Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Droplet Striations Formed in a 900-MHz Microwave Argon Atmospheric-Pressure Plasma Jet

Unique striations were observed in the formation of 900-MHz microwave argon atmospheric-pressure plasma jet in air. The striated patterns are easily observed even with the naked eyes at a flow rate of above 3 slm and an input power of below 3 W. Moreover, the striated patterns, which were associated with shortening in the plasma jet length, are obtained by adding less than 1 vol.% of O-2 gas to Ar.X114sciescopu

Correlation of Striated Discharge Patterns With Operating Conditions in Helium and Argon Atmospheric-Pressure Plasma Jets

This paper presents the evolution of striated discharge patterns in helium and argon atmospheric-pressure plasma jets as a function of gas flow rate and driving voltage. The striated patterns have been observed in helium and argon plasma jets at gas flow rates above 5 and 3 L/min, respectively. The striation patterns appear over the entire voltage range used for investigation (from 4 to 8 kV) in the helium plasma jet, whereas in the argon plasma jet, striation patterns appear over a limited voltage range (from 5.5 to 6.5 kV).X1177sciescopu

Atmospheric Pressure Plasma Jet Composed of Three Electrodes: Application to Tooth Bleaching

Three-electrode plasma jet system consisting of a perforated dielectric tube with two outer and one floating inner electrodes was developed and employed for tooth bleaching. Lowered gas breakdown voltage and increased discharge current were achieved by using the floating inner electrode. Optical emission spectra analysis showed that the rotational temperature of the second positive nitrogen bands was approximate to 290 K and vibrational temperature was approximate to 2 500 K, which means this plasma is in highly non-quilibrium state and nonthermal. The presence of excited He, N-2, H-2(+) and O in the plasma plume was revealed. The plasma jet was used in combination with hydrogen peroxide (H2O2) to remove stains from extracted teeth stained by either coffee or red wine. Combining the plasma jet and H2O2 improved the bleaching efficacy by a factor of 3.1 (coffee) and 3.7 (red wine) compared with using H2O2 alone.X1199107sciescopu

900-MHz Nonthermal Atmospheric Pressure Plasma Jet for Biomedical Applications

A portable microwave-excited atmospheric pressure plasma jet (APPJ) using a coaxial transmission line resonator is introduced for applications of plasma biomedicine. Its unique feature includes the portability and no need for matching network and cooling system with high power efficiency, operating at 900 MHz with low ignition power less than 2.5W in argon at atmospheric pressure. The temperature at the downstream of the APPJ stays less than 47 degrees C (approximate to 320K) during 5 min of continuous operation. The optical emission spectrum of the APPJ shows various reactive radicals such as OH, NO, and 0 which are responsible for biomedicine. The APPJ was applied to investigate the acceleration of blood coagulation, which occurred within 20s of plasma treatment in vitro and within 1 min in vivo. This is significantly faster than the natural coagulation.X114849sciescopu

Modeling of Nanoparticle-Mediated Electric Field Enhancement Inside Biological Cells Exposed to AC Electric Fields

We present in this article the effect of alternating electric field at kilohertz (kHz) and megahertz (MHz) frequencies on the biological cells in presence and absence of nanoparticles. The induced electric field strength distribution in the region around cell membrane and nucleus envelope display different behavior at kHz and MHz frequencies. The attachment of gold nanoparticles,(GNPs), especially gold nanowires around the surface of nucleus induce enhanced electric field strengths. The induced field strengths are, dependent on the length of nanowire and create varying field regions when the length of nanowire is increased from 2 to 4 mu m. The varying nanowire length increased the induced field strengths inside nucleoplasm and region adjacent to the nucleus in the cytoplasm. We investigated a process of electrostatic disruption of nucleus membrane when the induced electric field strength across the nucleus exceeds its tensile strength. (C) 2009 The Japan Society of Applied PhysicsX11109sciescopu

