Longer Lesions Research Articles

Application of rotational atherectomy in the drug-eluting stent era.

Rotational atherectomy (RA) was introduced in the interventional arena in 1988 as a dedicated device for calcified lesions. Due to the complexity of the technique, the development of alternative methods such as the cutting balloon procedure, and the high restenosis rate of subsequent bare metal stenting in long lesions, its use had later declined. However, with the increasing use of drug-eluting stents (DES) and the aggressive treatment of longer lesions, the number of procedure performed with RA has increased significantly again in recent years. In this article, we reviewed the application of RA in DES era.

ABSORB EXTEND: an Interim 12-month propensity adjusted comparison of clinical outcomes of approximately 450 ABSORB patients to XIENCE V patients

Purpose: The Absorb Bioresorbable Vascular Scaffold (BVS) has been designed based upon the MULTI-LINK VISION family of stents which includes the XIENCE V EES. Both designs have shown consistency in acute radial strength and recoil. Everolimus is the drug of choice for the Absorb BVS and the XIENCE V EES and both contain 100ug/cm2 of the drug with identical elution profiles. Therefore, similarities between these two devices allow for relevant comparison of the results obtained in the SPIRIT II and SPIRIT III studies using the XIENCE V and the ABSORB EXTEND study using the Absorb BVS. Methods: Approximately 450 patients enrolled in ABSORB EXTEND will be compared to patients from the SPIRIT II and SPIRIT III studies using propensity score adjustment in an effort to provide comparative data on the safety and performance of the Absorb BVS System in a larger population of patients, including those with longer lesions and dual vessel treatment when compared to XIENCE V. Results: A propensity adjusted descriptive comparison of clinical and lesion characteristics, and procedural and clinical outcomes between the two populations will be presented through 12 months. View this table: Unadjusted baseline characteristics Conclusion: Interim outcomes in approximately 450 patients through 12 months from ABSORB EXTEND (the largest patient cohort reported at this time point to date) and a propensity adjusted comparison to XIENCE V will provide further insight into the longer-term safety and efficacy of the Absorb BVS System.

Determinants of angiographic thrombus burden in patients with ST-elevation myocardial infarction

Aims: We aimed to investigate the determinants of angiographic thrombus burden in patients with ST elevation myocardial infarction (STEMI) who underwent to primary Percutaneous coronary intervention (PCI). Methods: The study population consisted of 662 patients with non-anemic STEMI who underwent to primary PCI. Clinical, laboratory and demographic properties of the patients were recorded Baseline hematologic indices were measured at time of admission. Angiographic coronary thrombus burden was scored based on TIMI thrombus grades. After wiring and/or small balloon dilation, patients with thrombus burden grade 4 and 5 was defined as high thrombus burden, patients with thrombus burden < grade 4 was defined as low thrombus burden. Results: Patients with high thrombus burden had more family history of coronary artery disease, longer pain-balloon time, higher Killip class (≥II), higher neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), baseline creatine kinase musclebrain fraction (CK-MB) and baseline troponin, higher peak CK-MB and peak troponin; however, lower triglycerides. As an angiographically, Patients with high thrombus burden had longer lesion in the infarct-related artery, less frequent direct stenting, lower epicardial and myocardial perfusion, more frequent distal embolization, more frequent electrocardiographic and angiographic no-reflow. In multivariate logistic regression analysis only RDW (OR:1.29, 95% CI 1.19 – 1.39, p<0.001) was determined as independent predictors in the analysis. The area under the ROC curve of the RDW was 0.733 (0.690 – 0.776, P<0.001) to predict high TIMI thrombus burden. Conclusion: Present study results demonstrated that high thrombus burden in patients with STEMI were associated with impaired postprocedural epicardial and myocardial perfusion and higher no-reflow and distal embolization; and increased RDW values was independent predictors of coronary thrombus burden.

Determinants of Angiographic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction

We aimed to investigate the determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). The study population consisted of 662 patients with nonanemic STEMI who underwent pPCI. Clinical, laboratory, and demographic properties of the patients were recorded. Baseline hematologic indices were measured at the time of admission. Angiographic coronary thrombus burden was scored based on thrombolysis in myocardial infarction (TIMI) thrombus grades. After wiring and/or small balloon dilation, patients with thrombus burden grades 4 and 5 were defined as high thrombus burden, and patients with thrombus burden <grade 4 was defined as low thrombus burden. Patients with high thrombus burden had more family history of coronary artery disease, longer pain to balloon time, higher Killip class (≥II), higher neutrophil to lymphocyte ratio, red cell distribution width (RDW), baseline creatine kinase-MB fraction (CK-MB) and baseline troponin, higher peak CK-MB, and peak troponinbut lower triglycerides. Angiographically, patients with high thrombus burden had longer lesion in the infarct-related artery, less frequent direct stenting, lower epicardial and myocardial perfusion, more frequent distal embolization, and more frequent electrocardiographic and angiographic no reflow. In multivariate logistic regression analysis, only RDW (odds ratio: 1.29, 95% confidence interval 1.19-1.39, P < .001) was determined as independent predictor. The area under the receiver-operating characteristic curve of the RDW was 0.733 (0.690-0.776, P < .001) to predict high TIMI thrombus burden. Present study results demonstrated that high thrombus burden in patients with STEMI was associated with impaired postprocedural epicardial and myocardial perfusion and higher no reflow and distal embolization; and increased RDW values were independent predictors of coronary thrombus burden.

