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  • 1
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    Stroke After Carotid Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) [Stroke] (2012)
    American Heart Association (AHA)
    Details
    Publication Date: 2012-12-18
    Description: Background— Stroke occurs more commonly after carotid artery stenting than after carotid endarterectomy. Details regarding stroke type, severity, and characteristics have not been reported previously. We describe the strokes that have occurred in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Methods and Results— CREST is a randomized, open-allocation, controlled trial with blinded end-point adjudication. Stroke was a component of the primary composite outcome. Patients who received their assigned treatment within 30 days of randomization were included. Stroke was adjudicated by a panel of board-certified vascular neurologists with secondary central review of clinically obtained brain images. Stroke type, laterality, timing, and outcome were reported. A periprocedural stroke occurred among 81 of the 2502 patients randomized and among 69 of the 2272 in the present analysis. Strokes were predominantly minor (81%, n=56), ischemic (90%, n=62), in the anterior circulation (94%, n=65), and ipsilateral to the treated artery (88%, n=61). There were 7 hemorrhages, which occurred 3 to 21 days after the procedure, and 5 were fatal. Major stroke occurred in 13 (0.6%) of the 2272 patients. The estimated 4-year mortality after stroke was 21.1% compared with 11.6% for those without stroke. The adjusted risk of death at 4 years was higher after periprocedural stroke (hazard ratio, 2.78; 95% confidence interval, 1.63–4.76). Conclusions— Stroke, particularly severe stroke, was uncommon after carotid intervention in CREST, but stroke was associated with significant morbidity and was independently associated with a nearly 3-fold increased future mortality. The delayed timing of major and hemorrhagic stroke after revascularization suggests that these strokes may be preventable. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00004732.
    Keywords: Restenosis, Primary prevention, Cerebrovascular disease/stroke, Carotid Stenosis, Carotid endarterectomy, Angioplasty and Stenting
    Electronic ISSN: 1524-4539
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 2
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    A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention: The PROTECT II Study [Interventional Cardiology] (2012)
    American Heart Association (AHA)
    Details
    Publication Date: 2012-10-02
    Description: Background— Although coronary artery bypass grafting is generally preferred in symptomatic patients with severe, complex multivessel, or left main disease, some patients present with clinical features that make coronary artery bypass grafting clinically unattractive. Percutaneous coronary intervention with hemodynamic support may be feasible for these patients. Currently, there is no systematic comparative evaluation of hemodynamic support devices for this indication. Methods and Results— We randomly assigned 452 symptomatic patients with complex 3-vessel disease or unprotected left main coronary artery disease and severely depressed left ventricular function to intra-aortic balloon pump (IABP) (n=226) or Impella 2.5 (n=226) support during nonemergent high-risk percutaneous coronary intervention. The primary end point was the 30-day incidence of major adverse events. A 90-day follow-up was required, as well, by protocol. Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of –0.04±0.24 W in comparison with –0.14±0.27 W for IABP ( P =0.001). The primary end point (30-day major adverse events) was not statistically different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP, P =0.227 in the intent-to-treat population and 34.3% versus 42.2%, P =0.092 in the per protocol population. At 90 days, a strong trend toward decreased major adverse events was observed in Impella 2.5–supported patients in comparison with IABP: 40.6% versus 49.3%, P =0.066 in the intent-to-treat population and 40.0% versus 51.0%, P =0.023 in the per protocol population, respectively. Conclusions— The 30-day incidence of major adverse events was not different for patients with IABP or Impella 2.5 hemodynamic support. However, trends for improved outcomes were observed for Impella 2.5–supported patients at 90 days. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00562016.
