Coronary optical frequency domain imaging (OFDI) for in vivo evaluation of stent healing: comparison with light and electron microscopy

Coronary late stent thrombosis, a rare but devastating complication, remains an important concern in particular with the increasing use of drug-eluting stents. Notably, pathological studies have indicated that the proportion of uncovered coronary stent struts represents the best morphometric predictor of late stent thrombosis. Intracoronary optical frequency domain imaging (OFDI), a novel second-generation optical coherence tomography (OCT)-derived imaging method, may allow rapid imaging for the detection of coronary stent strut coverage with a markedly higher precision when compared with intravascular ultrasound, due to a microscopic resolution (axial approximately 10-20 microm), and at a substantially increased speed of image acquisition when compared with first-generation time-domain OCT. However, a histological validation of coronary OFDI for the evaluation of stent strut coverage in vivo is urgently needed. Hence, the present study was designed to evaluate the capacity of coronary OFDI by electron (SEM) and light microscopy (LM) analysis to detect and evaluate stent strut coverage in a porcine model.

Perceived functional ability assessed with the spinal function sort: is it valid for European rehabilitation settings in patients with non-specific non-acute low back pain?

The aim of this study involving 170 patients suffering from non-specific low back pain was to test the validity of the spinal function sort (SFS) in a European rehabilitation setting. The SFS, a picture-based questionnaire, assesses perceived functional ability of work tasks involving the spine. All measurements were taken by a blinded research assistant; work status was assessed with questionnaires. Our study demonstrated a high internal consistency shown by a Cronbach's alpha of 0.98, reasonable evidence for unidimensionality, spearman correlations of >0.6 with work activities, and discriminating power for work status at 3 and 12 months by ROC curve analysis (area under curve = 0.760 (95% CI 0.689-0.822), respectively, 0.801 (95% CI 0.731-0.859). The standardised response mean within the two treatment groups was 0.18 and -0.31. As a result, we conclude that the perceived functional ability for work tasks can be validly assessed with the SFS in a European rehabilitation setting in patients with non-specific low back pain, and is predictive for future work status.

Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials

Background Idiopathic pulmonary fibrosis is a progressive and fatal lung disease with inevitable loss of lung function. The CAPACITY programme (studies 004 and 006) was designed to confirm the results of a phase 2 study that suggested that pirfenidone, a novel antifibrotic and anti-inflammatory drug, reduces deterioration in lung function in patients with idiopathic pulmonary fibrosis. Methods In two concurrent trials (004 and 006), patients (aged 40–80 years) with idiopathic pulmonary fibrosis were randomly assigned to oral pirfenidone or placebo for a minimum of 72 weeks in 110 centres in Australia, Europe, and North America. In study 004, patients were assigned in a 2:1:2 ratio to pirfenidone 2403 mg/day, pirfenidone 1197 mg/day, or placebo; in study 006, patients were assigned in a 1:1 ratio to pirfenidone 2403 mg/day or placebo. The randomisation code (permuted block design) was computer generated and stratified by region. All study personnel were masked to treatment group assignment until after final database lock. Treatments were administered orally, 801 mg or 399 mg three times a day. The primary endpoint was change in percentage predicted forced vital capacity (FVC) at week 72. Analysis was by intention to treat. The studies are registered with ClinicalTrials.gov, numbers NCT00287729 and NCT00287716. Findings In study 004, 174 of 435 patients were assigned to pirfenidone 2403 mg/day, 87 to pirfenidone 1197 mg/day, and 174 to placebo. In study 006, 171 of 344 patients were assigned to pirfenidone 2403 mg/day, and 173 to placebo. All patients in both studies were analysed. In study 004, pirfenidone reduced decline in FVC (p=0·001). Mean FVC change at week 72 was −8·0% (SD 16·5) in the pirfenidone 2403 mg/day group and −12·4% (18·5) in the placebo group (difference 4·4%, 95% CI 0·7 to 9·1); 35 (20%) of 174 versus 60 (35%) of 174 patients, respectively, had a decline of at least 10%. A significant treatment effect was noted at all timepoints from week 24 and in an analysis over all study timepoints (p=0·0007). Mean change in percentage FVC in the pirfenidone 1197 mg/day group was intermediate to that in the pirfenidone 2403 mg/day and placebo groups. In study 006, the difference between groups in FVC change at week 72 was not significant (p=0·501). Mean change in FVC at week 72 was −9·0% (SD 19·6) in the pirfenidone group and −9·6% (19·1) in the placebo group, and the difference between groups in predicted FVC change at week 72 was not significant (0·6%, −3·5 to 4·7); however, a consistent pirfenidone effect was apparent until week 48 (p=0·005) and in an analysis of all study timepoints (p=0·007). Patients in the pirfenidone 2403 mg/day group had higher incidences of nausea (125 [36%] of 345 vs 60 [17%] of 347), dyspepsia (66 [19%] vs 26 [7%]), vomiting (47 [14%] vs 15 [4%]), anorexia (37 [11%] vs 13 [4%]), photosensitivity (42 [12%] vs 6 [2%]), rash (111 [32%] vs 40 [12%]), and dizziness (63 [18%] vs 35 [10%]) than did those in the placebo group. Fewer overall deaths (19 [6%] vs 29 [8%]) and fewer deaths related to idiopathic pulmonary fibrosis (12 [3%] vs 25 [7%]) occurred in the pirfenidone 2403 mg/day groups than in the placebo groups. Interpretation The data show pirfenidone has a favourable benefit risk profile and represents an appropriate treatment option for patients with idiopathic pulmonary fibrosis.

