Sirolimus-eluting stent treatment at high-volume centers confers lower mortality at 6-month follow-up: results from the prospective multicenter German Cypher Registry

BACKGROUND: Studies continue to identify percutaneous coronary intervention procedural volume both at the institutional level and at the operator level as being strongly correlated with outcome. High-volume centers have been defined as those that perform >400 percutaneous coronary intervention procedures per year. The relationship between drug-eluting stent procedural volume and outcome is unknown. We investigated this relationship in the German Cypher Registry. METHODS AND RESULTS: The present analysis included 8201 patients treated with sirolimus-eluting stents between April 2002 and September 2005 in 51 centers. Centers that recruited >400 sirolimus-eluting stent patients in this time period were considered high-volume centers; those with 150 to 400 patients were considered intermediate-volume centers; and those with <150 patients were designated as low-volume centers. The primary end point was all death, myocardial infarction, and target-vessel revascularization at 6 months. This end point occurred in 11.3%, 12.1%, and 9.0% of patients in the low-, intermediate-, and high-volume center groups, respectively (P=0.0001). There was no difference between groups in the rate of target-vessel revascularization (P=0.2) or cerebrovascular accidents (P=0.5). The difference in death/myocardial infarction remained significant after adjustment for baseline factors (odds ratio 1.85, 95% confidence interval 1.31 to 2.59, P<0.001 for low-volume centers; odds ratio 1.69, 95% confidence interval 1.29 to 2.21, P<0.001 for intermediate-volume centers). Patient and lesion selection, procedural features, and postprocedural medications differed significantly between groups. CONCLUSIONS: The volume of sirolimus-eluting stent procedures performed on an institutional level was inversely related to death and myocardial infarction but not to target-vessel revascularization at 6-month follow-up. Safety issues are better considered in high-volume centers. These findings have important public health policy implications.

Regional climate model simulations for Europe at 6 and 0.2 k BP: sensitivity to changes in anthropogenic deforestation

This study aims to evaluate the direct effects of anthropogenic deforestation on simulated climate at two contrasting periods in the Holocene, ~6 and ~0.2 k BP in Europe. We apply We apply the Rossby Centre regional climate model RCA3, a regional climate model with 50 km spatial resolution, for both time periods, considering three alternative descriptions of the past vegetation: (i) potential natural vegetation (V) simulated by the dynamic vegetation model LPJ-GUESS, (ii) potential vegetation with anthropogenic land use (deforestation) from the HYDE3.1 (History Database of the Global Environment) scenario (V + H3.1), and (iii) potential vegetation with anthropogenic land use from the KK10 scenario (V + KK10). The climate model results show that the simulated effects of deforestation depend on both local/regional climate and vegetation characteristics. At ~6 k BP the extent of simulated deforestation in Europe is generally small, but there are areas where deforestation is large enough to produce significant differences in summer temperatures of 0.5–1 °C. At ~0.2 k BP, extensive deforestation, particularly according to the KK10 model, leads to significant temperature differences in large parts of Europe in both winter and summer. In winter, deforestation leads to lower temperatures because of the differences in albedo between forested and unforested areas, particularly in the snow-covered regions. In summer, deforestation leads to higher temperatures in central and eastern Europe because evapotranspiration from unforested areas is lower than from forests. Summer evaporation is already limited in the southernmost parts of Europe under potential vegetation conditions and, therefore, cannot become much lower. Accordingly, the albedo effect dominates in southern Europe also in summer, which implies that deforestation causes a decrease in temperatures. Differences in summer temperature due to deforestation range from −1 °C in south-western Europe to +1 °C in eastern Europe. The choice of anthropogenic land-cover scenario has a significant influence on the simulated climate, but uncertainties in palaeoclimate proxy data for the two time periods do not allow for a definitive discrimination among climate model results.

Comparative Effectiveness and Safety of New-Generation Versus Early-Generation Drug-Eluting Stents According to Complexity of Coronary Artery Disease: A Patient-Level Pooled Analysis of 6,081 Patients.

