Prediction of Coronary Risk by SYNTAX and Derived Scores Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery

The introduction of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score has prompted a renewed interest for angiographic risk stratification in patients undergoing percutaneous coronary intervention. Syntax score is based on qualitative and quantitative characterization of coronary artery disease by including 11 angiographic variables that take into consideration lesion location and characteristics. Thus far, this score has been shown to be an effective tool to risk-stratify patients with complex coronary artery disease undergoing percutaneous coronary intervention in the landmark SYNTAX trial, as well as in other clinical settings. This review provides an overview of its current applications, including its integration with other nonangiographic clinical scores, and explores future applications of the SYNTAX and derived scores. (C) 2013 by the American College of Cardiology FoundationAbbott VascularDoris Duke Charitable FoundationColumbia Univ, Med Ctr, New York, NY 10022 USACardiovasc Res Fdn, New York, NY USAUniv Bologna, Ist Cardiol, Bologna, ItalyUniversidade Federal de São Paulo, Hosp Israelita Albert Einstein, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniv Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, CanadaUniversidade Federal de São Paulo, Hosp Israelita Albert Einstein, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Revision of the 15N(p,{\gamma})16O reaction rate and oxygen abundance in H-burning zones

The NO cycle takes place in the deepest layer of a H-burning core or shell, when the temperature exceeds T {\simeq} 30 {\cdot} 106 K. The O depletion observed in some globular cluster giant stars, always associated with a Na enhancement, may be due to either a deep mixing during the RGB (red giant branch) phase of the star or to the pollution of the primordial gas by an early population of massive AGB (asymptotic giant branch) stars, whose chemical composition was modified by the hot bottom burning. In both cases, the NO cycle is responsible for the O depletion. The activation of this cycle depends on the rate of the 15N(p,{\gamma})16O reaction. A precise evaluation of this reaction rate at temperatures as low as experienced in H-burning zones in stellar interiors is mandatory to understand the observed O abundances. We present a new measurement of the 15N(p,{\gamma})16O reaction performed at LUNA covering for the first time the center of mass energy range 70-370 keV, which corresponds to stellar temperatures between 65 {\cdot} 106 K and 780 {\cdot}106 K. This range includes the 15N(p,{\gamma})16O Gamow-peak energy of explosive H-burning taking place in the external layer of a nova and the one of the hot bottom burning (HBB) nucleosynthesis occurring in massive AGB stars. With the present data, we are also able to confirm the result of the previous R-matrix extrapolation. In particular, in the temperature range of astrophysical interest, the new rate is about a factor of 2 smaller than reported in the widely adopted compilation of reaction rates (NACRE or CF88) and the uncertainty is now reduced down to the 10% level.Comment: 6 pages, 5 figure

Noncanonical Fungal Autophagy Inhibits Inflammation in Response to IFN-γ via DAPK1

Defects in a form of noncanonical autophagy, known as LC3-associated phagocytosis (LAP), lead to increased inflammatory pathology during fungal infection. Although LAP contributes to fungal degradation, the molecular mechanisms underlying LAP-mediated modulation of inflammation are unknown. We describe a mechanism by which inflammation is regulated during LAP through the death-associated protein kinase 1 (DAPK1). The ATF6/C/EBP-β/DAPK1 axis activated by IFN-γ not only mediates LAP to Aspergillus fumigatus but also concomitantly inhibits Nod-like receptor protein 3 (NLRP3) activation and restrains pathogenic inflammation. In mouse models and patient samples of chronic granulomatous disease, which exhibit defective autophagy and increased inflammasome activity, IFN-γ restores reduced DAPK1 activity and dampens fungal growth. Additionally, in a cohort of hematopoietic stem cell-transplanted patients, a genetic DAPK1 deficiency is associated with increased inflammation and heightened aspergillosis susceptibility. Thus, DAPK1 is a potential drugable player in regulating the inflammatory response during fungal clearance initiated by IFN-γ

Observable Signatures of Planet Accretion in Red Giant Stars I: Rapid Rotation and Light Element Replenishment

