Incidence of stent thrombosis and adverse cardiac events 5 years after sirolimus stent implantation in clinical practice.

BACKGROUND: The long-term incidence of stent thrombosis (ST) and complications after sirolimus-eluting stents (SES) implantation is still a matter of debate. METHOD: We conducted a systematic follow-up on the day of their 5-year SES implantation anniversary, in a series of consecutive real-world patients treated with a SES. The use of SES implantation was not restricted to "on-label" indications, and target lesions included in-stent restenosis, vein graft, left main stem locations, bifurcations, and long lesions. The Academic Research Consortium criteria were used for ST classification. RESULTS: Three hundred fifty consecutive patients were treated with SES between April and December 2002 in 3 Swiss hospitals. Mean age was 63 +/- 6 years, 78% were men, 20% presented with acute coronary syndrome, and 19% were patients with diabetes. Five-year follow-up was obtained in 98% of eligible patients. Stent thrombosis had occurred in 12 patients (3.6%) [definite 6 (1.8%), probable 1 (0.3%) and possible 5 (1.5%)]. Eighty-one percent of the population was free of complications. Major adverse cardiac events occurred in 74 (21%) patients and were as follows: cardiac death 3%, noncardiac death 4%, myocardial infarction 2%, target lesion revascularization 8%, non-target lesion revascularization target vessel revascularization 3%, coronary artery bypass graft 2%. Non-TVR was performed in 8%. CONCLUSION: Our data confirm the good long-term outcome of patients treated with SES. The incidence of complications and sub acute thrombosis at 5 years in routine clinical practice reproduces the results of prospective randomized trials.

El papel de la lengua en la construcción de la identidad: un estudio cualitativo con una muestra multicultural

En las últimas décadas ha incrementado considerablemente el contacto y la heterogeneidad de lenguas, culturas e identidades. La movilidad humana se ha convertido en una de las características estructurales de nuestras sociedades (Bauman, 1998) y la pluralización de las formas de vida (Berger y Luckman, 1997) en una de sus más destacadas consecuencias. El estudio que presentamos tiene el objetivo de explorar la función de la lengua en relación a la construcción narrativa de la identidad. Para ello se presentan diez historias de vida según la adaptación de la entrevista elaborada por Dan P. McAdams (2006). El análisis de los datos empíricos se ha realizado mediante el programa informático Atlas.ti (Muñoz, 2005). Se concluye que básicamente la lengua ejerce, en los sujetos entrevistados, tres funciones que responden a tres necesidades. Por un lado está la lengua familiar, identitaria o materna. Por otro, la lengua de intercomunicación sociolaboral que permite la comunicación en el trabajo o en los distintos escenarios socioculturales y, finalmente, la lengua de interconexión global, actualmente el inglés, presente en Internet y en los escenarios internacionales

Psychotherapeutic case conceptualization using plan analysis for bipolar affective disorder.

Valid individualized case conceptualization methodologies, such as plan analysis, are rarely used for the psychotherapeutic treatment conceptualization and planning of bipolar affective disorder (BD), even if data do exist showing that psychotherapy interventions might be enhanced by applying such analyses for treatment planning for several groups of patients. We applied plan analysis as a research tool (Caspar, 1995) to N=30 inpatients presenting BD, who were interviewed twice. Our study aimed at producing a prototypical plan structure encompassing the most relevant data from the 30 individual case conceptualizations. Special focus was given to links with emotions and coping plans. Inter-rater reliability of these plan analyses was considered sufficient. Results suggest the presence of two subtypes based on plananalytic principles: emotion control and relationship control, along with a mixed form. These subtypes are discussed with regard to inherent plananalytic conflicts, specific emotions and coping plans, as well as symptom level and type. Finally, conclusions are drawn for enhancing psychotherapeutic practice with BD patients, based on the motive-oriented therapeutic relationship.

Feed the ICU patient 'gastric' first, and go post-pyloric only in case of failure.

In a randomised trial comparing early enteral feeding by gastric and post-pyloric routes, White and colleagues have shown that gastric feeding is possible and efficient in the vast majority of critically ill patients. But the authors' conclusion that gastric is equivalent to post-pyloric is true in only the least severe patients. Given the extra workload and costs, post-pyloric is now clearly indicated in case of gastric feeding failure.

Nucleos(t)ide analogue treatment reduces apoptotic activity in patients with chronic hepatitis B.

