Increased intermediate CD14⁺⁺CD16⁺⁺ monocyte subset levels associate with restenosis after peripheral percutaneous transluminal angioplasty.

BACKGROUND AND AIMS: We aimed at studying the association of three major human monocyte subsets after percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal disease. METHODS: We prospectively studied 67 sequential patients (40 male, 27 female; mean age 71 ± 11 years) treated with femoropopliteal angioplasty. Multi-color flow cytometry characterized monocyte subsets from venous blood for expression of CD14 and CD16 and intracellular myeloperoxidase (MPO) prior to, and 3, 6 and 12 months post PTA. Analyses tested associations between monocyte subsets and risk for restenosis. RESULTS: 16/67 patients (24%) developed restenosis within 12 months after PTA. Patients with hyperlipidemia had increased risk for restenosis (HR = 1.7, 95% CI 0.7-2.9, p = 0.001). Increased baseline monocytes associated with an increased risk of late restenosis (HR = 4.9, 95% CI: 1.3-18.6, p = 0.047). CD14(++)CD16(++) 'intermediate' monocytes assessed at baseline, and after 3, 6, and 12 months significantly associated with the risk for subsequent restenosis: HR = 3.9 (95% CI: 2.4-6.5, p = 0.029), HR = 5.7 (95% CI = 0.7-44.7, p = 0.013), HR = 6.5 (95% CI: 2.5-16.9, p = 0.001) and HR = 1.5 (95% CI = 1.4-15.5 p = 0.001), respectively. Moreover, the probability for freedom of restenosis decreased with increased levels of intermediate subsets at 12 months after PTA. Additionally, intracellular MPO expression in CD14(++)CD16(++) measured at 3, 6 and 12 months associated with an increased restenosis risk (HR = 1.5, 95% CI: 0.8-2.1, p = 0.214, HR = 1.9, 95% CI: 1.0-2.3 p = 0.051 and HR = 1.4, 95% CI: 1.0-1.8, p = 0.052). CONCLUSIONS: Our results imply altered innate immunity after angioplasty. Elevated CD14(++)CD16(++) intermediate monocyte frequencies and increased MPO expression may identify individuals at heightened risk for restenosis

What sparks quality-driven change programmes in not-for-profit service sector? Some evidence from the voluntary sector

Despite the massive amount of attention paid to quality management in privately owned manufacturing and services firms and publicly owned organisations, few scholars have attempted to examine the application and outcomes of various quality-driven change initiatives in the context of voluntary sector organisations. This paper reports on the application of quality management programmes in terms of logic of adoption, implementation decisions and the resultant performance outcomes in a sample of voluntary sector organisations. Using a multiple case study design of three firms, the findings largely support the view that initiating quality-oriented change programmes poses a unique challenge to the management on two fronts: first, management logic and understanding for adopting quality initiatives, and the ability of the management to appreciate the synergetic relationship between efficiency gains and legitimacy concerns so that a continuous learning environment will follow. Drawing on insights from institutional theory literature, we shed light on the complexities inherent in the sector that necessitate a reappraisal of the logic of quality initiatives adoption, which in turn create a dilemma and indeed build resistance for the management to embody an unconditional commitment to the strategic importance of quality. The paper concludes with several working propositions and discusses the practical implications of the findings