Drug-Eluting Nitinol Stent Treatment of the Superficial Femoral Artery and Above-the-Knee Popliteal Artery (The Zilver PTX Single-Arm Clinical Study): A Comparison Between Diabetic and Nondiabetic Patients

To describe the 1-year results of drug-eluting nitinol stent placement in the femoropopliteal artery of diabetic and nondiabetic patients. All patients enrolled in this prospective, multicenter study underwent paclitaxel-eluting stent placement for de novo or restenotic lesions of the superficial femoral and/or popliteal artery. Baseline and follow-up walking impairment questionnaire (WIQ) scores, Rutherford classifications, and ankle-brachial index (ABI) measurements were obtained. Follow-up was completed at 1, 6, and 12 months. There were 285 diabetic patients and 502 nondiabetic patients treated. There were no significant differences in mean lesion length or lesion calcification between patient groups. Procedural success in both treatment groups was >97 %. There were no significant differences between diabetic and nondiabetic groups in Kaplan-Meier estimates of patency, event-free survival (EFS), or freedom from target lesion revascularization (TLR) at 6 and 12 months. Both groups experienced a significant increase in ABI and WIQ values after treatment, and these improvements were sustained to 12-month follow-up; however, nondiabetic patients had significantly greater 6- and 12-month WIQ scores compared with diabetic patients. Based on covariate analysis, the only factors shown to be significant and to negatively influence patency were longer lesion length (p = 0.009), higher Rutherford classification (p = 0.02), and lack of hypertension (p = 0.02); diabetic status was not found to be a significant factor. Diabetic and nondiabetic patients had similar estimates of primary patency, EFS, and freedom from TLR; however, diabetic patients showed less improvement in WIQ scores compared with nondiabetic patients.

Initial experience in the clinical use of everolimus-eluting bioresorbable vascular scaffold (BVS) in a single institution

We read with great interest the recent review article on bioresorbable vascular scaffolds by Bourantas et al. and wish to share our institution's experience with the use of the ABSORB bioresorbable vascular scaffold (BVS; Abbott Vascular, Santa Clara, California) [1]. There is currently limited published data on the use of BVS in routine clinical practice andwehaveundertaken a prospective evaluation of this novel device in our institution. All consecutive patients who underwent percutaneous coronary intervention (PCI) with intent for BVS implantation between July 2011 and September 2012were included in the analysis. All patients received dual anti-platelet therapyprior to PCI and this therapywascontinued for at least a year after implantation. This study fulfilled local ethical requirements and written informed consent was obtained from all patients. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. Once a suitable lesion was identified, the pre-procedural reference vessel diameter (RVD) was assessed by quantitative coronary analysis (QCA) using the Pie Medical CAAS QCA (quantitative coronary analysis) package in our Xcelera Workstations (Philips Medical Systems, Veenpluis, The Netherlands). Alternative vessel sizing was via the use of commercially available intravascular ultrasound (IVUS) or optical coherence tomography (OCT). A RVD of 2.0 to 3.8 mm and a lesion length of less than 28 mm were considered suitable for BVS (single or overlapping). The availableABSORBBVSwere2.5×18 mm,2.5×28 mm, 3.0×18 mm, 3.0×28 mm, 3.5×12 mm, 3.5×18 mm, or 3.5×28 mm in size. 6 Fr vascular access was used in all patients with a predominant radial access (77.1%). Mandatory predilation with balloon angioplasty using a balloon with a diameter of 0.5 mm smaller or equivalent to the intended BVS size was performed prior to BVS implantation. Device deployment was performed at a rate of ≤2 atm per 5 s up to 16 atm (rated burst pressure). Postdilation was with a non-compliant balloon with diameter≤0.25 mm beyond the implanted BVS if necessary to avoid scaffold damage. For longer lesions or edge dissections, overlapping scaffolds were used. A total of 35 consecutive patients with 41 lesions underwent attempted ABSORB BVS implantation during the study period. Baseline emographics, indications, procedure and quantitative coronary angiography details are summarized in Table 1. The mean age is 54.7± 11.2 years (range 36–86 years) and 85.7% of the patients (n=30) were male. Diabetes mellitus (type I or II) was present in 17.1% (n=6) of the study population. 51.4% of patients presented with an acute coronary syndrome including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). Overall, 45 BVS were successfully implanted in 33 (93.3%) patients (1.4 BVS/patient). Of the 41 lesions treated, the success rate was 100% (22/22) for the left anterior descending artery (LAD), 100% (11/11) for the right coronary artery (RCA), and 75% (6/8) for the left circumflex artery (LCX). Two patients had circumflex (LCX) stenosis not crossable by the BVS despite aggressive lesion preparation with multiple balloon predilations. An equivalent metallic drug eluting stent crossed without difficulty in both cases. The majority, 31 (75.6%), of lesions treated were complex (B2 or C). Pre-procedure RVD was assessed by QCA in 28 patients (80.0%), IVUS in 4 patients (11.4%), andOCT in 3 patients (8.6%). Themeanpre-procedural RVDwas 2.7±0.4 mm, diameter stenosiswas 77.7±13.0%, and lesion lengthwas 17.2±6.7 mm. Post-procedural RVD was 3.0±0.3 mmwith residual diameter stenosis of 2.4±2.0%.