The orbital angular momentum of a close-orbiting giant planet can be sufficiently large that, if transferred to the envelope of the host star during the red giant branch (RGB) evolution, it can spin-up the star's rotation to unusually large speeds. This spin-up mechanism is one possible explanation for the rapid rotators detected among the population of generally slow-rotating red giant stars. These rapid rotators thus comprise a unique stellar sample suitable for searching for signatures of planet accretion in the form of unusual stellar abundances due to the dissemination of the accreted planet in the stellar envelope. In this study, we look for signatures of replenishment in the Li abundances and (to a lesser extent) 12C/13C, which are both normally lowered during RGB evolution. Accurate abundances were measured from high signal-to-noise echelle spectra for samples of both slow and rapid rotator red giant stars. We find that the rapid rotators are on average enriched in lithium compared to the slow rotators, but both groups of stars have identical distributions of 12C/13C within our measurement precision. Both of these abundance results are consistent with the accretion of planets of only a few Jupiter masses. We also explore alternative scenarios for understanding the most Li-rich stars in our sample---particularly Li regeneration during various stages of stellar evolution. Finally, we find that our stellar samples show non-standard abundances even at early RGB stages, suggesting that initial protostellar Li abundances and 12C/13C may be more variable than originally thought.Comment: Accepted for publication in the Astrophysical Journal. 29 pages in emulateapj format, including 16 figures and 12 tables. Tables 4 and 8 are provided in their entirety as plain text ancillary files (and will also be available in the electronic edition of ApJ

The astrophysical S-factor of the direct 18

We attempted to determine the astrophysical S-factor of the direct part of the 18O(p, γ)19F capture by the indirect method of asymptotic normalization coefficients (ANC). We measured the differential cross section of the transfer reaction 18O(3He, d)19F at a 3He energy of 24.6 MeV. The measurement was realized on the cyclotron of the NPI in Řež, Czech Republic, with the gas target consisting of the high purity 18O (99.9 %). The reaction products were measured by eight ∆E-E telescopes composed from thin and thick silicon surface-barrier detectors. The parameters of the optical model for the input channel were deduced by means of the code ECIS and the analysis of transfer reactions to 12 levels of the 19F nucleus up to 8.014 MeV was made by the code FRESCO. The deduced ANCs were then used to specify the direct contribution to the 18O(p, γ)19F capture process and were compared with the mutually different results of two works

Trabectedin for patients with advanced soft tissue sarcoma: A non-interventional, retrospective, multicenter study of the italian sarcoma group

The Italian Sarcoma Group performed this retrospective analysis of patients with advanced soft tissue sarcoma, pretreated with ≥1 anthracycline-based treatment, and treated with trabectedin every three weeks. Primary endpoint was to describe real-life use of trabectedin across Italy. Secondary endpoints included objective response rate (ORR) and safety. Overall, 512 patients from 20 Italian centers were evaluated. Leiomyosarcoma (37.7%)/liposarcoma (30.3%) were the most prevalent histological types (abbreviated as L-sarcoma). Patients received a median of four trabectedin cycles (range: 1–40), mostly as a second-line treatment (~60% of patients). The ORR was 13.7% superior (p < 0.0001) in patients with L-sarcoma compared with patients with non-L-sarcoma (16.6% vs. 9.0%). Median progression-free survival (PFS) was 5.1 months, whereas median overall survival (OS) was 21.6 months. Significantly better PFS and OS were observed in patients with L-sarcoma, those with objective responses and/or disease stabilization, treated in an early line and treated with reduced dose. Bone marrow toxicity (61.4%) and transaminase increases (21.9%) were the most common grade 3/4 adverse events. The results of this real-life study suggest that trabectedin is an active treatment, which is mostly given as a second-line treatment to patients with a good performance status and high-grade, metastatic L-sarcoma (clinical trial information: NCT02793050)

Revascularization for Unprotected Left Main Coronary Artery Disease: An Evolution in Clinical Decision Making

