Before conclusions about their value to atherosclerosis are confirmed It’ll be necessary to investigate these same processes within the context of the artery wall. Pre clinical studies show efficacy in a number of breast, cervix, colorectal, ovary, and pancreas neoplasms. This antitumor effect was increased by the addition of docetaxel in vitro and in vivo a murine model with acceptable toxicity, irrespective of treatment sequence. The HDACI, vorinostat and the mixture of MK 5108, was investigated in numerous lymphoma cell lines. The addition of MK 5108 to CTEP vorinostat sensitized the cell lines to apoptosis, with inhibition of c Myc playing an essential role. A phase 1 study in patients with high level solid tumors examined the toxicities of singleagent MK 5108 and MK 5108 in combination with docetaxel 60mg/m2 IV every 21 days. Myelotoxicity and febrile neutropenia was identified since the dose limiting toxicity in combination individuals, but no DLT was identified within the arm. While partial response was seen in 2 of 17 patients in the combination arm and 0 of 17 within the monotherapy arm, Illness stabilization was seen in 11 of 34 patients from both arms. MLN8054 potently inhibits aurora A kinase Chromoblastomycosis by competitively blocking the ATP binding pocket. Significantly, MLN8054 is structurally and functionally similar to benzodiazepines, ultimately causing the DLT of somnolence at clinically relevant doses. Preclinical studies in a several cell culture and murine xenograft designs shown potent antitumor activity as dependant on direct tumor description and surrogate markers, consistent with aurora A kinase specific inhibition. Furthermore, MLN8054 surely could induce senescence both in vivo and in vitro. This research was the first to ever link aurora A senescence and kinase inhibition, a result typically seen with antimitotic agents. In murine designs, dose related and reversible somnolence and neutropenia were the DLTs. A dose finding study of MLN8054 was performed in 63 patients with advanced level cancer employing once-daily doses of 5 40mg/day being a single dose or 25 80mg/day Letrozole price in four divided doses. Doses above 45mg/day were given with methylphenidate to minimize sleep. The maximum tolerated dose for once daily administration was 60mg/day, 45mg/day if divided into 4 daily doses and 30mg/day if divided into 4 daily doses and used concomitantly with methylphenidate for 7 21 consecutive days of the 35 day period. Somnolence was the sole DLT and no responses were observed with any dose level. An additional dose finding study was done in 43 patients with advanced level cancers analyzing daily doses from 10mg to 80mg orally each day in divided doses. The DLTs recognized were grade 3 reversible somnolence and liver function test elevations. In relation to these results, MLN8054 development was abandoned and only MLN8237. MLN8237 shares structural homology to MLN8054, but has four fold higher inhibitory potency for aurora A kinase and reduced tendency to cause somnolence.
Monthly Archives: August 2013
The effectiveness of different therapeutic strategies for AD
The effectiveness of different therapeutic techniques for AD may depend critically on the timing of the therapy in accordance with the period of plaque development. For Dasatinib c-kit inhibitor example, research using Vitamin E in both young and old Tg2576 rats shows that antioxidant therapy might be useful only when given at a very early stage of the illness process. . Ingredients especially targeting AB technology, including secretase inhibitors, have already been shown to lower amyloid pathology in both young and old Tg2576 mice but might need additional amyloid clearance improving solutions for clinical efficacy. ACAT chemical CI 1011 fits into the same class with effectiveness in both young and old animals and secretase inhibitors with its anti amyloidogenic impact. Our data claim that ACAT inhibitors may increase clearance of AB from the head making this approach even more clinically applicable. Other substances with activities just like CI 1011 have been used in aged mouse types of AD. A 6 month treatment of Tg2576 mice with curcumin was found to decrease amyloid plaque burden and soluble AB levels, while exclusively promoting recruitment of microglia adjacent to plaques. In a related study, a diet enriched with the omega-3 fatty Lymphatic system acid docosahexaenoic acid substantially reduced amyloid load in old Tg2576 rats while decreasing insoluble AB as well as equally and B APP CTF levels within the mind. . A recent review also suggested that DHA may specifically bind and inhibit ACAT1. Perhaps the in vivo neuro-protective effects of DHA include inhibition of ACAT remains to be determined. Constantly elevated expression of APP and/or B CTF may be from the development neurodegenerative pathology in a few AD patients and also in Down syndrome. Although raised APP mRNA or protein levels could be found only in a part of AD patients, like due to promoter mutations or gene duplication, elevated gene dosage of APP due to triplication of the APP gene in DS is clearly order Canagliflozin related to growth of neuropathology and cognitive deficits. Apparently, it would appear that W and APP CTF, however not AB or CTF, may cause the conventional endocytic route disorder characteristic of DS, and together of the first neuropathological changes in late on-set AD which includes also been implicated. In this context, our results suggest that reduced amount of APP holoprotein and/or T CTF levels in mental performance via modulation of ACAT action or other similarly acting APP reducing compounds may be used therapeutically in DS. Future studies is likely to be necessary to characterize the elements of CI 1011 activity and effectiveness on cognitive decline in aged mouse models of AD, but our study shows that a clinically safe and efficacious ACAT inhibitor has the potential to reverse preformed calm amyloid pathology in aged hAPP mice.
