Characterization and optimization of ArtinM lectin expression in Escherichia coli

Background ArtinM is a D-mannose-specific lectin from Artocarpus integrifolia seeds that induces neutrophil migration and activation, degranulation of mast cells, acceleration of wound healing, induction of interleukin-12 production by macrophages and dendritic cells, and protective T helper 1 immune response against Leishmania major, Leishmania amazonensis and Paracoccidioides brasiliensis infections. Considering the important biological properties of ArtinM and its therapeutic applicability, this study was designed to produce high-level expression of active recombinant ArtinM (rArtinM) in Escherichia coli system. Results The ArtinM coding region was inserted in pET29a(+) vector and expressed in E. coli BL21(DE3)-Codon Plus-RP. The conditions for overexpression of soluble ArtinM were optimized testing different parameters: temperatures (20, 25, 30 or 37°C) and shaking speeds (130, 200 or 220 rpm) during induction, concentrations of the induction agent IPTG (0.01-4 mM) and periods of induction (1-19 h). BL21-CodonPlus(DE3)-RP cells induced under the optimized conditions (incubation at 20°C, at a shaking speed of 130 rpm, induction with 0.4 mM IPTG for 19 h) resulted in the accumulation of large amounts of soluble rArtinM. The culture provided 22.4 mg/L of rArtinM, which activity was determined by its one-step purification through affinity chromatography on immobilized D-mannose and glycoarray analysis. Gel filtration showed that rArtinM is monomeric, contrasting with the tetrameric form of the plant native protein (jArtinM). The analysis of intact rArtinM by mass spectrometry revealed a 16,099.5 Da molecular mass, and the peptide mass fingerprint and esi-cid-ms/ms of amino acid sequences of peptides from a tryptic digest covered 41% of the total ArtinM amino acid sequence. In addition, circular dichroism and fluorescence spectroscopy of rArtinM indicated that its global fold comprises β-sheet structure. Conclusions Overall, the optimized process to express rArtinM in E. coli provided high amounts of soluble, correctly folded and active recombinant protein, compatible with large scale production of the lectin.

Influence of obesity and cardiometabolic makers on lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in adolescents: the healthy young cross-sectional study

Abstract Background Lipoprotein-associated phospholipase A2 activity (Lp-PLA2) is a good marker of cardiovascular risk in adults. It is strongly associated with stroke and many others cardiovascular events. Despite this, the impact of obesity on this enzyme activity and its relation to biomarkers of cardiovascular disease in adolescents is not very well investigated. The purpose of this article is to evaluate the influence of obesity and cardiometabolic markers on Lp-PLA2 activity in adolescents. Results This cross-sectional study included 242 adolescents (10–19 years) of both gender. These subjects were classified in Healthy Weight (n = 77), Overweight (n = 82) and Obese (n = 83) groups. Lipid profile, glucose, insulin, HDL size, LDL(−) and anti-LDL(−) antibodies were analyzed. The Lp-PLA2 activity was determined by a colorimetric commercial kit. Body mass index (BMI), waist circumference and body composition were monitored. Food intake was evaluated using three 24-hour diet recalls. The Lp-PLA2 activity changed in function to high BMI, waist circumference and fat mass percentage. It was also positively associated with HOMA-IR, glucose, insulin and almost all variables of lipid profile. Furthermore, it was negatively related to Apo AI (β = −0.137; P = 0.038) and strongly positively associated with Apo B (β = 0.293; P < 0.001) and with Apo B/Apo AI ratio (β = 0.343; P < 0.001). The better predictor model for enzyme activity, on multivariate analysis, included Apo B/Apo AI (β = 0.327; P < 0.001), HDL size (β = −0.326; P < 0.001), WC (β = 0.171; P = 0.006) and glucose (β = 0.119; P = 0.038). Logistic regression analysis demonstrated that changes in Apo B/Apo AI ratio were associated with a 73.5 times higher risk to elevated Lp-PLA2 activity. Conclusions Lp-PLA2 changes in function of obesity, and that it shows important associations with markers of cardiovascular risk, in particular with waist circumference, glucose, HDL size and Apo B/Apo AI ratio. These results suggest that Lp-PLA2 activity can be a cardiovascular biomarker in adolescence.