Background: Reduction of necroinflammatory activity is a major goal of antiviral therapy of patients with chronic hepatitis B. Serum ALT does not detect all forms of cell death.Objectives: To analyze dynamics of novel serum cell death markers for apoptosis and necrosis in association with virologic response to nucleos(t)ide (Nuc) analogue treatment.Study design: Quantification of the M30-apoptosis neoepitope and the cytokeratin-18 (M65-necrosis) serum levels before and during treatment of patients with chronic hepatitis B with Nuc (n = 26).Results: Before treatment, M30-apoptotic activity was significantly correlated with M65-necrosis and fibrosis but not with serum ALT. During therapy with Nucs, cell death parameters M30-apoptosis, M65-necrosis, and ALT declined in association with virologic response. The most frequent cell death pattern was simultaneous decline of ALT and M30-apoptosis which occurred more frequently in patients with HBs-Antigen decline than in patients with HBs-Antigen increase during treatment (87.5% vs. 40.0%; p = 0.024). ALT decline in association with increase of M30 apoptosis was frequent in patients with HBs-Antigen increase during treatment (36.3%) but was not observed in patients with HBs-Antigen decline during treatment.Conclusion: Decline of cell death parameters in association with decline of HBV-DNA and HBs-Antigen indicates a reduction in overall cell death activity during Nuc treatment supporting the concept that response to Nuc therapy reduces necroinflammatory activity and progression of liver disease. (C) 2011 Elsevier B. V. All rights reserved.

Variabilidade espacial de atributos físicos de solo usada na identificação de classes pedológicas de microbacias na Amazônia meridional

A região noroeste do Estado de Mato Grosso compreende paisagens de grande complexidade para amostragem de solo. Isso ocorre devido à contínua atividade geomorfológica, que contribuiu para a existência de diferentes classes pedológicas em pequenas distâncias. O trabalho foi desenvolvido em Juruena (MT), com o objetivo de identificar as classes pedológicas em microbacias sob floresta não-perturbada, por meio do estudo da variabilidade espacial da textura (relação textural) e cor (índice de avermelhamento) do solo, considerando-se ainda a altitude da paisagem. A variabilidade espacial da textura e da cor do solo foi determinada em amostras de 185 pontos georreferenciados em malha sistemática regular com espaçamento de 20 x 20 m, abrangendo quatro microbacias. Usando profundidades de 0-20 e 40-60 cm, foi possível distinguir e mapear as principais classes de solo ocorrentes na área de estudo até o segundo nível categórico do Sistema Brasileiro de Classificação de Solos, associadas ao fator relevo da paisagem. Também foi estabelecida uma correspondência bastante satisfatória entre os intervalos do índice de avermelhamento do horizonte diagnóstico e as cores das classes de solo. As microbacias apresentaram as classes Plintossolos e Argissolos (com caráter plíntico) em altitudes inferiores a 280 m e Latossolos nas cotas superiores. Dessa forma, ficou evidenciada a possibilidade do uso da geoestatística para separar classes homogêneas de solo, além de estimar a precisão de mapeamento. Contudo, são indispensáveis o conhecimento pedológico e o trabalho posterior de campo para a aplicação e o ajuste dessa modelagem.

Disposition of oral valganciclovir during continuous renal replacement therapy in two lung transplant recipients

Background: Oral valganciclovir (VGC) is hydrolysed into active ganciclovir (GCV) which is eliminated in the kidney by filtration and secretion. VGC dosage has to be adapted in renal failure with continuous renal replacement therapy (CRRT), a condition sometimes encountered early after solid organ transplantation. This investigation aimed to determine whether VGC 450 mg every 48 hours provides appropriate GCV exposure for cytomegalovirus (CMV) prophylaxis during CRRT. Methods: GCV pharmacokinetics were extensively studied during CRRT in two lung transplant recipients with acute renal failure receiving VGC 450 mg every 48 hours trough a nasogastric tube. In vitro experiments using blank whole blood spiked with GCV further investigated exchanges between plasma and erythrocytes. Results: GCV disposition was characterised by an area under the curve (AUC) of 98.0 and 55.4 mg h/L, resulting in trough concentrations of 0.7 and 0.2 mg/L, an apparent total body clearance of 3.3 and 5.8 L/h, a terminal half-life of 16.9 and 14.1 h, and an apparent volume of distribution of 60.3 and 104.9 L. The observed sieving coefficient (filtrate/plasma) was 1.05 and 0.96, and the hemofiltration clearance 3.3 and 3.1 L/h, respectively. High sieving values could be explained by an efflux of GCV from erythrocytes. In vitro experiments confirmed that erythrocytes are loaded with significant GCV amount and release it quickly into plasma, thus contributing to the apparent efficacy of hemofiltration. Conclusion: These results indicate that a VGC dosage of 450 mg every 48 hours was adequate for CMV prophylaxis during CRRT, providing GCV levels similar to those reported using 900 mg qd in transplant recipients with normal renal function.