JNJ 770621 JNJ 770621 is just a powerful cell cycle inhibito
JNJ 770621 JNJ 770621 is really a potent cell cycle inhibitor targeting cyclin dependent kinases and Aurora Kinases. JNJ 770621 has specificity for AURKA and AURKB as well as CDK1, CDK2, CDK4, Cathepsin Inhibitor 1 and CDK6. The phenotypes exhibited by JNJ 770621 treatment are similar to AURKB inhibition, as an example, reduction in the phosphorylation of histone H3, affected spindle checkpoint function, and endoreduplication. JNJ 770621 was reported to be described as a substrate of ATP binding cassette transporter family member in HeLa cells selected for resistance to JNJ 770621. JNJ 7706621 shows potent antiproliferative activity in cancer cells regardless of p53, retinoblastoma position, or Pglycoprotein phrase level, and is a few fold less potent at inhibiting normal cell growth. The key aftereffects of this substance on cells stem from its capability to stimulate a G2 M arrest and delay transit through the cell cycle. SU6668 SU6668 was fundamentally characterized as an ATP competitive inhibitor of VEGFR2, PDGFR and FGFR1 RTKs in vitro, but, it’s been shown to inhibit Aurora kinases. SU6668 stops AURKA and AURKB, as evidenced by destabilizing the organization and elimination in Metastatic carcinoma the phosphorylation of histone H3, respectively. SU6668 causes defects in centrosome organization, histone modification and spindle assembly, and as a consequence, contributes to a charge in cell cycle progression. SU6668 was noted being an Aurora kinase inhibitor only in a single study, its development was ended in favor of a stronger inhibitor of VEGF receptors, sunitinib, making its use impossible on the level. CCT129202 CCT129202 is an ATP aggressive pot Aurora Kinase chemical inhibiting all three family members Aurora A, B, and C with IC50 values as 0. 042, 0. 198 and 0. 227, (-)-MK 801 respectively. It generally does not influence protein levels of Aurora An and B at IC50, but at higher concentrations. CCT129202 caused G2 M accumulation and induces development of abnormal mitotic spindles with various quantities of chromosome alignment defects. As shown by the reduction in the phosphorylation of histone H3 and p53 stabilization, respectively the molecular mechanism of the motion of CCT129202 is in line with the inhibition of Aurora An and B. CCT129202 has been reported to affect the p21/Rb/E2F pathway and downregulate thymidine kinase 1. Anti-tumor activity has already been noted in human cyst xenografts. Considered that TK1 is required for FLT uptake in vivo, Chan et al have effectively shown that FLT PET can be used to monitor the biological effects of CCT129202 in vivo and noted decrease in cyst FLT preservation using noninvasive PET imaging. AT9283 AT9283, a multitargeted kinase inhibitor, inhibits serine/threonine kinases and several closely linked tyrosine with an IC50 of 10nM including Aurora An and B, JAK and ABL.