Effect of lesion length on functional significance of intermediate long coronary lesions

To assess the relationship between lesion length and other angiographic parameters on the functional significance of long coronary lesions with moderate stenosis. Coronary revascularization is usually based on angiographic percent stenosis. Coronary stenosis length is not usually considered in daily clinical practice for revascularization decision-making. The relevance of lesion length might be greater in longer lesions with intermediate stenosis. All coronary lesions >20 mm and of 40-70% percent stenosis assessed by intracoronary pressure wire between 2007 and 2009 were included. Interventionists performing digital quantification of lesion stenosis were blinded to the result of fractional flow reserve (FFR). Correlations between angiographic data and FFR were analyzed. One hundred and six lesions from 103 patients were included. Reference diameter: 2.9 ± 0.56 mm; maximal stenosis: 49.0 ± 8.7%; minimal luminal diameter (MinimalLD): 1.48 ± 0.4 mm; mean luminal diameter (MeanLD): 2.3 ± 0.5 mm; mean lesion length: 28.7 ± 10.6 mm. Lesions with FFR <0.75 accounted for 33% (n = 35). Weak correlations were obtained between FFR and MinimalLD (r = 0.36; P < 0.0005), MeanLD (r = 0.24; P = 0.014), maximal stenosis (r = 0.31; P = 0.001), and mean stenosis (r = 0.018; P = 0.85); strong correlations were observed between FFR and lesion length (r = 0.63; P < 0.0005), lesion length/MinimalLD (r = 0.67; P < 0.0005), and lesion length/MeanLD (0.72; P < 0.0005). The predictive values of lesion length, lesion length/MinimalLD, and lesion length/MeanLD for FFR <0.75 were 0.86, 0.91, and 0.92, respectively. In long lesions (>20 mm) with moderate angiographic stenosis, lesion length might be the strongest determinant of functional repercussion. Lesion length should be considered when judging the benefit of revascularization or perform functional functional measures that overcome the limitations of simple stenosis quantification.

Incidence of definite stent thrombosis or in‐stent restenosis after drug‐eluting stent implantation for treatment of coronary in‐stent restenosis: From Western Denmark heart registry

There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis or restenosis after DES implantation for treatment of restenosis. From January 2002 to June 2005, all consecutive patients with restenosis < 12 months after index PCI with DES or BMS implantation, were identified in the population-based Western Denmark Heart Registry. Patients were followed until 24 months after their first restenosis. A total of 589 lesions were treated for clinically driven restenosis with target lesion revascularization (TLR) within 12 months after the index PCI. Among those, 302 lesions were treated with DES (BMS-restenosis n = 244 and DES-restenosis n = 58). Admission were due to stable angina pectoris (n = 249 (82.4%)), unstable angina pectoris (n = 34 (11.3%)), or non-ST segment elevation myocardial infarction (n = 19 (6.3%)). The clinical indication was not different between patients with BMS restenosis compared to DES restenosis. In the BMS restenosis group, older age, longer lesion, longer stent length, and a higher number of stents used was observed compared to the DES restenosis group. After a first restenosis, clinically driven re-TLR was seen in 26 (8.6%) patients within the following 24 months, stent thrombosis (median duration 155 days, interquartile range (IQR) 9-627 days) was seen in 3 lesions (1.0%), and secondary restenosis (median duration 168 days, IQR 88-266 days) was seen in 23 (7.6%) [DES restenosis group 6.9% vs. BMS restenosis group 7.8%, P = 0.818] lesions. The clinical presentation did not differ between BMS or DES and most patients present with stable angina pectoris. Risk of stent thrombosis or restenosis was not increased in patients with DES restenosis compared to patients with BMS restenosis treated with DES.

