Comparison of long versus short ("spot") drug-eluting stenting for long coronary stenoses

We compared spot drug-eluting stenting (DES) to full stent coverage for treatment of long coronary stenoses. Consecutive, consenting patients with a long (>20 mm) coronary lesion of nonuniform severity and indication for percutaneous coronary intervention were randomized to full stent coverage of the atherosclerotic lesion with multiple, overlapping stenting (full DES group, n = 90) or spot stenting of hemodynamically significant parts of the lesion only (defined as diameter stenosis >50%; spot DES group, n = 89). At 1-year follow-up, 14 patients with full DES (15.6%) and 5 patients (5.6%) with spot DES had a major adverse cardiac event (MACE; p = 0.031). At 3 years, MACEs occurred in 18 patients with full DES (20%) and 7 patients (7.8%) with spot DES (p = 0.019). Cox proportional hazard model showed that the risk for MACEs was almost 60% lower in patients with spot DES compared to those with full DES (hazard ratio 0.41, 95% confidence interval 0.17 to 0.98, p = 0.044). This association remained even after controlling for age, gender, lesion length, and type of stent used (hazard ratio 0.42, 95% confidence interval 0.17 to 1.00, p = 0.05). In conclusion, total lesion coverage with DES is not necessary in the presence of diffuse disease of nonuniform severity. Selective stenting of only the significantly stenosed parts of the lesion is an appropriate therapeutic alternative in this setting, offering a favorable clinical outcome.

Piezoelectric alveolar ridge-splitting technique with simultaneous implant placement: a cohort study with 2-year radiographic results

PURPOSE Extended grafting procedures in atrophic ridges are invasive and time-consuming and increase cost and patient morbidity. Therefore, ridge-splitting techniques have been suggested to enlarge alveolar crests. The aim of this cohort study was to report techniques and radiographic outcomes of implants placed simultaneously with a piezoelectric alveolar ridge-splitting technique (RST). Peri-implant bone-level changes (ΔIBL) of implants placed with (study group, SG) or without RST (control group, CG) were compared. MATERIALS AND METHODS Two cohorts (seven patients in each) were matched regarding implant type, position, and number; superstructure type; age; and gender and received 17 implants each. Crestal implant bone level (IBL) was measured at surgery (T0), loading (T1), and 1 year (T2) and 2 years after loading (T3). For all implants, ΔIBL values were determined from radiographs. Differences in ΔIBL between SG and CG were analyzed statistically (Mann-Whitney U test). Bone width was assessed intraoperatively, and vertical bone mapping was performed at T0, T1, and T3. RESULTS After a mean observation period of 27.4 months after surgery, the implant survival rate was 100%. Mean ΔIBL was -1.68 ± 0.90 mm for SG and -1.04 ± 0.78 mm for CG (P = .022). Increased ΔIBL in SG versus CG occurred mainly until T2. Between T2 and T3, ΔIBL was limited (-0.11 ± 1.20 mm for SG and -0.05 ± 0.16 mm for CG; P = .546). Median bone width increased intraoperatively by 4.7 mm. CONCLUSIONS Within the limitations of this study, it can be suggested that RST is a well-functioning one-stage alternative to extended grafting procedures if the ridge shows adequate height. ΔIBL values indicated that implants with RST may fulfill accepted implant success criteria. However, during healing and the first year of loading, increased IBL alterations must be anticipated.

Anatomical eligibility of the renal vasculature for catheter-based renal denervation in hypertensive patients.

OBJECTIVES This study sought to determine the vascular anatomical eligibility for catheter-based renal artery denervation (RDN) in hypertensive patients. BACKGROUND Arterial hypertension is the leading cardiovascular risk factor for stroke and mortality globally. Despite substantial advances in drug-based treatment, many patients do not achieve target blood pressure levels. To improve the number of controlled patients, novel procedure- and device-based strategies have been developed. RDN is among the most promising novel techniques. However, there are few data on the vascular anatomical eligibility. METHODS We retrospectively analyzed 941 consecutive hypertensive patients undergoing coronary angiography and selective renal artery angiography between January 1, 2010, and May 31, 2012. Additional renal arteries were divided into 2 groups: hilar (accessory) and polar (aberrant) arteries. Anatomical eligibility for RDN was defined according to the current guidelines: absence of renal artery stenosis, renal artery diameter ≥4 mm, renal artery length ≥20 mm, and only 1 principal renal artery. RESULTS A total of 934 hypertensive patients were evaluable. The prevalence of renal artery stenosis was 10% (n = 90). Of the remaining 844 patients without renal artery stenosis, 727 (86%) had nonresistant hypertension and 117 (14%) had resistant hypertension; 62 (53%) of the resistant hypertensive and 381 (52%) of the nonresistant hypertensive patients were anatomically eligible for sympathetic RDN. CONCLUSIONS The vascular anatomical eligibility criteria of the current guidelines are a major limiting factor for the utilization of RDN as a therapeutic option. Development of new devices and/or techniques may significantly increase the number of candidates for these promising therapeutic options.