AURKAs role in tumor growth AURKA gene amplification and or
AURKAs role in or higher expression and cancer development AURKA gene amplification is a frequent finding in many malignancies including breast, colon, pancreas, ovaries, kidney, liver, and gastric cancers. AURKA over-expression may appear because of gene amplification, transcriptional induction or post translational stabilization. Curiosity about AURKA intensified after a number of preclinical reports demonstrated reversible Aurora Kinase inhibitor the oncogenic potential of AURKA service resulting in the in vitro and in vivo transformation of rat fibroblast cells and the synthesis of multipolar mitotic spindles causing genome instability establishing AURKA like a bona fide oncogene. AURKA over expression has been reported to be significantly associated with a higher grade of a poor prognosis and cyst. Aneuploidy is an excellent sign of tumor development and prognosis caused due to chromosomal instability, the most frequent genomic damage that occurs during cancer development. In gastric carcinoma and in papillary thyroid carcinoma aneuploidy is a marker of metastasis and in several malignancies aneuploidy is associated Meristem with a poor outcome. A connection between AURKA over expression and aneuploidy exists in gastric cancer, clinical samples with AURKA amplification and overexpression showed aneuploidy and poor prognosis. AURKA plays an essential role in growth, and numerous centrosomal problems are observed in AURKAdeficient cells. Centrosomal anomalies have already been reported to develop at early stages of tumor formation and to develop concomitant with tumor progression an activity in agreement with the AURKA expression page pattern which raises from early to late stages of tumor. While no direct link has been discovered between AURKA overexpression and centrosome abnormalities Lapatinib ic50 in cancer, AURKA over expression, centrosome amplification and aneuploidy are always associated. Centrosomal problems cause bi-polar genetic segregation lack, mitotic spindle defects and aneuploidy. Centrosomal aberrations are found in mind, breast, lung, colon and prostrate tumors. Furthermore, centrosome aberrations result in aneuploidy, suggesting that AURKA over-expression is in charge of centrosome amplification, and ergo, participates in tumorigenesis. AURKA binds and phosphorylates the breast cancer associated gene product, BRAC1, in vitro and in vivo to manage its function. It’s reported that ovarian and breast epithelial carcinomas play a role in the regulation of human telomerase reverse transcriptase mRNA levels through h Myc. AURKA has also been reported to override the spindle checkpoint activated by paclitaxel and nocodazole. These defects may subscribe to change. AURKA interacts with the p53 pathway at multiple levels, suggesting these proteins form an integral part of a functional community.
the phosphorylation web sites in trypanosome TbH3 and TbH2B
the phosphorylation sites in trypanosome TbH3 and TbH2B were evaluated by LC MS. In each case, the phosphorylation site was discovered inside the carboxyl region of the protein, although not inside the variable amino Chk1 inhibitor terminal tail region. TbH3 was phosphorylated on T116 within the peptide DTNRACIHSGRVT IQPK. That deposit corresponds to T118 in human and S. cerevisae histone H3. TbH2B was phosphorylated on T77 within the peptide KRT LGARELQTAVR. This deposit refers to T88 in human and T90 in S. cerevisae. Attempts were made to verify these sites were utilized in vivo. We’re able to not discover this phosphorylation by LC/MS/MS of histones that had been acid extracted from chromatin or subsequent acid extraction of the total cell homogenate. Our strategies can not exclude the possibility that phosphorylation occurs inside a small region of the chromatin, and only transiently at one stage of the cell cycle. Nevertheless, phosphorylation of TbH3 is used as a substrate for our in vitro kinase assay to measure sensitivity of TbAUK1 to the small molecule inhibitor Hesperadin. Hesperadin inhibits TbAUK1 activity and development of BF and PF countries Hesperadin can be an chemical of Aurora B. Its sulfonamide group extends Papillary thyroid cancer beyond the ATP pocket and into the adjacent hydrophobic pocket. To judge binding of Hesperadin to TbAUK1, molecular models were made. The crystal structure of Xenopus Aurora W with Hesperadin bound inside the ATP pocket was employed as a template. As a control for the techniques, we also modeled human Aurora An as template using the same Xenopus Aurora B crystal structure. Hesperadin was within the template during modeling, but it was removed before the models were permitted to flake out by usage of a conjugant gradient energy minimization routine Dasatinib BMS-354825 within the NAMD molecular dynamics package. The structures were then found in Hesperadin docking experiments. Of the 25 greatest affinity Hesperadin dockings to the human Aurora A model, we observed that 22 bound to the ATP pocket. These results are consistent with the crystal structures obtained with Aurora B. By contrast, only 3 of the 25 greatest affinity Hesperadin dockings localized for the ATP pocket in the TbAUK1 model. Many dockings were close to the C helix. The affinities for these interactions varied in the range of 0. 2 1. 1 uM for the individual Aurora A model and 1. 4 3. 6 uM for the design. These values are not dramatically different due to the known limitations associated with estimating binding affinities from in silico docking calculations. These data claim that small molecule inhibitors can bind to novel and conserved sites in TbAUK1 in comparison to the human host proteins. Hesperadin was examined using the in vitro analysis. It inhibited the TbAUK1 mediated phosphoryation of TbH3 in a dose-dependent manner.
