OP0230 ANTIHISTAMINE USE AND STRUCTURAL PROGRESSION OF KNEE OA: A POST-HOC ANALYSIS OF TWO PHASE III CLINICAL TRIALS

Background

Prior studies indicate that mast cells are involved in chronic inflammation and that their activity in the synovium may contribute to structural progression of osteoarthritis (OA), however the exact role of mast cells in OA remains unclear. Antihistamines act by blocking histamine receptors, and further are found to have anti-inflammatory effects by stabilizing mast cell membranes. Current reports describing antihistamine use in OA patients suggest that antihistamines may reduce development of OA and lead to reduced risk of structural progression.

Objectives

We aimed to investigate whether antihistamine use during a two-year trial period was associated with differences in structural progression of OA, as compared with non-use.

Methods

This is a post-hoc analysis of two large phase III trials investigating oral salmon calcitonin in knee OA (NCT00486434 and NCT00704847). The primary outcome measure was structural progression defined as the change in minimum joint-space width measured by use of x-ray imaging from baseline to Year Two. In these trials, participants reported use of antihistamines, defined as medication coded with the ATC code R06A. In our study, we evaluated differences between groups of participants who reported use of antihistamines, versus those who did not, over the 2-year study period. Secondly, the duration of antihistamine use divided into categories of either no use, 1-49, 50-299 or >300 days of use was investigated to evaluate exposure-response relationships. The effect of use of antihistamines was evaluated using ANCOVA analysis adjusting for age, sex, BMI, and baseline JSW.

Results

Of a total study population of 2,206 participants, 1,485 completed the trial. Of these, 1,327 were non-users of antihistamines (mean age 64.4 years, 64.1% female, mean BMI 29.0 kg/m2) and 158 reported use of antihistamines of any duration during the trial (mean age 64.5 years, 75.2% female, mean BMI 28.1 kg/m2). Seventy-four participants reported use of antihistamines of a duration between 1-49 days, 21 participants between 50-299 days, and 63 reported use of 300 days or more. As illustrated in Figure 1A, the mean JSW change from baseline in the group of non-users was -0.32 mm (95% CI: -0.36 to -0.29), versus -0.19 mm (95%CI: -0.29 to -0.08, p=0.02 for difference) in the group of patients reporting antihistamine use of any duration. A trend towards an association between duration of antihistamine use and reductions in narrowing of JSW was observed (p for trend: 0.02), Figure 1B).

Conclusion

Use of antihistamines was associated with reduced structural progression in knee OA. Further research evaluating the role of antihistamines in OA is needed to further characterize this observation.

Disclosure of Interests

Asger Reinstrup Bihlet Shareholder of: Shareholder of NBCD A/S, Employee of: Employee at NBCD A/S, Claire Prener Miller Employee of: Employee at NBCD A/S, Inger Byrjalsen Employee of: Past employee at NBCD A/S, Jeppe Ragnar Andersen Shareholder of: Shareholder of NBCD A/S, Employee of: Employee at NBCD A/S, Morten Karsdal Shareholder of: Shareholder of Nordic Bioscience A/S, Employee of: Employee at Nordic Bioscience A/S, Matthew C. Baker Shareholder of: Shareholder of Mobility Bio Inc., Employee of: Employee at Mobility Bio Inc., Tharaknath Rao Shareholder of: Shareholder of Mobility Bio Inc., Employee of: Employee of Mobility Bio Inc.

Long lifetime of bialkali photocathodes operating in high gradient superconducting radio frequency gun

High brightness, high charge electron beams are critical for a number of advanced accelerator applications. The initial emittance of the electron beam, which is determined by the mean transverse energy (MTE) and laser spot size, is one of the most important parameters determining the beam quality. The bialkali photocathodes illuminated by a visible laser have the advantages of high quantum efficiency (QE) and low MTE. Furthermore, Superconducting Radio Frequency (SRF) guns can operate in the continuous wave (CW) mode at high accelerating gradients, e.g. with significant reduction of the laser spot size at the photocathode. Combining the bialkali photocathode with the SRF gun enables generation of high charge, high brightness, and possibly high average current electron beams. However, integrating the high QE semiconductor photocathode into the SRF guns has been challenging. In this article, we report on the development of bialkali photocathodes for successful operation in the SRF gun with months-long lifetime while delivering CW beams with nano-coulomb charge per bunch. This achievement opens a new era for high charge, high brightness CW electron beams.

