Biolimus-eluting stent with biodegradable polymer improves clinical outcomes in patients with acute myocardial infarction

OBJECTIVE To investigate clinical outcomes of coronary intervention using a biolimus-eluting stent (BES) compared with a sirolimus-eluting stent (SES) in patients with acute myocardial infarction (AMI) in the Limus Eluted from A Durable versus ERodable Stent (LEADERS) coating trial at the final 5-year follow-up. METHODS The LEADERS trial is a multicentre all-comer study, where patients (n=1707) were randomised to percutaneous intervention with either BES containing biodegradable polymer or SES containing durable polymer. Out of 1707 patients enrolled in this trial, 573 patients had percutaneous coronary intervention for AMI (BES=280, SES=293) and were included in the current analysis. Patient-oriented composite endpoint (POCE, including all death, all myocardial infarction (MI) and all revascularisations), major adverse cardiac events (MACE, including cardiac death, MI and clinically indicated target vessel revascularisation) and stent thrombosis were assessed at 5-year follow-up. RESULTS The baseline clinical, angiographic and procedural characteristics were well matched between BES and SES groups. In all patients with AMI, coronary intervention with a BES, compared with SES, significantly reduced POCE (28.9% vs 42.3%; relative risk (RR) 0.61, 95% CI 0.47 to 0.82, p=0.001) at 5-year follow-up. There was also a reduction in MACE rate in the BES group (18.2% vs 25.9%; RR 0.67, 95% CI 0.47 to 0.95, p=0.025); however, there was no difference in cardiac death and stent thrombosis. In patients with ST-elevation MI (STEMI), coronary intervention with BES significantly reduced POCE (24.4% vs 39.3%; RR 0.55, 95% CI 0.36 to 0.85, p=0.006), MACE (12.6% vs 25.0%; RR 0.47, 95% CI 0.26 to 0.83, p=0.008) and cardiac death (3.0% vs 11.4%; RR 0.25, 95% CI 0.08 to 0.75, p=0.007), along with a trend towards reduction in definite stent thrombosis (3.7% vs 8.6%; RR 0.41, 95% CI 0.15 to 1.18, p=0.088), compared with SES. CONCLUSIONS BES, compared with SES, significantly improved safety and efficacy outcomes in patients with AMI, especially those with STEMI, at 5-year follow-up. TRIAL REGISTRATION NUMBER NCT 00389220.

Comparison of a Novel Biodegradable Polymer Sirolimus-Eluting Stent With a Durable Polymer Everolimus-Eluting Stent: Results of the Randomized BIOFLOW-II Trial.

BACKGROUND Biodegradable polymers for release of antiproliferative drugs from drug-eluting stents aim to improve vascular healing. We assessed noninferiority of a novel ultrathin strut drug-eluting stent releasing sirolimus from a biodegradable polymer (Orsiro, O-SES) compared with the durable polymer Xience Prime everolimus-eluting stent (X-EES) in terms of the primary end point in-stent late lumen loss at 9 months. METHODS AND RESULTS A total of 452 patients were randomly assigned 2:1 to treatment with O-SES (298 patients, 332 lesions) or X-EES (154 patients, 173 lesions) in a multicenter, noninferiority trial. The primary end point was in-stent late loss at 9 months. O-SES was noninferior to X-EES for the primary end point (0.10±0.32 versus 0.11±0.29 mm; difference=0.00063 mm; 95% confidence interval, -0.06 to 0.07; Pnoninferiority<0.0001). Clinical outcome showed similar rates of target-lesion failure at 1 year (O-SES 6.5% versus X-EES 8.0%; hazard ratio=0.82; 95% confidence interval, 0.40-1.68; log-rank test: P=0.58) without cases of stent thrombosis. A subgroup of patients (n=55) underwent serial optical coherence tomography at 9 months, which demonstrated similar neointimal thickness among lesions allocated to O-SES and X-EES (0.10±0.04 mm versus 0.11±0.04 mm; -0.01 [-0.04, -0.01]; P=0.37). Another subgroup of patients (n=56) underwent serial intravascular ultrasound at baseline and 9 months indicating a potential difference in neointimal area at follow-up (O-SES, 0.16±0.33 mm(2) versus X-EES, 0.43±0.56 mm(2); P=0.04). CONCLUSIONS Compared with durable polymer X-EES, novel biodegradable polymer-based O-SES was found noninferior for the primary end point in-stent late lumen loss at 9 months. Clinical event rates were comparable without cases of stent thrombosis throughout 1 year of follow-up. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01356888.

