Abrupt closure: The CAVEAT I experience

Objectives.This study sought to assess the incidence and consequences of abrupt closure in a series of patients undergoing directional coronary atherectomy versus percutaneous coronary angioplasty.Background.Abrupt closure with coronary angioplasty has been associated with adverse outcome. The results from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) I, a randomized trial of coronary angioplasty versus directional coronary atherectomy, were analyzed.Method.This multicenter trial enrolled 1,012 patients from 1991 to 1992. All records from patients with abrupt closure, which was coded as a discrete complication, were reviewed.Results.Abrupt closure occurred in 60 patients (5.9%) and was associated with a significantly longer hospital stay (median 8 vs. 3 days). Severe proximal target vessel tortuosity was more common in patients with abrupt closure (20.3% vs. 11.6%, p = 0.046), as was preexistent coronary artery thrombus (30.5% vs. 18.3%, p = 0.02). Abrupt closure was associated with a marked increase in subsequent complications (myocardial infarction 46.7% vs. 2.1%, emergency bypass surgery 383% vs. 0.32%, death 33% vs. 0%) and occurred more frequently in the directional coronary atherectomy group (8.0% vs. 3.8%, p = 0.005). In the coronary angioplasty group, the occlusion usually occurred at the target lesion (91%), presumably related to the effects of barotrauma. In the directional coronary atherectomy group, the site of the occlusion was the target lesion in only 58% (p = 0.045). The remaining occlusions related to problems with the technique (guide catheter or nose cone trauma), reflecting the fact that directional coronary atherectomy is a more complex procedure.Conclusions.Abrupt closure remains the principal determinant of adverse outcome after percutaneous procedures for the treatment of coronary artery disease. Although abrupt closure is more common with directional atherectomy than angioplasty, the sequelae are similar

Colorectal Cancer Stem Cells Are Enriched in Xenogeneic Tumors Following Chemotherapy

Patients generally die of cancer after the failure of current therapies to eliminate residual disease. A subpopulation of tumor cells, termed cancer stem cells (CSC), appears uniquely able to fuel the growth of phenotypically and histologically diverse tumors. It has been proposed, therefore, that failure to effectively treat cancer may in part be due to preferential resistance of these CSC to chemotherapeutic agents. The subpopulation of human colorectal tumor cells with an ESA(+)CD44(+) phenotype are uniquely responsible for tumorigenesis and have the capacity to generate heterogeneous tumors in a xenograft setting (i.e. CoCSC). We hypothesized that if non-tumorigenic cells are more susceptible to chemotherapeutic agents, then residual tumors might be expected to contain a higher frequency of CoCSC.Xenogeneic tumors initiated with CoCSC were allowed to reach approximately 400 mm(3), at which point mice were randomized and chemotherapeutic regimens involving cyclophosphamide or Irinotecan were initiated. Data from individual tumor phenotypic analysis and serial transplants performed in limiting dilution show that residual tumors are enriched for cells with the CoCSC phenotype and have increased tumorigenic cell frequency. Moreover, the inherent ability of residual CoCSC to generate tumors appears preserved. Aldehyde dehydrogenase 1 gene expression and enzymatic activity are elevated in CoCSC and using an in vitro culture system that maintains CoCSC as demonstrated by serial transplants and lentiviral marking of single cell-derived clones, we further show that ALDH1 enzymatic activity is a major mediator of resistance to cyclophosphamide: a classical chemotherapeutic agent.CoCSC are enriched in colon tumors following chemotherapy and remain capable of rapidly regenerating tumors from which they originated. By focusing on the biology of CoCSC, major resistance mechanisms to specific chemotherapeutic agents can be attributed to specific genes, thereby suggesting avenues for improving cancer therapy

Early Tudor poetry, 1485-1547,

At head of title: Studies in Tudor literature. First published in 1920.Mode of access: Internet

Early Tudor poetry, 1485-1547 /

Includes index.Includes bibliographies.Mode of access: Internet

The poems of John Cleveland /

Bibliography; p. 262-263."Editions of Cleveland's works": p. 248-256.pt. 1. Non-political poems of the 1677 edition.--pt. 2. Political poems.--pt. 3. Poems attributed to Cleveland by modern scholars, not in the edition of 1677.Mode of access: Internet

The poems of John Cleveland,

"This edition was originally undertaken as a thesis for the doctorate degree at Yale University." -- Pref.Bibliography; p. 262-263."Editions of Cleveland's works": p. 248-256.pt. 1. Non-political poems of the 1677 edition.--pt. 2. Political poems.--pt. 3. Poems attributed to Cleveland by modern scholars, not in the edition of 1677.Mode of access: Internet

Modern essays,

--The mildness of the yellow press, by G. K. Chesterton.--What is education? by C. M. Flandrau.--Why a classic is a classic, by A. Bennett.--Homer and the study of Greek, by A. Lang.--Homer and humbug, an academic discussion, by S. Leacock.--On the case of a certain man who is never thought of, by W. G. Sumner.--The training of intellect, by W. Wilson.--The responsibility of authors, by Sir O. Lodge.--Filial relations, by J. Addams.--The irony of nature, by R. Burton.--0n seeing ten bad plays, by F. M. Colby.--A stepdaughter of the prairie, by Margaret Lynn.--Yosemite, by A. Colton.--The Bowery and Bohemia, by H. C. Bunner.--Evolution, by J. Galsworthy.--Biographical index."Ten o'clock," by J. M. Whistler.--Tact, by Sir J. Lubbock, lord Avebury.--Book-buying, by A. Birrell.--Alexander Hamilton, by F. Harrsion.--Salad, by C. S. Baldwin.--Words that laugh and cry, by C. A. Dana.--National characteristics as moulding public opinion, by J. Bryce.--American manners, by Wu Tingfang.--Franklin, by H. C. Lodge.--The serious Pepys, by W. C. Abbott.--What the ten-year sergeant of police tells, by H. H. Curran.--The powers of the President, by W. H. Taft.--John Greenleaf Whittier, by G. E. Woodberry.--Thackeray's centenary, by H. A. Beers.--Tennyson, by P. E. More.--Realism Canby. Edward Gibbon, by J. F. Rhodes.Mode of access: Internet

The life of King Henry the Eighth,

Mode of access: Internet