Phenolic compounds from Rosemary (Rosmarinus officinalis L.) attenuate oxidative stress and reduce blood cholesterol concentrations in diet-induced hypercholesterolemic rats

Abstract Background Phenolic compounds combine antioxidant and hypocholesterolemic activities and, consequently, are expected to prevent or minimize cardiometabolic risk. Methods To evaluate the effect of an aqueous extract (AQ) and non-esterified phenolic fraction (NEPF) from rosemary on oxidative stress in diet-induced hypercholesterolemia, 48 male 4-week old Wistar rats were divided into 6 groups: 1 chow diet group (C) and 5 hypercholesterolemic diet groups, with 1 receiving water (HC), 2 receiving AQ at concentrations of 7 and 140 mg/kg body weight (AQ70 and AQ140, respectively), and 2 receiving NEPF at concentrations of 7 and 14 mg/kg body weight (NEPF7 and NEPF14, respectively) by gavage for 4 weeks. Results In vitro, both AQ and NEPF had remarkable antioxidant activity in the 2,2-diphenyl-1-picrylhydrazyl (DPPH●) assay, which was similar to BHT. In vivo, the group that received AQ at 70 mg/kg body weight had lower serum total cholesterol (−39.8%), non-HDL-c (−44.4%) and thiobarbituric acid reactive substance (TBARS) levels (−37.7%) compared with the HC group. NEPF (7 and 14 mg/kg) reduced the tissue TBARS levels and increased the activity of tissular antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase). Neither AQ nor NEPF was able to ameliorate the alterations in the hypercholesterolemic diet-induced fatty acid composition in the liver. Conclusions These data suggest that phenolic compounds from rosemary ameliorate the antioxidant defense in different tissues and attenuate oxidative stress in diet-induced hypercholesterolemic rats, whereas the serum lipid profile was improved only in rats that received the aqueous extract.

Competência informacional e midiática no ensino superior: Desafios e propostas para o Brasil

A presença das tecnologias e das mídias é hoje tão importante, que é impossível ignorá-la. Os calouros e estudantes universitários de hoje têm telefones celulares com fotos digitais e ídeos. Eles usam blogs, twitter e sites de redes sociais. Ao mesmo tempo, leem livros e artigos, e fazem seus projetos e a lição de casa. Continuamente, diferentes tecnologias e novas informações estão impactando o ensino superior. Isto exige uma rápida atualização da competência informacional e midiática pelos alunos. Apesar do impacto progressivo da tecnologia digital na cultura acadêmica contemporânea, é imperativo resgatar e consolidar um compromisso mais crítico com a informação, mídia e tecnologia. Nós defendemos a convergência da literacia da informação e da literacia dos media no ensino superior. O Projeto CIMES (Competência em Informação e Mídia no Ensino Superior) está em estágio inicial. O presente artigo tem como objetivo revisar as questões teóricas, políticas e práticas sobre a educação para a competência em informação e mídia no ensino superior, especialmente no Brasil. O objetivo final do Projeto CIMES é fornecer uma estrutura para desenvolver programas educacionais no Brasil que tenham a competência em informação e a competência midiática como uma aplicação transversal no ensino superior. O atual estágio do projeto permite apenas traçar um quadro geral analítico

Natural antibody response to Plasmodium falciparum merozoite antigens MSP5, MSP9 and EBA175 is associated to clinical protection in the Brazilian Amazon

BACKGROUND: Antibodies have an essential role in the acquired immune response against blood stage P. falciparum infection. Although several antigens have been identified as important antibody targets, it is still elusive which antigens have to be recognized for clinical protection. Herein, we analyzed antibodies from plasmas from symptomatic or asymptomatic individuals living in the same geographic area in the Western Amazon, measuring their recognition of multiple merozoite antigens. METHODS: Specific fragments of genes encoding merozoite proteins AMA1 and members of MSP and EBL families from circulating P. falciparum field isolates present in asymptomatic and symptomatic patients were amplified by PCR. After cloning and expression of different versions of the antigens as recombinant GST-fusion peptides, we tested the reactivity of patients' plasmas by ELISA and the presence of IgG subclasses in the most reactive plasmas. RESULTS: 11 out of 24 recombinant antigens were recognized by plasmas from either symptomatic or asymptomatic infections. Antibodies to MSP9 (X2(DF=1) = 9.26/p = 0.0047) and MSP5 (X2(DF=1) = 8.29/p = 0.0069) were more prevalent in asymptomatic individuals whereas the opposite was observed for MSP1 block 2-MAD20 (X2(DF=1) = 6.41/p = 0.0206, Fisher's exact test). Plasmas from asymptomatic individuals reacted more intensely against MSP4 (U = 210.5, p < 0.03), MSP5 (U = 212, p < 0.004), MSP9 (U = 189.5, p < 0.002) and EBA175 (U = 197, p < 0.014, Mann-Whitney's U test). IgG1 and IgG3 were predominant for all antigens, but some patients also presented with IgG2 and IgG4. The recognition of MSP5 (OR = 0.112, IC95% = 0.021-0.585) and MSP9 (OR = 0.125, IC95% = 0.030-0.529, cross tab analysis) predicted 8.9 and 8 times less chances, respectively, to present symptoms. Higher antibody levels against MSP5 and EBA175 were associated by odds ratios of 9.4 (IC95% = 1.29-69.25) and 5.7 (IC95% = 1.12-29.62, logistic regression), respectively, with an asymptomatic status. CONCLUSIONS: Merozoite antigens were targets of cytophilic antibodies and antibodies against MSP5, MSP9 and EBA175 were independently associated with decreased symptoms.

