Comparison between catheter-based delivery of paclitaxel after bare-metal stenting and drug-eluting stents in coronary artery disease patients at high risk for in-stent restenosis

Antiproliferative drug-loaded multi-functionalized intraocular lens for reducing posterior capsular opacification

Posterior capsule opacification (PCO) is one of the most frequent complications in cataract surgery and likely to cause the second loss of vision. Proliferation and migration of postoperative remnants of lens epithelial cells (LECs) on the implanted intraocular lens (IOL) are the leading causes of PCO. Antiproliferative drugs can be an effective solution but also possess some problems including sudden release and accompanying adverse effects to surrounding normal tissues, which greatly limit the clinical trials. In this study, an antiproliferative drug Paclitaxel (Pac) -sustained released hyaluronic acid (HA) and chitosan (CHI) multilayer modified IOL with postoperatively long-term PCO prevention was fabricated via layer by layer (LbL) technique. Quartz crystal microbalance with dissipation monitoring (QCM-D) result shows that HA-Pac/CHI multilayer is modified onto IOL material via LbL technique successfully. The HA-Pac/CHI multilayer coating greatly improves the hydrophilicity of the IOL material surfaces without change the transmittance significantly, whereas the proliferation of LECs is distinctly reduced on the HA-Pac/CHI multilayer-modified surfaces. The drug release in vitro reveals that the multilayer modified IOL material is stable under physiological condition and has good sustained drug release property. All these results demonstrate that HA-Pac/CHI multilayer modified IOL material can effectively inhibit LECs proliferation which provides a novel approach for reducing of PCO incidence in clinical.

A potential strategy for in-stent restenosis: Inhibition of migration and proliferation of vascular smooth muscle cells by Cu ion

The in-stent restenosis (ISR) often happens after the implantation of metal stents, including both bare metal stents (BMSs) and drug-eluting stents (DESs). Drug release from DESs could reduce significantly the occurrence of ISR but also suppress the revascularization and cause thrombosis. In this study, the effect of Cu ion in a range of 0 to 500 μM on the migration and proliferation of rat aortic smooth muscle cells (RASMCs) was investigated by a series of in vitro experiments including wound-healing assay, cell viability assay and flow cytometric analysis. It has been found that the critical concentration of Cu ion should be at least 250 μM in order to significantly inhibit the migration of RASMCs and the proliferation of RASMCs were impeded by every dose of Cu ion used in this study. In addition, the protein level of caspase-3 was upregulated by 250 μM and 500 μM Cu²⁺ exposure, which might be the main reason for RASMCs apoptosis. Thus, it is proposed that ISR might be prevented by the constant release of Cu ion.

Duration of dual antiplatelet therapy in patients with acute coronary syndrome undergoing drug-eluting stent implantation: A meta-analysis

Objective

This meta-analysis was performed to evaluate the optimal discontinuation of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation in acute coronary syndrome (ACS) patients.

Methods

A systematic search was conducted without language restrictions using PubMed, the Cochrane Library, and Clinical Trials.gov from January 2008 to July 2019. Studies that met the following criteria were included: (1) randomized trials that compared DAPT durations of <12 months (“short DAPT”) or ≥12 months (“long DAPT”); (2) studies that included data on patients with ACS; and (3) studies that included data on outcomes. The outcomes were pooled using the Mantel–Haenszel model, generating relative risk (RR) and 95% confidence intervals (CI). Statistical heterogeneity was evaluated using the Cochrane Q statistic P -value and I 2 value. Publication bias was assessed by visually inspecting the funnel plots.

Results

Eight studies comprising 10,537 participants were included in the analysis. The primary endpoint was not different between short-term and long-term DAPT (RR, 1.11; 95% CI, 0.92–1.34).

Conclusion

A meta-analysis of the available evidence suggests that DAPT can be reduced to 3 or 6 months without increasing the risk of cardiovascular and cerebrovascular events in patients with ACS who are undergoing DES implantation.