Immunohistochemical studies showed powerful AURKA expression
Immunohistochemical analyses showed strong AURKA expression in most of the main tumor samples and poor to moderate expression among a notable community. AURKA is vital for bi-polar spindle assembly and proliferation of somatic cells and ergo a great target for halting cell development and inducing apoptosis, not surprisingly from its documented role in mitosis. It is conceivable that selective inhibition of AURKA results in activation of the spindle assembly checkpoint Ibrutinib price and extended mitotic charge, resulting in apoptosis, in much the same way as microtubule toxins or kinesis spindle protein inhibitors. This effect is likely to be exacerbated by the complete cytotoxic action of paclitaxel, which balances microtubules by binding tubulin and disrupts microtubule dis-assembly, causing cells to build up in the transition between metaphase and anaphase and ultimately causing apoptotic death. Such robust antiproliferative effect of AURKA inhibition in conjunction with paclitaxel makes this an attractive therapeutic Organism technique for HNSCC. Further investigations in to smallmolecule inhibitors of AURKA either alone or combined with chemotherapeutic agents are warranted. Purpose Patients with persistent pulmonary hypertension who demonstrate a pulmonary vasodilation following calcium channel blocker administration are understood to be responders. In contrast, non responders pifithrin alpha are individuals who don’t show such a pulmonary vasodilation with CCB treatment. The objective of this investigation was to examine the effects of CCB treatment on right heart aspects in experimental CCB responders versus CCB non responders. Methods In 12 puppies, right atrial and ventricular pressure and volume were simultaneously recorded after a few months of progressive pulmonary artery banding. Diltiazem was given at 10 mg/hr with all the PA constricted. Responders were then developed by releasing the ventricle to be unloaded by the PA band. RA and RV contractility and diastolic stiffness were determined and RA reservoir and channel purpose were quantified as RA inflow with the tricuspid valve closed versus open, respectively. Benefits With CCB, RA contractility and cardiac output were sacrificed in simulated non-responders while RA stroke work was pharmacologically depressed within the environment of an unchanged afterload. After replicating a responder by controlled PA group launch, the RA turned less distensible, producing a shift from reservoir to gateway function towards physiologic baseline conditions and a recovery in the hyperdynamic compensatory response in both chambers as shown in a declined RA and RV contractility using an improved cardiac output as compared to CPH and simulated non responders.
angiotensin converting enzyme inhibitors are considered the
angiotensin converting enzyme inhibitors are the initial drug class of preference by some investigators, it’s probably more vital that you address to accomplish target blood pressure levels than to insist on a specific antihypertensive agent. 33,84 With that warning, and until there are reasons to favor another blood pressure lowering agent, ACE inhibitors are a nice-looking first-line agent. Lapatinib Tykerb They’ve favorable effects to the cardiovascular system well beyond their blood pressure lowering capabilities. 85,86 In the HOPE trial, individuals with known vascular illness or diabetes and 1 other cardiovascular risk factor were randomized to ramipril or placebo. Patients treated with ramipril experienced a 22-year reduction in the principal composite end-point of MI, stroke, or cardio-vascular death despite small blood pressure lowering. 87 Similar cardiovascular event reductions were observed with perindopril in 12,218 patients with stable CAD, 883 of whom had PAD. 88 Although there continues to be the opinion that fi blockers Inguinal canal worsen claudication symptoms in patients with PAD, a meta-analysis of 11 randomized controlled trials by Radack and Deck89 clearly showed that fi blockers don’t worsen claudication in patients with PAD and works extremely well if clearly indicated. 33 The part of diabetes management in patients with PAD is discussed in detail elsewhere. 26 Anti-thrombotic Therapy. Aspirin. Antiplatelet agents such as aspirin are indicated for secondary prevention in high-risk cardiovascular patients. Even though gains of aspirin in patients with carotid artery disease and CAD have been demonstrated by large scale scientific trials,90,91 many recent reports have questioned the efficacy of aspirin in patients with PAD. 92,93 Ivacaftor molecular weight Yet, the American College of Cardiology/American Heart Association Tips for the Management of Patients With Peripheral Arterial Disease and the Inter Society Consensus for the Management of Peripheral Arterial Disease support aspirin use in patients with PAD. 4,94 The Anti-thrombotic Trialists Collaboration reviewed 287 randomized trials including over 135,000 patients and reported that the odds of a vascular event were reduced by 22-year in high-risk patients receiving anti-platelet therapy. 90 Within the 9214 patients with PAD, anti-platelet drugs paid down serious vascular events by 23%. A similar decline was observed in patients with intermittent claudication and in patients undergoing peripheral by-pass graft procedures or angioplasty. 90 In a current meta analysis by Berger et al92 evaluating 5269 participants and 18 trials, cardiovascular events were experienced by 269 of 2446 participants in the get a handle on group and by 251 of 2823 patients taking aspirin. Although not statistically significant, the point estimate showed a great development.
