Metabolic syndrome and alanine aminotransferase: a global perspective from the NAVIGATOR screening population

Non-alcoholic fatty liver disease (NAFLD) is associated with features of the metabolic syndrome (MetS) and may be an expression of the syndrome within the liver. Using screening data from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study (n = 42 149), we examined whether alanine aminotransferase (ALT), a biomarker for NAFLD, clustered with features of MetS and whether the clusters differed across global geographic regions.

Late Holocene summer temperatures in the central Andes reconstructed from the sediments of high-elevatin Laguna Chepical, Chile (32° S)

High-resolution reconstructions of climate variability that cover the past millennia are necessary to improve the understanding of natural and anthropogenic climate change across the globe. Although numerous records are available for the mid- and high-latitudes of the Northern Hemisphere, global assessments are still compromised by the scarcity of data from the Southern Hemisphere. This is particularly the case for the tropical and subtropical areas. In addition, high elevation sites in the South American Andes may provide insight into the vertical structure of climate change in the mid-troposphere. This study presents a 3000 yr-long austral summer (November to February) temperature reconstruction derived from the 210Pb- and 14C-dated organic sediments of Laguna Chepical (32°16' S, 70°30' W, 3050 m a.s.l.), a high-elevation glacial lake in the subtropical Andes of central Chile. Scanning reflectance spectroscopy in the visible light range provided the spectral index R570/R630, which reflects the clay mineral content in lake sediments. For the calibration period (AD 1901–2006), the R570/R630 data were regressed against monthly meteorological reanalysis data, showing that this proxy was strongly and significantly correlated with mean summer (NDJF) temperatures (R3 yr = −0.63, padj = 0.01). This calibration model was used to make a quantitative temperature reconstruction back to 1000 BC. The reconstruction (with a model error RMSEPboot of 0.33 °C) shows that the warmest decades of the past 3000 yr occurred during the calibration period. The 19th century (end of the Little Ice Age (LIA)) was cool. The prominent warmth reconstructed for the 18th century, which was also observed in other records from this area, seems systematic for subtropical and southern South America but remains difficult to explain. Except for this warm period, the LIA was generally characterized by cool summers. Back to AD 1400, the results from this study compare remarkably well to low altitude records from the Chilean Central Valley and southern South America. However, the reconstruction from Laguna Chepical does not show a warm Medieval Climate Anomaly during the 12–13th century, which is consistent with records from tropical South America. The Chepical record also indicates substantial cooling prior to 800 BC. This coincides with well-known regional as well as global glacier advances which have been attributed to a grand solar minimum. This study thus provides insight into the climatic drivers and temperature patterns in a region for which currently very few data are available. It also shows that since ca. AD 1400, long-term temperature patterns were generally similar at low and high altitudes in central Chile.

Clinical outcome of patients with and without diabetes mellitus after percutaneous coronary intervention with the resolute zotarolimus-eluting stent: 2-year results from the prospectively pooled analysis of the international global RESOLUTE program

OBJECTIVES The aim of this study was to describe the process to obtain Food and Drug Administration (FDA) approval for the expanded indication for treatment with the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Inc., Santa Rosa, California) in patients with coronary artery disease and diabetes. BACKGROUND The R-ZES is the first drug-eluting stent specifically indicated in the United States for percutaneous coronary intervention in patients with diabetes. METHODS We pooled patient-level data for 5,130 patients from the RESOLUTE Global Clinical Program. A performance goal prospectively determined in conjunction with the FDA was established as a rate of target vessel failure at 12 months of 14.5%. In addition to the FDA pre-specified cohort of less complex patients with diabetes (n = 878), we evaluated outcomes of the R-ZES in all 1,535 patients with diabetes compared with all 3,595 patients without diabetes at 2 years. RESULTS The 12-month rate of target vessel failure in the pre-specified diabetic cohort was 7.8% (upper 95% confidence interval: 9.51%), significantly lower than the performance goal of 14.5% (p < 0.001). After 2 years, the cumulative incidence of target lesion failure in patients with noninsulin-treated diabetes was comparable to that of patients without diabetes (8.0% vs. 7.1%). The higher risk insulin-treated population demonstrated a significantly higher target lesion failure rate (13.7%). In the whole population, including complex patients, rates of stent thrombosis were not significantly different between patients with and without diabetes (1.2% vs. 0.8%). CONCLUSIONS The R-ZES is safe and effective in patients with diabetes. Long-term clinical data of patients with noninsulin-treated diabetes are equivalent to patients without diabetes. Patients with insulin-treated diabetes remain a higher risk subset. (The Medtronic RESOLUTE Clinical Trial; NCT00248079; Randomized, Two-arm, Non-inferiority Study Comparing Endeavor-Resolute Stent With Abbot Xience-V Stent [RESOLUTE-AC]; NCT00617084; The Medtronic RESOLUTE US Clinical Trial (R-US); NCT00726453; RESOLUTE International Registry: Evaluation of the Resolute Zotarolimus-Eluting Stent System in a 'Real-World' Patient Population [R-Int]; NCT00752128; RESOLUTE Japan-The Clinical Evaluation of the MDT-4107 Drug-Eluting Coronary Stent [RJ]; NCT00927940).

