Staged versus ＂one-time＂ multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome

Objective To evaluate the clinical outcomes of ＂one-time＂ versus staged multivessel stenting in elderly （〉 60 years）patients with non-ST-elevation acute coronary syndrome （NSTE-ACS） and multivessel disease （MVD）. Methods We analyzed data of consecutive NSTE-ACS patients with multivessel percutaneous coronary intervention （PCI） who were enrolled in General Hospital of Shenyang Military Region between 2008 and 2012. A total of 1090 eligible patients aged 〉 60 were further categorized into ＂one-time＂ group （n = 623） and staged PCI group （n = 467） according to intervention strategy. The primary endpoint was composite outcome of myocardial infarction （MI） or cardiac death during 3-year follow-up. Results The estimated 3-year composite rate of cardiac death or MI was 7.0% in the staged PCI group and 9.5% in the ＂one-time＂ group （P = 0.110）. Multivariate analysis confmned the benefit of staged PCI on the primary events in the elderly （HR： 0.638, 95% CI： 0.408-3.998, P = 0.049）. In a propensity score matched cohort, staged PCI was associated with lower rates of primary events （6.1% vs. 10.4%, P = 0.046） and MI （3.4% vs. 7.4%, P = 0.037） at three years. In addition, there were reduced trends in the stent thrombosis at 30 days （0.3% vs. 1.4%, P = 0.177） and at three years （1.1% vs. 2.4%, P = 0.199） in the staged PCI group. There was no significant difference in the 3-year target vessel revascularization （15.5% vs. 14.4%, P = 0.746）. Conclusions In elderly NSTE-ACS patients with MVD, staged PCI might be an optimal strategy associated with reduced long-term cardiac death or MI compared with ＂one-time＂ PCI strategy, which needs further confirmation.

Microencapsulation of immunoglobulin Y: optimization with response surface morphology and controlled release during simulated gastrointestinal digestion

Immunoglobulin Y(Ig Y)is an effective orally administered antibody used to protect against various intestinal pathogens,but which cannot tolerate the acidic gastric environment.In this study,Ig Y was microencapsulated by alginate(ALG)and coated with chitooligosaccharide(COS).A response surface methodology was used to optimize the formulation,and a simulated gastrointestinal(GI)digestion(SGID)system to evaluate the controlled release of microencapsulated Ig Y.The microcapsule formulation was optimized as an ALG concentration of 1.56%(15.6 g/L),COS level of 0.61%(6.1 g/L),and Ig Y/ALG ratio of 62.44%(mass ratio).The microcapsules prepared following this formulation had an encapsulation efficiency of 65.19%,a loading capacity of 33.75%,and an average particle size of 588.75μm.Under this optimum formulation,the coating of COS provided a less porous and more continuous microstructure by filling the cracks on the surface,and thus the GI release rate of encapsulated Ig Y was significantly reduced.The release of encapsulated Ig Y during simulated gastric and intestinal digestion well fitted the zero-order and first-order kinetics functions,respectively.The microcapsule also allowed the Ig Y to retain 84.37%immune-activity after 4 h simulated GI digestion,significantly higher than that for unprotected Ig Y(5.33%).This approach could provide an efficient way to preserve Ig Y and improve its performance in the GI tract.