Staphylococcus rostri sp. nov., a haemolytic bacterium isolated from the noses of healthy pigs

Twenty coagulase-negative Staphylococcus strains displaying alpha-haemolysis (delta-haemolysin) on sheep-blood agar were isolated from the noses of different pigs in Switzerland. The strains were Gram-stain-positive, non-motile cocci, catalase-positive and coagulase-negative. Sequence analysis of the 16S rRNA gene, sodA, rpoB, dnaJ and hsp60 and phylogenetic characteristics revealed that the strains showed the closest relatedness to Staphylococcus microti CCM 4903(T) and Staphylococcus muscae DSM 7068(T). The strains can be differentiated from S. microti by the absence of mannose fermentation and arginine arylamidase and from S. muscae by the absence of beta-glucuronidase activity and production of alkaline phosphatase. The chosen type strain ARI 262(T) shared 20.1 and 31.9 % DNA relatedness with S. microti DSM 22147(T) and S. muscae CCM 4903(T), respectively, by DNA-DNA hybridization. iso-C(15 : 0), anteiso-C(15 : 0) and iso-C(17 : 0) were the most common fatty acids. Cell-wall structure analysis revealed the peptidoglycan type A3alpha l-Lys-Gly(2)-l-Ser-Gly (type A11.3). The presence of teichoic acid was determined by sequencing the N-acetyl-beta-d-mannosaminyltransferase gene tarA, which is involved in biosynthesis of ribitol teichoic acid. Menaquinone 7 (MK-7) was the predominant respiratory quinone. The G+C content of ARI 262(T) was 38.8 mol%. The isolated strains represent a novel species of the genus Staphylococcus, for which we propose the name Staphylococcus rostri sp. nov. The type strain is ARI 262(T) (=DSM 21968(T) =CCUG 57266(T)) and strain ARI 602 (=DSM 21969 =CCUG 57267) is a reference strain.

Comparative analysis of the value of allogeneic hematopoietic stem-cell transplantation in acute myeloid leukemia with monosomal karyotype versus other cytogenetic risk categories

To determine to what extent allogeneic hematopoietic stem-cell transplantation (alloHSCT) quantitatively reduces relapse in acute myeloid leukemia with monosomal karyotype (MK-AML) compared with alternative postremission therapy and how it compares with other cytogenetic subcategories.

Pleasant Events, Activity Restriction, and Blood Pressure in Dementia Caregivers

Objective: A combination of high engagement in pleasurable activities and low perceived activity restriction is potentially protective for a number of health and quality of life outcomes. This study tests the newly proposed Pleasant Events and Activity Restriction (PEAR) model to explain level of blood pressure (BP) in a sample of elderly dementia caregivers. Methods: This cross-sectional study included 66 caregivers, ≥55 years of age, providing in-home care to a relative with dementia. Planned comparisons were made to assess group differences in BP between caregivers reporting high engagement in pleasant events plus low perceived activity restriction (HPLR; n = 22) to those with low pleasure plus high restriction (LPHR; n = 23) or those with either high pleasure plus high restriction or low pleasure plus low restriction (HPHR/LPLR; n = 21). Results: After adjustments for age, sex, body mass index, use of antihypertensive medication, physical activity, and number of health problems, HPLR participants (86.78 mm|Hg) had significantly lower mean arterial pressure compared with LPHR participants (94.70 mm|Hg) (p = .01, Cohen's d = 0.89) and HPHR/LPLR participants (94.84 mm|Hg) (p = .023, d = 0.91). Similar results were found in post hoc comparisons of both systolic and diastolic BP. Conclusions: This study extends support for the PEAR model to physical health outcomes. Differences in BP between the HPLR group and other groups were of large magnitude and thus clinically meaningful. The findings may inform intervention studies aimed at investigating whether increasing pleasant events and lowering perceived activity restriction may lower BP. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Elaboration et caractérisation de ciments géopolymères à base de scories volcaniques

