48 research outputs found
Drug-Eluting Stents in Patients with Chronic Kidney Disease: A Prospective Registry Study
BACKGROUND: Chronic kidney disease (CKD) is strongly associated with adverse outcomes after percutaneous coronary intervention (PCI). There are limited data on the effectiveness of drug-eluting stents (DES) in patients with CKD. METHODOLOGY/PRINCIPAL FINDINGS: Of 3,752 consecutive patients enrolled in the Guthrie PCI Registry between 2001 and 2006, 436 patients with CKD - defined as a creatinine clearance <60 mL/min - were included in this study. Patients who received DES were compared to those who received bare metal stents (BMS). Patients were followed for a mean duration of 3 years after the index PCI to determine the prognostic impact of stent type. Study end-points were all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and the composite of major adverse cardiovascular events (MACE), defined as death, MI or TVR. Patients receiving DES in our study, by virtue of physician selection, had more stable coronary artery disease and had lower baseline risk of thrombotic or restenotic events. Kaplan-Meier estimates of proportions of patients reaching the end-points were significantly lower for DES vs. BMS for all-cause death (p = 0.0008), TVR (p = 0.029) and MACE (p = 0.0015), but not MI (p = 0.945) or ST (p = 0.88). Multivariable analysis with propensity adjustment demonstrated that DES implantation was an independent predictor of lower rates of all-cause death (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.25-0.92), TVR (HR 0.50, 95% CI 0.27-0.94) and MACE (HR 0.62, 95% CI 0.41-0.94). CONCLUSIONS: In a contemporary PCI registry, selective use of DES in patients with CKD was safe and effective in the long term, with lower risk of all-cause death, TVR and MACE and similar risk of MI and ST as compared with BMS. The mortality benefit may be a result of selection bias and residual confounding, or represent a true finding; a hypothesis that warrants clarification by randomized clinical trials
Inflammatory Gene Regulatory Networks in Amnion Cells Following Cytokine Stimulation: Translational Systems Approach to Modeling Human Parturition
A majority of the studies examining the molecular regulation of human labor have
been conducted using single gene approaches. While the technology to produce
multi-dimensional datasets is readily available, the means for facile analysis
of such data are limited. The objective of this study was to develop a systems
approach to infer regulatory mechanisms governing global gene expression in
cytokine-challenged cells in vitro, and to apply these methods
to predict gene regulatory networks (GRNs) in intrauterine tissues during term
parturition. To this end, microarray analysis was applied to human amnion
mesenchymal cells (AMCs) stimulated with interleukin-1β, and differentially
expressed transcripts were subjected to hierarchical clustering, temporal
expression profiling, and motif enrichment analysis, from which a GRN was
constructed. These methods were then applied to fetal membrane specimens
collected in the absence or presence of spontaneous term labor. Analysis of
cytokine-responsive genes in AMCs revealed a sterile immune response signature,
with promoters enriched in response elements for several inflammation-associated
transcription factors. In comparison to the fetal membrane dataset, there were
34 genes commonly upregulated, many of which were part of an acute inflammation
gene expression signature. Binding motifs for nuclear factor-κB were
prominent in the gene interaction and regulatory networks for both datasets;
however, we found little evidence to support the utilization of
pathogen-associated molecular pattern (PAMP) signaling. The tissue specimens
were also enriched for transcripts governed by hypoxia-inducible factor. The
approach presented here provides an uncomplicated means to infer global
relationships among gene clusters involved in cellular responses to
labor-associated signals
Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK): Explanation and Elaboration
The REMARK “elaboration and explanation” guideline, by Doug Altman and colleagues, provides a detailed reference for authors on important issues to consider when designing, conducting, and analyzing tumor marker prognostic studies