Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis.

BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stents is the standard of care for treatment of native coronary artery stenoses, but optimum treatment strategies for bare metal stent and drug-eluting stent in-stent restenosis (ISR) have not been established. We aimed to compare and rank percutaneous treatment strategies for ISR. METHODS We did a network meta-analysis to synthesise both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, and Embase for randomised controlled trials published up to Oct 31, 2014, of different PCI strategies for treatment of any type of coronary ISR. The primary outcome was percent diameter stenosis at angiographic follow-up. This study is registered with PROSPERO, number CRD42014014191. FINDINGS We deemed 27 trials eligible, including 5923 patients, with follow-up ranging from 6 months to 60 months after the index intervention. Angiographic follow-up was available for 4975 (84%) of 5923 patients 6-12 months after the intervention. PCI with everolimus-eluting stents was the most effective treatment for percent diameter stenosis, with a difference of -9·0% (95% CI -15·8 to -2·2) versus drug-coated balloons (DCB), -9·4% (-17·4 to -1·4) versus sirolimus-eluting stents, -10·2% (-18·4 to -2·0) versus paclitaxel-eluting stents, -19·2% (-28·2 to -10·4) versus vascular brachytherapy, -23·4% (-36·2 to -10·8) versus bare metal stents, -24·2% (-32·2 to -16·4) versus balloon angioplasty, and -31·8% (-44·8 to -18·6) versus rotablation. DCB were ranked as the second most effective treatment, but without significant differences from sirolimus-eluting (-0·2% [95% CI -6·2 to 5·6]) or paclitaxel-eluting (-1·2% [-6·4 to 4·2]) stents. INTERPRETATION These findings suggest that two strategies should be considered for treatment of any type of coronary ISR: PCI with everolimus-eluting stents because of the best angiographic and clinical outcomes, and DCB because of its ability to provide favourable results without adding a new stent layer. FUNDING None.

Impact of Diabetic Status on Outcomes After Revascularization With Drug-Eluting Stents in Relation to Coronary Artery Disease Complexity: Patient-Level Pooled Analysis of 6081 Patients.

BACKGROUND Diabetes mellitus and angiographic coronary artery disease complexity are intertwined and unfavorably affect prognosis after percutaneous coronary interventions, but their relative impact on long-term outcomes after percutaneous coronary intervention with drug-eluting stents remains controversial. This study determined drug-eluting stents outcomes in relation to diabetic status and coronary artery disease complexity as assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score. METHODS AND RESULTS In a patient-level pooled analysis from 4 all-comers trials, 6081 patients were stratified according to diabetic status and according to the median SYNTAX score ≤11 or >11. The primary end point was major adverse cardiac events, a composite of cardiac death, myocardial infarction, and clinically indicated target lesion revascularization within 2 years. Diabetes mellitus was present in 1310 patients (22%), and new-generation drug-eluting stents were used in 4554 patients (75%). Major adverse cardiac events occurred in 173 diabetics (14.5%) and 436 nondiabetic patients (9.9%; P<0.001). In adjusted Cox regression analyses, SYNTAX score and diabetes mellitus were both associated with the primary end point (P<0.001 and P=0.028, respectively; P for interaction, 0.07). In multivariable analyses, diabetic versus nondiabetic patients had higher risks of major adverse cardiac events (hazard ratio, 1.25; 95% confidence interval, 1.03-1.53; P=0.026) and target lesion revascularization (hazard ratio, 1.54; 95% confidence interval, 1.18-2.01; P=0.002) but similar risks of cardiac death (hazard ratio, 1.41; 95% confidence interval, 0.96-2.07; P=0.08) and myocardial infarction (hazard ratio, 0.89; 95% confidence interval, 0.64-1.22; P=0.45), without significant interaction with SYNTAX score ≤11 or >11 for any of the end points. CONCLUSIONS In this population treated with predominantly new-generation drug-eluting stents, diabetic patients were at increased risk for repeat target-lesion revascularization consistently across the spectrum of disease complexity. The SYNTAX score was an independent predictor of 2-year outcomes but did not modify the respective effect of diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00297661, NCT00389220, NCT00617084, and NCT01443104.

Fair Housing Enforcement and Changes in Discrimination between 1989 and 2000: An Exploratory Study

Using paired testing data from the 1989 and 2000 Housing Discrimination Studies (HDS) and data on fair housing enforcement activities during the 1990s in the corresponding metro areas, we investigate whether 1989-2000 changes in the metropolitan incidence of racial/ethnic discrimination correlate with fair housing enforcement activity during the 1990s. We found that higher amounts of state and local enforcement activity supported by HUD through its FHIP and FHAP programs (especially the amount of dollars awarded by the courts) were consistently associated with greater declines in discrimination against black apartment-seekers and home-seekers. The evidence does not support similar conclusions for housing market discrimination against Hispanics where the level of enforcement is much lower.