Stabilizing Lead Cathodes with Diammonium Salt Additives in the Deoxygenation of Aromatic Amides

Lead is efficiently protected against cathodic corrosion by the addition of diammonium salts in the electrolyte. The cationic coating of the cathode allows the efficient electroreduction of benzamides to benzylamines. The electrochemical deoxygenation of the amide is achieved without the use of oxophilic agents or sacrificial anodes. The surface of the lead cathode stays smooth and the cathode can be reused for multiple runs, providing <2.5 ppm of the crude product. Cyclic voltammetry studies reveal a shift in the onset potential of the hydrogen evolution reaction by −157 mV.

Clinical Outcomes According to Diabetic Status in Patients Treated With Biodegradable Polymer Sirolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents: Prespecified Subgroup Analysis of the BIOSCIENCE Trial.

BACKGROUND Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) proved noninferior to durable polymer everolimus-eluting stents (DP-EES) for a composite clinical end point in a population with minimal exclusion criteria. We performed a prespecified subgroup analysis of the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation (BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in patients with diabetes mellitus. METHODS AND RESULTS BIOSCIENCE trial was an investigator-initiated, single-blind, multicentre, randomized, noninferiority trial comparing BP-SES versus DP-EES. The primary end point, target lesion failure, was a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target lesion revascularization within 12 months. Among a total of 2119 patients enrolled between February 2012 and May 2013, 486 (22.9%) had diabetes mellitus. Overall diabetic patients experienced a significantly higher risk of target lesion failure compared with patients without diabetes mellitus (10.1% versus 5.7%; hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.27-2.56; P=0.001). At 1 year, there were no differences between BP-SES versus DP-EES in terms of the primary end point in both diabetic (10.9% versus 9.3%; HR, 1.19; 95% CI, 0.67-2.10; P=0.56) and nondiabetic patients (5.3% versus 6.0%; HR, 0.88; 95% CI, 0.58-1.33; P=0.55). Similarly, no significant differences in the risk of definite or probable stent thrombosis were recorded according to treatment arm in both study groups (4.0% versus 3.1%; HR, 1.30; 95% CI, 0.49-3.41; P=0.60 for diabetic patients and 2.4% versus 3.4%; HR, 0.70; 95% CI, 0.39-1.25; P=0.23, in nondiabetics). CONCLUSIONS In the prespecified subgroup analysis of the BIOSCIENCE trial, clinical outcomes among diabetic patients treated with BP-SES or DP-EES were comparable at 1 year. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01443104.

Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents for primary percutaneous coronary revascularisation of acute myocardial infarction.

AIMS Our aim was to compare the safety and efficacy of a novel, ultrathin strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin strut, durable polymer everolimus-eluting stent (DP-EES) in a pre-specified subgroup of patients with acute ST-segment elevation myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial. METHODS AND RESULTS The BIOSCIENCE trial is an investigator-initiated, single-blind, multicentre, randomised non-inferiority trial (NCT01443104). Randomisation was stratified according to the presence or absence of STEMI. The primary endpoint, target lesion failure (TLF), is a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularisation within 12 months. Between February 2012 and May 2013, 407 STEMI patients were randomly assigned to treatment with BP-SES or DP-EES. At one year, TLF occurred in seven (3.4%) patients treated with BP-SES and 17 (8.8%) patients treated with DP-EES (RR 0.38, 95% CI: 0.16-0.91, p=0.024). Rates of cardiac death were 1.5% in the BP-SES group and 4.7% in the DP-EES group (RR 0.31, 95% CI: 0.08-1.14, p=0.062); rates of target vessel myocardial infarction were 0.5% and 2.6% (RR 0.18, 95% CI: 0.02-1.57, p=0.082), respectively, and rates of clinically indicated target lesion revascularisation were 1.5% in the BP-SES group versus 2.1% in the DP-EES group (RR 0.69, 95% CI: 0.16-3.10, p=0.631). There was no difference in the risk of definite stent thrombosis. CONCLUSIONS In this pre-specified subgroup analysis, BP-SES was associated with a lower rate of target lesion failure at one year compared to DP-EES in STEMI patients. These findings require confirmation in a dedicated STEMI trial.

Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable-Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularization: 2-Year Results of the BIOSCIENCE Trial.

