Long-term tissue coverage of a biodegradable polylactide polymer-coated biolimus-eluting stent: comparative sequential assessment with optical coherence tomography until complete resorption of the polymer

Biolimus-eluting stents (BESs) with a biodegradable polymer in abluminal coating achieve more complete coverage at 9 months compared with sirolimus-eluting stents (SESs) with a durable polymer, as assessed by optical coherence tomography (OCT). Whether this advantage persists or augments after complete resorption of the polymer (>12 months) is unknown.

The three year follow-up of the randomised "all-comers" trial of a biodegradable polymer biolimus-eluting stent versus permanent polymer sirolimus-eluting stent (LEADERS)

Aims: The current study reports clinical outcomes at three year follow-up of the LEADERS clinical trial which was the first all-comers trial comparing a new generation biodegradable polymer biolimus drug-eluting stent (BES) with the first generation permanent polymer sirolimus-eluting stent (SES). Methods and results: One thousand seven hundred and seven patients were randomised to unrestricted use of BES (n=857) or SES (n=850) in an all-comers population. Three year follow-up was available in 95% of the patients, 812 treated with BES and 809 treated with SES. At three years, BES remains non-inferior to SES for the primary endpoint of major adverse cardiac events (composite of cardiac death, myocardial infarction (MI), or clinically-indicated target vessel revascularisation (CI-TVR) (BES 15.7% versus SES 19%; HR 0.82 CI 0.65-1.03; p=0.09). The MACE Kaplan Meier event curves increasingly diverge with the difference in events increasing from 1.4% to 2.4% and 3.3% at 1, 2 and 3 years, respectively in favour of BES. The rate of cardiac death was non-significantly lower 4.2% versus 5.2% (HR=0.81 CI 0.52-1.26; p=0.34) and the rate of myocardial infarction was equivalent 7.2% versus 7.1% (HR 1.01 CI 0.70-1.44; p=0.97) for BES versus SES, respectively. Thus BES was non-inferior to SES in all the safety endpoints. Clinically-indicated TVR occurred in 9.4% of BES treated patients versus 11.1% of SES treated patients (HR 0.84 CI 0.62-1.13; p=0.25). Rates of definite stent thrombosis were 2.2% for BES and 2.9% for SES (HR 0.78 CI 0.43-1.43; p=0.43), with the event rate increase of 0.2% from one to three years for BES and 0.9% for SES. For patients presenting with ST-elevation myocardial infarction BES was superior to SES in reducing MACE. Conclusions: The findings of the three year follow-up support the claim that the biodegradable polymer biolimus-eluting stent has equivalent safety and efficacy to permanent polymer sirolimus-eluting stent in an all-comers patient population. Its performance is superior in some subpopulations such as in ST-elevation MI patients and event rates for BES are overall lower than for SES with a trend toward increasing divergence of outcomes over three years. - See more at: http://www.pcronline.com/eurointervention/42nd_issue/125/#sthash.E5HhMQ4a.dpuf

Implantation of the biodegradable polymer biolimus-eluting stent in patients with high SYNTAX score is associated with decreased cardiac mortality compared to a permanent polymer sirolimus-eluting stent: two year follow-up results from the "all-comers" LEADERS trial

Background: The SYNTAX score (SXscore) has been shown to be an effective predictor of clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods and results: The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the “all-comers” LEADERS trial (patients post-surgical revascularisation were excluded). Post hoc analysis was performed by stratifying clinical outcomes at two-year follow-up, according to one of three SXscore tertiles: SXlow ≤8 (n=464), 816 (n=461). At two-year follow-up the rate of major adverse cardiovascular events was 18.4%, 12.0% and 9.4% in the SXhigh, SXmid, and SXlow tertile, respectively (HR 1.45; CI 1.21-1.74; p<0.01). There was a significantly higher rate of cardiac death in patients in the highest SXscore tertile (7% SXhigh versus 2.4% SXmid versus 1.8% SXlow; HR 2.22; CI 1.5-3.27; p<0.001). Within the SXhigh tertile the rate of cardiac death was significantly lower in patients treated with the biolimus-eluting stent compared with the sirolimus-eluting stent (4.7% versus 9.6%, HR 0.48; CI 0.23-0.99; p=0.046). Conclusions: The SXscore when applied to an “all-comers” patient population allows for prospective risk stratification of patients undergoing PCI up to two years follow-up. In addition, the SXscore appears to separate the performance of devices in high risk patient groups.

