Coronary stent strut fractures: classification, prevalence and clinical associations

Introduction. The frequency, characteristics and clinical implications of Strut fractures (SFs) remain incompletely understood. Methods and results. A total of 185 (160 patients) newer-generation drug-eluting stents (DES) were imaged. SFs were found in 21 DES (11.4%) and were classified in four patterns: one single stacked strut (41%); two or more stacked struts (23%); deformation without gap (27%); transection (9%). In multivariable analysis, calcific and bifurcation lesions were associated with SF in DES (OR: 3.5 [1.1-11] and 4.0 [2.2-7.2], p < 0.05). Device eccentricity and asymmetry as well as optical coherence tomography (OCT) features of impaired strut healing were also associated with SF. The prevalence of fractures was similar in a set of 289 bioresorbable scaffolds (BRS). In a separate series of 20 device thromboses and 36 device restenoses, the prevalence of SF was higher (61.2% of DES and 66.7% of BRS, p < 0.001 for both), with a higher frequency of complex SF patterns (p < 0.0001). In logistic regression analysis, fractures were a correlate of device complications (p < 0.0001, OR = 24.9 [5.6-111] for DES and OR = 6.0 [1.8-20] for BRS). Discussion. The prevalence of OCT-diagnosed SF was unexpectedly high in the setting of elective controls and it increased by about three-fold in the setting of device failure. Fractures were associated with increased lesion complexity and device asymmetry/eccentricity and were more frequent in the setting of device failure such as restenosis and thrombosis.Cardiovascular Aspects of Radiolog

