28 research outputs found

    HEART UK Consensus Statement on Lipoprotein(a) - a call to action

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    Lipoprotein(a), Lp(a), is a modified atherogenic low-density lipoprotein particle that contains apolipoprotein(a). Its levels are highly heritable and variable in the population. This consensus statement by HEART UK is based on the evidence that Lp(a) is an independent cardiovascular disease (CVD) risk factor, provides recommendations for its measurement in clinical practice and reviews current and emerging therapeutic strategies to reduce CVD risk. Ten statements summarise the most salient points for practitioners and patients with high Lp(a). HEART UK recommends that Lp(a) is measured in adults as follows: 1)those with a personal or family history of premature atherosclerotic CVD; 2)those with first-degree relatives who have Lp(a)levels > 200nmol/l; 3) patients with familial hypercholesterolemia; 4) patients with calcific aortic valve stenosis and 5) those with borderline (but<15%) 10 year risk of a cardiovascular event. The management of patients with raised Lp(a) levels should include: 1) reducing overall atherosclerotic risk; 2)controlling dyslipidemia with a desirable nonHDL-cholesterol level of <100mg/d (2.5mmol/l) and 3) consideration of lipoprotein apheresis

    HEART UK statement on the management of homozygous familial hypercholesterolaemia in the United Kingdom

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    This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and bile acid sequestrants. Two new classes of drug, effective in lowering cholesterol in HoFH, are now licensed in the United Kingdom. Lomitapide is restricted to use in HoFH but, may cause fatty liver and is very expensive. PCSK9 inhibitors are quite effective in receptor defective HoFH, are safe and are less expensive. Lower treatment targets for lipid lowering in HoFH, in line with those for the general FH population, have been proposed to improve cardiovascular outcomes. HEART UK presents a strategy combining Lp apheresis with pharmacological treatment to achieve these targets in the United Kingdom (UK). Improved provision of Lp apheresis by use of existing infrastructure for extracorporeal treatments such as renal dialysis is promoted. The clinical management of adults and children with HoFH including advice on pregnancy and contraception are addressed. A premise of the HEART UK strategy is that the risk of early use of drug treatments beyond their licensed age restriction may be balanced against risks of liver transplantation or ineffective treatment in severely affected patients. This may be of interest beyond the UK

    The Solidification Behavior of Slags: Phenomena Related to Mold Slags

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    An Investigation of the Crystallization of a Continuous Casting Mold Slag Using the Single Hot Thermocouple Technique

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    The conditions under which crystallization develops in a mold slag must be understood in order to select or design a mold flux for use in the continuous casting of steels. In this paper, the crystallization of an industrial mold slag was quantified using a single hot thermocouple technique which, when combined with a video camera based observation system, allowed observation of the onset and growth of the crystals which were precipitated from the melt. The beginning of crystallization was determined by direct observation and the growth rate of crystals were measured by frame by frame image analysis of recordings of the progress of crystallization. Isothermal experiments were performed at different temperatures and a Time-Temperature-Transformation (TTT) diagram was determined for this industrial mold slag. X-ray diffraction of quenched samples was used to determine the type of crystalline phases that were precipitated. The TTT diagram was divided into two separate regions which corresponded to the precipitation of dicalcium silicate (Ca2SiO4) at temperatures over 1050°C and of Cuspidine (Ca4Si2O7F2) at temperatures below 1050°C. The evolution crystal fraction was described by Avrami's equation. This work indicates that industrial mold slags are easily undercooled, that crystallization occurs throughout the melt, that crystals grow initially as equiaxed dendrites and that the onset of crystallization is a function of cooling rate and must be described by either TTT or CCT curves

    Development of Double and Single Hot Thermocouple Technique for in Situ Observation and Measurement of Mold Slag Crystallization

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    To overcome the limitations of differential thermal analysis (DTA) and direct casting experimentation in the measurement and understanding of the solidification phenomena of mold slags, the double and single hot thermocouple techniques (DHTT and SHTT) for the direct observation and measurement of mold slag crystallization were developed. These methods enable the solidification and melting process of transparent slags to be observed "in situ" under conditions where the temperature or temperature gradient can be measured and controlled. The SHTT allows a sample to be subjected to rapid cooling rates or to be held under isothermal conditions. The DHTT allows large temperature gradients to be developed between the two thermocouples and allows a simulation of the transient conditions which can occur in the infiltrated slag film that occurs between the mold and the solidifying shell in the mold of a continuous caster. By these techniques both isothermal and non-isothermal phenomena can be studied. A number of mold slags are optically transparent or translucent at steelmaking temperatures while the crystalline phase which precipitates upon cooling is opaque and can be clearly observed using optical microscopy. Thus the SHTT and DHTT are connected to an image capturing and analysis system that allows the onset and growth of the opaque crystals which precipitate from the slags to be documented. The development and application of these techniques to mold slag crystallization will be discussed in this paper
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