Two-year clinical follow-up from the randomized comparison of biolimus-eluting stents with biodegradable polymer and sirolimus-eluting stents with durable polymer in routine clinical practice

Objectives This study sought to investigate safety and efficacy of biolimus-eluting stents (BES) with biodegradable polymer as compared with sirolimus-eluting stents (SES) with durable polymer through 2 years of follow-up. Background BES with a biodegradable polymer provide similar efficacy and safety as SES with a durable polymer at 9 months. Clinical outcomes beyond the period of biodegradation of the polymer used for drug release and after discontinuation of dual antiplatelet therapy are of particular interest. Methods A total of 1,707 patients were randomized to unrestricted use of BES (n = 857) or SES (n = 850) in an all-comers patient population. Results At 2 years, BES remained noninferior compared with SES for the primary endpoint, which was a composite of cardiac death, myocardial infarction, or clinically indicated target vessel revascularization (BES 12.8% vs. SES 15.2%, hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.65 to 1.08, pnoninferiority < 0.0001, psuperiority = 0.18). Rates of cardiac death (3.2% vs. 3.9%, HR: 0.81, 95% CI: 0.49 to 1.35, p = 0.42), myocardial infarction (6.3% vs. 5.6%, HR: 1.12, 95% CI: 0.76 to 1.65, p = 0.56), and clinically indicated target vessel revascularization (7.5% vs. 8.6%, HR: 0.86, 95% CI: 0.62 to 1.20, p = 0.38) were similar for BES and SES. The rate of definite stent thrombosis through 2 years was 2.2% for BES and 2.5% for SES (p = 0.73). For the period between 1 and 2 years, event rates for definite stent thrombosis were 0.2% for BES and 0.5% for SES (p = 0.42). After discontinuation of dual antiplatelet therapy, no very late definite stent thrombosis occurred in the BES group. Conclusions At 2 years of follow-up, the unrestricted use of BES with a biodegradable polymer maintained a similar safety and efficacy profile as SES with a durable polymer. (Limus Eluted From a Durable Versus Erodable Stent Coating [LEADERS]; NCT00389220)

Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials

The efficacy of durable polymer drug-eluting stents (DES) is delivered at the expense of delayed healing of the stented vessel. Biodegradable polymer DES aim to avoid this shortcoming and may potentially improve long-term clinical outcomes, with benefit expected to accrue over time. We sought to compare long-term outcomes in patients treated with biodegradable polymer DES vs. durable polymer sirolimus-eluting stents (SES).

Full body low radiation radiography using Lodox Statscan

Lodox Statscan provides high-speed, high-quality, low radiation, full body imaging in a single scan, combined with three-dimensional reconstructive and zooming functionality. Several trauma centres have incorporated it into their advanced trauma life support protocol. This review gives a brief overview of the system.

A review of full-body radiography in nontraumatic emergency medicine

This paper reports on the application of full-body radiography to nontraumatic emergency situations. The Lodox Statscan is an X-ray machine capable of imaging the entire body in 13 seconds using linear slit scanning radiography (LSSR). Nontraumatic emergency applications in ventriculoperitoneal (VP) shunt visualisation, emergency room arteriography (ERA), detection of foreign bodies, and paediatric emergency imaging are presented. Reports show that the fast, full-body, and low-dose scanning capabilities of the Lodox system make it well suited to these applications, with the same or better image quality, faster processing times, and lower dose to patients. In particular, the large format scans allowing visualisation of a greater area of anatomy make it well suited to VP shunt monitoring, ERA, and the detection of foreign bodies. Whilst more studies are required, it can be concluded that the Lodox Statscan has the potential for widespread use in these and other nontraumatic emergency radiology applications.