BACKGROUND No data are available on the long-term performance of ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES). We reported 2-year clinical outcomes of the BIOSCIENCE (Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation) trial, which compared BP-SES with durable-polymer everolimus-eluting stents (DP-EES) in patients undergoing percutaneous coronary intervention. METHODS AND RESULTS A total of 2119 patients with minimal exclusion criteria were assigned to treatment with BP-SES (n=1063) or DP-EES (n=1056). Follow-up at 2 years was available for 2048 patients (97%). The primary end point was target-lesion failure, a composite of cardiac death, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. At 2 years, target-lesion failure occurred in 107 patients (10.5%) in the BP-SES arm and 107 patients (10.4%) in the DP-EES arm (risk ratio [RR] 1.00, 95% CI 0.77-1.31, P=0.979). There were no significant differences between BP-SES and DP-EES with respect to cardiac death (RR 1.01, 95% CI 0.62-1.63, P=0.984), target-vessel myocardial infarction (RR 0.91, 95% CI 0.60-1.39, P=0.669), target-lesion revascularization (RR 1.17, 95% CI 0.81-1.71, P=0.403), and definite stent thrombosis (RR 1.38, 95% CI 0.56-3.44, P=0.485). There were 2 cases (0.2%) of definite very late stent thrombosis in the BP-SES arm and 4 cases (0.4%) in the DP-EES arm (P=0.423). In the prespecified subgroup of patients with ST-segment elevation myocardial infarction, BP-SES was associated with a lower risk of target-lesion failure compared with DP-EES (RR 0.48, 95% CI 0.23-0.99, P=0.043, Pinteraction=0.026). CONCLUSIONS Comparable safety and efficacy profiles of BP-SES and DP-EES were maintained throughout 2 years of follow-up. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01443104.

Enhanced in vivo angiogenesis within a model tissue engineered construct using biodegradable microspheres containing encapsulated VEGF

Introduction. Tissue engineering techniques offer a potential means to develop a tissue engineered construct (TEC) for the treatment of tissue and organ deficiencies. However, a lack of adequate vascularization is a limiting factor in the development of most viable engineered tissues. Vascular endothelial growth factor (VEGF) could aid in the development of a viable vascular network within TECs. The long-term goals of this research are to develop clinically relevant, appropriately vascularized TECs for use in humans. This project tested the hypothesis that the delivery of VEGF via controlled release from biodegradable microspheres would increase the vascular density and rate of angiogenesis within a model TEC. ^ Materials and methods. Biodegradable VEGF-encapsulated microspheres were manufactured using a novel method entitled the Solid Encapsulation/Single Emulsion/Solvent Extraction technique. Using a PLGA/PEG polymer blend, microspheres were manufactured and characterized in vitro. A model TEC using fibrin was designed for in vivo tissue engineering experimentation. At the appropriate timepoint, the TECs were explanted, and stained and quantified for CD31 using a novel semi-automated thresholding technique. ^ Results. In vitro results show the microspheres could be manufactured, stored, degrade, and release biologically active VEGF. The in vivo investigations revealed that skeletal muscle was the optimal implantation site as compared to dermis. In addition, the TECs containing fibrin with VEGF demonstrated significantly more angiogenesis than the controls. The TECs containing VEGF microspheres displayed a significant increase in vascular density by day 10. Furthermore, TECs containing VEGF microspheres had a significantly increased relative rate of angiogenesis from implantation day 5 to day 10. ^ Conclusions. A novel technique for producing microspheres loaded with biologically active proteins was developed. A defined concentration of microspheres can deliver a quantifiable level of VEGF with known release kinetics. A novel model TEC for in vivo tissue engineering investigations was developed. VEGF and VEGF microspheres stimulate angiogenesis within the model TEC. This investigation determined that biodegradable rhVEGF 165-encapsulated microspheres increased the vascular density and relative rate of angiogenesis within a model TEC. Future applications could include the incorporation of microvascular fragments into the model TEC and the incorporation of specific tissues, such as fat or bone. ^

Study of the effect of four warm mix asphalt additives on bitumen modified with 15% crumb rubber

Due to a growing concern over global warming, the bituminous mixture industry is making a constant effort to diminish its emissions by reducing manufacturing and installation temperatures without compromising the mechanical properties of the bituminous mixtures. The use of mixtures with tyre rubber has demonstrated that these mixtures can be economical and ecological and that they improve the behaviour of the pavements. However, bituminous mixtures with a high rubber content present one major drawback: they require higher mixing and installation temperatures due to the elevated viscosity caused by the high rubber content and thus they produce larger amounts of greenhouse gas emissions than conventional bituminous mixtures. This article presents a study of the effect of four viscosity-reducing additives (Sasobit®, Asphaltan A®, Asphaltan B® and Licomont BS 100®) on a bitumen modified with 15% rubber. The results of this study indicate that these additives successfully reduce viscosity, increase the softening temperature and reduce penetration. However, they do not have a clear effect on the test for elastic recovery and ductility at 25 °C.

