The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA'S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial's conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified.

Angioplasty↗

PubMedDate not supplied

Structure of 5' regions and expression of phenobarbital-inducible rabbit cytochrome P450IIC genes.

To analyze phenobarbital-inducible genes in the P450IIC subfamily, fragments of rabbit genomic DNA containing portions of the P450IIC1 and P450IIC4 genes were isolated and the DNA sequences of the 5'-flanking regions and exons were determined and compared to that of the P450IIC2 gene. The sequences have consensus TATA motifs about 20 bp from the mRNA initiation sites as determined by single-strand nuclease mapping and primer extension. Sequences similar to those for proposed liver-specific regulatory factors, HNF-1 and CCAAT, are found in the P450 5'-flanking regions. A glucocorticoid response element is present in the P450IIC2 gene but is not conserved in P450IIC1 or P450IIC4. Other sequences similar to binding sites for AP-1, the octamer binding proteins, and SPH-1 are present. Except for the TATA motif, none of the potential regulatory sequences was conserved at the same location in the different genes. The P450IIC1 and P450IIC2 genes exhibited high similarity detectable by dot matrix analysis throughout the 700 bp of sequenced 5'-flanking region while the P450IIC4 gene exhibited high similarity to both P450IIC1 and P450IIC2 only for about -150 nucleotides from the RNA initiation site. Southern analysis using probes from the 5' region of the P450IIC4 gene suggests that there are at least three closely related members in the P450IIC4 subgroup in agreement with previous studies. After phenobarbital treatment, levels of P450IIC4 mRNA increased about fourfold, as measured by dot blot hybridization with a P450IIC4-specific oligonucleotide probe or by single-strand nuclease mapping of the 5' end of the mRNA, indicating that the P450IIC4 gene characterized in this study is responsive to phenobarbital. Phenobarbital treatment of rabbits increased in vitro transcription of RNA for both the P450IIC1/2 and P450IIC4 gene subgroups but only slightly and transiently for the constitutive P450IIC3 gene.

Amino Acid Sequence↗

PubMedDate not supplied

Transformational complexity and sentence difficulty: a developmental study.

Explore the source record for details and available documents.

Age Factors↗

PubMedDate not supplied

Breast-feeding in the workplace: how to succeed.

As the numbers of women of childbearing age in the workforce continue to increase, some employers and employees have viewed maternal employment to be incompatible with breast-feeding. This qualitative study investigated factors that hindered as well as facilitated breast-feeding in the workplace. Findings suggest breast-feeding and employment can and should be compatible.

Adaptation, Psychological↗

PubMedDate not supplied