High-Brightness Continuous-Wave Electron Beams from Superconducting Radio-Frequency Photoemission Gun

Continuous-wave photoinjectors operating at high accelerating gradients promise to revolutionize many areas of science and applications. They can establish the basis for a new generation of monochromatic x-ray free electron lasers, high-brightness hadron beams, or a new generation of microchip production. In this Letter we report on the record-performing superconducting rf electron gun with CsK_{2}Sb photocathode. The gun is generating high charge electron bunches (up to 10  nC/bunch) and low transverse emittances, while operating for months with a single photocathode. This achievement opens a new era in generating high-power beams with a very high average brightness.

Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches

Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.

The neutron electric dipole moment experiment at the Spallation Neutron Source

Novel experimental techniques are required to make the next big leap in neutron electric dipole moment experimental sensitivity, both in terms of statistics and systematic error control. The nEDM experiment at the Spallation Neutron Source (nEDM@SNS) will implement the scheme of Golub & Lamoreaux [Phys. Rep., 237, 1 (1994)]. The unique properties of combining polarized ultracold neutrons, polarized 3He, and superfluid 4He will be exploited to provide a sensitivity to ∼ 10−28 e · cm. Our cryogenic apparatus will deploy two small (3 L) measurement cells with a high density of ultracold neutrons produced and spin analyzed in situ. The electric field strength, precession time, magnetic shielding, and detected UCN number will all be enhanced compared to previous room temperature Ramsey measurements. Our 3He co-magnetometer offers unique control of systematic effects, in particular the Bloch-Siegert induced false EDM. Furthermore, there will be two distinct measurement modes: free precession and dressed spin. This will provide an important self-check of our results. Following five years of “critical component demonstration,” our collaboration transitioned to a “large scale integration” phase in 2018. An overview of our measurement techniques, experimental design, and brief updates are described in these proceedings.

The Surface Composition of Commercial Polyester Arterial Prostheses - An XPS Study

The importance of identifying and quantifying the level of contaminants on the surface of biomaterials has long been recognized as a significant step towards predicting the biocompatibility and rate of healing of implantable devices. Yet suitable techniques for characterizing the surface chemistry of soft and flexible biomaterials with an uneven surface contour such as those used in vascular prostheses have only recently been made available. As a first step towards determining the effect of surface contaminants on the healing behaviour of vascular prostheses, this study used X-ray photoelectron spectroscopy (XPS) to characterize the surface chemistry of 14 virgin polyester arterial prostheses from a wide variety of sources. Generally speaking, all surfaces appeared relatively clean. However, the results indicate that certain prostheses were not manufactured with Dacrorf-like fibres, and that some exhibit significantly carbon-rich surfaces. This suggests that the surface of these devices has been modified either by a hydrocarbon lubricant or by vapour phase hydrocarbons during fabrication.

Design of a high-bunch-charge 112-MHz superconducting RF photoemission electron source

High-bunch-charge photoemission electron-sources operating in a continuous wave (CW) mode are required for many advanced applications of particle accelerators, such as electron coolers for hadron beams, electron-ion colliders, and free-electron lasers. Superconducting RF (SRF) has several advantages over other electron-gun technologies in CW mode as it offers higher acceleration rate and potentially can generate higher bunch charges and average beam currents. A 112 MHz SRF electron photoinjector (gun) was developed at Brookhaven National Laboratory to produce high-brightness and high-bunch-charge bunches for the coherent electron cooling proof-of-principle experiment. The gun utilizes a quarter-wave resonator geometry for assuring beam dynamics and uses high quantum efficiency multi-alkali photocathodes for generating electrons.

Evolution and Evaluation of Human Resources Function in India

This article attempts to trace the development of human resources (HR) in the last four decades in India since the first dedicated Human Resources Development Department was conceptualized and initiated at Larsen & Toubro. The article traces the development of this function and presents results from periodic audits of the function. The article highlights that significant development in the HR function has come about in the last two decades and the function and its leaders are growing in numbers to make a positive impact in terms of achieving organizational objectives. The article concludes with recent trends and studies as indicators of this maturity. The article recommends five levels of HR with the need to focus on the higher levels of work, including intellectual capital formation to make a transformational impact on firm’s success.

