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Objective: Percutaneous coronary intervention with drug-eluting stents is challenging coronary artery bypass grafting (CABG) as the gold standard for treatment of three-vessel and left main coronary disease.We evaluated the current practice pattern in hospitals throughout Europe and USA.Methods: To qualify for participation in the SYNTAX (Synergy between PCI with TAXUS drug-eluting stent and Cardiac Surgery) study, a randomized trial comparing percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting for three-vessel and left main disease, 104 centers were asked to provide their case volume in 3 months in 2004.Anonymous procedural data were collected.Results: A total of 12,072 patients were recorded.Coronary artery bypass grafting was the most frequently performed procedure (N = 8895, 74%).Three-vessel disease (3VD) predominated in this population (N = 8532, 71%) versus left main (N = 3540, 29%).In the 3-month period, per center a mean of 8.3 patients with left main and 22.3 patients with three-vessel disease were treated by percutaneous coronary intervention, while 26.0 patients with left main and 60.3 patients with three-vessel disease were treated by coronary artery bypass grafting.In USA, percutaneous coronary intervention for left main and/or three-vessel disease was performed in 18% of the cases while this was performed in 29% of the cases in Europe.Of all CABG procedures, only 12% were done with total arterial grafting while 7% were treated with only venous grafts.Conclusions: In patients with multivessel or left main disease, still coronary artery bypass grafting remains the dominant revascularization strategy.Percutaneous coronary intervention is performed frequently without supporting data from the literature.Percutaneous coronary intervention for this indication is performed more often in Europe than in USA.Only a minority of the patients receives total arterial grafting in case of coronary artery bypass grafting.The SYNTAX trial with randomized and registry cohorts should provide guidance for selecting the preferred form of treatment.

No abstract is provided for this article.

No abstract is provided for this article.

Asthma is characterised by increased numbers of Th2-like cells in the airways and IgE secretion. Generation of Th2 cells requires interleukin (IL)-4 and IL-13 acting through their specific receptors and activating the transcription factor, signal transducer and activator of transcription 6 (STAT6). STAT6 knockout mice fail to produce IgE, airway hyperresponsiveness and bronchoalveolar lavage eosinophilia after allergen sensitisation, suggesting a critical role for STAT6 in allergic responses.We have investigated the expression of STAT6 in peripheral blood T-lymphocytes, alveolar macrophages and bronchial biopsies from 17 normal subjects and 18 mild-moderate steroid-naïve stable asthmatic patients.STAT6 expression was variable and was detected in T-lymphocytes, macrophages and bronchial epithelial cells from all subjects with no difference between normal and stable asthmatic subjects.STAT6 expression in different cells suggests that it may be important in regulating the expression of not only Th2-like cytokines in T cells of man, but may also regulate STAT-inducible genes in alveolar macrophages and airway epithelial cells.

Our aim was to investigate whether long-term (three-year) clinical outcomes after multivessel treatment with the Resolute zotarolimus-eluting stent (R-ZES) were similar to single-vessel treatment.The RESOLUTE Global Clinical Trial Program enrolled 7,618 patients, of whom 1,562 underwent multivessel and 6,053 single-vessel treatment with the R-ZES. Patients in the multivessel group were more likely to have complex lesions (58% vs. 44%, p<0.001). Clinical outcomes were compared using a Cox regression model adjusted by propensity score to account for differences in baseline characteristics. Compared with single-vessel treatment, multivessel treatment was associated with more complex anatomy and longer mean total stent length (57.8±28.6 vs. 26.7±15.2 mm, p<0.001). At three years, the cumulative incidence of target lesion failure was similar in patients with multivessel and single-vessel treatment (11.0% vs. 9.1%, adjusted p=0.986), as was the incidence of cardiac death or target vessel myocardial infarction (6.7% vs. 5.7%, adjusted p=0.793), the incidence of clinically driven target lesion revascularisation (5.1% vs. 4.4%, adjusted p=0.904), and the incidence of Academic Research Consortium definite or probable stent thrombosis (1.2% vs. 0.9%, adjusted p=0.544).Multivessel treatment with R-ZES provided good long-term clinical outcomes that were comparable to those achieved with single-vessel stenting, supporting the efficacy and safety of R-ZES in patients in this setting.

<h3>Background</h3> The usual analysis of forced oscillometry measures respiratory resistance (Rrs) and reactance (Xrs) averaged over several tidal breaths (whole-breath analysis). Recent within-breath analyses have separated Rrs and Xrs into their mean inspiratory and mean expiratory components (inspiratory–expiratory breath analysis) but these have not been used to compare patients with asthma and those with chronic obstructive pulmonary disease (COPD). Large inspiratory–expiratory variations in Xrs at 5 Hz (ΔX5) in an individual have been used as a surrogate marker of expiratory flow limitation. <h3>Methods</h3> Whole-breath and inspiratory–expiratory impulse oscillometry was assessed in 34 patients with asthma (49±3 years; 15 male, forced expiratory volume in 1 s (FEV₁) 69±4% predicted), 48 patients with COPD (64±2 years; 32 male, FEV₁ 59±3% predicted) and 18 normal subjects (37±2 years; 8 male). <h3>Results</h3> Whole-breath analysis failed to discriminate between patients with asthma and patients with COPD either for all patients or for patients with FEV₁ &lt;60% predicted. Inspiratory–expiratory analysis in patients with FEV₁ &lt;60% predicted showed that in the COPD group mean expiratory X5 (−0.44±0.04 kPa/l/s) was greater than inspiratory X5 (−0.23±0.02 kPa/l/s, p&lt;0.001) whereas patients with asthma did not show such changes (−0.36±0.07 kPa/l/s vs −0.26±0.03 kPa/l/s, p=0.23). Even though ΔX5 was larger in patients with COPD (0.21±0.03 kPa/l/s) than in patients with asthma (0.10±0.07 kPa/l/s), this was not significant (p=0.15). <h3>Conclusions</h3> Whole-breath impulse oscillation system analysis failed to discriminate between patients with asthma and those with COPD. Inspiratory–expiratory X5 analysis differentiated patients with asthma from those with COPD presumably reflecting enhanced dynamic airway narrowing on expiration in COPD. Further studies are needed to confirm these differences and investigate their cause.