    Keywords: Catheter-based coronary interventions: stents, Other Treatment
    Electronic ISSN: 1524-4539
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 3
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    A randomized trial evaluating everolimus-eluting Absorb bioresorbable scaffolds vs. everolimus-eluting metallic stents in patients with coronary artery disease: ABSORB Japan (2015)
    Oxford University Press
    Details
    Publication Date: 2015-12-15
    Description: Aims Theoretically, bioresorbable vascular scaffolds (BVSs) may provide superior long-term results compared with permanent metallic drug-eluting stents (DESs). However, whether BVSs are as safe and effective as metallic DESs prior to complete bioresorption is unknown. Methods and results ABSORB Japan was a single-blind, multicentre, active-controlled, randomized trial designed to support regulatory approval of the Absorb BVS in Japan. Eligible patients with one or two de novo lesions in different epicardial vessels were randomized at 38 Japanese sites in a 2:1 ratio to Absorb BVS vs. cobalt-chromium everolimus-eluting stents (CoCr-EESs). The primary endpoint was target lesion failure [TLF: a composite of cardiac death, myocardial infarction attributable to target vessel, or ischaemia-driven target lesion revascularization (ID-TLR)] at 12 months, powered for non-inferiority. The major secondary endpoint was angiographic in-segment late lumen loss (LLL) at 13 months. A total of 400 patients were randomized to BVSs (266 patients and 275 lesions) or CoCr-EESs (134 patients and 137 lesions). TLF through 12 months was 4.2% with BVSs and 3.8% with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.39% (3.95%); P non-inferiority 〈 0.0001]. Definite/probable stent/scaffold thrombosis at 12 months occurred in 1.5% of the patients with both devices ( P = 1.0), and ID-TLR for restenosis was infrequent (1.1% with BVSs and 1.5% with CoCr-EESs, P = 1.0). With 96.0% angiographic follow-up, in-segment LLL at 13 months was 0.13 ± 0.30 mm with BVSs and 0.12 ± 0.32 mm with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.01 (0.07); P non-inferiority 〈 0.0001). Conclusion In the ABSORB Japan randomized trial, 12-month clinical and 13-month angiographic outcomes of BVSs were comparable to CoCr-EESs. Clinical registration ClinicalTrials.gov, number NCT01844284.
    Print ISSN: 0195-668X
    Electronic ISSN: 1522-9645
    Topics: Medicine
    Published by Oxford University Press
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  • 4
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    Novel lymphocyte screening tube using dried monoclonal antibody reagents (2015)
    Wiley-Blackwell
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    Publication Date: 2015-05-06
    Description: We previously developed a 10-color 11 antibody combination including a viability dye, to screen T, B and NK cell populations in blood, bone marrow, tissue and body fluids. Recently Beckman Coulter has introduced a line of dried reagents which unlike liquid reagents and cocktails, require no refrigeration, titration or manipulation before using. We evaluated custom tubes based on our standard lymphocyte screening panel, focusing on comparative analysis, ease of use and advantages compared to our liquid reagent set. We tested 42 samples from blood (n=15), bone marrow (n=17) and tissue (n=10) with the combination CD4/CD8/KAPPA/LAMBDA/CD19/CD56/CD5/CD20/CD10/CD3/CD45 and a vital dye by both methods and compared positivity and staining intensity for each antigen. Of the 42 samples, 5 were normal samples, 3 were red cell disorders, 20 were B cell, 5 T cell, 4 myeloid malignancies and the remaining 5 were other diagnoses. Dried reagents gave equivalent staining intensity results to our standard panel in a variety of sample types with diagnoses including reactive lymphocytosis, CLL and various lymphomas. Our standard panel for evaluation of mature lymphoid malignancies allows rapid assessment of any sample type while providing direct assessment of viability. The dried reagent tube reduces pre-analytical work with simple addition of sample and the viability dye to the tube, saving time, reducing potential errors, and obviating need to titrate and monitor individual antibodies. With a shelf life of at least 12 months, the reagents also offers potential savings in reagent costs by reducing wastage due to expiration or tandem breakdown in standard liquid formulation. This article is protected by copyright. All rights reserved.