Comparison of quantum-dots- and fluorescein-isothiocyanate-based technology for detecting prostate-specific antigen expression in human prostate cancer

Quantum dots (QDs) are a new class of fluorescent labelling for biological and biomedical applications. In this study, the authors evaluated the sensitivity and stability of quantum-dots-based immunolabelling, in comparison with the conventional fluorescein-isothiocyanate-based immunolabelling (FITC), for detecting prostate-specific antigen (PSA) expression in human prostate cancer. The authors' data revealed that the two methods had similar sensitivity in differential display of the PSA expression correlated with tumour stage and grade (=0.88, p<0.001). Moreover, the intensity of QDs fluorescence remain stable for 10 days after conjugation to the PSA protein in 97% of the cases and more than 1 month in 92% of the cases, although the FITC fluorescence became undetectable after 6 min for all cases.

Effect of combination inhibition of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGF-R) on ovarian cancer cell lines

13112

Background: Bevacizumab, a VEGF inhibitor, and cetuximab, an EGF-R inhibitor, have shown promising results in the treatment of solid tumors. The combination of these two antibodies and combinations with platinum chemotherapy is of interest for the treatment of ovarian cancer. Our objective is evaluate the mechanism of action and to determine the direct effect on tumor proliferation, the role of antibody dependent cell cytotoxicity (ADCC) with immune effector cells and the outcome in nude mouse xenografts with antibody treatment combinations. Methods: Five ovarian cancer cell lines were studied; SKOV3, SKOV8, OVCAR3, A2780, and CaOV3. VEGF secretion levels were determined for each cell line by standard ELISA. EGF-R, VEGF-R and VEGF surface expression was determined by flow cytometry. Cytotoxicity alamar blue 96-well plate assays were performed and cells were plated and exposed to bevacizumab or cetuximab alone, in combination and with cisplatin. Standard 51chromium release assays were performed to determine if bevacizumab and cetuximab have a role in ADCC when combined with peripheral blood mononuclear cells (PBMC). Results: All ovarian cancer cell lines secreted VEGF ranging from 210 to 1,849 pg/ml. Flow cytometry studies demonstrated varying degrees of expression of VEGF-R and minimal surface expression of VEGF ligand. EGF-R was present on all cell lines. Five day alamar blue cytotoxicity assays using varying concentrations of single agent bevacizumab (0.1–10 μM) or single agent cetuximab (0.01–1.0 μM) had minimal to no cytotoxic effect on ovarian cancer cell lines. The IC50 for cisplatin in these cell lines was obtained and ranged from 1–5 μM and was not altered by the addition of antibodies. In 51chromium release assays, the combination of bevacizumab and cetuximab caused a trend toward increased SKOV3 cell lysis by PBMC. Conclusion: Bevacizumab or cetuximab alone or in combination with each other in vitro had minimal direct cytotoxic effect. ADCC may be a mechanism of cell lysis when these antibodies are combined with effector cells (PBMC) and further studies are underway. In vivo studies with nude mouse SKOV3 xenografts are being performed to evaluate the effect on combination antibody therapy on established tumors.

No significant financial relationships to disclose.

Environmentally induced autoimmune diseases: potential mechanisms

Environmental and other xenobiotic agents can cause autoimmunity. Examples include drug-induced lupus, toxic oil syndrome, and contaminated l-tryptophan ingestion. Numerous mechanisms, based on (italic)in vitro(/italic) evidence and animal models, have been proposed to explain how xenobiotics induce or accelerate autoimmunity. The majority of these can be divided into three general categories. The first is those inhibiting the processes involved in establishing tolerance by deletion. Inhibiting deletion can result in the release of newly generated autoreactive cells into the periphery. The second mechanism is the modification of gene expression in the cells participating in the immune response, permitting lymphocytes to respond to signals normally insufficient to initiate a response or allowing the antigen-presenting cells to abnormally stimulate a response. Abnormal gene expression can thus disrupt tolerance maintained by suppression or anergy, permitting activation of autoreactive cells. The third is the modification of self-molecules such that they are recognized by the immune system as foreign. Examples illustrating these concepts are presented, and related mechanisms that have the potential to similarly affect the immune system are noted. Some mechanisms appear to be common to a variety of agents, and different mechanisms appear to produce similar diseases. However, evidence that any of these mechanisms are actually responsible for xenobiotic-induced human autoimmune disease is still largely lacking, and the potential for numerous and as yet unidentified mechanisms also exists.