Asphalt rubber mixtures with warm mix asphalt additives

En los últimos años, debido a la creciente preocupación por el calentamiento global y el cambio climático, uno de los retos más importantes a los que se enfrenta nuestra sociedad es el uso eficiente y económico de energía así como la necesidad correspondiente de reducir los gases de efecto invernadero (GEI). Las tecnologías de mezclas semicalientes se han convertido en un nuevo e importante tema de investigación en el campo de los materiales para pavimentos ya que ofrece una solución potencial para la reducción del consumo energético y las emisiones de GEI durante la producción y puesta en obra de las mezclas bituminosas. Por otro lado, los pavimentos que contienen polvo de caucho procedente de neumático fuera de uso, al hacer uso productos de desecho, ahorran energía y recursos naturales. Estos pavimentos ofrecen una resistencia mejorada a la formación de roderas, a la fatiga y a la fisuración térmica, reducen los costes de mantenimiento y el ruido del tráfico así como prolongan la vida útil del pavimento. Sin embargo, estas mezclas presentan un importante inconveniente: la temperatura de fabricación se debe aumentar en comparación con las mezclas asfálticas convencionales, ya que la incorporación de caucho aumenta la viscosidad del ligante y, por lo tanto, se producen mayores cantidades de emisiones de GEI. En la presente Tesis, la tecnología de mezclas semicalientes con aditivos orgánicos (Sasobit, Asphaltan A, Asphaltan B, Licomont) se incorporó a la de betunes de alta viscosidad modificados con caucho (15% y 20% de caucho) con la finalidad de dar una solución a los inconvenientes de mezclas con caucho gracias a la utilización de aditivos reductores de la viscosidad. Para este fin, se estudió si sería posible obtener una producción más sostenible de mezclas con betunes de alto contenido en caucho sin afectar significativamente su nivel de rendimiento mecánico. La metodología aplicada para evaluar y comparar las características de las mezclas consistió en la realización de una serie de ensayos de laboratorio para betunes y mezclas con caucho y con aditivos de mezclas semicalientes y de un análisis del ciclo de vida híbrido de la producción de mezclas semicalientes teniendo en cuenta la papel del aditivo en la cadena de suministro con el fin de cuantificar con precisión los beneficios de esta tecnología. Los resultados del estudio indicaron que la incorporación de los aditivos permite reducir la viscosidad de los ligantes y, en consecuencia, las temperaturas de producción y de compactación de las mezclas. Por otro lado, aunque la adición de caucho mejoró significativamente el comportamiento mecánico de los ligantes a baja temperatura reduciendo la susceptibilidad al fenómeno de fisuración térmica, la adición de las ceras aumentó ligeramente la rigidez. Los resultados del estudio reológico mostraron que la adición de porcentajes crecientes de caucho mejoraban la resistencia del pavimento con respecto a la resistencia a la deformación permanente a altas temperaturas y a la fisuración térmica a bajas temperaturas. Además, se observó que los aditivos mejoran la resistencia a roderas y la elasticidad del pavimento al aumentar el módulo complejo a altas temperaturas y al disminuir del ángulo de fase. Por otra parte, el estudio reológico confirmó que los aditivos estudiados aumentan ligeramente la rigidez a bajas temperaturas. Los ensayos de fluencia llevados a cabo con el reómetro demostraron una vez más la mejora en la elasticidad y en la resistencia a la deformación permanente dada por la adición de las ceras. El estudio de mezclas con caucho y aditivos de mezclas semicalientes llevado a cabo demostró que las temperaturas de producción/compactación se pueden disminuir, que las mezclas no experimentarían escurrimiento, que los aditivos no cambian significativamente la resistencia conservada y que cumplen la sensibilidad al agua exigida. Además, los aditivos aumentaron el módulo de rigidez en algunos casos y mejoraron significativamente la resistencia a la deformación permanente. Asimismo, a excepción de uno de los aditivos, las mezclas con ceras tenían la misma o mayor resistencia a la fatiga en comparación con la mezcla control. Los resultados del análisis de ciclo de vida híbrido mostraron que la tecnología de mezclas semicalientes es capaz de ahorrar significativamente energía y reducir las emisiones de GEI, hasta un 18% y 20% respectivamente, en comparación con las mezclas de control. Sin embargo, en algunos de los casos estudiados, debido a la presencia de la cera, la temperatura de fabricación debe reducirse en un promedio de 8 ºC antes de que los beneficios de la reducción de emisiones y el consumo de combustible puedan ser obtenidos. Los principales sectores contribuyentes a los impactos ambientales generados en la fabricación de mezclas semicalientes fueron el sector de los combustibles, el de la minería y el de la construcción. Due to growing concerns over global warming and climate change in recent years, one of the most important challenges facing our society is the efficient and economic use of energy, and with it, the corresponding need to reduce greenhouse gas (GHG) emissions. The Warm Mix Asphalt (WMA) technology has become an important new research topic in the field of pavement materials as it offers a potential solution for the reduction of energy consumption and GHG emissions during the production and placement of asphalt mixtures. On the other hand, pavements containing crumb-rubber modified (CRM) binders save energy and natural resources by making use of waste products. These pavements offer an improved resistance to rutting, fatigue and thermal cracking; reduce traffic noise and maintenance costs and prolong pavement life. These mixtures, however, present one major drawback: the manufacturing temperature is higher compared to conventional asphalt mixtures as the rubber lends greater viscosity to the binder and, therefore, larger amounts of GHG emissions are produced. In this dissertation the WMA technology with organic additives (Sasobit, Asphaltan A, Asphaltan B and Licomont) was applied to CRM binders (15% and 20% of rubber) in order to offer a solution to the drawbacks of asphalt rubber (AR) mixtures thanks to the use of fluidifying additives. For this purpose, this study sought to determine if a more sustainable production of AR mixtures could be obtained without significantly affecting their level of mechanical performance. The methodology applied in order to evaluate and compare the performance of the mixtures consisted of carrying out several laboratory tests for the CRM binders and AR mixtures with WMA additives (AR-WMA mixtures) and a hybrid input-output-based life cycle assessment (hLCA) of the production of WMA. The results of the study indicated that the incorporation of the organic additives were able to reduce the viscosity of the binders and, consequently, the production and compaction temperatures. On the other hand, although the addition of rubber significantly improved the mechanical behaviour of the binders at low temperatures reducing the susceptibility to thermal cracking phenomena, the addition of the waxes slightly increased the stiffness. Master curves showed that the addition of increasing percentages of rubber improved the resistance of the pavement regarding both resistance to permanent deformation at high temperatures and thermal cracking at low temperatures. In addition, the waxes improved the rutting resistance and the elasticity as they increased the complex modulus at high temperatures and decreased the phase angle. Moreover, master curves also attest that the WMA additives studied increase the stiffness at low temperatures. The creep tests carried out proved once again the improvement in the elasticity and in the resistance to permanent deformation given by the addition of the waxes. The AR-WMA mixtures studied have shown that the production/compaction temperatures can be decreased, that the mixtures would not experience binder drainage, that the additives did not significantly change the retained resistance and fulfilled the water sensitivity required. Furthermore, the additives increased the stiffness modulus in some cases and significantly improved the permanent deformation resistance. Except for one of the additives, the waxes had the same or higher fatigue resistance compared to the control mixture. The results of the hLCA demonstrated that the WMA technology is able to significantly save energy and reduce GHG emissions, up to 18% and 20%, respectively, compared to the control mixtures. However, in some of the case studies, due to the presence of wax, the manufacturing temperature at the asphalt plant must be reduced by an average of 8ºC before the benefits of reduced emissions and fuel usage can be obtained. The results regarding the overall impacts generated using a detailed production layer decomposition indicated that fuel, mining and construction sectors are the main contributors to the environmental impacts of manufacturing WMA mixtures.