    Topics: Biology , Medicine
    Published by Wiley-Blackwell
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  • 5
    Electronic Resource
    Electronic Resource
    Leaf dynamics of seedlings of rain forest species in relation to canopy gaps (1990)
    Springer
    Oecologia 82 (1990), S. 122-127 
    Details
    ISSN: 1432-1939
    Keywords: Canopy gaps ; Leaf dynamics ; Seedling growth ; Shade tolerance ; Tropical rain forest
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Summary Leaf dynamics of eight tropical rain forest species seedlings was studied in three environments: the shaded forest understorey, a small gap of ±50 m2, and a large gap of ±500 m2. Leaf production rate and leaf loss rate were enhanced in gaps, and a large gap resulted in larger increases than a small gap. For most species net leaf gain rate was larger in gaps, although this rate was not always largest in the large gap. Leaf loss decreased, and leaf survival percentages increased with increasing shade tolerance of species, indicating a slower leaf turnover for more shade tolerant species. Leaf area growth rate was only partly determined by net leaf gain rate. Ontogenetic effects on leaf size were also important, especially in the large gap. Species which possessed leaves with high specific leaf weight (SLW) showed lower leaf loss rates and higher leaf survival percentages than species with low SLW leaves. Leaf life span seemed to be related to leafcost per unit area. The relation of specific patterns in leaf production and leaf loss to the regeneration mode of the species is briefly discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00318543
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  • 6
    Electronic Resource
    Electronic Resource
    The effect of canopy gaps on growth and morphology of seedlings of rain forest species (1988)
    Springer
    Oecologia 75 (1988), S. 625-632 
    Details
    ISSN: 1432-1939
    Keywords: Biomass allocation ; Canopy gaps ; Seedling growth ; Shade tolerance ; Tropical rain forest
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Summary Growth and morphology of seedlings of ten tropical rain forest species were studied at Los Tuxtlas, Mexico. Seedlings were grown in three environmental conditions: the shaded forest understorey (FU, receiving 0.9–2.3% of the daily photosynthetic photon flux, PF, above the canopy), a small canopy gap of approx. 50 m2 (SG, receiving 2.1–6.1% of daily PF), and a large canopy gap of approx. 500 m2 (LG, receiving 38.6–53.4% of daily PF). The growth of all species was enhanced in gaps, and in LG the effect was stronger than in SG. Plants grown in LG had a sunplant morphology, with a high root-shoot ratio (R/S), a high specific leaf weight (SLW) and a low leaf area ratio (LAR). Plants grown in SG or FU showed a shade-plant morphology, with a low R/S, a low SLW and a high LAR. Growth responses varied from species unable to grow in the shade but with strong growth in the sun, to species with relatively high growth rates in both shade and sun conditions. Shade tolerant species were able to grow in the shade because of a relatively high unit leaf rate. The pioneerCecropia had a high growth rate in LG because of a high LAR. Most species showed a complex growth response in which they resembled the shade intolerant extreme in some aspects of the response, and the shade tolerant extreme in other aspects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00776429
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  • 7
    Electronic Resource
    Electronic Resource
    On the determination of optimal levels in phytosociological classification (1983)
    Springer
    Plant ecology 52 (1983), S. 65-75 
    Details
    ISSN: 1573-5052
    Keywords: Arrhenatheretum ; Classification ; Clustering ; Mesobromion ; Optimal level ; Phytosociological table ; Spartina communities ; Stopping rule
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract A method is introduced to compare results of a clustering technique at different levels of abstraction, or of different clustering techniques. The method emphasizes within cluster homogeneity as well as discontinuities between clusters. It has been derived from Hogeweg's method with some important changes. First each cluster is handled separately to determine the ratio between homogeneity and similarity to the nearest neighbour cluster. For a given clustering a weighted average value is computed over all clusters. This average value is standardized using an expected average value for a cluster configuration with the same number of clusters having the same sizes. A low level of the ratio between expected and observed values is supposed to indicate an optimal clustering. A derivation of the criterion is given and results from three sets of data with different properties are evaluated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00037763