[Smooth intramural and kink-resistant polyester vascular prosthesis]

OBJECTIVE

To study the healing effect, neointimal formation and patency rate of smooth intramural and kink-resistant polyester vascular prosthesis.

METHODS

Experimental implantations of the smooth intramural and kink-resistant polyester vascular prosthesis of internal diameters of 0.6-1. Ocm were performed in segments of abdominal aorta and thoracic descending aorta.

RESULTS

The patency rate was 100% in both abdominal aortic implantations and thoracic descending aortic implantations after postoperative observation for 425 days, while the total patency rate was only 70% in the crimped controls. The thickness of the neointimal linings of both implantation groups was determined, smooth intramural, kink-resistant polyester vascular prostheses were significantly thinner than that using crimped polyester vascular grafts (P < 0.001).

CONCLUSION

Our study proves the feasibility of using smooth intramural and kink-resistant polyester vascular prosthesis to substitute small arteries with an internal diameter of 0.6-1. Ocm.

15N and 1H NMR spectroscopy of the catalytic histidine in chloromethyl ketone-inhibited complexes of serine proteases

The hemiketal hydroxyl groups in chloromethyl ketone (cmk) complexes of trypsin and chymotrypsin have been reported to ionize to the oxyanion with pK(a) values 2-4 pK(a) units below expectations for such a functional group on the basis of the behavior of the hemiketal carbon atom in 13C NMR spectra [Finucane, M. D., & Malthouse, J. P. G. (1992) Biochem. J. 286, 889-900]. The low pK(a) indicates the enzymes selectively stabilize the oxyanion form of the bound inhibitor, and therefore that cmk complexes may be good models of enzyme-mediated transition-state stabilization. However, the 13C NMR studies could not rule out His57 as the titrating group. Here we report the behavior of the ring 15N atoms of His57 in the Ala-Ala-Pro-Val-cmk complex of alpha-lytic protease. Both N(delta 1) and N(epsilon 2) of His57 respond to an ionization with a pK(a) of approximately 7.5, but His57 itself does not titrate as N(epsilon 2) remains alkylated and N(delta 1) remains bonded to a proton over the entire pH range. The species titrating with a pK(a) of approximately 7.5 must therefore be the hemiketal hydroxyl. The results also show that the 1H NMR signal from the proton in the Asp-His hydrogen bond behaves in a characteristic manner in cmk complexes and can be used diagnostically to confirm that His57 does not titrate and to measure the pK(a) of the hemiketal hydroxyl in cmk-protease complexes without resorting to 15N-labeling. We have used the behavior of this signal to directly confirm that His57 does not titrate in the trypsin and chymotrypsin complexes that were the subjects of the original 13C NMR studies.

Characterization of 5-lipoxygenase inhibitors in biochemical and functional in vivo assays

Several potent and selective inhibitors of 5-lipoxygenase (5-LO) have been recently developed with excellent activity in certain in vivo assays of leukotriene production. The efficacy of three such inhibitors that have been in clinical trials (zileuton, A-78773 and ZD2138) were evaluated in: 1) ex vivo whole blood assay, 2) dermal Arthus reaction, and 3) functional airway response. In addition, a model of eicosanoid production in rat lung was developed that provides a simple assay for evaluation of the biochemical efficacy of 5-LO inhibitors in the lung. Bronchoalveolar lavage of rat lung with calcium ionophore A23187 resulted in rapid and robust production of PGE2, 6-keto-PGF1 alpha, thromboxane (TxB2), and leukotriene B4 (LTB4). Supplementation of lavage fluid with archidonic acid markedly augmented production of all eicosanoids except LTB4. All three inhibitors were potent and selective blockers of LTB4 production in the ex vivo whole blood assay and in the dermal Arthus reaction. In contrast, higher doses of inhibitor were needed to block LTB4 production in the rat lung lavage model than were needed to block ex vivo whole blood LTB4 production when both end points were measured in the same animal. Similarly, zileuton and A-78733 were less effective in suppressing the functional airway response to antigen in sensitized guinea pigs, whereas both inhibitors were effective in suppressing LTB4 production in the ex vivo whole blood assay. These results demonstrate that different 5-LO inhibitors have markedly distinct efficacy for inhibition of leukotriene production, depending on the animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular adjustments and gas exchange during extreme hemodilution in humans

OBJECTIVE

To examine the cardiovascular adjustments and pattern of gas exchange that occur during hemodilution.