A validated assay by liquid chromatography-tandem mass spectrometry for the simultaneous quantification of elvitegravir and rilpivirine in HIV positive patients

Because of the large variability in the pharmacokinetics of anti-HIV drugs, therapeutic drug monitoring in patients may contribute to optimize the overall efficacy and safety of antiretroviral therapy. An LC–MS/MS method for the simultaneous assay in plasma of the novel antiretroviral agents rilpivirine (RPV) and elvitegravir (EVG) has been developed to that endeavor. Plasma samples (100 μL) extraction is performed by protein precipitation with acetonitrile, and the supernatant is subsequently diluted 1:1 with 20-mM ammonium acetate/MeOH 50:50. After reverse-phase chromatography, quantification of RPV and EVG, using matrix-matched calibration samples, is performed by electrospray ionization–triple quadrupole mass spectrometry by selected reaction monitoring detection using the positive mode. The stable isotopic-labeled compounds RPV-13C6 and EVG-D6 were used as internal standards. The method was validated according to FDA recommendations, including assessment of extraction yield, matrix effects variability (<6.4%), as well as EVG and RPV short and long-term stability in plasma. Calibration curves were validated over the clinically relevant concentrations ranging from 5 to 2500 ng/ml for RPV and from 50 to 5000 ng/ml for EVG. The method is precise (inter-day CV%: 3–6.3%) and accurate (3.8–7.2%). Plasma samples were found to be stable (<15%) in all considered conditions (RT/48 h, +4°C/48 h, −20°C/3 months and 60°C/1 h). Selected metabolite profiles analysis in patients' samples revealed the presence of EVG glucuronide, that was well separated from parent EVG, allowing to exclude potential interferences through the in-source dissociation of glucuronide to parent drug. This new, rapid and robust LCMS/MS assay for the simultaneous quantification of plasma concentrations of these two major new anti-HIV drugs EVG and RPV offers an efficient analytical tool for clinical pharmacokinetics studies and routine therapeutic drug monitoring service.

Challenging conservation agriculture on marginal slopes in Sehoul, Morocco

In Sehoul, Morocco, the use of marginal land for agriculture became a necessity for the local population due to increased poverty and the occupation of the best land by new owners. Desertification poses an additional threat to agricultural production on marginal slopes, which are often stony and degraded. In a participatory process embedded in the EU DESIRE research project, potential sustainable land management measures were selected to address land degradation and desertification. Promising experiences with no-tillage practices elsewhere in Morocco had motivated the Moroccan government to promote conservation agriculture throughout the country. This combination of crop rotation, minimal soil disturbance and soil cover maintenance, however, had not yet been tested on sloping degraded land. Field trials of grazing enclosure combined with no or minimum tillage were conducted on the plots of two farmers, and trial results were analyzed based on stakeholders’ criteria. Results suggest that increased soil cover with barley residues improved rainwater use efficiency and yields only slightly, although soil water was generally enhanced. Soil moisture measurements revealed that no-tillage was favorable mainly at soil depths of 5 cm and in connection with low-rainfall events (<20 mm); under these circumstances, moisture content was generally higher under no-tillage than under conventional tillage. Moreover, stakeholder discussion confirmed that farmers in Sehoul remain primarily interested in animal husbandry and are reluctant to change the current grazing system. Implementation of conservation agriculture is thus challenged both by the degraded, sloping and stony nature of the land, and by the socio-economic circumstances in Sehoul.

Pulmonary aspergilloma: A rare differential diagnosis to lung cancer after positive FDG PET scan

Early diagnosis and treatment of lung cancer, one of the leading causes of cancer-related death, is important to improve morbidity and mortality. Therefore any suspect solitary pulmonary nodule should prompt the pursuit for a definitive histological diagnosis. We describe the case of a 55-years-old male ex-smoker, who was admitted to our hospital due to recurrent hemoptysis and dry cough. A CT scan showed an irregular nodule of increasing size (28 mm in diameter) in the left lower lobe (LLL). A whole body PET-CT scan (643 MBq F-18 FDG i.v.) was performed and confirmed an avid FDG uptake of the nodule in the LLL, highly suspicious of lung cancer, without any evidence of lymphogenic or hematogenic metastasis. Bronchoscopy was not diagnostic and due to severe adhesions after prior chest trauma and the central location of the nodule, a lobectomy of the LLL was performed. Surprisingly, histology showed a simple aspergilloma located in a circumscribed bronchiectasis with no evidence of malignancy. This is a report of an informative example of an aspergilloma, which presented with symptoms and radiological features of malignant lung cancer.

Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis

OBJECTIVE The aim of the present systematic review and meta-analysis was to assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone. MATERIALS AND METHODS The Cochrane Oral Health Group specialist trials, MEDLINE, and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and forest plots were calculated for CAL gain, probing depth (PD), and gingival recession (REC). RESULTS Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95 % CI 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32 ± 1.04 mm (median 3.40; 95 % CI 3.28-3.52) following treatment with EMD alone. Mean PD reduction measured 4.22 ± 1.20 mm (median 4.10; 95 % CI 3.96-4.24) at sites treated with EMD and bone graft and yielded 4.12 ± 1.07 mm (median 4.00; 95 % CI 3.88-4.12) at sites treated with EMD alone. Mean REC increase amounted to 0.76 ± 0.42 mm (median 0.63; 95 % CI 0.58-0.68) at sites treated with EMD and bone graft and to 0.91 ± 0.26 mm (median 0.90; 95 % CI 0.87-0.93) at sites treated with EMD alone. CONCLUSIONS Within their limits, the present results indicate that the combination of EMD and bone grafts may result in additional clinical improvements in terms of CAL gain and PD reduction compared with those obtained with EMD alone. The potential influence of the chosen graft material or of the surgical procedure (i.e., flap design) on the clinical outcomes is unclear. CLINICAL RELEVANCE The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.

Recruitment Habitats and Nursery Grounds of the American Lobster Homarus Americanus: A Demographic Bottleneck?

We have identified benthic recruitment habitats and nursery grounds of the American lobster Homarus americanus Milne Edwards in the coastal Gulf of Maine, USA, by systematically censusing subtidal sediment, cobble, and ledge substrata. We distinguish lobsters between settlement size (5 mm carapace length (CL) to ca 40 mm CL as the 'early benthic phase' (EBP) because they are ecologically and behaviorally distinct from larger lobsters. EBP lobsters are cryptic and apparently restricted to shelter-providing habitats (primarily cobble substratum) in coastal Gulf of Maine. In these habitats we found average population densities of EBP lobsters as high as 6.9 m-2. EBP lobsters were virtually absent from ledge and sedimentary substrata devoid of vegetation although larger lobsters are commonly found there. It is possible that the requirement for shelter-providing substrata by this life phase creates a natural demographic 'bottleneck' to benthic recruitment for the species. Prime cobble recruitment habitat is relatively rare and comprises ca 11 % of the 60.2 km of shoreline at our study area in midcoast Maine. If this low availability of cobble exists throughout the Gulf of Maine, as other studies indicate, it could limit lobster production potential. We verified the geographic extent of recruitment to cobble habitats censused in 3 of 4 regions spanning ca 300 km of the coastal Gulf of Maine (from Nahant, Massachusetts to Swans Island, Maine). Early benthic phase lobsters were absent from cobble censused in the northeastern extreme of our survey (Swans Island). This pattern is consistent with earlier speculation that relatively cool water temperatures may limit larval settlement in this region.

Oceanography during TYDEMAN cruise DCM (DeepChlorMax) to the Equatorial Atlantic

The cruise with RV Tydeman was devoted to study permanently stratified plankton systems in the (sub)tropical ocean, which are characterised by a deep chlorophyll peak between 80 and 150 m. To minimise lateral effects by horizontal transport of nutrients and organic matter from river outflow and upwelling regions, stations were selected in the middle of the North Atlantic Ocean between the continents of America and Africa. (5 - 35° N and 50 - 15° W). Here the vertical distributions of light and nutrients control the abundance and growth of autotrophic algae in the thermically stratified water column. This phytoplankton is numerically dominated by the prokaryotic picoplankters Synechococcus spp. and Prochlorococcus spp., which are smaller than 2 ?m. The productivity of the 100 to 150 m deep euphotic zone can be high, because a high heterotrophic/autotrophic biomass ratio induces a rapid regeneration of nutrients and inorganic carbon. Primary grazers are mainly micro-organisms such as heterotrophic nannoflagellates and ciliates, which feed on the small algae and on bacteria. Heterotrophic bacteria can outnumber the autotrophic algae, because their number is related to the substrate pools of dissolved and particulate dead organic matter. These DOC and detritus pools reach equilibrium at a concentration, where the rate of their production (proportional to algal biomass) equals their mineralisation and sinking rate (proportional to the concentration and weight of POC and detritus). At a relatively low value of the weight-specific loss rates, the equilibrium concentration of these carbon pools and their load of bacteria can be high. The bacterial productivity is proportional to the mineralisation rate, which in a steady state can never be higher than the rate of primary production. Hence the ratio in turnover rate of bacteria and autotrophs tends to be reciprocally proportional to their biomass ratio.

