Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.

BACKGROUND: Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. METHODS: We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. RESULTS: At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9 to 6.5; P = 0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). CONCLUSIONS: In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.)

Quasiliving Carbocationic Polymerization Iv. Polymerization of P-tert-butylstyrene

The mechanism of polymerization of p-tert-butylstyrene (ptBuSt) initiated by the cumyl chloride/BCl3initiating system in CH2Cl2 at -50°C has been investigated. At and below ∼0.4 M ptBuSt, quasiliving polymerizations proceed, i.e., initiation is instantaneous, termination is absent or reversible, and chain transfer to monomer can be suppressed or eliminated. In the quasiliving range the M n versus [ptBuSt]0plot is linear and passes through the origin, and a M w/M n decreases much below 2.0 with decreasing [ptBuSt]. GPC traces change from broad multimodal to narrow monomodal and the color of polymerization charges change from colorless to golden-yellow with decreasing [ptBuSt]. The effect of temperature jump subsequent to monomer addition has been examined; however, it does not explain the peculiar monomer concentration effect on the mechanism. Changes in the ionicity may be responsible for this phenomenon

Quasiliving Carbocationic Polymerization Ix: Forced Ideal Copolymerization of Styrene Derivatives

Forced ideal carbocationic copolymerization of α-methylstyrene (αMeSt) with p-tert-butylstyrene (ptBuSt) and (αMeSt) with styrene (St) has been achieved by continuous monomer feed addition to a cumyl chloride/BCl3 charge at -50°C by keeping the feeding rate of the monomer mixtures equal to the overall rate of copolymerization, The composition of the copolymers was identical to the composition of the monomer feeds over the entire concentration range. A quantitative expression has been derived to show that under forced ideal copolymerization conditions the composition of the copolymer can be controlled by the composition of the feed. Further, conditions have been found for forced ideal quasiliving copolymerizations, i.e., the number-average molecular weight of the copolymers increased almost linearly with the cumulative weight of consumed monomers by the use of suitably slow, continuous feed addition in the presence of relatively nonpolar solvent mixtures (60/40 v/v n-hexane + methylene chloride). In polar solvent (methylene chloride) the molecular weight increase was less pronounced due to chain transfer to monomer involving indane-skeleton formation; however, with charges containing large amounts of ptBuSt the molecular weight increase was surprisingly strong. Interestingly, ptBuSt does not homopolymerize in 60/40 v/v n-hexane/methylene chloride but it readily copolymerizes with αMeSt. This observation was explained by examining the relative rates of terminations of the cationic species involved. Conditions have been found for the pronounced quasiliving polymerization of St. In forced ideal quasiliving copolymerizations neither the molecular weights of αMeSt/ptBuSt or αMeSt/St copolymers nor the initiating efficiencies of the initiating systems used show a depression. The microstructure of representative αMeSt/ptBuSt copolymers obtained under forced ideal quasiliving conditions has been analyzed by C-NMR spectroscopy. According to these studies, true copolymers have formed and resonance peaks for various triads have been deduced

Assessment of Availability and Human Health Risk Posed by Arsenic Contaminated Well Waters from Timis-Bega Area, Romania

Mobilization of As from geological materials into ground and drinking water sources may represent an important threat to human health. The objective of this study was to assess the As concentration and availability in underground water used as drinking water sources. Water samples were collected from public and private wells in Timis-Bega area of Pannonian Basin, West Romania. Total-dissolved As measured after “classical” filtration of water samples was in the range of 0.10–168 μg L−1, thus exceeding the guideline value in majority of the samples. The aim of this study was also to assess the “truly dissolved” concentrations of As considered as available concentrations, in well waters, after passive sampling by Diffusive Gradients in Thin-films (DGT). The results showed that over 70% of total-dissolved As is in available forms. The obtained data were used to evaluate the risks of using the wells as drinking water source. Hazard quotients for ingestion and dermal pathways and hazard index (HI) for exposure to As were calculated. The HI values > 1 found that majority of samples indicated a health risk for local residents

Dexmedetomidine, an α-2a adrenergic agonist, promotes ischemic tolerance in a murine model of spinal cord ischemia-reperfusion