The Genous™ Bio-engineered R™ stent (GS) aims to promote vascular healing by capture of circulatory endothelial progenitor cells (EPCs) to the surface of the stent struts, resulting in accelerated re-endothelialization. Here, we assessed the function of the GS in comparison to bare-metal stent (BMS), when exposed to the human and animal circulation.First, 15 patients undergoing coronary angiography received an extracorporeal femoral arteriovenous (AV) shunt containing BMS and GS. Macroscopical mural thrombi were observed in BMS, whereas GS remained visibly clean. Confocal and scanning electron microscopic (SEM) analysis of GS showed an increase in strut coverage. Quantitative polymerase chain reaction (qPCR) analysis of captured cells on the GS demonstrated increased expression of endothelial markers KDR/VEGFR2 and E-selectin, and a decrease in pro-thrombogenic markers tissue factor pathway inhibitor and plasminogen activator inhibitor-1 compared with BMS. Secondly, a similar primate AV shunt model was used to validate these findings and occlusion of BMS was observed, while GS remained patent, as demonstrated by live imaging of indium-labelled platelets. Thirdly, in an in vitro cell-capture assay, GS struts showed increased coverage by EPCs, whereas monocyte coverage remained similar to BMS. Finally, the assessment of re-endothelialization was studied in a rabbit denudation model. Twenty animals received BMS and GS in the aorta and iliac arteries for 7 days. Scanning electron microscopic analysis showed a trend towards increased strut coverage, confirmed by qPCR analysis revealing increased levels of endothelial markers (Tie2, CD34, PCD31, and P-selectin) in GS.In this proof-of-concept study, we have demonstrated that the bio-engineered EPC-capture stent, Genous™ R™ stent, is effective in EPC capture, resulting in accelerated re-endothelialization and reduced thrombogenicity.

No abstract is provided for this article.

Of 38 patients (28 men, 58±10 years) treated by conventional balloon angioplasty followed by local heparin delivery (1660±656 IU at low pressure 110±48 mmHg during 30±7 min) through the DispatchTM (Scimed) 20 (12 men, 57±10 years). have undergone 6 month review. One 78 year old patient with aortic stenosis died in hospital 7 weeks after the procedure from acute heart failure following 2 transfusions for the exacerbation of ulcerative colitis. Of the 19 remaining patients clinical follow-up was available for all and control angiography was performed in 14 (74%). Of the 5 who declined, all asymptomatic, 3 had a negative MIBI scintigram and 2 refused further examination. Symptoms Five (26%) of the 19 patients were symptomatic (3 exertional and 2 atypical angina) and angiography showed 4 new lesions and 1 restenosis (diameter stenosis 60%) of the target lesion. Angiogram No aneurysmatic dilatation at the site of delivery was visualized. However 4 out of 14 (29%) lesions had a increase in MLD (range: 0.17–0,51 mm). Mean MLD measured by quantitative analysis (CAAS II) in matched projections (post-procedure vs 6 month follow-up) was 2.0±0.5 mm vs 1.73±0.4 mm representing a mean late loss of 0.27 mm. The incidence of restenosis, defined as a diameter stenosis at follow-up of &gt;50% was 7%. None of patients required re-angioplasty of the treated segment. Conclusion Local, low pressure heparin delivery following balloon angioplasty may reduce incidence of restenosis and decrease the need for re-angioplasty.

Conference Abstract| January 01 1988 Differential Effect of Inflammatory Mediators on Microvascular Permeability in Different Parts of the Guinea Pig Airways TW Evans; TW Evans 1Dept. Clinical Pharmacology. Cardiothoracic Institute, Brompton Hospital. Fulham Road, LONDON SW3 6HP Search for other works by this author on: This Site PubMed Google Scholar DF Rogers; DF Rogers 1Dept. Clinical Pharmacology. Cardiothoracic Institute, Brompton Hospital. Fulham Road, LONDON SW3 6HP Search for other works by this author on: This Site PubMed Google Scholar B Aursudkij; B Aursudkij 1Dept. Clinical Pharmacology. Cardiothoracic Institute, Brompton Hospital. Fulham Road, LONDON SW3 6HP Search for other works by this author on: This Site PubMed Google Scholar KF Chung; KF Chung 1Dept. Clinical Pharmacology. Cardiothoracic Institute, Brompton Hospital. Fulham Road, LONDON SW3 6HP Search for other works by this author on: This Site PubMed Google Scholar PJ Barnes PJ Barnes 1Dept. Clinical Pharmacology. Cardiothoracic Institute, Brompton Hospital. Fulham Road, LONDON SW3 6HP Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1988) 74 (s18): 46P. https://doi.org/10.1042/cs074046Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation TW Evans, DF Rogers, B Aursudkij, KF Chung, PJ Barnes; Differential Effect of Inflammatory Mediators on Microvascular Permeability in Different Parts of the Guinea Pig Airways. Clin Sci (Lond) 1 January 1988; 74 (s18): 46P. doi: https://doi.org/10.1042/cs074046Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1988 The Biochemical Society and the Medical Research Society1988 Article PDF first page preview Close Modal You do not currently have access to this content.

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.