Fatty acids and intact polar lipids of laminated microbial sediments from St. Peter Ording, German Wadden Sea

Hidden for the untrained eye through a thin layer of sand, laminated microbial sediments occur in supratidal beaches along the North Sea coast. The inhabiting microbial communities organize themselves in response to vertical gradients of light, oxygen or sulfur compounds. We performed a fine-scale investigation on the vertical zonation of the microbial communities using a lipid biomarker approach, and assessed the biogeochemical processes using a combination of microsensor measurements and a 13C-labeling experiment. Lipid biomarker fingerprinting showed the overarching importance of cyanobacteria and diatoms in these systems, and heterocyst glycolipids revealed the presence of diazotrophic cyanobacteria even in 9 to 20 mm depth. High abundance of ornithine lipids (OL) throughout the system may derive from sulfate reducing bacteria, while a characteristic OL profile between 5 and 8 mm may indicate presence of purple non-sulfur bacteria. The fate of 13C-labeled bicarbonate was followed by experimentally investigating the uptake into microbial lipids, revealing an overarching importance of cyanobacteria for carbon fixation. However, in deeper layers, uptake into purple sulfur bacteria was evident, and a close microbial coupling could be shown by uptake of label into lipids of sulfate reducing bacteria in the deepest layer. Microsensor measurements in sediment cores collected at a later time point revealed the same general pattern as the biomarker analysis and the labeling experiments. Oxygen and pH-microsensor profiles showed active photosynthesis in the top layer. The sulfide that diffuses from deeper down and decreases just below the layer of active oxygenic photosynthesis indicates the presence of sulfur bacteria, like anoxygenic phototrophs that use sulfide instead of water for photosynthesis.

Oidiopsis taurica : nuevo patógeno de pimiento (Capsicum annum L.) y ají (Capsicum frutescens L.) en Mendoza (Argentina)

En febrero de 1998 se observó en cultivos de pimiento y ají de Mendoza (Argentina) muerte anticipada de plantas con severos daños en la producción. La magnitud del problema motivó una prospección en los principales oasis de la provincia, a fin de describir la sintomatología, conocer su dispersión, estimar los daños causados y recolectar material para realizar estudios en laboratorio tendientes a confirmar su etiología. Se constató que la afección se encontraba distribuida en todos los oasis del centro y norte. La sintomatología en hojas se caracterizó por la presencia en la cara adaxial de manchas amarillentas, de forma circular de 15 a 20 mm de diámetro, con puntuaciones necróticas, con tendencia a presentarse en anillos concéntricos. En la cara abaxial, generalmente las lesiones eran acompañadas de un micelio blanco tenue. Posteriormente siguió una severa defoliación. La producción disminuyó notablemente y además en pimiento los frutos fueron afectados por escaldaduras de sol y perdieron su valor comercial. A partir de aislamientos de pimiento y ají, mantenidos en plantas de brincos (Impatiens balsamina L.), se inocularon plantas sanas y se logró reproducir la enfermedad en condiciones de invernáculo.

Abundance and biomass of dinoflagellates and ciliates at time series station Helgoland Roads, North Sea, 2007-2009

A monitoring programme for microzooplankton was started at the long-term sampling station ''Kabeltonne'' at Helgoland Roads (54°11.30' N; 7°54.00' E) in January 2007 in order to provide more detailed knowledge on microzooplankton occurrence, composition and seasonality patterns at this site and to complement the existing plankton data series. Ciliate and dinoflagellate cell concentration and carbon biomass were recorded on a weekly basis. Heterotrophic dinoflagellates were considerably more important in terms of biomass than ciliates, especially during the summer months. However, in early spring, ciliates were the major group of microzooplankton grazers as they responded more quickly to phytoplankton food availability. Mixotrophic dinoflagellates played a secondary role in terms of biomass when compared to heterotrophic species; nevertheless, they made up an intense late summer bloom in 2007. The photosynthetic ciliate Myrionecta rubra bloomed at the end of the sampling period. Due to its high biomass when compared to crustacean plankton especially during the spring bloom, microzooplankton should be regarded as the more important phytoplankton grazer group at Helgoland Roads. Based on these results, analyses of biotic and abiotic factors driving microzooplankton composition and abundance are necessary for a full understanding of this important component of the plankton.