Impact of overlapping newer generation drug-eluting stents on clinical and angiographic outcomes: pooled analysis of five trials from the international Global RESOLUTE Program

BACKGROUND Overlapping first generation sirolimus- and paclitaxel-eluting stents are associated with persistent inflammation, fibrin deposition and delayed endothelialisation in preclinical models, and adverse angiographic and clinical outcomes--including death and myocardial infarction (MI)--in clinical studies. OBJECTIVES To establish as to whether there are any safety concerns with newer generation drug-eluting stents (DES). DESIGN Propensity score adjustment of baseline anatomical and clinical characteristics were used to compare clinical outcomes (Kaplan-Meier estimates) between patients implanted with overlapping DES (Resolute zotarolimus-eluting stent (R-ZES) or R-ZES/other DES) against no overlapping DES. Additionally, angiographic outcomes for overlapping R-ZES and everolimus-eluting stents were evaluated in the randomised RESOLUTE All-Comers Trial. SETTING Patient level data from five controlled studies of the RESOLUTE Global Clinical Program evaluating the R-ZES were pooled. Enrollment criteria were generally unrestrictive. PATIENTS 5130 patients. MAIN OUTCOME MEASURES 2-year clinical outcomes and 13-month angiographic outcomes. RESULTS 644 of 5130 patients (12.6%) in the RESOLUTE Global Clinical Program underwent overlapping DES implantation. Implantation of overlapping DES was associated with an increased frequency of MI and more complex/calcified lesion types at baseline. Adjusted in-hospital, 30-day and 2-year clinical outcomes indicated comparable cardiac death (2-year overlap vs non-overlap: 3.0% vs 2.1%, p=0.36), major adverse cardiac events (13.3% vs 10.7%, p=0.19), target-vessel MI (3.9% vs 3.4%, p=0.40), clinically driven target vessel revascularisation (7.7% vs 6.5%, p=0.32), and definite/probable stent thrombosis (1.4% vs 0.9%, p=0.28). 13-month adjusted angiographic outcomes were comparable between overlapping and non-overlapping DES. CONCLUSIONS Overlapping newer generation DES are safe and effective, with comparable angiographic and clinical outcomes--including repeat revascularisation--to non-overlapping DES.

Reflection of solar wind hydrogen from the lunar surface

The solar wind continuously flows out from the Sun and directly interacts with the surfaces of dust and airless planetary bodies throughout the solar system. A significant fraction of solar wind ions reflect from an object's surface as energetic neutral atoms (ENAs). ENA emission from the Moon was first observed during commissioning of the Interstellar Boundary Explorer (IBEX) mission on 3 December 2008. We present the analysis of 10 additional IBEX observations of the Moon while it was illuminated by the solar wind. For the viewing geometry and energy range (> 250 eV) of the IBEX-Hi ENA imager, we find that the spectral shape of the ENA emission from the Moon is well-represented by a linearly decreasing flux with increasing energy. The fraction of the incident solar wind ions reflected as ENAs, which is the ENA albedo and defined quantitatively as the ENA reflection coefficient RN, depends on the incident solar wind speed, ranging from ~0.2 for slow solar wind to ~0.08 for fast solar wind. The average energy per incident solar wind ion that is reflected to space is 30 eV for slow solar wind and 45 eV for fast solar wind. Once ionized, these ENAs can become pickup ions in the solar wind with a unique spectral signature that reaches 3vSW. These results apply beyond the solar system; the reflection process heats plasmas that have significant bulk flow relative to interstellar dust and cools plasmas having no net bulk flow relative to the dust.