Visualization of plasma membrane domains in Arabidopsis thaliana

Unter Verwendung fluoreszenzmarkierter Remorine der taxonomischen Gruppe 1b wurden Nanodomänen in Arabidopsis Plasmamembranen (PM) unter Verwendung hoch auflösender Laser Scanning-Systeme sichtbar gemacht. In diesen kompartimentierten Membranbereichen lagerten sich Sterol-abhängige Remorine aus verschiedenen Pflanzen-familien zusammen und zeigten dort Kolokalisation. Dies wurde statistisch belegt durch hohe Pearson und Spearman Korrelationskoeffizienten. Remorine konnten schließlich als pflanzliche Markerproteine für kompartimentierte Membranbereiche etabliert werden. Die Nanodomänen zeigten zu keinem Zeitpunkt laterale Bewegungen in der PM und scheinen sowohl von zytoskelettären Strukturen als auch von Komponenten der Zellwand stabilisiert zu werden. Möglicherweise spielen transmembrane Tetraspanine sowie GPI-verankerte SKU5-Proteine eine Rolle bei der stabilen Verankerung. Für zwei native Arabidopsis Remorine wurden posttranslationale Modifikationsstellen aufgedeckt, die der Anheftung dieser hydrophilen Proteine an die PM dienen. Weiterhin scheinen gleichartige Remorine miteinander zu interagieren. Beispielsweise waren im Zytosol lokalisierte Remorin-Mutanten bei einer gleichzeitigen Expression der entsprechenden Vollängenproteine erneut an der PM zu finden. Für die Remorine wurde postuliert, dass sie mit anderen Proteinen interagieren und dabei makromolekulare Strukturen ausbilden. Den Remorinen könnte daher eine Aufgabe bei der molekularen Organisation pflanzlicher Membrandomänen zukommen, indem sie ein filamentartiges Netzwerk innerhalb distinkter Domänen ausbilden, das möglicherweise zur Stabilität und Aufrechterhaltung dieser spezialisierten Bereiche beiträgt. Unter Einbeziehung der STED-Mikroskopie wurde eine empirische Größenverteilung von 97±4nm Durchmesser für PM-ständige Domänen in Arabidopsis ermittelt. Hinsichtlich der physiologischen Relevanz konnte gezeigt werden, dass die Domänen eine Rolle bei der ABA-vermittelten, kalziumabhängigen Regulation des Anionenkanals SLAH3 einnehmen. SLAH3 wird durch kalziumabhängige Kinasen aus der CDPK-Familie aktiviert, im Speziellen durch CPK21 und CPK23. Beide Kinasen werden durch die ABA-sensitiven Phosphatasen ABI1 und ABI2 reguliert. Die spezifisch stattfindenden Interaktionen zwischen SLAH3 und CPK21, sowie zwischen CPK21 und ABI1 waren auf Nanodomänen beschränkt und wurden durch die Methodik der bimolekularen Fluoreszenzkomplementation erstmals in planta nachgewiesen, mit Remorinen der taxonomischen Gruppe 1b als etablierte Markerproteine für Membrandomänen.In this work, membrane nanodomains have been visualized in planta via confocal microscopy of group 1b Remorin proteins fused to fluorescent proteins. Within these nanodomains, sterol-dependent Remorins originating from different plant species accumulated as shown by multiple color colocalization microscopy, and through which it was statistically verified by high Spearman and Pearson correlation coefficients. Thus, group 1b Remorins were established here as reliable marker proteins for plasma membrane (PM) nanodomains in plants. Since individual domains did not exhibit any kind of lateral movement within the plane of the membrane, a stabilization of them from cytoskeletal components as well as from components of the cell wall was presumed. Other proteins such as trans-membrane Tetraspanins and GPI-anchored proteins like SKU5 were ruled out as possible candidates being involved in the maintenance of domains´ lateral stability. For two Remorins originating from Arabidopsis thaliana, sites of posttranslational lipid modifications, which allow the proteins to anchor to the plasma membrane, were revealed. In experiments using truncated Remorins with these modification sites deleted, the mutant Remorins appeared to be no longer located at the PM but rather within the cytosol. Truncated Remorins re-appeared at the PM as soon as the full length Remorin proteins were co-expressed. In close proximity to the sites of lipid modifications a highly conserved C-terminal region, whose likely role is to facilitate homo-Remorin protein interactions, was uncovered. Therefore Remorins could possibly be involved in the molecular organization of a filamentous protein structure that could help mediate the stability and maintenance of individual domains. As well, the sizes of individual nanodomains were empirically measured in Arabidopsis thaliana mesophyll cells with STED microscopy, which allowed for optical measurements of domains with 60nm resolution, and were narrowly distributed in a histogram of domain diameters with an average diameter of 97 ± 4nm. One possible physiological role of PM-based nanodomains was demonstrated to be the ABA-mediated, calcium-dependent regulation of the SLAH3 anion channel. At the inception of the regulation, SLAH3 becomes activated upon phosphorylation by calcium-dependent protein kinases of the CDPK-family, CPK21 and CPK23. Both CPK´s in turn are regulated by the ABA-dependent phosphatases ABI1 and ABI2. As visualized by fluorescence colocalization microscopy for the first time, the interactions between SLAH3 and CPK21, as well as interactions between CPK21 and ABI1 were restricted to PM compartments. As well, these protein interactions were corroborated by also imaging them in planta using the bimolecular fluorescence complementation technique - involving group 1b Remorins as the established marker proteins for PM nanodomains

Methods of staining and visualization of sphingolipid enriched and non-enriched plasma membrane regions of Arabidopsis thaliana with fluorescent dyes and lipid analogues

Background: Sterols and Sphingolipids form lipid clusters in the plasma membranes of cell types throughout the animal and plant kingdoms. These lipid domains provide a medium for protein signaling complexes at the plasma membrane and are also observed to be principal regions of membrane contact at the inception of infection. We visualized different specific fluorescent lipophilic stains of the both sphingolipid enriched and non-sphingolipid enriched regions in the plasma membranes of live protoplasts of Arabidopsis thaliana. Results: Lipid staining protocols for several fluorescent lipid analogues in plants are presented. The most emphasis was placed on successful protocols for the single and dual staining of sphingolipid enriched regions and exclusion of sphingolipid enriched regions on the plasma membrane of Arabidopsis thaliana protoplasts. A secondary focus was placed to ensure that these staining protocols presented still maintain cell viability. Furthermore, the protocols were successfully tested with the spectrally sensitive dye Laurdan. Conclusion: Almost all existing staining procedures of the plasma membrane with fluorescent lipid analogues are specified for animal cells and tissues. In order to develop lipid staining protocols for plants, procedures were established with critical steps for the plasma membrane staining of Arabidopsis leaf tissue and protoplasts. The success of the plasma membrane staining protocols was additionally verified by measurements of lipid dynamics by the fluorescence recovery after photobleaching technique and by the observation of new phenomena such as time dependent lipid polarization events in living protoplasts, for which a putative physiological relevance is suggested