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  • 8
    Electronic Resource
    Electronic Resource
    Structure and floristic composition of the lowland rain forest of Los Tuxtlas, Mexico (1988)
    Springer
    Plant ecology 74 (1988), S. 55-80 
    Details
    ISSN: 1573-5052
    Keywords: Allometry ; Diversity ; Dynamics ; Physiognomy ; Population structure ; Tropical rain forest ; Vegetation structure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract Physiognomy, structure and floristic composition of one hectare of lowland tropical rain forest was studied in detail at Los Tuxtlas, Mexico. Physiognomically, the Los Tuxtlas forest should be classified as ‘lowland tropical high evergreen rain forest’. The forest showed a closed canopy at 30–35 m. Of all woody, non-climbing species with a DBH≥1.0 cm 89.4% (94.5% of all individuals) were evergreen, 25.4% (59.5% of the individuals) had compound leaves, and over 80% of species (and individuals) had leaves in the notophyll and mesophyll size classes. The forest structure was characterized by a low density (2976 individuals with a DBH≥1.0 cm, 346 individuals with a DBH≥10.0 cm, per ha, excluding vines) with an average basal area (38.1 m2, DBH≥1.0 cm, 34.9 m2, DBH≥10.0 cm, per ha, excluding vines). This was attributed to the relative maturity of the forest on the study plot. The study plot contained 234 species (11 208 individuals with a height ≥0.5 m), of which 55.1% (34.8% of individuals) were trees, 9.4% (6.8%) shrubs, 3.4% (44.3%) palms, 20.1% (5.2%) vines, 6.8% (8.7%) herbs and 5.1% (0.3%) of unknown lifeform. Furthermore, 58 species of epiphytes and hemi-epiphytes were found. Diversity of trees, shrubs and palms with a DBH≥1.0 cm was calculated as Shannon-Wiener index (4.65), Equitability index (0.65), and Simpson index (0.10). The dominance-diversity curve showed a lognormal form, characteristic for tropical rain forest. The community structure was characterized by a relative dominance of Astrocaryum mexicanum in the understorey, Pseudolmedia oxyphyllaria in the middle storeys, and Nectandra ambigens in the canopy. Species population structures of 31 species showed three characteristic patterns, differentiated by recruitment: continuously high, discontinuously high, and continuously low recruitment. Height/diameter and crown cover/diameter diagrams suggested a very gradual shift from height growth to crown growth during tree development. Forest turnover was calculated as 138 years. Compared to other tropical rain forests the Los Tuxtlas forest had 1. similar leaf physiognomical characteristics, 2. a lower diversity, 3. a lower density, 4. an average basal area, and 5. a slow canopy turnover.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00045614
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  • 9
    Electronic Resource
    Electronic Resource
    Patterns in the vertical structure of the tropical lowland rain forest of Los Tuxtlas, Mexico (1988)
    Springer
    Plant ecology 74 (1988), S. 81-91 
    Details
    ISSN: 1573-5052
    Keywords: Diversity ; Floristics ; Physiognomy ; Scale problem ; Stratification ; Vertical vegetation structure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract The vertical structure of one hectare of tropical rain forest was studied at Los Tuxtlas, State of Veracruz, Mexico. The structure was analysed at various scales of analysis, using different methodologies e.g. profile diagrams (0.1 ha) and vertical structure diagrams (1 ha). All profile diagrams suggested presence of stratification to some extent. However, simultaneous evaluation of several adjacent profile diagrams showed that the use of one profile diagram only can be very misleading: gaps or layers apparent in a diagram did usually not reflect gaps or layers that could be recognized in the field. Structure diagrams of abundance, basal area and crown cover showed that this forest community is not stratified, with the exception of an understorey layer below 7.5 m dominated by palms. The vertical structure was described using arbitrarily chosen height intervals. From the forest floor to the canopy top basal area, percentage of deciduous species (and individuals), and percentage of compound-leaved species (and individuals), increased, but total number of individuals and number of species decreased. Leaf sizes tended to decrease in the same direction, and crown cover was approximately evenly distributed. Species from different families dominated different parts along the vertical plane. It is concluded that the vertical structure of tropical rain forest can best be described as a complex gradient, involving many community features. Stratification can best be emphasized as a special case of such a gradient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00045615
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