DESIGN

Nonrandomized prospective study.

SETTING

Operating room in a university hospital.

PATIENTS

Seven patients undergoing elective aortocoronary artery bypass surgery.

INTERVENTIONS

Before initiating cardiopulmonary bypass, the patients' hematocrit levels were decreased to approximately 15%. This hemodilution was done by removing a sufficient amount of autologous blood from the aortic cannula and replacing it with a sufficient amount of crystalloid solution. After the discontinuation of cardiopulmonary bypass, measurements were made at a hematocrit of approximately 15%. Then, after autologous blood infusion, measurements were made at a hematocrit of 20%, followed by more blood infusion to approximately 25% with repeat measurements.

MEASUREMENTS AND MAIN RESULTS

The following measurements were made before hemodilution and then at all three levels of hemodilution: heart rate, mean arterial pressure (MAP), right atrial pressure, mean pulmonary artery pressure, pulmonary artery occlusion pressure, and cardiac output. From these measurements, the following derived variables were calculated: cardiac index, systemic vascular resistance, and pulmonary vascular resistance. From measurements of arterial oxygen content, mixed venous oxygen content, and cardiac output, intrapulmonary shunt (Qsp/Qt), oxygen uptake (VO2), oxygen extraction ratio, and oxygen delivery (DO2) were derived. The MAP was lowest (57 +/- 3 [SD] vs. 92 +/- 3 mm Hg) at the lowest hematocrit. The cardiac index was highest (4.0 +/- 0.3 vs. 2.3 +/- 0.6 L/min.m2) at the lowest hematocrit. DO2 was lowest at the lowest hematocrit but VO2 remained constant at all levels of hematocrit. The oxygen extraction ratio increased as hematocrit decreased. With progressive increases in hematocrit, DO2 increased and Qsp/Qt decreased.

CONCLUSIONS

The data suggest that, during hemodilution, tissue autoregulation of VO2 and utilization are not impaired, but gas exchange function (Qsp/Qt) is impaired.

Effect of opening the pericardium on right ventricular hemodynamics during cardiac surgery

The impact of the pericardium on right ventricular performance in the presence of normal filling pressures was evaluated using a rapid response RVEF thermodilution pulmonary artery catheter and TEE. In eight patients with normal right coronary arteries undergoing coronary artery bypass surgery, hemodynamic measurements revealed increased right ventricular end-diastolic and end-systolic volumes with diminished RVEF after opening the pericardium. In eight additional patients with right coronary artery disease, directionally similar changes in right ventricular volume were seen. Ejection fraction, however, was unchanged possibly due to altered right ventricular compliance. Echocardiogram evaluation of right ventricular area changes in patients with compromised right coronary systems corresponded to ejection fraction determinations obtained with thermodilution technique.

Effect of cardiac output on gas exchange in one-lung atelectasis

To evaluate the effect of administration of dobutamine on gas exchange in patients with one-lung atelectasis during pneumonectomy, ten patients with normal pulmonary function and localized carcinoma of the lung were studied during pulmonary resection. With each patient in the lateral decubitus position, hemodynamic profiles and oxygen transport data were recorded before and after administration of dobutamine at 5 micrograms/kg/min. Patients were ventilated with one-lung anesthesia and administration of 100 percent oxygen. With infusion of dobutamine, the heart rate, cardiac index, and LVSWI significantly increased. Mean arterial pressure increased while PAP fell. Systemic and pulmonary vascular resistance also declined. Arterial oxygenization and delivery improved, while oxygen uptake was unchanged. Pulmonary shunt fraction was significantly reduced. While the mechanism for shunt reduction in our patients is unclear, operative factors may include pulmonary vasodilation with dobutamine inhibition of HPV. The negative impact of reduced HPV may have been lessened by gravitational distribution of blood flow and dobutamine-mediated reduction in PAP in our patients.

Hemodynamic compromise associated with air trapping following coronary artery bypass surgery

Cardiovascular collapse due to pulmonary hyperinflation was noted in a patient with chronic obstructive pulmonary disease following median sternotomy for cardiac surgery. Treatment included bronchodilator therapy to reduce airway obstruction, limitation of minute ventilation, and increasing time available for exhalation. High inspiratory flow rates and expiratory retard may be beneficial.