ObjectiveDexmedetomidine, an α-2a adrenergic agonist, given pre- and postoperatively was previously shown to attenuate neuronal injury in a murine model of spinal cord ischemia-reperfusion. In the brain, α-2 agonists have been shown to induce the phosphorylation of cyclic AMP response-element binding protein (CREB), a transcription factor necessary for neuron survival. We hypothesized that the α-2a adrenergic agonist given preoperatively increases CREB-mediated neuroprotective proteins, attenuating neuronal injury and cytoarchitectural decay.MethodsMice (ie, C57BL/6 mice) underwent 5 minutes of aortic occlusion via median sternotomy. Mice received 25 μg/kg dexmedetomidine or equivalent normal saline at 24 hours, 12 hours, and 30 minutes preoperatively. Functional outcomes were recorded at 6 to 48 hours postoperatively when spinal cords were removed for histologic analysis. Spinal cords were examined for protein kinase B, CREB, B-cell lymphoma 2, and brain-derived neurotrophic factor following treatment alone or ischemia-reperfusion surgery.ResultsFollowing aortic occlusion, mice in the treatment group had preserved neurologic function at all time points (P < .05). Histologic analysis showed preserved cytoarchitecture and decreased neuronal injury in the treatment group when compared with ischemic controls. Additionally, analysis of spinal cord homogenate following surgery and pretreatment revealed a significant (P < .05) increase in B-cell lymphoma 2 and brain-derived neurotrophic factor expression and protein kinase B and CREB phosphorylation with α-2a adrenergic agonist pretreatment.ConclusionsPretreatment with the α-2a agonist dexmedetomidine preserved neurologic function and attenuated neuronal injury following thoracic aortic occlusion in mice. This relationship was associated with an increased phosphorylation of protein kinase B and CREB and subsequent up-regulation of antiapoptotic factor B-cell lymphoma 2 and brain-derived neurotrophic factor. Thus, α-2a receptor agonism-induced CREB phosphorylation and contributes to dexmedetomidine's protective mechanism in the spinal cord following ischemia

[Carta de España]

Min. 0.56: Reportaje en el Colegio Mayor Guadalupe con los estudiantes -- Min. 07.06: El Museo del Prado y entrevista con su subdirector Javier Salas -- Min. 12.53: Entrevista con Lola Flores, intervienen además El Pescailla y su hija Lolita -- Min. 18.06: Reportaje sobre la Exposición de la Construcción en el Paseo de la Castellana con palabras de su director Julio Diamante -- Min. 19.37: Entrevista a Ferenc Puskas con motivo de la llegada a España de su madre -- Min. 23.25: Música interpretada por el Trio Albéniz -- Min. 24.17: Posdata de novedades: Incremento de intercambio comercial España-México. Regresa a España el Embajador de Chile Ricardo Irarrazabal. Creación del Consejo Nacional de Prensa. El Médico Ors Llorca nombrado Honoris Causa por la Universidad de Córdaba, Argentina. El cine argentino. Construcción de viviendas en Barcelona después de las inundaciones -- Min. 27.20: El consultorio: pregunta un oyente Raúl Azcarrága pregunta sobre el número de universidades laborales en España -- Min. 28.59: DespedidaPeriodistas: Aurora de Andrés y Eufrasio Zúñiga. Entrevistados: Javier Salas. Lola Flores. Antonio González. Lolita. Julio Diamante. Ferenc Puskas. Trío Albéni

[Carta de España]

Periodistas: Aurora de Andrés y Eufrasio Zúñiga. Entrevistados: Javier Salas. Lola Flores. Antonio González. Lolita. Julio Diamante. Ferenc Puskas. Trío AlbénizMin. 0.56: Reportaje en el Colegio Mayor Guadalupe con los estudiantes -- Min. 07.06: El Museo del Prado y entrevista con su subdirector Javier Salas -- Min. 12.53: Entrevista con Lola Flores, intervienen además El Pescailla y su hija Lolita -- Min. 18.06: Reportaje sobre la Exposición de la Construcción en el Paseo de la Castellana con palabras de su director Julio Diamante -- Min. 19.37: Entrevista a Ferenc Puskas con motivo de la llegada a España de su madre -- Min. 23.25: Música interpretada por el Trio Albéniz -- Min. 24.17: Posdata de novedades: Incremento de intercambio comercial España-México. Regresa a España el Embajador de Chile Ricardo Irarrazabal. Creación del Consejo Nacional de Prensa. El Médico Ors Llorca nombrado Honoris Causa por la Universidad de Córdaba, Argentina. El cine argentino. Construcción de viviendas en Barcelona después de las inundaciones -- Min. 27.20: El consultorio: pregunta un oyente Raúl Azcarrága pregunta sobre el número de universidades laborales en España -- Min. 28.59: Despedid