Partioning of dietary energy of chickens fed maize or wheat-based diets with and without a commercial blend of phytogenic feed additives

The aim of the study was to investigate the effects of a standardized mixture of a commercial blend of phytogenic feed additives containing 5% carvacrol, 3% cinnamaldehyde, and 2% capsicum on utilization of dietary energy and performance in broiler chickens. Four experimental diets were offered to the birds from 7 to 21 d of age. These included 2 basal control diets based on either wheat or maize that contained 215 g CP/kg and 12.13 MJ/kg ME and another 2 diets using the basal control diets supplemented with the plant extracts combination at 100 mg/kg diet. Each diet was fed to 16 individually penned birds following randomization. Dietary plant extracts improved feed intake and weight gain (P < 0.05) and slightly (P < 0.1) improved feed efficiency of birds fed the maize-based diet. Supplementary plant extracts did not change dietary ME (P > 0.05) but improved (P < 0.05) dietary NE by reducing the heat increment (P < 0.05) per kilogram feed intake. Feeding phytogenics improved (P < 0.05) total carcass energy retention and the efficiency of dietary ME for carcass energy retention. The number of interactions between type of diet and supplementary phytogenic feed additive suggest that the chemical composition and the energy to protein ratio of the diet may influence the efficiency of phytogenics when fed to chickens. The experiment showed that although supplementary phytogenic additives did not affect dietary ME, they caused a significant improvement in the utilization of dietary energy for carcass energy retention but this did not always relate to growth performance.