Discrimination in Metropolitan Housing Markets: National Results from Phase 1 of the Housing Discrimination Study (HDS)

The Housing Discrimination Study 2000 (HDS 2000) is the third nationwide effort sponsored by HUD to measure the amount of discrimination faced by minority home seekers. This report provides national estimates of discrimination faced by African Americans and Hispanics in 2000 as they searched for housing in the sales and rental markets. It also provides an accurate measure of how housing discrimination has changed since 1989. The report shows large decreases between 1989 and 2000 in the level of discrimination experienced by Hispanics and African Americans seeking to a buy a home. There are, however, worrisome upward trends of discrimination in the areas of geographic steering in home sales for African Americans and the amount of help agents provide to Hispanics with obtaining financing. There has also been a modest decrease in discrimination toward African Americans seeking to rent a unit. This downward trend, however, has not been seen for Hispanic renters. Hispanic renters now are more likely to experience discrimination in their housing search than do African American renters.

Na 1 Nachlass Max Horkheimer, 34 - Korrespondenzen u.a. mit Ludwig Marcuse und Henryk Grossmann (p. I 17, 255-472)

1 Brief von Eleanor Wilson MacAdoo an Max Horkheimer, 04.09.1942; 1 Brief von Walter J. Mahoney an Max Horkheimer, 27.03.1941; 6 Briefe zwischen Josef Maier und Max Horkheimer, 1935, 1936; 8 Briefe und 2 Beilagen zwischen Kurt Mandelbaum und Max Horkheimer, 1935, 1936; 1 Brief von Ernest Fred Manfred an Max Horkheimer, 10.07.1948; 1 Brief von Gertrud Marcuse an Max Horkheimer, 31.03.1937; 52 Brief und Beilage zwischen Sascha Marcuse, Ludwig Marcuse und Max Horkheimer, 1936-1943; 1 Brief von Juliette Favez an Sascha und Ludwig Marcuse, 09.09.1937; 2 Briefe von Max Horkheimer an Hendrik W. van Loon, 1940, 1941; 1 Brief von Bruno Frank an John Simon Guggenheim Memorial Foundation New York, 03.12.1940; 3 Briefe zwischen Paul Klapper und Max Horkheimer, 30.08.1939, 1939; 1 Brief von Max Horkheimer an Collector of Customs New York, 04.04.1939; 3 Briefe zwischen Paul Marcuse und Max Horkheimer, 06.06.1939, 1939; 1 brief von Friedrich Pollock an Leon C. Marshall, 05.05.1941; 1 Brief von Max Horkheimer an Marsten, 17.04.1939; 6 Briefe und 1 Beilage zwsichen A. Mansloff und Max Horkheimer, 1941; 1 Brief von Henrik Grossmann an Paul Mettick, 30.10.1935; 11 Briefe zwischen Paul Mattick und Max Horkheimer sowie Briefwechsel mit der John Simon Guggenheim Memorial Foundation, New York, 1935-1937; 4 Briefe zwischen der John Simon Guggenheim Memorial Foundation, New York und Max Horkheimer, 1937, 1938; 1 Brief von Henryk Grossmann an Paul Mattick, 30.10.1935; 2 Briefe zwischen Henryk Grossmann und Max Horkheimer, 15.10.1935, 02.02.1937; 1 Brief von Edith Mautner an Max Horkheimer, 15.06.1944; 2 Briefe zwischen Carl Mayer und Max Horkheimer, 23.10.1940, 22.11.1940; 5 Briefe zwischen Gustav Mayer und Max Horkheimer, 1940 sowie 1 Brief von Ulrich Mayer an Gumperz, 07.06.1940;

Organic-walled dinoflagellate cysts analysis and statistical analysis of 116 surface sediment samples from the eastern Indian Ocean

Assemblages of organic-walled dinoflagellate cysts (dinocysts) from 116 marine surface samples have been analysed to assess the relationship between the spatial distribution of dinocysts and modern local environmental conditions [e.g. sea surface temperature (SST), sea surface salinity (SSS), productivity] in the eastern Indian Ocean. Results from the percentage analysis and statistical methods such as multivariate ordination analysis and end-member modelling, indicate the existence of three distinct environmental and oceanographic regions in the study area. Region 1 is located in western and eastern Indonesia and controlled by high SSTs and a low nutrient content of the surface waters. The Indonesian Throughflow (ITF) region (Region 2) is dominated by heterotrophic dinocyst species reflecting the region's high productivity. Region 3 is encompassing the area offshore north-west and west Australia which is characterised by the water masses of the Leeuwin Current, a saline and nutrient depleted southward current featuring energetic eddies.