Coronary artery bypass grafting (CABG) has been considered the standard therapy for unprotected (nonrevascularized) left main coronary disease (ULM). However, increasing experience with ULM percutaneous coronary intervention (PCI) has resulted in high procedural success and favorable early and late clinical outcomes. In particular, reduction in clinical restenosis with drug-eluting stents, evolution of procedural technique, and demonstration of favorable outcomes from comparative trials with CABG have promoted consideration of PCI as an alternative revascularization strategy in selected patients with ULM disease. This review summarizes the results from comparative studies examining PCI versus CABG for ULM disease, discusses changing indications for ULM PCI and identifies outstanding issues that must be considered before further advancing treatment recommendations

The 19F(α, p)22Ne and 23Na(p,α)20Ne reaction in AGB nucleosynthesis via THM

In AGB environment, fluorine and sodium abundances are still matter of debate. About 19F (only stable isotope of fluorine), its abundance in the universe is strictly related to standard and extra-mixing processes taking place inside AGB-stars, that are considered to be the most important sites for its production. Nevertheless the way in which it is destroyed is far from being well understood. On the other hand, 23Na presence in Globular Clusters, along with is well-known anticorrelation with oxygen has made clear that this element must be produced in previous generations stars, and intermediatemass AGB stars are one of the possible candidates for its production. For this reason we studied the 19F(α,p)22Ne and 23Na(p,α)20Ne reactions in the energy range of relevance for astrophysics via the Trojan Horse Method (THM), using the three-body reactions 6Li(19F, p22Ne)d and 23Na(d, pn)20Ne

Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects

<p>Abstract</p> <p>Background</p> <p>Few data exist regarding the direct effects of caffeine and smoking on cardiac function. We sought to explore the acute effects of caffeine assumption, cigarette smoking, or both on left ventricular (LV) and right ventricular (RV) function in a population of young normal subjects.</p> <p>Methods</p> <p>Forty-five healthy subjects aged 25 ± 2 years underwent echocardiography. Fifteen of them were non-smokers and habitual coffee consumers (group 1), 15 were smokers and not habitual coffee consumers (group 2), and 15 were smokers and habitual coffee consumers (group 3). Peak systolic (S_a), early diastolic E_a, and late diastolic (A_a) velocity of mitral annulus were measured by pulsed Tissue Doppler, and left atrioventricular plane displacement was determined by M-mode. Tricuspid annular velocities and systolic excursion (TAPSE) were also determined. Measurements were performed at baseline and after oral assumption of caffeine 100 mg in group 1, one cigarette smoking in group 2, and both in group 3.</p> <p>Results</p> <p>No changes in ventricular function were observed in group 1 after caffeine administration. In group 2, cigarette smoking yielded an acute increase in mitral A_a(+12.1%, p = 0.0026), tricuspid S_a(+9.8%, p = 0.012) and TAPSE (+7.9%, p = 0.017), and a decrease in the mitral E_a/A_aratio (-8.5%, p = 0.0084). Sequential caffeine assumption and cigarette smoking in group 3 was associated with an acute increase in mitral A_a(+13.0%, p = 0.015) and tricuspid A_a(+11.6%, p < 0.0001) and a reduction in mitral E_a/A_aratio (-8.5%, p = 0.0084) tricuspid E_a(-6.6%, p = 0.048) and tricuspid E_a/A_aratio (-9.6%, p = 0.0003). In a two-way ANOVA model controlling for hemodynamic confounding factors, changes in the overall population remained significant for mitral A_aand E_a/A_aratio, and for tricuspid A_aand E_a/A_aratio.</p> <p>Conclusion</p> <p>In young healthy subjects, one cigarette smoking is associated to an acute impairment in LV diastolic function and a hyperdynamic RV systolic response. Caffeine assumption alone does not exert any acute effect on ventricular long-axis function, but potentiates the negative effect of cigarette smoking by abolishing RV supernormal response and leading to a simultaneous impairment in both LV and RV diastolic function.</p