Self-Renewal of Adult Education Programmes Through Evaluation : A Case Study

The continuous appraisal or evaluation of adult education programmes by external agencies has been an integral part of the design of this programme since the time the Ministry of Education stepped up adult education in the late seventies. Several faculty members of the Indian Institute of Management, Ahmedabad (IIMA) have partici pated in these evaluations since 1979. The State of Rajasthan was assigned for such an evaluation by the IIMA faculty. In the first five evaluation studies conducted, attempts were made to continuously improve the methodology of evaluation from study to study. This article is an attempt to present the evaluation methodologies used in these studies. This presentation is followed by a critical examination of the extent to which such evaluation studies will help in the self-renewal of adult education programmes. Finally some suggestions are made for using the evaluation studies of these programmes for self-renewal and development.

X-ray studies on crystalline complexes involving amino acids and peptides. Part XX. Crystal structures of DL-arginine acetate monohydrate and DL-lysine acetate and a comparison with the corresponding L-amino acid complexes

Crystals of DL-arginine acetate monohydrate, C6H15N4O2+C2H3O2-.H2O, are monoclinic, P2(1)/c, with a = 13.552(2), b = 5.048(2), c = 18.837(3) A, beta = 101.34(2) degrees and Z = 4, and those of DL-lysine acetate, C6H15N2O2+.C2H3O2- are triclinic, P1, with a = 5.471(2), b = 7.656(2), c = 12.841(2) A, alpha = 94.48(1), beta = 94.59(2), gamma = 98.83(2) degrees and Z = 2. The structures have been solved by direct methods and refined to R = 0.058 and 0.077 for 1522 and 1259 observed reflections respectively. The difference in the number and the nature of proton donors leads to a difference in hydrogen bond density in the two structures. The basic elements of aggregation in both the structures are pairs of amino acid molecules, each pair stabilized by two centrosymmetrically related hydrogen bonds involving alpha-amino and alpha-carboxylate groups, stacked along the shortest dimension to form columns. The pairs are held together in each column by head-to-tail sequences. The columns stack along a crystallographic axis to form layers. Adjacent layers are bridged by acetate ions. The amino acid-acetate interactions are primarily through side chains and involve specific interactions and characteristic interaction patterns. The gross features of molecular aggregation are nearly the same in DL-arginine acetate monohydrate and L-arginine acetate whereas they are substantially different in the lysine complexes. In both cases, one of the two head-to-tail sequences in the L complex is replaced by a hydrogen bonded loop involving alpha-amino and alpha-carboxylate groups, in the DL complex. This may have implications for prebiotic condensation during chemical evolution.

The surface composition of commercial polyester arterial prostheses--an XPS study

The importance of identifying and quantifying the level of contaminants on the surface of biomaterials has long been recognized as a significant step towards predicting the biocompatibility and rate of healing of implantable devices. Yet suitable techniques for characterizing the surface chemistry of soft and flexible biomaterials with an uneven surface contour such as those used in vascular prostheses have only recently been made available. As a first step towards determining the effect of surface contaminants on the healing behaviour of vascular prostheses, this study used X-ray photoelectron spectroscopy (XPS) to characterize the surface chemistry of 14 virgin polyester arterial prostheses from a wide variety of sources. Generally speaking, all surfaces appeared relatively clean. However, the results indicate that certain prostheses were not manufactured with Dacron-like fibres, and that some exhibit significantly carbon-rich surfaces. This suggests that the surface of these devices has been modified either by a hydrocarbon lubricant or by vapour phase hydrocarbons during fabrication.

Reduction in mortality from cardiac causes in Goldman class IV patients

In 1977, Goldman et al evaluated cardiac patients for non-cardiac operations and showed a high incidence of cardiac death in high-risk cardiac patients (Goldman class IV). The present study was designed to prospectively evaluate the incidence of cardiac death as well as overall mortality in 49 patients belonging to Goldman class IV at the present time. Four patients of 49 (8.2%) died of cardiac causes, and seven other patients died of non-cardiac causes. Thus, the overall mortality rate was 22.4% (11/49). There has been a marked reduction in cardiac mortality from 56% in Goldman et al's 1977 data to 8.2% in the present data. All of the developments and advances in patient care over the past 10 years probably contributed to this reduction in mortality from cardiac causes.