Enhanced expression of OGG1 and other BER enzymes may protec
Enhanced expression of OGG1 and other BER minerals may protect neurological stem progenitor cells from eatures: similar signalling pathways may control self renewal in stem cells and cancer cells, and cancer cells may include cancer stem cells rare cells with indefinite possibility of self renewal and differentiation that drive tumorigenesis. Reveal ALK inhibitor familiarity with the scientific distinctness of cancer stem cells could be critical for the development of specific treatments directed to tumor eradication. Specifically, the existence of cells endowed with features of cancer initiating purpose and primitive progenitor cells has been demonstrated in high grade gliomas. 3. 1. High-grade Gliomas. Despite aggressive medical resections using preoperative and intra-operative neuroimaging, along with recent developments in radiotherapy and chemotherapy, the prognosis for high grade glioma patients remains dismal, the mean survival being 24-60 months for patients with anaplastic astrocytoma grade III and 12-15 months for patients with glioblastoma multiforme. Proven prognostic facets are restricted and Plastid include age at diagnosis, Karnofsky performance status, extent of surgery and probably MGMT promoter methylation. Standard treatment involves resection of 9-5ers of the cyst, followed closely by concurrent chemotherapy and radiotherapy. Malignant gliomas are connected with such dismal prognoses partly because glioma cells may earnestly migrate through the brain, frequently traveling relatively long distances, making them challenging targets for nearly invariable sources and effective surgery of relapse. In young ones, the management of high-grade gliomas remains an even greater problem for neuro oncologists partly because of the greater vulnerability of the developing mind to treatment related toxicity. 3. 2. Roots of Glioma Stem Cells. It maintains a qualification of plasticity throughout living, including axonal remodeling, synaptogenesis, but also neural cell birth, migration and integration, although the brain is wholly established Erlotinib clinical trial and organized couple weeks after birth. The SVZ and the dentate gyrus of the hippocampus are the two main neurogenic sites in the adult brain. NSC make progenitors that possess migratory ability and have a home in these structures. One recent modern model suggests that gliomas may arise in the transformation of neural stem or progenitor cells, coming cancer cells that are undifferentiated, selfrenewing, together with the capacity for driving tumor development and designated glioma stem cells, because of their stem like qualities. The origin of GSC is investigated by activating oncogenic K RAS in adult SVZ cells and mouse neuronal precursor cells. E RAS triggered mice showed a marked growth of stem-cell numbers within the SVZ and developed intermediate level, infiltrating glioma with a large number of penetrance.