Comparative Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Elderly Patients Undergoing Revascularization of Chronic Total Coronary Occlusions: Results From the National Cardiovascular Data Registry, 2005–2008

This study sought to investigate the long-term effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS). Improved recanalization techniques have increased interest in percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO). The long-term effectiveness of DES and BMS is not known. We used data from 10,261 stable patients age ≥65 years at 889 U.S. hospitals who underwent CTO PCI from January 1, 2005, to December 31, 2008, in the NCDR (National Cardiovascular Data Registry) CathPCI Registry with linked Medicare inpatient claims for follow-up. Patient and procedural characteristics, and 30-month death, myocardial infarction, revascularization, and hospitalization for bleeding were evaluated by stent type. Outcomes following stenting were adjusted and compared using propensity score matching. DES were used for CTO PCI in 8,218 (80%) and BMS in 2,043 (20%). DES patients were younger (74.0 vs. 75.5 years, p < 0.001), had longer lesions (18.8 vs. 16.5 mm, p < 0.001), received more stents (≥2 stents in 45.7% vs. 37.9%, p < 0.001), and underwent multivessel PCI (18.9% vs. 15.1%, p < 0.001). DES implantation was associated with a lower hazard of mortality (hazard ratio [HR]: = 0.72, 95% confidence interval [CI]: 0.60 to 0.86, p < 0.001), a similar hazard for myocardial infarction (HR: 0.85, 95% CI: 0.61 to 1.19, p = 0.35), and subsequent revascularization (HR: 0.94, 95% CI: 0.79 to 1.12, p = 0.48), including PCI (HR: 0.98, 95% CI: 0.83 to 1.19, p = 0.87) and coronary artery bypass grafting (HR: 0.71, 95% CI: 0.46 to 1.10, p = 0.12). Hospitalization for bleeding was also similar for DES versus BMS (HR: 0.92; 95% CI: 0.61 to 1.39, p = 0.70). Compared with BMS, DES use in stable patients undergoing CTO PCI was associated with lower mortality, as well as similar myocardial infarction and repeat revascularization rates without an increase in subsequent bleeding requiring hospitalization.

TCT-251 Impact of Plaque Composition Assessed by iMap™-intravascular Ultrasound on Elevation of High Sensitive Cardiac Troponin T After Percutaneous Coronary Intervention

Background: It remains unclear whether coronary plaque composition is associated with peri-procedural myocardial injury (PMI) after percutaneous coronary intervention (PCI). This study sought to determine the impact of plaque composition analysis by iMapTMintravascular ultrasound (iMap-IVUS) (Boston Scientific, Boston, MA), a recently developed intracoronary imaging system for tissue characterization, on PMI assessed using a highly sensitive assay for cardiac troponin T (hs-TnT). Methods: We examined 56 culprit plaques in patients with 52 stable and 4 unstable angina pectoris by iMap-IVUS. The major tissue characteristics at minimal lumen area site were classified by iMap-IVUS as fibrotic, lipidic, necrotic and calcified components, and these are described herein as relative plaque areas. The hs-TnT values were measured before and 24 hours after PCI, and differences were expressed as hs-TnT. High hs-TnT elevation was defined as hs-TnT level 0.037 pg/mL of median value. Patients were divided into 2 groups according to the presence (Group I, n 28) or absence (Group II, n 28) of high hs-TnT elevation. Results: Compared with Group II, Group I had significantly higher percent necrotic area (45 12 vs. 35 18%, p 0.012) and lower percent fibrotic area (42 12 vs. 53 20%, p 0.016). The percent lipidic and calcified areas were similar between the two groups. Group I also had longer lesion length (17.9 9.9 vs. 13.0 4.9 mm, p 0.024), a lower frequency of direct stenting (18 vs. 54%, p 0.011), and a higher frequency of post-dilation (89 vs. 61%, p 0.014) than Group II. The hs-TnT level correlated positively with percent necrotic area (r 0.40, p 0.003), lesion length (r 0.31, p 0.021), and negatively with percent fibrotic area (r -0.35, p 0.008). In multivariate logistic regression analysis, a larger percent necrotic area (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.02 1.14; p 0.005) and less direct stenting (OR, 0.11; 95%CI, 0.025 0.51; p 0.005) were independent predictors of high hs-TnT elevation. Conclusions: Plaque composition analysis by iMap-IVUS is useful to predict the elevation of hs-TnT after PCI.