How reliable and safe is full-body low-dose radiography (LODOX Statscan) in detecting foreign bodies ingested by adults?

OBJECTIVE: Foreign body ingestion is common and potentially lethal. This study evaluates the use of low-dose Statscans (LODOX) in emergency departments. DESIGN: This comparative cross-sectional study retrospectively assessed 28 289 digital chest x-rays and 2301 LODOX scans performed between 2006 and 2010 at a tertiary emergency centre. The radiographic appearance, image quality and location of ingested foreign bodies were evaluated in standard digital chest and LODOX radiography. The mean irradiation (μSv) and cumulative mean radiation dose per patient with the ingested foreign body were calculated according to literature-based data, together with the sensitivity and specificity for each modality. RESULTS: A total of 62 foreign bodies were detected in 39 patients, of whom 19 were investigated with LODOX and 20 with conventional digital chest radiography. Thirty-three foreign bodies were located in the two upper abdominal quadrants, 21 in the lower quadrants-which are not visible on conventional digital chest radiography-seven in the oesophagus and one in the bronchial system. The sensitivity and specificity of digital chest radiography were 44.4% and 94.1%, respectively, and for the LODOX Statscan 90% and 100%, respectively. The calculated mean radiation dose for LODOX investigations was 184 μS, compared with 524 μS for digital chest radiography. CONCLUSIONS: LODOX Statscan is superior to digital chest radiography in the diagnostic work-up of ingested foreign bodies because it makes it possible to enlarge the field of view to the entire body, has higher sensitivity and specificity, and reduces the radiation dose by 65%.

Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal stents on cardiovascular events among patients with acute myocardial infarction: the COMFORTABLE AMI randomized trial

The efficacy and safety of drug-eluting stents compared with bare-metal stents remains controversial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

A study of high solids anaerobic digestion of Bucknell University food waste followed by aerobic curing

Anaerobic digestion of food scraps has the potential to accomplish waste minimization, energy production, and compost or humus production. At Bucknell University, removal of food scraps from the waste stream could reduce municipal solid waste transportation costs and landfill tipping fees, and provide methane and humus for use on campus. To determine the suitability of food waste produced at Bucknell for high-solids anaerobic digestion (HSAD), a year-long characterization study was conducted. Physical and chemical properties, waste biodegradability, and annual production of biodegradable waste were assessed. Bucknell University food and landscape waste was digested at pilot-scale for over a year to test performance at low and high loading rates, ease of operation at 20% solids, benefits of codigestion of food and landscape waste, and toprovide digestate for studies to assess the curing needs of HSAD digestate. A laboratory-scale curing study was conducted to assess the curing duration required to reduce microbial activity, phytotoxicity, and odors to acceptable levels for subsequent use ofhumus. The characteristics of Bucknell University food and landscape waste were tested approximately weekly for one year, to determine chemical oxygen demand (COD), total solids (TS), volatile solids (VS), and biodegradability (from batch digestion studies). Fats, oil, and grease and total Kjeldahl nitrogen were also tested for some food waste samples. Based on the characterization and biodegradability studies, Bucknell University dining hall food waste is a good candidate for HSAD. During batch digestion studies Bucknell University food waste produced a mean of 288 mL CH4/g COD with a 95%confidence interval of 0.06 mL CH4/g COD. The addition of landscape waste for digestion increased methane production from both food and landscape waste; however, because the landscape waste biodegradability was extremely low the increase was small.Based on an informal waste audit, Bucknell could collect up to 100 tons of food waste from dining facilities each year. The pilot-scale high-solids anaerobic digestion study confirmed that digestion ofBucknell University food waste combined with landscape waste at a low organic loading rate (OLR) of 2 g COD/L reactor volume-day is feasible. During low OLR operation, stable reactor performance was demonstrated through monitoring of biogas production and composition, reactor total and volatile solids, total and soluble chemical oxygendemand, volatile fatty acid content, pH, and bicarbonate alkalinity. Low OLR HSAD of Bucknell University food waste and landscape waste combined produced 232 L CH4/kg COD and 229 L CH4/kg VS. When OLR was increased to high loading (15 g COD/L reactor volume-day) to assess maximum loading conditions, reactor performance became unstable due to ammonia accumulation and subsequent inhibition. The methaneproduction per unit COD also decreased (to 211 L CH4/kg COD fed), although methane production per unit VS increased (to 272 L CH4/kg VS fed). The degree of ammonia inhibition was investigated through respirometry in which reactor digestate was diluted and exposed to varying concentrations of ammonia. Treatments with low ammoniaconcentrations recovered quickly from ammonia inhibition within the reactor. The post-digestion curing process was studied at laboratory-scale, to provide a preliminary assessment of curing duration. Digestate was mixed with woodchips and incubated in an insulated container at 35 °C to simulate full-scale curing self-heatingconditions. Degree of digestate stabilization was determined through oxygen uptake rates, percent O2, temperature, volatile solids, and Solvita Maturity Index. Phytotoxicity was determined through observation of volatile fatty acid and ammonia concentrations.Stabilization of organics and elimination of phytotoxic compounds (after 10–15 days of curing) preceded significant reductions of volatile sulfur compounds (hydrogen sulfide, methanethiol, and dimethyl sulfide) after 15–20 days of curing. Bucknell University food waste has high biodegradability and is suitable for high-solids anaerobic digestion; however, it has a low C:N ratio which can result in ammonia accumulation under some operating conditions. The low biodegradability of Bucknell University landscape waste limits the amount of bioavailable carbon that it can contribute, making it unsuitable for use as a cosubstrate to increase the C:N ratio of food waste. Additional research is indicated to determine other cosubstrates with higher biodegradabilities that may allow successful HSAD of Bucknell University food waste at high OLRs. Some cosubstrates to investigate are office paper, field residues, or grease trap waste. A brief curing period of less than 3 weeks was sufficient to produce viable humus from digestate produced by low OLR HSAD of food and landscape waste.