OBJECTIVES The purpose of this study was to compare the 2-year safety and effectiveness of new- versus early-generation drug-eluting stents (DES) according to the severity of coronary artery disease (CAD) as assessed by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score. BACKGROUND New-generation DES are considered the standard-of-care in patients with CAD undergoing percutaneous coronary intervention. However, there are few data investigating the effects of new- over early-generation DES according to the anatomic complexity of CAD. METHODS Patient-level data from 4 contemporary, all-comers trials were pooled. The primary device-oriented clinical endpoint was the composite of cardiac death, myocardial infarction, or ischemia-driven target-lesion revascularization (TLR). The principal effectiveness and safety endpoints were TLR and definite stent thrombosis (ST), respectively. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 2 years for overall comparisons, as well as stratified for patients with lower (SYNTAX score ≤11) and higher complexity (SYNTAX score >11). RESULTS A total of 6,081 patients were included in the study. New-generation DES (n = 4,554) compared with early-generation DES (n = 1,527) reduced the primary endpoint (HR: 0.75 [95% CI: 0.63 to 0.89]; p = 0.001) without interaction (p = 0.219) between patients with lower (HR: 0.86 [95% CI: 0.64 to 1.16]; p = 0.322) versus higher CAD complexity (HR: 0.68 [95% CI: 0.54 to 0.85]; p = 0.001). In patients with SYNTAX score >11, new-generation DES significantly reduced TLR (HR: 0.36 [95% CI: 0.26 to 0.51]; p < 0.001) and definite ST (HR: 0.28 [95% CI: 0.15 to 0.55]; p < 0.001) to a greater extent than in the low-complexity group (TLR pint = 0.059; ST pint = 0.013). New-generation DES decreased the risk of cardiac mortality in patients with SYNTAX score >11 (HR: 0.45 [95% CI: 0.27 to 0.76]; p = 0.003) but not in patients with SYNTAX score ≤11 (pint = 0.042). CONCLUSIONS New-generation DES improve clinical outcomes compared with early-generation DES, with a greater safety and effectiveness in patients with SYNTAX score >11.

Na 1 Nachlass Max Horkheimer, 302 - Korrespondenzen u.a. mit Arthur Hübscher (p. V 89, 51-199)

83 Briefe und Beilagen zwischen Arthur Hübscher und Max Horkheimer, 1963-1973; 15 Briefe und Beilagen zwischen Bundesminister a. D. Ewald Bucher und Max Horkheimer, 1966-1971; 1 Brief und Beilage von Dr. Christoph Meyer an Max Horkheimer, 1969; 6 Briefe zwischen Dr. Johann Joeden und Max Horkheimer, 1966; 5 Briefe zwischen dem Oberregierungsrat Gustav Adolf Hünniger und Max Horkheimer, 1951-1953; 2 Briefe und eine Empfehlung und ein Gutachten von Edith Hünniger an Max Horkheimer, 1952-1953;

Na 1 Nachlass Max Horkheimer, 697 - Cultural Aspects of National Socialism. A Research Project (p. IX 170.6 - 170.10)

"Bureaucracy" verschiedene Typoskripte, zum Teil mit handschriftlichen Korrekturen, circa 51 Blatt; Handschriftliche Notizen, 4 Blatt; "Mass Culture" verschiedene Typoskripte, zum Teil mit handschriftlichen Korrekturen, circa 40 Blatt ; zwei Manuskripte, eins von Max Horkheimer, 3 Blatt; "Anti-Christianity" verschiedene Typoskripte, zum Teil mit handschriftlichen Korrekturen, circa 51 Blatt; Eigenhändige Notizen von Max Horkheimer, 1 Blatt; "The War and Post-War Generation" verschiedene Typoskripte, zum Teil mit handschriftlichen Korrekturen, darunter ein Typoskript auf deutsch, mit eigenhändigen Korrekturen von Max Horkheimer, circa 67 Blatt; "Ideological Permeation of Labor and New Middle Classes" [enthält unter anderem den Titel "The German Masses and the Philosophy of National Socialism"] verschiedene Typoskripte, zum Teil mit handschriftlichen Korrekturen, circa 36 Blatt; Notizem, 2 Blatt;

(Table 1) Concentrations and isotopic ratio of Argon in Cretaceous deep-sea basaltic glass of DSDP Hole 51-417D

The abundance and isotopic composition of rare gas in the mantle provides an important constraint on the origin and evolution of the Earth's atmosphere. One of sources of such information is basalts which erupted from ocean ridges. Ozima (1975, doi:10.1016/0016-7037(75)90054-X) stated that a high 40Ar/36Ar ratio in the mantle suggests sudden degassing at an early stage of the Earth's evolution. Several authors (Funkhouser et al., 1968, doi:10.1016/S0012-821X(68)80021-4; Darlymple and Moor, 1968, doi:10.1126/science.161.3846.1132) have reported excess 40Ar and high 40Ar/36Ar ratios in rapidly quenched rims of young deep-sea basalts. However, the Ar composition in old ridge basalts was not known. We report here a measurement of the isotopic composition of Ar in old deep-sea basalts. The Glomar Challenger drilled a Cretaceous ocean floor near the southern end of the Bermuda Rise in Deep Sea Drilling Project. The drilled site (Site 417) is on the magnetic anomaly MO which has been estimated to be 108 Myr old.