Evaluation der Ösophagoskopie im Staging und Restaging von Kopf-Hals-Plattenepithelkarzinomen

Objective Oesophagoscopy is important in diagnostic and follow up investigation in patients with head and neck squamous cell carcinoma (HNSCC). Second primary malignancies of the oesophagus have major impact on therapy of the primary tumour. Considering the low incidence of oesophageal second primaries and the serious complication of oesophageal perforation routine oesophagoscopy is being discussed. Material and Methods Incidence of oesophageal second primaries and complication rates in oesophagoscopy were identified in a systematic review. A retrospective analysis was performed in our own patient collective. To evaluate the current practice at German ENT Clinics a survey was conducted. Results 1053 oesophagoscopies in 800 patients were analysed. In 800 patients seven (0.9%) synchronous secondary malignancies of the oesophagus occurred. In 253 follow up oesophagoscopies five (2 %) metachronous secondary malignancies were discovered. 14 (1.3 %) complications were detected; oesophageal perforation was only detected in one case (0.1 %). There was no association of certain risk factors with the incidence of secondary malignancies. The review of literature showed an incidence of secondary malignancies for Europe/USA of 1.8% and for Asia of 4.1 %. Incidence of oesophageal perforation was 0-0.2%. Survey results showed routine oesophagoscopy in staging (100%) and regularly in follow up (65.3 %). Conclusions Oesophagoscopy is a convenient method to detect secondary malignancies of the oesophagus. To allow a selection of patients developing secondary malignancies according to risk profiles further prospective multicentre studies are required

Methods of staining and visualization of sphingolipid enriched and non-enriched plasma membrane regions of <it>Arabidopsis thaliana</it> with fluorescent dyes and lipid analogues

Abstract Background Sterols and Sphingolipids form lipid clusters in the plasma membranes of cell types throughout the animal and plant kingdoms. These lipid domains provide a medium for protein signaling complexes at the plasma membrane and are also observed to be principal regions of membrane contact at the inception of infection. We visualized different specific fluorescent lipophilic stains of the both sphingolipid enriched and non-sphingolipid enriched regions in the plasma membranes of live protoplasts of Arabidopsis thaliana. Results Lipid staining protocols for several fluorescent lipid analogues in plants are presented. The most emphasis was placed on successful protocols for the single and dual staining of sphingolipid enriched regions and exclusion of sphingolipid enriched regions on the plasma membrane of Arabidopsis thaliana protoplasts. A secondary focus was placed to ensure that these staining protocols presented still maintain cell viability. Furthermore, the protocols were successfully tested with the spectrally sensitive dye Laurdan. Conclusion Almost all existing staining procedures of the plasma membrane with fluorescent lipid analogues are specified for animal cells and tissues. In order to develop lipid staining protocols for plants, procedures were established with critical steps for the plasma membrane staining of Arabidopsis leaf tissue and protoplasts. The success of the plasma membrane staining protocols was additionally verified by measurements of lipid dynamics by the fluorescence recovery after photobleaching technique and by the observation of new phenomena such as time dependent lipid polarization events in living protoplasts, for which a putative physiological relevance is suggested.</p

Arabidopsis nanodomain-delimited ABA signaling pathway regulates the anion channel SLAH3