Zotarolimus and Everolimus DES: Which Should You Choose?

Aim: The optimal newer generation coronary drug eluting stent (DES) remains unknown. We compared clinical outcomes in patients treated with zotarolimus (ZDES) and everolimus eluting stents (EDES). Methods: The Melbourne Interventional Group (MIG) registry compared patients treated with ZDES (n = 1134) and EDES (n = 936) over a five-year period (2006-2011). Cohorts included only patients with de novo lesions stented exclusively with either DES type (excluding patients treated with additional bare metal stents). Results: The cohorts were matched for baseline demographics and lesion characteristics, except ZDES were used more frequently in ST- elevation myocardial infarction (17.9 vs. 13.6%, p = 0.03), smaller vessels (2.9 ± 1.0 vs.3.1 ± 1.0 mm, p < 0.01), and longer lesions (20.8 ± 9.3 vs. 19.6 ± 8.2 mm, p < 0.01). Clinical outcomes at 12 months are shown (Table).Tabled 1ZDES (n = 1134)EDES (n = 936)pDeath, n (%)35 (3.1)32 (3.4)0.67Myocardial infarction, n (%)69 (6.1)36 (3.8)0.02Target lesion revascularisation, n (%)41 (3.6)20 (2.1)0.05Target vessel revascularisation, n (%)75 (6.6)55 (5.9)0.49Stent thrombosis, n (%)34 (3.0)16 (1.7)0.06MACE, n (%)136 (12.0)101 (10.8)0.39 Open table in a new tab Conclusion: Patients with de novo lesions stented with ZDES have a higher incidence of myocardial infarction and target lesion revascularisation, yet were used in a higher risk cohort. An expanded cohort with complete late thrombosis rates will be available at presentation.Keywords: Drug Eluting Stent; Clinical Outcomes; MACE; Zotarolimus; Everolimus

Fungi associated with die-back symptoms of apple and pear trees, a possible inoculum source of grapevine trunk disease pathogens

A survey was undertaken on apple and pear trees in the main pome fruit growing areas ofthe Western Cape of South Africa to determine the aetiology of trunk diseases with specific reference to pathogens known to occur on grapevine, which are frequently cultivated in close proximity of these orchards. Several fungal genera containing known trunk disease pathogens were found. Two Diplodia species, D. seriata and Diplodia sp., were isolated along with Neofusicoccum australe and N. vitifusiforme . Four Phaeoacremonium species, Phaeoacremonium aleophilum , Pm. iranianum , Pm. mortoniae and Pm. viticola , two Phomopsis species linked to clades identified in former studies as Phomopsis theicola and Phomopsis sp. 7, and Eutypa lata were found. In addition, Paraconiothyrium brasiliense , Pr. variabile and a Pyrenochaeta like species were also isolated. Diplodia seriata (56% of total isolates) and Pm. aleophilum (22%) were most frequently isolate. First reports from pear wood include the Phaeoacremonium spp. and Paraconiothyrium brasiliense , while new reports from apple include Pm. aleophilum , Ph. theicola , Phomopsis sp. 7, Pr. variabile and E. lata . A pathogenicity trial was undertaken to determine the role of these species on apple, pear and grapevine shoots. Neofusicoccum australe caused the longest lesions on grapevine shoots, while Pr. variabile , D. seriata , Pm. mortoniae and the Pyrenochaeta -like sp. caused lesions that were longer than non-inoculatedand non-pathogen experimental controls. On pear shoots, Diplodia sp. and N. australe caused the longest lesions,followed by D. seriata and E. lata . On apple shoots, the longest lesions were caused by N. australe and Pm. iranianum . These results demonstrate that apple and pear trees in Western Cape orchards are hosts to many known trunk pathogens along with potential new trunk disease-causing fungi.

Long-term outcomes with cobalt-chromium bare-metal vs. drug-eluting stents: the REgistro regionale AngiopLastiche dell'Emilia-Romagna registry

To compare the long-term efficacy of cobalt-chromium bare-metal stents (CCSs) with that of first-generation drug-eluting stents (DESs) in patients within a large real-world multicentre registry. The incidence of major adverse cardiac events [death, acute myocardial infarction, and target-vessel revascularization (TVR)] and angiographic stent thrombosis were assessed in consecutive patients undergoing percutaneous coronary intervention with CCS (n = 1103) or DES (n = 5195) during 2-year follow-up. Propensity score-adjusted outcomes, overall and in patients with low (≤ 10%), intermediate (10-15%), and high (>15%) 1-year restenosis risk, were estimated. DES-treated patients had significantly higher rates of diabetes, longer lesions, and smaller vessel diameters than CCS-treated patients (all P < 0.0001). However, CCS patients were older and presented a higher rate of hypertension, previous myocardial infarction, and heart failure (all P < 0.01). At 2 years, adjusted rates of myocardial infarction, death, and cumulative-stent thrombosis were similar for DES and CCS. DES provided statistically significant (P < 0.01) reductions in TVR and adjusted major adverse cardiac event rates (9.7 and 17.2%, respectively) compared with CCS (13.2 and 21.2%, respectively). In patients at highest and intermediate risk of restenosis, adjusted TVR rates were significantly (P < 0.01) lower with DES (12.2 and 8.9%, respectively) than CCS (19.9 and 17.1%, respectively), but rates were similar in low-risk patients. DESs were more effective than CCSs in lowering TVR rates in patients with an intermediate-high baseline restenosis risk.

