No abstract

Background-Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). 0001).The mean duration to ST from the stent implantation was 8.9Ϯ8.5 days in subacute and 152.7Ϯ100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; PϽ0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (PϽ0.05). Conclusions-ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.

Conclusion:A conservative strategy of fluid management in patients with acute lung injury shortens duration of mechanical ventilation without increasing nonpulmonary organ failure.Summary: There is debate about optimal fluid management of patients with acute lung injury. Limiting fluids or inducing diuresis may improve lung function but at the expense of impaired perfusion of other organs. In this randomized study, a conservative or liberal strategy of fluid management in patients with acute lung injuries was used. The protocol was applied for 7 days in 1000 patients with acute lung injury. The primary end point was death at 60 days. Ventilator-free days and organ-failure-free days and measures of lung physiology were secondary end points. There was no difference between the two groups in the primary end point at 60 days. In the conservative strategy group, 25.5% of the patients died, and 28.4% of the patients died in the liberal strategy group (P Ͻ .30; 95% confidence interval for a difference, Ϫ2.6% to 8.4%). The cumulative fluid balance in the first 7 days in the conservative strategy group was Ϫ136 Ϯ 491 mL. The cumulative fluid balance in the first 7 days in the liberal strategy group was ϩ6992 Ϯ 502 mL (P Ͻ .001). The conservative strategy group had an improved oxygenation index, lung injury score, and an increased number of ventilatorfree days (14.6 Ϯ 0.5 vs 12.1 Ϯ 0.5, P Ͻ .001) vs the liberal strategy group. The conservative strategy group also had more days not spent in the intensive care unit (13.4 Ϯ 0.4 vs 11.2 Ϯ 0.4, P Ͻ .001) during the first 28 days. There was no difference between the conservative and liberal strategy groups with respect to prevalence of shock during the course of the study or the use of dialysis during the first 60 days (10% vs 14%, P Ͻ .06).Comment: A conservative fluid management strategy did not decrease death at 60 days vs a liberal fluid management strategy in patients with acute respiratory distress syndrome. However, intensive care unit days were reduced and lung function was improved with the conservative fluid management posture. The results are consistent with other recent reports suggesting improved overall patient outcome with conservative fluid management in acute respiratory distress syndrome. The days of essentially drowning patients with acute lung injury to preserve distal organ perfusion should be over.Chlamydia pneumoniae in foci of "early" calcification of the tunica media in atherosclerotic arteries; an incidental presence?

Here we report the characterization of an SV40 large-T antigen-immortalized stromal cell line, WPMY-1, derived from the same prostate as our previously described epithelial cell lines. The WPMY-1 cells were determined to be myofibroblasts on the basis of co-expression of smooth muscle alpha-actin and vimentin. They also show positive staining for androgen receptor, large-T antigen, and positive but heterogeneous staining for p53 and pRb. Their growth is stimulated by the synthetic androgen mibolerone to 145% of control (100%). Platelet-derived growth factor BB, epidermal growth factor and basic fibroblast growth factor, at 10 ng/ml, stimulated growth to 138, 143 and 146% of control, respectively. Transforming growth factor-beta, at 10 ng/ml, inhibited serum-induced growth to 65% of control in the presence of 1% serum, and bFGF-induced growth to 30% of control. A serum-free medium was developed for optimal growth of WPMY-1 cells. They show anchorage-independent growth in soft agar. Studies on paracrine interactions show that myofibroblast-conditioned medium causes a marked inhibition of growth in WPE1-10 cells, while conditioned medium from WPE1-10 prostatic epithelial cells caused only a small increase in the growth of WPMY-1 cells. WPMY-1 cells secrete very low levels of MMP-9 but high levels of MMP-2, markedly higher than the epithelial cells. These epithelial and myofibroblast cell lines, derived from the same prostate, provide novel and useful models for studies on paracrine stromal-epithelial interactions in carcinogenesis, tumor progression, prevention and treatment of prostate cancer and benign prostatic hyperplasia.

Summary:The role of the cardiologist is expanding and involves the management of patients with lower extremity atherosclerotic occlusive arterial disease. Peripheral arterial disease (PAD) remains an underdiagnosed and undertreated disease. The purpose of this review is to educate the clinician on the significance of lower extremity atherosclerotic occlusive arterial disease. Pathophysiology and anatomy are briefly reviewed. The definition of PAD is based upon both anatomic and functional considerations. Risk factors for PAD include traditional atherosclerotic risk factors. There is a considerable overlap between coronary and cerebrovascular diseases and PAD. Diagnosis is made mainly by history and physical examination. Noninvasive and invasive tests help diagnosis and localize disease. Expanded therapies to improve outcomes include lifestyle changes, medical treatment, interventional cardiovascular procedures, or surgical intervention.