A General Approach Towards the Synthesis of Amido-Functionalized Biodegradable Polyesters

The thesis presented here describes methodologies to produce pendant group functionalized polyesters from amido-functionalized α-hydroxy acids. The synthetic methods used to produce the functionalized α-hydroxy acids are compatible with a wide array of functional groups, making this technique highly versatile. The synthesis of functionalized polyesters was investigated to develop polymers with properties that may improve the capabilities of existing biodegradable polyesters for applications in controlled release pharmaceuticals. Chemically modified a-hydroxy acids were synthesized by reacting glyoxylic acid with a primary or secondary amide. To demonstrate the utility of this reaction, fourstructurally dissimilar amide substituents were examined including 2-pyrrolidione, benzamide, acetamide and acrylamide. The reaction is synthetically simple, provides high yields and is uniquely flexible, functionalized monomer. The compatibility of this procedure with the collection of functional groups mentioned circumvents the need for syntheses. The amido-functionalized monomers were polymerized by two different techniques: melt polycondensation and solution polymerization. Melt polycondensation was conducted by heating the monomer past its melting temperature under reduced pressure. Oligomeric functionalized polyesters (= 800 g/mol) with low PDIs (= 1.05) were obtained by melt polycondensation. Melt polycondensation was not compatible with all of the synthesized monomers. Two of the monomers (containing benzamide and acrylamide functionalities) degraded before the polycondensation reaction occurred. Thermal gravimetric analysis confirmed that a process other than polyesterification was occurring, indicating that some amido-functionalized α-hydroxy acids cannot be synthesized in the melt.Solution polymerization was conducted to polymerize functionalized α-hydroxy acids that were incompatible with melt polycondensation. Several modified Steglich polyesterifications were tested including p-toluenesulfonic acid mediated and scandium (III) triflate catalyzed. Only oligomeric functionalized polyesters were formed bythis method. A number of possible side reactions including the formation of an N-acylurea and a cyclic polymer ring were possible. The utility of this procedure appears to be limited due to the complexity of the reaction and its inability to produce high molecular weight polymer.