Studi ed approfondimenti sulla composizione in acidi grassi del latte bovino di razza Reggiana con diverso fenotipo per k-caseina e Beta-lactoglobulina

The aim of the present study was to examine the association between milk protein polymorphism and fatty acids profiles of bovine milk. Milk samples were collected from each of 55 Reggiana cows during early, mid and late lactation, respectively, in two farms within the production area of Parmigiano Reggiano cheese. Identification and quantification of fatty acids were performed by gas chromatography. Milk fatty acid composition using cows of differing κ-casein (κ-Cn) and β-lactoglobulin (β-Lg) phenotypes was investigated. Statistically significant results regarding the associations between milk fatty acid composition and κ-Cn phenotype were found, in particular, κ-Cn BB seems to influence de novo fatty acid synthesis in the mammary gland. Also κ-Cn AB seems to have the same effect. Proportions of C10:0 (2,29a AA; 2,53b AB; 2,59b BB), C12:0 (2,77a AA; 3,17b AB; 3,20b BB) and C14:0 (9,22a AA; 10,25b AB; 10,27b BB) were higher in the milk from cows with κ-Cn phenotype AB and BB vs κ-Cn phenotype AA (p<0,05). Conversely C18:0 (7,84b AA; 7,20a,b AB; 6,94a BB) and C18:1 (19,19b AA; 16,81a AB; 16,79a BB) were lower in the milk from cows with κ-Cn phenotype AB and BB vs κ-Cn phenotype AA. The association between milk fatty acid composition and β-Lg phenotype was not statistically significant, except for some fatty acids. In particular, C12:0 (3,05a AA; 3,04a AB; 3,33b BB) was higher in the milk from cows with β-Lg phenotype BB vs β-Lg phenotype AA and AB (p<0,05). Concentrations of C18:0 (6,93a AA; 7,86b AB; 6,59a BB) and C18:1 (16,74a,b AA; 18,24b AB; 16,07a BB) were lower in the milk from cows with β-Lg phenotype AA and BB vs β-Lg phenotype AB (p<0,05). Moreover this research, carried out in farms within the Parmigiano Reggiano cheese district, analysed also the size distribution of fat globules in bulk milk of Reggiana and Frisona breed cows. In particular, the size distribution of individual milk fat globules of Reggiana cows with differing κ-Cn phenotypes was considered. From first observations, no statistically significant differences were observed.

Untersuchungen am Drei-Eichbosonen-Vertex der elektroschwachen Wechselwirkung mit dem ALEPH-Detektor

