Rationale and design of the East-West late lumen loss study: Comparison of late lumen loss between Eastern and Western drug-eluting stent study cohorts

BACKGROUND

The contemporary evaluation of novel drug-eluting stents (DES) includes mechanistic observations that characterize postdeployment stent behavior. Quantification of late lumen loss due to neointimal hyperplasia 8-13 months after stent implantation, via quantitative coronary angiography (QCA), constitutes such an observation and is required by most regulatory authorities. Late lumen loss, as determined by QCA, has been validated as a surrogate for clinical endpoints such as target vessel revascularization. The mechanistic response to DES has not been directly compared across predominantly Asian or Western populations, whereas understanding their comparability across geographic populations could enhance global DES evaluation.

OBJECTIVE

The East-West late lumen loss study is designed to demonstrate whether the residual differences in late lumen loss, as assessed by QCA, is different between Eastern and Western DES recipients from studies with protocol angiography at 8-13 months of follow-up.

METHODS

Data from independent core laboratories that have characterized angiographic late lumen loss in DES clinical trials with protocol follow-up angiography will be compiled and dichotomized into Eastern and Western populations. A prospectively developed propensity score model incorporating clinical and anatomic variables affecting late lumen loss will be used to adjust comparisons of QCA measurements.

CONCLUSION

Documentation of whether there are clinically meaningful differences in mechanistic response to DES implantation across genetically unique geographies could facilitate both the quality and efficiency of global device evaluation requiring invasive follow-up for novel stent designs.

A 10-Year Comparative Study of the Incidence of Third Molar Removal in the Aging Population

PURPOSE

The study goal was to evaluate the incidence of patients older than 40 years who required third molar removal.

PATIENTS AND METHODS

Two prospective 5-year studies were compared over a 10-year period of 1992 to 1997 and 1997 to 2002. The study was initiated to evaluate how the large increase in the older population with longer life expectancies is reflected in the third molar population.

RESULTS

In 1997, 10.5% of patients requiring third molar surgery were 40 years or older. In 2002, 17.3% of patients were 40 years or older.

CONCLUSIONS

It is well known that patients 40 years and older have increased risk in removal of third molars. It is concluded that 1 patient in 5 in the high-risk category is in a very high risk category. The risk to patients and to the profession can be dramatically reduced by considering early removal of abnormal third molars.

Rhodococcus equi lung abscess complicating Evan's syndrome treated with corticosteroid

We report a case of Rhodococcus equi, an unusual pathogen, causing a right upper lobe lung abscess in a patient with Evan's syndrome (auto-immune haemolytic anaemia and thrombocytopenia) who was treated with high-dose corticosteroid therapy. The patient was treated successfully with clarithromycin, vancomycin, ciprofloxacin and imipenen which appear to be effective in combination for this unusual condition in which the treatment regimen has been controversial.

Using restorations borne totally by anterior implants to preserve the edentulous mandible

BACKGROUND

This study quantifies the changes in bone height of the posterior area of the edentulous mandible when the load of complete dentures is borne entirely by anteriorly placed osseointegrated implants.

METHODS

Thirty-three patients, of whom there were radiographs from the beginning of implant loading and from a follow-up visit at least three years later (a mean of 6.6 years later), were included in the study. Working with panoramic radiographs, the authors took height measurements in the premolar area (15 millimeters distal to the most distal implants). A valid correction factor was available because implants of known length were proximal to the area being evaluated.

RESULTS

The authors calculated descriptive statistics using means, standard deviations, medians and proportions as appropriate. A P-value of less than .05 was considered significant. Of the 33 subjects, most showed increases in bone height--29 (87.9 percent) on the right side and 28 (84.9 percent) on the left side. The mean change in all subjects was +1.0 mm (range -0.8 to +3.3 mm). A comparison of mandibular height at implant placement vs. follow-up showed a statistically significant increase bilaterally (P < .001).

CONCLUSIONS

This study demonstrates that dentures for edentulous mandibles that are borne totally by implants in the anterior area conserve or enhance the bone of the posterior portion of the mandible. An important future study should test the effect of implant-assisted restorations for the edentulous mandible that load the posterior ridge (a bar clasp, for example).

CLINICAL IMPLICATIONS

One of the considerations in planning treatment for the edentulous mandible should be the preserving effect of totally implant-borne restorations vs. the continued resorption of the body of the mandible with conventional dentures.

Fate and risk evaluation of persistent organic contaminants and related compounds in Victoria Harbour, Hong Kong

The Environment Protection Department of Hong Kong has a monitoring program for persistent organic contaminants in sediments of Victoria Harbour, the main harbour of Hong Kong. A fugacity model has been used, based on this sedimentary data, to estimate inputs to the system (probably from sewage, stormwater and industrial discharges) as well as the fate of the contaminants, particularly in terms of the aqueous and biotic concentrations. The risk of deleterious effects on the natural marine system, as well as on the consumers of seafood from the system, was carried out using the estimated aqueous and biotic concentrations together with accepted environmental quality guidelines. The result of our analysis indicated that the chlorohydrocarbons, PCBs (as Aroclor 1254) total DDT and total HCH pose a significant risk, and probably have caused damage to the marine ecosystem as well as posing a hazard to seafood consumers. Much higher concentrations of the less toxic total alkanes, nonaromatic hydrocarbons, linear alkyl benzenes and the compounds giving a unresolved complex mixture (UCM) cannot be evaluated due to a lack of environmental guidelines and the complexity of these substances. However, it is probable that these substances add adverse effects to those due to the other contaminants.