Feasibility of nonthermal atmospheric pressure plasma for intracoronal bleaching

P>Aim To investigate the effect of nonthermal atmospheric pressure plasma on intracoronal tooth bleaching in blood stained human teeth. Methodology Forty extracted single-root and blood stained human teeth were used. The teeth were randomly divided into two groups (n = 20): group 1 received 30% HP activated by nonthermal atmospheric pressure plasma in the pulp chamber for 30 min, whilst group 2 received 30% HP alone in the pulp chamber for 30 min. The overall colour changes (Delta E) were assessed using the Commission Internationale de L&apos;Eclairage (CIE) Lab Colour System. The data were analysed using Student&apos;s t-test to determine the significant differences. Results The temperature of all teeth was maintained at approximately 37 degrees C during plasma bleaching. The plasma treatment with 30% HP resulted in significantly higher bleaching efficacy compared to 30% HP alone in discoloured teeth (P < 0.05). The average Delta E values of group 1 and group 2 were 9.24 (0.37) and 4.47 (1.62), respectively, at 30 min. Conclusions The application of nonthermal atmospheric pressure plasma to intracoronal bleaching could be a novel and efficient therapy in the bleaching of haemorrhagically stained teeth.X113735sciescopu

Reactive hydroxyl radical-driven oral bacterial inactivation by radio frequency atmospheric plasma

We demonstrated bacterial (Streptococcus mutans) inactivation by a radio frequency power driven atmospheric pressure plasma torch with H2O2 entrained in the feedstock gas. Optical emission spectroscopy identified substantial excited state center dot OH generation inside the plasma and relative center dot OH formation was verified by optical absorption. The bacterial inactivation rate increased with increasing center dot OH generation and reached a maximum 5-log(10) reduction with 0.6% H2O2 vapor. Generation of large amounts of toxic ozone is drawback of plasma bacterial inactivation, thus it is significant that the ozone concentration falls within recommended safe allowable levels with addition of H2O2 vapor to the plasma. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3574639]open112532sciescopu

Medical students&rsquo; knowledge, attitude, and practice of complementary and alternative medicine: a pre- and post-exposure survey in Majmaah University, Saudi Arabia

Mohammed Abdullah Al Mansour,1 Abdullah MN Al-Bedah,2 Mohammed Othman AlRukban,3 Ibrahim S Elsubai,2 Elsadiq Yousif Mohamed,4 Ahmed Tawfik El Olemy,2 Asim AH Khalil,2 Mohamed KM Khalil,2 Meshari Saleh Alqaed,2 Abdullah Almudaiheem,2 Waqas Sami Mahmoud,4 Khalid Altohami Medani,4 Naseem Akhtar Qureshi2 1College of Medicine, Majmaah University, Al Majma&rsquo;ah, 2National Center of Complementary and Alternative Medicine, Ministry of Health, 3Department of Family Medicine and Community Medicine, College of Medicine, King Saud University, Riyadh, 4Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Al Majma&rsquo;ah, Saudi Arabia Background: Evidently, complementary and alternative medicine (CAM) is a recognized medical practice that efficiently uses multiple treatment therapies and techniques in the prevention and management of a variety of human disorders. Many medical schools have integrated CAM curriculum in medical education system worldwide. Research in knowledge, attitude, and practice (KAP) of diverse health professionals exposed to CAM courses is important from many perspectives including improvement in KAP and teaching skills of faculty, together with capacity building and curriculum development.Objective and setting: This pre- and post-design cross-sectional study aimed to assess CAM-KAP of two intakes of medical students in Majmaah University, Saudi Arabia.Methods: The second-year medical students of the first (year 2012&ndash;2013) and second (year 2013&ndash;2014) intake (n=26 and 39, respectively) were selected for this study. A reliable, 16-item self-administered questionnaire was distributed among all the students for answering before and after the 48-hour CAM course. The data were analyzed using appropriate statistical test of significance.Results: Medical students&rsquo; knowledge and attitude toward CAM significantly improved across some subitems of CAM questionnaire with a positive trend in the rest of its items including their views on CAM practices.Conclusion: CAM course tends to have a positive impact on KAP of medical students. The preliminary results of this study call for further research with a larger sample in academic settings across the nation.Keywords: traditional medical system, medical schools, undergraduate medical students, curriculum, Saudi Arabi