In der vorliegenden Arbeit werden vom ALEPH-Detektor am Speicherring LEP des CERN in Genf genommene Datenmengen aus den Jahren 1997 bis 1999 analysiert und sowohl Kopplungsparameter am Drei-Eichbosonen-Vertex derW-Boson-Paarproduktion, als auch die Anteile longitudinal beziehungsweise transversal polarisierter W-Bosonen, bei Schwerpunktsenergien von 183 GeV bis 202 GeV bestimmt. Betrachtet wird der rein leptonische Zerfallskanal, in dembeide W-Bosonen in ein Elektron-Neutrino- oder ein Myon-Neutrino-Paar zerfallen, der einen geringen Wirkungsquerschnitt aufweist, aber eine klareDetektorsignatur. Die aufgezeichneten Ereignisse werden selektiert und dabei eine Reinheit von durchschnittlich 72% erreicht. Der Hauptuntergrund besteht aus W-Boson-Paaren, bei denen zumindest ein W-Boson in ein Tauon-Neutrino-Paarzerfällt. Dieser Kanal zeigt ein sehr signalähnliches Verhalten. Die selektierten Ereignisse werden kinematisch rekonstruiert, um die Winkelverteilungen der Zerfallsprodukte der W-Bosonen zu extrahieren. Aus den Polarwinkelverteilungen der geladenen Zerfallsprodukte der W-Bosonen werden die Anteile longitudinal beziehungsweise transversal polarisierterW-Bosonen durch Anpassung der theoretischen Vorhersage an die selektierten Daten bestimmt. Dabei wird gefunden, daß f? = (71,6 ? 6,4_{stat.} ? 3,7_{syst.}) % der produzierten W-Bosonen transversal polarisiert sind, in Übereinstimmung mit der Vorhersage des Standardmodells (75,1%). Dieser Wert ist ein erster Hinweis auf die Kopplungsparameter am Drei-Eichbosonen-Vertex. Die CP-erhaltenden allgemeinen Kopplungsparameter $g_{rm Z}^1$, $kappa_gamma$ und $lambda_gamma$ werden bestimmt zu: $g_{rm Z}^1 = {{1,19^{+0,13}_{-0,16}}_{stat.}} {^{+0,09}_{-0,09}}_{syst.}$,$kappa_gamma = {{1,06^{+0,27}_{-0,09}}_{stat.}} {^{+0,08}_{-0,08}}_{syst.}$,$lambda_gamma = {{0,16^{+0,11}_{-0,13}}_{stat.}} {^{+0,08}_{-0,08}}_{syst.}$. Das Standardmodell sagt $g_{rm Z}^1 = 1$, $kappa_gamma = 1$ und $lambda_gamma = 0$ voraus. Mit diesen Kopplungsparametern lassen sich das magnetischeDipolmoment und das elektrische Quadrupolmoment der W-Bosonen bestimmen zu: $mu_{rm W} = frac{e}{2m_{rm W}} cdot (2,22^{+0,31}_{-0,19})$,$q_{rm W} = - frac{e}{m_{rm W}^2} cdot (0,90^{+0,32}_{-0,18})$. Die Messung der Kopplungsparameter stellt einen wichtigen Test des minimalen Standardmodells dar. In einem Jahr wird es möglich sein, diesen Test mit allen Daten aus der Phase II des Betriebs von LEP durchzuführen und die Genauigkeit durch Kombination mit anderen LEP-Experimenten zu erhöhen.

Bestimmung der Analysierstärke des A4-Compton-Rückstreupolarimeters zur Messung der longitudinalen Spinpolarisation des MAMI-Elektronenstrahls

Das A4-Experiment bestimmt den Beitrag der Strangequarks zu den elektromagnetischen Formfaktoren des Nukleons durch Messung der Paritätsverletzung in der elastischen Elektron-Nukleon-Streuung. Diese Messungen werden mit dem spinpolarisierten Elektronenstrahl des Mainzer Mikrotrons (MAMI) bei Strahlenergien zwischen 315 und 1508 MeV ndurchgeführt. Die Bestimmung des Strahlpolarisationsgrades ist für die Analyse der Daten unerläßlich, um die physikalische Asymmetrie aus der gemessenen paritätsverletzenden Asymmetrie extrahieren zu können. Aus diesem Grund wird von der A4-Kollaboration ein neuartiges Compton-Laserrückstreupolarimeter entwickelt, das eine zerstörungsfreie Messung der Strahlpolarisation, parallel zum laufenden Paritätsexperiment erlaubt. Um den zuverlässigen Dauerbetrieb des Polarimeters zu ermöglichen, wurde das Polarimeter im Rahmen dieser Arbeit weiterentwickelt. Das Datenerfassungssystem für Photonen- und Elektronendetektor wurde neu aufgebaut und im Hinblick auf die Verarbeitung hoher Raten optimiert. Zum Nachweis der rückgestreuten Photonen wurde ein neuartiger Detektor (LYSO) in Betrieb genommen. Darüber hinaus wurden GEANT4-Simulationen der Detektoren durchgeführt und eine Analyseumgebung für die Extraktion von Comptonasymmetrien aus den Rückstreudaten entwickelt. Das Analyseverfahren nutzt die Möglichkeit, die rückgestreuten Photonen durch koinzidente Detektion der gestreuten Elektronen energiemarkiert nachzuweisen (Tagging). Durch die von der Energiemarkierung eingeführte differentielle Energieskala wird somit eine präzise Bestimmung der Analysierstärke möglich. In der vorliegenden Arbeit wurde die Analysierstärke des Polarimeters bestimmt, so daß nun das Produkt von Elektronen- und Laserstrahlpolarisation bei einem Strahlstrom von 20 muA, parallel zum laufenden Paritätsexperiment, mit einer statistischen Genauigkeit von 1% in 24 Stunden bei 855 MeV bzw. <1% in 12 Stunden bei 1508 MeV gemessen werden kann. In Kombination mit der Bestimmung der Laserpolarisation in einer parallelen Arbeit (Y. Imai) auf 1% kann die statistische Unsicherheit der Strahlpolarisation im A4-Experiment von zuvor 5% auf nun 1,5% bei 1508MeV verringert werden. Für die Daten zur Messung der paritätsverletzenden Elektronenstreuung bei einem Viererimpulsübertrag von $Q^2=0,6 (GeV/c)^2$ beträgt die Rohasymmetrie beim derzeitigen Stand der Analyse $A_{PV}^{Roh} = ( -20,0 pm 0,9_{stat} ) cdot 10^{-6}$. Für eine Strahlpolarisation von 80% erhält man einen Gesamtfehler von $1,68 cdot 10^{-6}$ für $Delta P_e/P_e = 5 %$. Als Ergebnis dieser Arbeit wird sich dieser Fehler durch Analyse der Daten des Compton-Laserrückstreupolarimeters um 29% auf $1,19 cdot 10^{-6}$ ($Delta P_e/P_e = 1,5 %$) verringern lassen.

Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis

We report on a 74-year-old male patient who presented with progressive neuroophthalmologic symptoms soon after the administration of a long-acting gonadotropin-releasing hormone agonist for treatment of a prostate cancer. Imaging revealed a destructively growing and extensively calcified sellar mass inconsistent with a pituitary adenoma. A transseptal transsphenoidal tumor mass reduction yielded a histological diagnosis of a collision tumor comprised of a gonadotroph adenoma intermingled with osteochondroma. We discuss a potential causal relationship between the administration of the long-acting gonadotropin-releasing hormone agonist and the sudden appearance of the previously unsuspected sellar lesion. Although the association of these two tumors is very likely coincidental, the possibility of causal relationship is addressed.

Predictors of early mortality after acute ischaemic stroke.

BACKGROUND The study set out to identify clinical, laboratory and radiological predictors of early mortality after an acute ischaemic stroke (AIS) and to analyse medical and neurological complications that caused death. METHODS A total of 479 consecutive patients (mean age 63+/-14 years) with AIS underwent stroke examination and treatment. Examination included clinical evaluation, laboratory tests, and brain CT and/or MRI. Follow-up data at 30 days were available for 467 patients (93%) who were included in the present analysis. RESULTS The median National Institute of Health Stroke Study (NIHSS) score on admission was 6. A total of 62 patients (13%) died within 30 days. The cause of death was the initial event in 43 (69%), pneumonia in 12 (19%), intracerebral haemorrhage in 9 (15%), recurrent stroke in 6 (10%), myocardial infarction in 2 (3%), and cancer in 1 (2%) of the patients. In univariate comparisons, advanced age (p<0.001), hypertension (p=0.013), coronary disease (p=0.001), NIHSS score (p<0.001), undetermined stroke etiology (p=0.031), relevant co-morbidities (p=0.008), hyperglycemia (p<0.001), atrial fibrillation (p<0.001), early CT signs of ischemia (p<0.001), dense artery sign (p<0.001), proximal vessel occlusion (p<0.001), and thrombolysis (p=0.008) were associated with early mortality. In multivariate analysis, advanced age (HR=1.12; 95% CI 1.05-1.19; p<0.001) and high NIHSS score on admission (HR=1.15, 95% CI 1.05-1.25; p=0.002) were independent predictors of early mortality. CONCLUSIONS We report 13% mortality at 30 days after AIS. More than two thirds of the deaths are related to the initial stroke. Advanced age and high NIHSS score are the only independent predictors of early mortality in this series.

Treatment failure and mortality factors in patients receiving second-line HIV therapy in resource-limited countries

Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. Objectives To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. Design, Setting, and Participants Multicohort study of 632 patients >14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. Main Outcome Measures Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. Results The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for <80% vs ≥95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/μL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/μL vs 200/μL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results. Conclusions Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.

Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial

OBJECTIVES: We aimed to assess the predictive value of the SYNTAX score (SXscore) for major adverse cardiac events in the all-comers population of the LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial. BACKGROUND: The SXscore has been shown to be an effective predictor of clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention. METHODS: The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the LEADERS trial (patients after surgical revascularization were excluded). Post hoc analysis was performed by stratifying clinical outcomes at 1-year follow-up, according to 1 of 3 SXscore tertiles. RESULTS: The 1,397 patients were divided into tertiles based on the SXscore in the following fashion: SXscore8 and 16 (SXhigh) (n=461). At 1-year follow-up, there was a significantly lower number of patients with major cardiac event-free survival in the highest tertile of SXscore (SXlow=92.2%, SXmid=91.1%, and SXhigh=84.6%; p<0.001). Death occurred in 1.5% of SXlow patients, 2.1% of SXmid patients, and 5.6% of SXhigh patients (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 1.29 to 3.01; p=0.002). The myocardial infarction rate tended to be higher in the SXhigh group. Target vessel revascularization was 11.3% in the SXhigh group compared with 6.3% and 7.8% in the SXlow and SXmid groups, respectively (HR: 1.38, 95% CI: 1.1 to 1.75; p=0.006). Composite of cardiac death, myocardial infarction, and clinically indicated target vessel revascularization was 7.8%, 8.9%, and 15.4% in the SXlow, SXmid, and SXhigh groups, respectively (HR: 1.47, 95% CI: 1.19 to 1.81; p<0.001). CONCLUSIONS: The SXscore, when applied to an all-comers patient population treated with drug-eluting stents, may allow prospective risk stratification of patients undergoing percutaneous coronary intervention. (LEADERS Trial Limus Eluted From A Durable Versus ERodable Stent Coating; NCT00389220).

Influence of loupes and age on the near visual acuity of practicing dentists

We evaluated the near visual acuity of 40 dentists and its improvement by using different magnification devices. The acuity was tested with miniaturized E-optotype tests on a negatoscope under the following conditions: 1. natural visual acuity, 300 mm; 2. single lens loupe, 2×, 250 mm; 3. Galilean loupe, 2.5×, 380 mm; and 4. Keplerian loupe, 4.3×, 400 mm. In part 1, the influence of the magnification devices was investigated for all dentists. The Keplerian loupe obtained the highest visual acuity (4.64), followed by the Galilean loupe (2.43), the single lens loupe (1.42), and natural visual acuity (1.19). For part 2, the dentists were classified according to their age (

Comparison of titanium-nitride-oxide-coated stents with zotarolimus-eluting stents for coronary revascularization a randomized controlled trial

Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitride-oxide (TiNO) with drug-eluting stents releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota). Background Stent coating with TiNO has been shown to reduce restenosis compared with bare-metal stents in experimental and clinical studies. Methods In an assessor-blind noninferiority study, 302 patients undergoing percutaneous coronary intervention were randomized to treatment with TiNO or ZES. The primary endpoint was in-stent late loss at 6 to 8 months, and analysis was by intention to treat. Results Both groups were well balanced with respect to baseline clinical and angiographic characteristics. The TiNO group failed to reach the pre-specified noninferiority margin for the primary endpoint (in-stent late loss: 0.64 ± 0.61 mm vs. 0.47 ± 0.48 mm, difference: 0.16, upper 1-sided 95% confidence interval [CI]: 0.26; pnoninferiority = 0.54), and subsequent superiority testing was in favor of ZES (psuperiority = 0.02). In-segment binary restenosis was lower with ZES (11.1%) than with TiNO (20.5%; psuperiority = 0.04). A stratified analysis of the primary endpoint found particularly pronounced differences between stents among diabetic versus nondiabetic patients (0.90 ± 0.69 mm vs. 0.39 ± 0.38 mm; pinteraction = 0.04). Clinical outcomes showed a similar rate of death (0.7% vs. 0.7%; p = 1.00), myocardial infarction (5.3% vs. 6.7%; p = 0.60), and major adverse cardiac events (21.1% vs. 18.0%, hazard ratio: 1.19, 95% CI: 0.71 to 2.00; p = 0.50) at 1 year. There were no differences in rates of definite or probable stent thrombosis (0.7% vs. 0%; p = 0.51) at 1 year. Conclusions Compared with TiNO, ZES was superior with regard to late loss and binary restenosis. The concept of passive stent coating with TiNO remains inferior to drug-eluting stent technology in reducing restenosis. ([TIDE] Randomized Trial Comparing Titan Stent With Zotarolimus-Eluting Stent: NCT00492908)