Hydrate abundances at the high-flux Batumi seep area in the southeastern Black Sea

Submarine gas hydrates are a major global reservoir of the potent greenhouse gas methane. Since current assessments of worldwide hydrate-bound carbon vary by one order of magnitude, new technical efforts are required for improved and accurate hydrate quantifications. Here we present hydrate abundances determined for surface sediments at the high-flux Batumi seep area in the southeastern Black Sea at 840 m water depth using state-of-the art autoclave technology. Pressure sediment cores of up to 2.65 m in length were recovered with an autoclave piston corer backed by conventional gravity cores. Quantitative core degassing yielded volumetric gas/bulk sediment ratios of up to 20.3 proving hydrate presence. The cores represented late glacial to Holocene hemipelagic sediments with the shallowest hydrates found at 90 cmbsf. Calculated methane concentrations in the different cores surpassed methane equilibrium concentrations in the two lowermost lithological Black Sea units sampled. The results indicated hydrate fractions of 5.2% of pore volume in the sapropelic Unit 2 and mean values of 21% pore volume in the lacustrine Unit 3. We calculate that the studied area of ~ 0.5 km**2 currently contains about 11.3 kt of methane bound in shallow hydrates. Episodic detachment and rafting of such hydrates is suggested by a rugged seafloor topography along with variable thicknesses in lithologies. We propose that sealing by hydrate precipitation in coarse-grained deposits and gas accumulation beneath induces detachment of hydrate/sediment chunks. Floating hydrates will rapidly transport methane into shallower waters and potentially to the sea-atmosphere boundary. In contrast, persistent in situ dissociation of shallow hydrates appears unlikely in the near future as deep water warming by about 1.6 °C and/or decrease in hydrostatic pressure corresponding to a sea level drop of about 130 m would be required. Because hydrate detachment should be primarily controlled by internal factors in this area and in similar hydrated settings, it serves as source of methane in shallow waters and the atmosphere which is mainly decoupled from external forcing.

In-situ sediment temperature and pore water chloride concentration at pockmarks of the Nigerian continental margin

A joint research expedition between the French IFREMER and the German MARUM was conducted in 2011 using the R/V 'Pourquoi pas?' to study gas hydrate distributions in a pockmark field (1141-1199 m below sea surface) at the continental margin of Nigeria. The seafloor drill rig MeBo of MARUM was used to recover sediments as deep as 56.74 m below seafloor. The presence of gas hydrates in specific core sections was deduced from temperature anomalies recorded during continuous records of infrared thermal scanning and anomalies in pore water chloride concentrations. In situ sediment temperature measurements showed elevated geothermal gradients of up to 258 °C/km in the center of the so-called pockmark A which is up to 4.6 times higher than that in the background sediment (72 °C/km). The gas hydrate distribution and thermal regime in the pockmark are largely controlled by the intensity, periodicity and direction of fluid flow. The joint interaction between fluid flow, gas hydrate formation and dissolution, and the thermal regime governs pockmark formation and evolution on the Nigerian continental margin.

XRD mineralogy of sediments from the Greenland east coast

Quantitative X-Ray Diffraction (qXRD) analysis of the <2 mm sediment fraction from surface (sea floor) samples, and marine sediment cores that span the last 10-12 cal ka BP, are used to describe spatial and temporal variations in non-clay mineral compositions for an area between Kangerlussuaq Trough and Scoresby Sund (?67°-70°N), East Greenland. Bedrock consists primarily of an early Tertiary alkaline complex with high weight% of pyroxene and plagioclase. Farther inland and to the north, the bedrock is dominantly felsic with a high fraction of quartz and potassium feldspars. Principal Component (PC) analysis of the non-clay sediment compositions indicates the importance of quartz and pyroxene as compositional end members, with an abrupt shift from quartz and k-feldspar dominated sediments north of Scoresby Sund to sediments rich in pyroxene and plagioclase feldspars offshore from the early Tertiary basaltic outcrop. Coarse (<2 mm or <1 mm) ice-rafted sediments are largely absent from the trough sediments between ?8 and 5 cal ka BP, but then increase in the last 4 cal ka BP. Compositional unmixing of the sediments in Grivel Basin and Kangerlussuaq Trough indicate the dominance of local over long distance sediment sources, with pulses of sediment from tidewater glaciers in Kangerlussuaq and Nansen fjords reaching the inner shelf during the Neoglaciation. The change in IRD is more dramatic in the sediment grain-size proxies than in the quartz wt%. Forty to seventy percent of the variance in the quartz records from either side of Denmark Strait is explained by low frequency trends, but the data from the Grivel Basin, East Greenland, are distinctly different, with an approximate 2500 yr periodicity.