Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions.

OBJECTIVES: The aim of the study was to examine outcomes subsequent to implantation of drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND: Use of DES might be associated with increased risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: From January 2002 through June 2005, data from all percutaneous coronary interventions in western Denmark were prospectively recorded in the Western Denmark Heart Registry; 12,395 consecutive patients (17,152 lesions) treated with stent implantation were followed for 15 months. Data on death and MI were ascertained from the national databases. The Academic Research Consortium definition of ST was used. RESULTS: The DES were implanted in 3,548 patients (5,422 lesions) and BMS were implanted in 8,847 patients (11,730 lesions). Definite, probable, or possible ST was found in 190 (2.15%) patients in the BMS group and in 64 (1.80%) patients in the DES. The risk of definite ST was similar in the 2 groups (DES: 0.65%; BMS: 0.61%). Very late definite ST (between 12 and 15 months after implantation) occurred more frequently in patients receiving DES (hazard ratio [HR] 10.93, 95% confidence interval [CI] 1.27 to 93.76). Also, the risk of MI between 12 and 15 months after implantation was higher in the DES group (HR 4.00, 95% CI 2.06 to 7.79). Mortality was similar in the 2 groups. Target lesion revascularization was reduced by 43% in patients treated with DES (HR 0.57, 95% CI 0.48 to 0.67). CONCLUSIONS: The minor risk of ST and MI within 15 months after implantation of DES seems unlikely to outweigh the benefit of these stents.     

Dropping out of psychiatric treatment: a prospective study of a first-admission cohort

This study examined patient and treatment variables associated with patients dropping out of psychiatric treatment, drop-outs’ reasons for terminating treatment, and the relationship between drop-out and patient satisfaction. The term ‘drop-out’ was defined as termination of treatment despite therapeutic need. In a cohort of 131 first-admission psychiatric patients, 26% of these subjects dropped out of treatment during the first year. Multivariate analysis showed that dropping out was predicted by (a) living alone, (b) unemployment, (c) young age and (d) change of treatment service within the last month demanded by the patient against medical advice. Variables such as gender, diagnosis, mode of admission, type of hospital ward, level of treatment, transfer in accordance with treatment needs and inappropriate transfer caused by the treatment system were all non-significant. The dropouts were markedly less satisfied with both the outcome and various aspects of the treatment process than those who did not drop out. The most common reasons given by the drop-outs for terminating treatment were dissatisfaction with care (44%) and no need for further treatment (20%). Greater knowledge of the factors related to drop-out might increase the likelihood of keeping patients in treatment.     

CXCR7 and syndecan-4 are potential receptors for CXCL12 in human cytotrophoblasts

The placenta forms the interface between the mother and the fetus. During placental development cytotrophoblasts differentiate to form the syncytium or to invade the decidual wall to breach maternal vessels and establish the blood flow in the intervillous space. This process is still not well understood but it is proposed that chemokines and their receptors are involved in guiding cytotrophoblasts to the decidua and maternal vessels as well as attracting immunocompetent cells to the implantation site. CXCL12 is a chemokine expressed by cytotrophoblasts and is involved in cytotrophoblast invasion, differentiation and survival. One of its receptors, CXCR4, has been detected on cytotrophoblasts. Recent data show that CXCR7 and syndecan-4 might partially mediate CXCL12 function in other cell types. In this study, we examined CXCR7 and syndecan-4 expression at the maternal-fetal interface via immmunolocalization in placental tissue sections and in isolated cytotrophoblasts. We further used immunoblot analyses to confirm the data. We were able to show that cytotrophoblasts express both receptors and that upregulation occurs during the differentiation process of cytotrophoblasts towards the invasive phenotype. On a functional level CXCR7 seems not to be involved in JAR cell chemotaxis, suggesting a different function of this receptor. In conclusion, we propose that CXCL12 binds to CXCR4, but also to CXCR7 and syndecan-4. These three receptors could mediate different functions of CXCL12, such as cell migration, directed invasion, proliferation and survival. The latter molecules might also be involved in the development of placental pathologies, such as preeclampsia or choriocarcinoma growth.