Presence of gene expression as determined by gene expression
Presence of gene expression as determined by gene expression profiling according to PANP has to be interpreted as presence above the background level viewed for unspecific hybridization for negative strand related probesets. Alternate explanations are a more higher level patient citizenry, or even a contamination by other cell types, as in these series, purity of CD138 sorted plasma cells was only assessed by morphology, and expression of Aurora An and B could possibly be discovered in just about all our bone marrow samples. The reduced frequency of Aurora B compared to Aurora An expression in the same sample as detected by GEP appears Tipifarnib R115777 also to be related to the diagnosis threshold: In typical plasma cells, the expression levels of Aurora An and B are of the same height, however the differential expression of Aurora An in growing plasmablastic cells and myeloma cell lines is higher compared to Aurora B. Despite of the tight correlation between gene expression profiling and qRT PCR, qRT PCR shows an identical expression level for myeloma cell lines when it comes to Aurora An and B expression. All examples expressing Aurora W by PANP communicate likewise Aurora A. Natural implications Aurora kinases have been related to genetic instability 8 and growth 7 in different cancer organizations 9 14, including multiple myeloma 25. Aurora An and B are expressed in every myeloma cell lines and proliferating 36 plasmablastic cells, and are somewhat higher expressed in these two in comparison to memory B cells or normal plasma cells. At the Eumycetoma same time, expression of Aurora An and B correlates with the plasma cell labeling index determined by PI staining as well as the gene expression based proliferation index. Thus, Aurora kinase expression is clearly connected with growth in multiple myeloma. As chromosomal aberrations could be found by iFISH in virtually all primary myeloma cells 5,6, e. g. in all our patients tested, but only myeloma cells from a small portion of myeloma patients communicate Aurora An or B, Aurora kinase Lu AA21004 expression in CD138 positive primary myeloma cells cannot be the reason for aneuploidy or ongoing genetic instability in myeloma. Two further strong arguments are given by the fact that Aurora An or B expression height neither correlates with the mean number of chromosomal aberrations in a individual test, or the presence of subclonal aberrations, but to the contrary, presence of subclonal aberrations at all is somewhat associated with the absence of Aurora expression. Exactly the same holds true when the presence of specific subclonal aberrations is considered versus. clonal gain or normal copy variety state with the exception of deletions of 8p21. It is interesting to signify that aberrations of 1q21, 13q14. 8p21 and 3, the very first two connected with advanced stages 52, 53, are much more regular in myeloma cells expressing Aurora A.
The per cent atheroma size measured by IVUS in 274 people wa
The per cent atheroma volume measured by IVUS in 274 individuals was relatively unchanged in the amlodipine group, and increased notably in the enalapril group,, and significantly in the placebo group. There is no statistical difference in percent change in atheroma volume across organizations. 2. 1. 2. Angiotensin Converting Enzyme Inhibitors and Angiotensin Tipifarnib solubility II Receptor Blockers. The Prevention of Atherosclerosis with Ramipril Collaborative Research Group reviewed the anti atherosclerotic effect of ramipril or placebo in individuals with coronary or other occlusive arterial disease. B mode ultrasonography revealed no structural distinction between groups in changes in keeping carotid artery wall thickness or in carotid plaque report at 2 and 4 years with a tendency toward a benefit in death from cardio-vascular events. The Study to Gauge Carotid Ultrasound improvements with Ramipril and Vitamin E, a substudy of the Heart Outcomes Prevention Evaluation trial, used W mode carotid ultrasonography to observe atherosclerotic lesions in patients aged 55 years or older with vascular disease or diabetes and at the very least another risk Immune system factor. Ramipril paid down carotid artery atherosclerosis advancement prices, as measured by intimal medial thickness. In a quantitative coronary angiography substudy of 450 randomly selected patients from the Quinapril Ischemic Event Trial, quinapril did not differ from placebo in development of coronary atherosclerosis, new stenosis growth, change in minimal lumen diameter index, or change in percent diameter stenosis index. Similar results were obtained from another quantitative coronary angiography review, the Simvastatin/Enalapril Coronary Atherosclerosis Trial, where Enalapril did not show regression in atheroma volume, but showed a considerably lower combined end-point of death/myocardial infarction/stroke than placebo. The anti atherosclerotic effects of Angiotensin II receptor blockers were CTEP elucidated in animal models. The MORE research used 2D ultrasound to gauge the changes in accordance carotid intima media thickness in hypertensive patients treated with olmesartan. Olmesartan dramatically paid down the atheroma level of larger atherosclerotic plaques in contrast to atenolol. The result of ARB on atheroma volume in coronary arteries was examined in 64 patients with nonocclusive left main CAD. Successive IVUS studies were performed at baseline and after 7 month followup. In the ARB party, vessel size catalog dramatically decreased throughout followup. These clinical trials suggest that ARB may cause regression of atherosclerosis in the vascular beds of individuals. 2. 1. 3. B Adrenergic Receptor Blockers. W Adrenergic receptor blockers reduce recurrent myocardial infarction, unexpected cardiac death, and all-cause mortality in patients after myocardial infarction.