively for all food groups, withthe exception of cooked vegetables which represented a protectivefactor only when hospital controls were considered (high consumers,population controls: adjusted, OR=0.9, trend p value 0.54; highconsumers, hospital controls, adjusted OR=0.5, trend p value<0.01). Hospital controls were slightly less often currentsmokers (22.6 versus 30.0%) and more often regular wine drinkers(57.5 versus 47.8%) compared with population controls, but noneof these variables was associated with GC risk. The main resultsin this study were consistent using both types of controls,nevertheless the distribution of some dietary variables notrelated to the disease under study differed between the 2 controlgroups, suggesting some caution in the use of hospital controlswhen studying diseases other than GC.     

Membrane Expression and Function of Complement Receptors CR1 and CR3 on Neutrophils from HIV-Infected Subjects: Modulation by rTNF-α and rGM-CSF

We evaluated membrane expression and function of complement receptors CR1 and CR3 on neutrophils from 27 HIV-positive (HIV+) subjects (14 in the CDC class III and 13 class IV) as well as their modulation in vitro by recombinant tumour necrosis factor-alpha (rTNF-alpha) and granulocyte-macrophage colony stimulating factor (rGM-CSF). While CR1 was expressed at similar levels on neutrophils from controls and HIV+ subjects, CR3 expression was significantly higher in CDC class IV subjects than in healthy controls. CR1 and CR3 expression was significantly increased after treatment of neutrophils with both cytokines, without differences between controls and HIV+ subjects. Similarly, the superoxide anion (O2-) production in response to C3-coated zymosan (C3zy) was significantly enhanced on neutrophils from CDC class IV subjects when compared with controls. rGM-CSF and rTNF-alpha treatment significantly enhanced the spontaneous as well as C3zy-stimulated O2- production by neutrophils from controls and CDC class III subjects, and induced an upward trend in the CDC class IV group. These results indicate that the neutrophils of HIV+ patients are preactivated in vivo but they also indicate that these cells may correctly respond to a subsequent particulate stimulus as well as to activating cytokines. Our findings suggest that desensitization or functional exhaustion of complement receptors are not implicated in the abnormalities observed on neutrophils from HIV+ patients.     

Selective strategies in food webs

Food webs are described as control systems where the controlsare chosen according to given myopic strategies. In particular,strategies describing selective feeding and selective escapeare defined. The existence of optimal myopic solutions and theiruniqueness are discussed. Computer simulations modelling ‘switching’are given for a one-predator—two-prey system.     

Daytime continuous polysomnography predicts MSLT results in hypersomnias of central origin

In the diagnostic work‐up of hypersomnias of central origin, the complaint of excessive daytime sleepiness should be objectively confirmed by MSLT findings. Indeed, the features and diagnostic utility of spontaneous daytime sleep at 24 h continuous polysomnography (PSG) have never been investigated. We compared daytime PSG features to MSLT data in 98 consecutive patients presenting with excessive daytime sleepiness and with a final diagnosis of narcolepsy with cataplexy/hypocretin deficiency (n = 39), narcolepsy without cataplexy (n = 7), idiopathic hypersomnia without long sleep time (n = 19), and ‘hypersomnia’ with normal sleep latency at MSLT (n = 33). Daytime sleep time was significantly higher in narcolepsy‐cataplexy but similar in the other groups. Receiver operating characteristics (ROC) curves showed that the number of naps during daytime PSG predicted a mean sleep latency ≤8 min at MSLT with an area under the curve of 0.67 ± 0.05 (P = 0.005). The number of daytime sleep‐onset REM periods (SOREMPs) in spontaneous naps strikingly predicted the scheduled occurrence of two or more SOREMPs at MSLT, with an area under the ROC curve of 0.93 ± 0.03 (P < 10^?12). One spontaneous SOREMP during daytime had a sensitivity of 96% with specificity of 74%, whereas two SOREMPs had a sensitivity of 75%, with a specificity of 95% for a pathological REM sleep propensity at MSLT. The features of spontaneous daytime sleep well correlated with MSLT findings. Notably, the occurrence of multiple spontaneous SOREMPs during daytime clearly identified patients with narcolepsy, as well as during the MSLT.