Riego con equipos presurizados

En un área de aprox. 2 000 000 ha del sur de Córdoba (Argentina) se evaluaron los equipos de riego con el fin de conocer su funcionamiento, el grado de uniformidad con que trabajan y la eficiencia de riego lograda por los productores. Se realizaron 21 evaluaciones sobre equipos operando de acuerdo con la programación establecida por sus usuarios; 14 sobre pivote, una sobre avance lateral, 4 sobre enrolladores (3 de cañón y uno de baja presión) y 2 sobre side roll. Los parámetros de calidad de riego brindaron coeficiente medio de uniformidad = 81,4 %, con uniformidad de distribución = 73,23 %. En el 80 % de los casos, la lámina aplicada fluctuó entre 10 y 20 mm siendo su promedio = 17 mm. De los resultados se puede inferir que -en general- la superficie asignada a cada equipo es siempre mayor que su capacidad para realizar oportunamente una óptima reposición del agua al suelo y que, si bien los coeficientes de uniformidad y distribución del agua pueden considerarse aceptables, la programación del riego es mala en todos los establecimientos evaluados poniéndose de manifiesto en la baja eficiencia de almacenamiento y repercutiendo directamente sobre la producción de los cultivos regados.

Eficiencia en la retención del agua de lluvia de cubiertas vegetadas de tipo "extensivo" e "intensivo"

La inundación en áreas urbanas por sobrecarga de las redes de drenaje es un problema recurrente de importancia creciente. Las cubiertas vegetadas (naturadas) retienen parte de la lámina de agua precipitada, reduciendo el escurrimiento superficial y generando hidrogramas de escorrentía directa con caudales pico menores y más retardados. Estas propiedades hacen que esta tecnología pueda contribuir a reducir la sobrecarga de cauces urbanos. Los resultados obtenidos a lo largo de casi dos años de estudio permitieron estimar una capacidad de retención de las cubiertas ensayadas (en la Ciudad de Buenos Aires), que ha sido variable en función de la precipitación, del grado de cobertura y profundidad del sustrato. Es así que el porcentaje retenido ha sido alto (73% a 100%) con precipitaciones menores o iguales a los 20 mm, alrededor del 60% con lluvias de 35 a 40 mm, y con precipitaciones cercanas a 100 mm los porcentajes de retención se redujeron notablemente, alcanzando valores cercanos al 30%. Estos resultados posicionan las cubiertas vegetadas, para las condiciones y sitio del ensayo, como una alternativa dentro del manejo hídrico integrado en cuencas urbanas.

(Table 1) Experimental results of Kd at various conditions from ODP Hole 131-808C

A comprehensive experimental study, utilizing a rocking autoclave hydrothermal apparatus with isotope tracers, was applied to evaluate the temperature of squeezing artifacts on B contents and isotopic compositions in pore waters. The partition coefficient (KD) was determined at temperatures from 25 ° to 350 °C, at 800 bars, and this information was applied to reconstruct pore water B and d11B in ODP drill sites, where pH, T, and porosity are known. The partition coefficient of B is a function of temperature, pH, and sediment mineralogy. The solution pH exerts a dominant control at low temperatures; however, KD decreases to a value of essentially zero (compared to that of KD = ~3.5 at 25 °C) at high temperatures indicating no adsorption. Two empirical equations were derived to represent most of the available experimental results. For pelagic clay rich sediments, a KD = -3.84-0.020T + 0.88pH (R = 0.84; 1sigma = 0.25) is established. For sediments that have experienced progressive metamorphism, a KD = -1.38-0.008T + 0.59pH (R = 0.81; 1sigma = 0.37) can be applied. Similarly the effect on pore water d11B can be corrected if the fractionation factors at different temperatures are assumed. The corrected B and d11B in ODP Sites 671, 672, and 808 indicate significant mobilization of bulk B in sediment (exchangeable + lattice bound) at depth, especially near the décollement zone or other potential flow conduits. Tectonically expelled fluids from mud diapirs of Barbados Ridge Complex, hot springs of Rumsey Hills, California, and mud pot waters of the Salton Sea geothermal field, are enriched in B (up to 20 mM) with lower d11B, supporting the argument of B mobilization as a result of fluid expulsion in accretionary prisms.