Objectives: To compare initial and one year costs of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the stent or surgery trial. Design: Prospective, unblinded, randomised trial. Setting: Multicentre study. Patients: 988 patients with multivessel disease. Interventions: CABG and stent assisted PCI. Main outcome measures: Initial hospitalisation and one year follow up costs. Results: At one year mortality was 2.5% in the PCI arm and 0.8% in the CABG arm (p = 0.05). There was no difference in the composite of death or Q wave myocardial infarction (6.9% for PCI v 8.1% for CABG, p = 0.49). There were more repeat revascularisations with PCI (17.2% v 4.2% for CABG). There was no significant difference in utility between arms at six months or at one year. Quality adjusted life years were similar 0.6938 for PCI v 0.6954 for PCI, D = 0.00154, 95% confidence interval (CI) 20.0242 to 0.0273). Initial length of stay was longer with CABG (12.2 v 5.4 days with PCI, p , 0.0001) and initial hospitalisation costs were higher (£7321 v £3884 for PCI, D = £3437, 95% CI £3040 to £3848). At one year the cost difference narrowed but costs remained higher for CABG (£8905 v £6296 for PCI, D = £2609, 95% CI £1769 to £3314). Conclusions: Over one year, CABG was more expensive and offered greater survival than PCI but little added benefit in terms of quality adjusted life years. The additional cost of CABG can be justified only if it offers continuing benefit at no further increase in cost relative to PCI over several years.
[4] reflects relative specificity for the meta-phenolate pyridinium structure with a 5-hydroxymethyl function. Taking advantage of this specificity, binding proteins for B6 have been isolated from renal brush border plasma membranes subjected to affinity chromatography on 4'-nvridoxamino affinoses [51.Since the B6 transporter can accept analogues differing at position 4, it became clear one might compete with entry of the vitamin or even gain facilitated entry of N-(4'-pyridoxyl)amines which are derivatives of pyridoxamine. If the latter occurred, it would seem likely that pyridoxal kinase could catalyze phosphorylation of such analogues, because the kinase accepts all three natural vitaminic forms of B6 and several other 4f-substituted analogues [6][7][8]. The resulting N-(5'-phospho-4f-pyridoxypamines would be good substrates for the pyridoxamine (pyridoxine) 5f-phosphate oxidase which can act upon diverse 4'-secondary amines of B6 phosphate [9][10][11][12]. Hence, if 4'-(N)-substituted pyridoxamines gained facilitated entry into cells with cytosolic kinase and oxidase activities, the end result would be formation of pyridoxal 5-phosphate with release of the original amine that had been covalently attached to B6. That this is the case has recently been demonstrated for proximal tubular cells from rat kidney [13], and will be shown herein for both bipolar kidney and liver cells. As will be discussed, this provides one of several means to deliver cellular effectors by transporter-enhanced delivery followed by enzymecatalyzed release.
Synthesis of 1,3-Diketones Using α-Diazo Ketones and Aldehydes in the Presence of Tin(II) Chloride.-Reaction of the α-diazo ketones (I) with the aldehydes (II) in the presence of tin(II) chloride gives the unsymmetrical 1,3-diketones (III). In the case of the diazo ketones (IV) and (VII), bearing a diazo ketone moiety and another carbonyl group located close in space, the intermediate α-diazo β-hydroxy keto derivatives (V) and (VIII) are isolated. Further treatment of (V) with Lewis acid forms the diones (VI). Additional examples are given in the original paper. -(PADWA, A.; HORNBUCKLE, S. F.; ZHANG, Z.; ZHI, L.; J.
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