Novel cancer suppressor gene for esophageal cancer: manganese superoxide dismutase

To explore the expression of manganese superoxide dismutase (MnSOD) in esophageal squamous cell carcinoma (ESCC) and its relationship with clinicopathological characteristics and biological behavior. On 45 patients with ESCC, immunohistochemistry (SP method), reverse transcription-polymerase chain reaction (RT-PCR), and Western blot were used to detect MnSOD protein and mRNA expression in ESCC and in its adjacent normal tissue 5 cm apart from the edge of cancer lesion and without documented microscopic invasive cancer. Meanwhile, the relationship between the pathological features of esophageal cancer and its biological behavior was analyzed. In ESCC and normal esophageal tissue, MnSOD protein expression was identified 31.1% (14/45) and 86.7% (31/45) (P= 0.000), respectively, with the relative expression levels of MnSOD mRNA 0.310 ± 0.036 and 0.482 ± 0.053 (P= 0.000), relatively. Western blot study showed that the relative expressions of MnSOD protein in cancer lesion and in adjacent normal tissue were 0.384 ± 0.038 and 0.766 ± 0.041, respectively (P= 0.000). With longer lesion, deeper invasion, and poorer differentiation, the expression of MnSOD would get lower, indicating that the levels of MnSOD protein and mRNA expression were closely related to the length of lesion, depth of invasion, and degree of differentiation in ESCC (P < 0.05). Nevertheless, the result showed no association with the presence of lymph node metastasis, cancer location, and macroscopic classification (P > 0.05). MnSOD protein and mRNA expression both decreased in ESCC, which may be related to carcinogenesis and the development of esophageal cancer. Therefore, detecting the expression of MnSOD in esophageal carcinoma would be of clinical significance in understanding its biological behavior and in guiding therapeutic strategy of esophageal cancer.

First Report of Lasiodiplodia crassispora as a Pathogen of Grapevine Trunks in South Africa.

In 2003 and 2004, a survey of grapevine (Vitis vinifera L.) trunk pathogens was conducted in 30 vineyards in the Western and Northern Cape and Limpopo provinces of South Africa. In each vineyard, 20 visually healthy plants were sampled randomly by removing the distal part of one cordon arm. Isolations were made onto potato dextrose agar (PDA) from the internal wood decay symptoms observed in the cordon samples. Seven Botryosphaeriaceae spp. were identified, including Lasiodiplodia crassispora (1). Other Botryosphaeriaceae spp. are known grapevine trunk pathogens (2). Species identity was confirmed by DNA sequence data of the partial translation factor 1-α gene (1) and sequences deposited in GenBank (GU233658 and GU233659). The L. crassispora isolates (CBS 125626 and 125627) were associated with brown internal necrosis, a known symptom of grapevine Botryosphaeriaceae spp. infection (3), in the cordon arms of Ruby Cabernet grapevines occurring in two vineyards in the Northern Cape Province. L. crassispora was described from cankered wood of Santalum album in Western Australia and endophytically from Eucalyptus urophylla in Venezuela (1). Its grapevine pathogen status was determined using both isolates in a repeated pathogenicity test that included three isolates each of Botryosphaeria dothidea and Neofusicoccum australe as positive controls (2), Trichoderma harzianum as a nonpathogen treatment, and an uncolonized agar plug as a negative control. The Botryosphaeriaceae spp. and T. harzianum were plated on PDA and incubated at 25°C for 7 days. Lignified, 6-month-old shoots of grapevine cv. Chardonnay were excised from grapevines with internodes 4 to 6 used for inoculations. Before wounding, shoots were disinfected by submersion for 1 min in a 1 ml/liter solution of a quaternary ammonium compound (Sporekill; ICA International Chemicals (Pty) Ltd, Stellenbosch, South Africa). Twelve shoots were used for each isolate or control treatment. Wounds were made 2 mm deep on the fifth internode of the shoots with a 5-mm flame-sterilized cork borer (2,3). Wounds were inoculated with a pathogen colonized agar plug (5 mm in diameter) or an uncolonized agar plug and then covered with Parafilm (2,3). Inoculated shoots were incubated in the dark in moist chambers for 14 days at 25°C. After incubation, the bark of the shoots was peeled from the area around the wound and the lengths of any resultant lesions were measured under sterile conditions. The inoculum effect was assessed by analysis of variance and Student's t-test. Results showed that significantly (P < 0.0001) longer lesions were caused by L. crassispora (13.36 mm) compared with N. australe (9.27 mm) and B. dothidea (5.28 mm) and also significantly longer than lesions caused by the nonpathogen and negative controls (3.23 and 2.90 mm, respectively). To determine if lesions were caused by inoculated fungi, isolations were made from the tissue at the edges of the lesions by aseptically removing five 0.5 × 1 mm pieces of wood and placing them on PDA dishes amended with 0.04 g/liter of streptomycin sulfate. Dishes were incubated under normal fluorescent light at 25°C for 14 days before identifying isolated fungi based on morphological and cultural characteristics (1). To our knowledge, this is the first report of L. crassispora as a grapevine pathogen.