[Carta de España]

Min. 0.56: Reportaje en el Colegio Mayor Guadalupe con los estudiantes -- Min. 07.06: El Museo del Prado y entrevista con su subdirector Javier Salas -- Min. 12.53: Entrevista con Lola Flores, intervienen además El Pescailla y su hija Lolita -- Min. 18.06: Reportaje sobre la Exposición de la Construcción en el Paseo de la Castellana con palabras de su director Julio Diamante -- Min. 19.37: Entrevista a Ferenc Puskas con motivo de la llegada a España de su madre -- Min. 23.25: Música interpretada por el Trio Albéniz -- Min. 24.17: Posdata de novedades: Incremento de intercambio comercial España-México. Regresa a España el Embajador de Chile Ricardo Irarrazabal. Creación del Consejo Nacional de Prensa. El Médico Ors Llorca nombrado Honoris Causa por la Universidad de Córdaba, Argentina. El cine argentino. Construcción de viviendas en Barcelona después de las inundaciones -- Min. 27.20: El consultorio: pregunta un oyente Raúl Azcarrága pregunta sobre el número de universidades laborales en España -- Min. 28.59: DespedidaPeriodistas: Aurora de Andrés y Eufrasio Zúñiga. Entrevistados: Javier Salas. Lola Flores. Antonio González. Lolita. Julio Diamante. Ferenc Puskas. Trío Albéni

Exercise training worsens cardiac performance in males but does not change ejection fraction and improves hypertrophy in females in a mouse model of metabolic syndrome

Background Metabolic syndrome (MetS) refers to a cluster of co-existing cardio-metabolic risk factors, including visceral obesity, dyslipidemia, hyperglycemia with insulin resistance, and hypertension. As there is a close link between MetS and cardiovascular diseases, we aimed to investigate the sex-based differences in MetS-associated heart failure (HF) and cardiovascular response to regular exercise training (ET). Methods High-fat diet-fed male and female APOB-100 transgenic (HFD/APOB-100, 3 months) mice were used as MetS models, and age- and sex-matched C57BL/6 wild-type mice on standard diet served as healthy controls (SD/WT). Both the SD/WT and HFD/APOB-100 mice were divided into sedentary and ET groups, the latter running on a treadmill (0.9 km/h) for 45 min 5 times per week for 7 months. At month 9, transthoracic echocardiography was performed to monitor cardiac function and morphology. At the termination of the experiment at month 10, blood was collected for serum low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol measurements and homeostatic assessment model for insulin resistance (HOMA-IR) calculation. Cardiomyocyte hypertrophy and fibrosis were assessed by histology. Left ventricular expressions of selected genes associated with metabolism, inflammation, and stress response were investigated by qPCR. Results Both HFD/APOB-100 males and females developed obesity and hypercholesterolemia; however, only males showed insulin resistance. ET did not change these metabolic parameters. HFD/APOB-100 males showed echocardiographic signs of mild HF with dilated ventricles and thinner walls, whereas females presented the beginning of left ventricular hypertrophy. In response to ET, SD/WT males developed increased left ventricular volumes, whereas females responded with physiologic hypertrophy. Exercise-trained HFD/APOB-100 males presented worsening HF with reduced ejection fraction; however, ET did not change the ejection fraction and reversed the echocardiographic signs of left ventricular hypertrophy in HFD/APOB-100 females. The left ventricular expression of the leptin receptor was higher in females than males in the SD/WT groups. Left ventricular expression levels of stress response-related genes were higher in the exercise-trained HFD/APOB-100 males and exercise-trained SD/WT females than exercise-trained SD/WT males. Conclusions HFD/APOB-100 mice showed sex-specific cardiovascular responses to MetS and ET; however, left ventricular gene expressions were similar between the groups except for leptin receptor and several stress response-related genes.Peer reviewe