The phytohormone abscisic acid (ABA) plays a key role in the plant response to drought stress. Hence, ABA-dependent gene transcription and ion transport is regulated by a variety of protein kinases and phosphatases. However, the nature of the membrane-delimited ABA signal transduction steps remains largely unknown. To gain insight into plasma membrane-bound ABA signaling, we identified sterol-dependent proteins associated with detergent resistant membranes from Arabidopsis thaliana mesophyll cells. Among those, we detected the central ABA signaling phosphatase ABI1 (abscisic-acid insensitive 1) and the calcium-dependent protein kinase 21 (CPK21). Using fluorescence microscopy, we found these proteins to localize in membrane nanodomains, as observed by colocalization with the nanodomain marker remorin Arabidopsis thaliana remorin 1.3 (AtRem 1.3). After transient coexpression, CPK21 interacted with SLAH3 [slow anion channel 1 (SLAC1) homolog 3] and activated this anion channel. Upon CPK21 stimulation, SLAH3 exhibited the hallmark properties of S-type anion channels. Coexpression of SLAH3/CPK21 with ABI1, however, prevented proper nanodomain localization of the SLAH3/CPK21 protein complex, and as a result anion channel activation failed. FRET studies revealed enhanced interaction of SLAH3 and CPK21 within the plasma membrane in response to ABA and thus confirmed our initial observations. Interestingly, the ABA-induced SLAH3/CPK21 interaction was modulated by ABI1 and the ABA receptor RCAR1/PYL9 [regulatory components of ABA receptor 1/PYR1 (pyrabactin resistance 1)-like protein 9]. We therefore propose that ABA signaling via inhibition of ABI1 modulates the apparent association of a signaling and transport complex within membrane domains that is necessary for phosphorylation and activation of the S-type anion channel SLAH3 by CPK21

Five‐year follow‐up of patients who underwent everolimus‐eluting bioresorbable scaffold implantation

Objectives The aim of this study was to evaluate very long‐term results after unrestricted everolimus‐eluting bioresorbable scaffolds (BRS) implantation. Background Previous randomized studies mainly included selected patients differing from those seen during daily routine and long‐term data from all‐comers registries are sparse. Methods Consecutive patients undergoing BRS implantation were included in this observational, single center study. Clinical follow‐up was conducted up to 5 years. Endpoint of interest was the composite of target lesion failure (TLF), including target‐vessel myocardial infarction and target lesion revascularization and cardiac death. Furthermore, ARC‐defined scaffold thrombosis (ScT) were assessed. Results A total of 176 patients with a median age of 64 (55 – 72) years were analyzed, of which 59.6% presented an acute coronary syndrome. A total of 183 mainly complex lesions (55.8%) were treated. At 5 years, the rate for TLF was 21.6%. Definite or probable ScT rate was 4.1%. The rate of ScT within the first year was 2.8% and afterwards 1.2%. Notably, no ScT was seen later than 2 years. Conclusions Although this real‐world registry displays high rates of clinical events during long‐term follow‐up, no ScT was seen after 2 years

Incidental Finding of Strut Malapposition Is a Predictor of Late and Very Late Thrombosis in Coronary Bioresorbable Scaffolds

Malapposition is a common finding in stent and scaffold thrombosis (ScT). Evidence from studies with prospective follow-up, however, is scarce. We hypothesized that incidental observations of strut malapposition might be predictive of late ScT during subsequent follow-up. One hundred ninety-seven patients were enrolled in a multicentre registry with prospective follow-up. Optical coherence tomography (OCT), performed in an elective setting, was available in all at 353 (0&#8722;376) days after bioresorbable scaffold (BRS) implantation. Forty-four patients showed evidence of malapposition that was deemed not worthy of intervention. Malapposition was not associated with any clinical or procedural parameter except for a higher implantation pressure (p = 0.0008). OCT revealed that malapposition was associated with larger vessel size, less eccentricity (all p &lt; 0.01), and a tendency for more uncovered struts (p = 0.06). Late or very late ScT was recorded in seven of these patients 293 (38&#8722;579) days after OCT. OCT-diagnosed malapposition was a predictor of late and very late scaffold thrombosis (p &lt; 0.001) that was independent of the timing of diagnosis. We provide evidence that an incidental finding of malapposition&#8212;regardless of the timing of diagnosis of the malapposition&#8212;during an elective exam is a predictor of late and very late ScT. Our data provide a rationale to consider prolonged dual antiplatelet therapy if strut malapposition is observed