The influence of Ceratocystis polonica inoculation and methyl jasmonate application on terpene chemistry of Norway spruce, Picea abies

Constitutive and inducible terpene production is involved in conifer resistance against bark beetles and their associated fungi. In this study 72 Norway spruce ( Picea abies) were randomly assigned to methyl jasmonate (MJ) application, inoculation with the bluestain fungus Ceratocystis polonica, or no-treatment control. We investigated terpene levels in the stem bark of the trees before treatment, 30 days and one year after treatment using GC–MS and two-dimensional GC (2D-GC) with a chiral column, and monitored landing and attack rates of the spruce bark beetle, Ips typographus, on the trees by sticky traps and visual inspection. Thirty days after fungal inoculation the absolute amount and relative proportion of (+)-3-carene, sabinene, and terpinolene increased and (+)-α-pinene decreased. Spraying the stems with MJ tended to generally increase the concentration of most major terpenes with minor alteration to their relative proportions, but significant increases were only observed for (−)-β-pinene and (−)-limonene. Fungal inoculation significantly increased the enantiomeric ratio of (−)-α-pinene and (−)-limonene 1 month after treatment, whereas MJ only increased that of (−)-limonene. One year after treatment, both MJ and fungal inoculation increased the concentration of most terpenes relative to undisturbed control trees, with significant changes in (−)-β-pinene, (−)-β-phellandrene and some other compounds. Terpene levels did not change in untreated stem sections after treatment, and chemical induction by MJ and C. polonica thus seemed to be restricted to the treated stem section. The enantiomeric ratio of (−)-α-pinene was significantly higher and the relative proportions of (−)-limonene were significantly lower in trees that were attractive to bark beetles compared to unattractive trees. One month after fungal inoculation, the total amount of diterpenes was significantly higher in putative resistant trees with shorter lesion lengths than in putative susceptible trees with longer lesions. Thus, terpene composition in the stem bark may be related to resistance of Norway spruce against I. typographus and C. polonica.

Outcomes With Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Graft Intervention: Results From the STENT (Strategic Transcatheter Evaluation of New Therapies) Group

This study compares outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients undergoing saphenous vein graft (SVG) intervention. The safety and efficacy of DES in patients undergoing SVG intervention is controversial. The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is a multicenter U.S. registry evaluating outcomes with DES. Our study population includes patients undergoing PCI of SVG lesions with DES (n = 785) or BMS (n = 343) who completed 9-month or 2-year follow-up. Outcomes were adjusted with propensity analyses. The DES patients had fewer emergent procedures but had smaller vessels and longer lesions. The DES patients had less death or myocardial infarction at 9 months (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.33 to 0.83, p = 0.006) and less death at 2 years (HR: 0.60, 95% CI: 0.36 to 0.98, p = 0.041). Target vessel revascularization (TVR) was less with DES at 9 months (7.2% vs. 10.0%, HR: 0.36, 95% CI: 0.22 to 0.61, p < 0.001) but was no different by 2 years (18.3% vs. 16.9%, p = 0.86), although adjusted TVR rates were lower (HR: 0.60, 95% CI: 0.40 to 0.90, p = 0.014). The DES reduced TVR at 9 months in SVG lesions with diameter <3.5 mm (8.0% vs. 17.2%, p = 0.013) but not >or=3.5 mm (6.0% vs. 6.6%, p = 0.74). Treatment of SVG lesions with DES vs. BMS is effective in reducing TVR at 9 months, although most of this advantage is lost at 2 years. The DES seem safe with less death or myocardial infarction, although selection bias might have affected these results. Our data suggest that DES might have short-term advantages over BMS in SVG lesions with diameter <3.5 mm.