Two types of volcanic ashes referenced as ZD (volcanic ashes from Djoungo) and ZG (volcanic ashes from Galim) were collected from two Cameroonian localities. They were characterized (chemical and mineralogical compositions, amorphous phase content, particle size distribution and specific surface area) and used as raw materials for the synthesis of geopolymer cements at ambient temperature of laboratory (24 ± 3 °C). The synthesized products were characterized by determining their setting time, linear shrinkage and compressive strength, X-ray Diffraction, Fourier Transform Infrared Spectroscopy and Scanning Electron Microscopy. The mineralogical composition, the amorphous phase content, the particle size distribution, the specific surface area of the volcanic ashes as well as the mass ratio of the alkaline solution (sodium silicate / sodium hydroxide) were the main parameters which influenced the synthesis of geopolymers with interesting characteristics at ambient temperature (24 ± 3 °C). The volcanic ashes (ZD) whose mineralogical composition contained anhydrite, low amorphous phase content and low specific surface area led to long setting times. Moreover, its products swelled and presented cracks due to the formation of ettringite and these resulted in low compressive strengths (7 to 19 MPa). The volcanic ashes (ZG) containing high amounts of amorphous phase and high specific surface area led geopolymers with setting times between 490 and 180 minutes and compressive strength between 7 and 50 MPa at ambient temperature of laboratory. The properties of geopolymers were improved when elaborated with a mixture of volcanic ashes and metakaolin (ZD–MK and ZG–MK). For geopolymers obtained from ZD–MK, the setting time was between 500 and 160 minutes while it was between 220 and 125 minutes for geopolymers obtained from ZG–MK. The compressive strength greatly increased between 23 and 68 MPa and 39 and 64 MPa for geopolymers obtained from ZG –MK and ZD–MK respectively. A comparative study of the properties of mixtures of metakaolin–alumina and volcanic ash–alumina based geopolymers shows that metakaolin is a good source of Al2O3 and SiO2 and which highly reactive with alkaline solution and produces geopolymers with better characteristics compared to volcanic ash based–geopolymer. The properties of volcanic ash–based geopolymer were also improved when amorphous alumina was incorporated into the volcanic ash. This additive is used to compensate the deficiencies in Al2O3 content in the volcanic ash. Compare to when volcanic ash is used alone 20 to 40 % incorporation of this additive corresponded to increases of the compressive strength by 18.1 % for metakaolin-alumina based-geopolymers and by 32.4 % for volcanic ash-based geopolymers.

DEVELOPMENT OF POROUS CONCRETE GEOPOLYMER USING HYDROGEN PEROXIDE AS BLOWING AGENT.

Metakaolin and volcanic ashes respectively called MK and ZG were used as aluminosilicate raw materials for the synthesis of porous geopolymers. The hydrogen peroxide was used as a blowing agent. The geopolymer prepared were characterized by Spectroscopy Fourier Transform Infrared (SFTI), X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and the determination of some physical properties such as bulk density, total porosity, volume shrinkage, compressive strength and thermal conductivity was also carried out. The presence of pores in the geopolymer obtained is function of the percentage of hydrogen peroxide added, causing the concomitantly decrease in compressive strength, apparent density and thermal conductivity. The use of hydrogen peroxide as a blowing agent gave some thermal insulation properties to these geopolymers which could be close to the properties of some commercial insulation materials.

Influence of cristalline structure of two minerals clays of type 1/1 on their pozzolanic power

Two clayey materials, one provided by a patner in mineral sector and the other coming from Balengou (West Region Cameroon) were subject of a comparative study in order to evaluate the influence of their crystalline structure on their pozzolanic property. These two natural materials were preliminary enriched in clay minerals by wet sieving and the fractions obtained are denoted K and H respectively. K and H were calcinated at 700 °C, with a heating rate of 5 °C/min and 10 hours dwell at the peak temperature, the products obtained were named MK and MH. Samples K, H, MK and MH were physicochemically characterized by the chemical (ICP), thermal(TGA/DTA) and mineralogical (DRX and Spectrometry IR) analyses together with the measurement of specific surface (BET), crystallinity and the pouzzolanicity test. The results confirmed K as a kaolinitic and H halloysic clay. The kaolinite and the halloysite respectively presented in these clayey materials exhibited a poor crystallinity, but the degree of disorder is higher in K than in H. These results were largely affected by the significant fraction of gibbsite in kaolinitic clay K. At the crude state, the pozzolanic activity of the material H is weak compared with that of K, but the heat treatment makes largely improve this property for both samples.

Working With Families of Impaired Elderly

In this article, several approaches to working with the complexity of family relationships in later adulthood are described. Basic information on family forms and the pattern of family support for older adults is discussed. In addition, several examples of interventions with family members of older adults are reviewed. The goal of these activities is to increase the range of options available to older adults and their family caregivers.