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

This study was designed to compare long-term clinical outcomes of drug-eluting stents (DES) versus bare metal stents (BMS) in patients with saphenous vein graft (SVG) disease in the "real world." The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports of either lower revascularization rates with DES; or clinical equivalence to BMS; or even an excess of clinical events associated with DES use. We identified consecutive patients who underwent stent placement within a de novo SVG lesion between May 1, 2003 and July 31, 2007. Follow-up was obtained at regular intervals. The Kaplan-Meier method was used to produce actuarial survival estimates. Cox regression analysis was used to predict the risk associated with stent type, and propensity scores were generated to risk-adjust the results. The study group included 379 stent recipients (284 DES; 95 BMS) with 410 stented lesions. BMS were placed more frequently in current smokers, acute myocardial infarctions, larger vessels, and longer lesions. In-hospital mortality was higher in BMS recipients than in their DES counterparts (3.2% vs. 0, respectively; P = 0.015). At 3 years, there was no significant difference in clinical adverse event rates between DES and BMS recipients, even after risk adjustment. Three-year adverse event rates are similar among patients treated with DES or BMS in SVG lesions. Therefore, while DES are safe, they do not appear to offer an advantage in terms of long-term graft patency.

Association of a Unique Cardiovascular Risk Profile With Outcomes in Hispanic Patients Referred for Percutaneous Coronary Intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)

Although previous studies have demonstrated that Hispanic patients have a higher cardiovascular risk profile than Caucasians and present at a younger age for percutaneous coronary intervention (PCI), limited studies exist examining the outcomes of Hispanics after PCI and potential explanations for differences noted. Using patients from the National Heart, Lung, and Blood Institute Dynamic Registry waves 1 to 5 (1997 to 2006), demographic features, angiographic data, and 1-year outcomes of Hispanic patients (n = 542) versus Caucasian patients (n = 1,357) undergoing PCI were evaluated. Compared to Caucasians, Hispanic patients were younger and had more hypertension and diabetes mellitus, including more insulin-treated diabetes mellitus. Although mean lesion length was longer in Hispanics (15.4 vs 14.1 mm, p <0.001), there were no differences in the number of significant lesions or in the use of drug-eluting stents. At follow-up, Hispanics were more likely to report recent anginal symptoms but had a similar incidence of 1-year hospitalizations for angina. Adjusted 1-year hazard ratios for adverse events for Hispanics versus Caucasians revealed lower rates of coronary artery bypass graft surgery (hazard ratio 0.43, confidence interval 0.22 to 0.85, p = 0.02) and a trend toward lower rates of repeat revascularization (hazard ratio 0.76, confidence interval 0.57 to 1.03, p = 0.08). In conclusion, despite the presence of diabetes in almost 50% of Hispanic patients and longer lesions than in Caucasians, Hispanic patients were less likely to undergo coronary artery bypass graft surgery 1 year after PCI and had a trend toward lower rates of repeat revascularization.

Differential aggressiveness of fungi implicated in esca and associated diseases of grapevine in France

We tested differences in the aggressiveness of six fungal species, Phaeomoniella chlamydospora, Phaeoacremonium aleophilum, Fomitiporia mediterranea, Eutypa lata, Diplodia seriata and Neofusicoccum parvum , all of which are associated with esca, Eutypa dieback or ‘black dead arm’ (BDA) of grapevines in France. Ten isolates per species (nine isolates for P. aleophilum ), originating in various regions of France, were tested on rooted cuttings of cv. Cabernet Sauvignon by inoculating the mycelium of the species on wounds made in the vine wood. The inoculated plants were incubated in an open greenhouse and the experiment was repeated twice . The isolates were divided into three groups depending on the severity of the infection. Infection severity was based on the extent of the external cankers and the internal lesions, measured 5 and 15 months after inoculation, as compared with the controls. The fi rst group included all the P. chlamydospora and N. parvum isolates and two of the E. lata isolates. These isolates induced internal necrosis and external cankers developing from the point of inoculation. P. chlamydospora and N. parvum, produced large cankers and the longest internal lesions, and were the most virulent. The second group, comprising those E. lata isolates not in Group one and all isolates of D. seriata and of P. aleophilum , caused internal necrosis from which the vine afterwards totally healed. The third group included all the F. mediterranea isolates. These isolates caused the smallest lesions, generally not different from those in the controls, and developed a characteristic mycelium in the pith. No foliar symptoms were observed on any of the inoculated cuttings, except with the two E. lata isolates. Some seedlings displayed the typical foliar symptoms of Eutypa dieback. Different isolates within individual species exhibited signifi cant differences ( P <0.05) in lesion development. This made it possible to select the most aggressive isolates for further study.