Late recurrent ischaemia in infarct patients with a normal predischarge exercise test after thrombolysis

We investigated the prognostic value of normal predischarge exercise test in 109 patients after myocardial infarction treated with i. v. thrombolysis within 4 h. In 29 of these 109 patients, elective PTCA or bypass surgery was performed for prognostic reasons after coronary angiography; 80 patients were treated conservatively with drug therapy. Recurrent postinfarct angina early after hospital discharge was the reason in 4 of 80 for PTCA or bypass surgery. Twenty-three of the remaining 76 conservatively treated patients developed recurrent ischaemia during long-term follow-up of 12.0 ± 6.2 months, including one patient with reinfarction. Late recurrent ischaemia during long-term follow-up was observed in one third of the conservatively treated patients with a normal predischarge exercise test, although a high percentage (30%) of patients in this subgroup had been treated with PTCA or bypass surgery mainly for prognostic reasons. Predischarge exercise test is therefore of limited value for detection of still viable myocardium at risk of further ischaemic events after acute myocardial infarction and thrombolysi

Influence of coronary artery bypass grafting on ventricular late potentials as a predictive factor for ventricular arrhythmias during short- and long-term follow-up

Ventricular late potentials have been identified as a prognostic factor in the prediction of ventricular arrhythmias in patients after myocardial infarction. In this prospective study the possible impact of late potentials on the prediction of ventricular arrhythmias in the short- and long-term follow-up after coronary artery bypass grafting was evaluated. In 188 patients (165 men, 23 women, age 57 ±8 years) with chronic coronary heart disease 48 (26%) had late potentials before bypass grafting; after the procedure this was reduced to 39 (21%) (ns). In 16 (33%) of the 48 patients with late potentials before bypass grafting, late potentials were no longer present in the short-term follow-up (9 ±6 days). Conversely, seven (5%) of the 140 patients without late potentials before bypass grafting had late potentials in the short-term follow-up after grafting. Nine (19%) of the 48 patients with late potentials before bypass grafting had ventricular arrhythmias in the peri-operative phase, which had to be treated with antiarrhythmic agents. In contrast, only three (2%>) of the 140 patients without late potentials before bypass grafting had to be treated for ventricular arrhythmias (P<0.001). In the long-term follow-up of 29 ± 3 months, there were no events in the group of 149 patients without late potentials after grafting. In the 39 patients with late potentials after grafting, there were two (5%) events (two patients with arrhythmic syncope). Conclusions (1) Patients with late potentials before bypass grafting have a markedly higher risk of developing serious ventricular arrhythmias in the peri-operative period than patients without late potentials. (2) Patients without late potentials have a very low risk of developing serious ventricular arrhythmias in the peri-operative period. (3) During long-term follow-up there was only a low probability of developing symptomatic ventricular arrhythmias in patients with or without late potential

Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997-2014.

OBJECTIVE: Compliance with guidelines is increasingly used to benchmark the quality of hospital care, however, very little is known on patients admitted with acute coronary syndromes (ACS) and treated palliatively. This study aimed to evaluate the baseline characteristics and outcomes of these patients. DESIGN: Prospective cohort study. SETTING: Eighty-two Swiss hospitals enrolled patients from 1997 to 2014. PARTICIPANTS: All patients with ACS enrolled in the AMIS Plus registry (n=45,091) were analysed according to three treatment groups: palliative treatment, defined as use of aspirin and analgesics only and no reperfusion; conservative treatment, defined as any treatment including antithrombotics or anticoagulants, heparins, P2Y12 inhibitors, GPIIb/IIIa but no pharmacological or mechanical reperfusion; and reperfusion treatment (thrombolysis and/or percutaneous coronary intervention during initial hospitalisation). The primary outcome measure was in-hospital mortality and the secondary measure was 1-year mortality. RESULTS: Of the patients, 1485 (3.3%) were palliatively treated, 11,119 (24.7%) were conservatively treated and 32,487 (72.0%) underwent reperfusion therapy. In 1997, 6% of all patients were treated palliatively and this continuously decreased to 2% in 2013. Baseline characteristics of palliative patients differed in comparison with conservatively treated and reperfusion patients in age, gender and comorbidities (all p&lt;0.001). These patients had more in-hospital complications such as postadmission onset of cardiogenic shock (15.6% vs 5.2%; p&lt;0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher in-hospital mortality (25.8% vs 5.6%; p&lt;0.001).The subgroup of patients followed 1 year after discharge (n=8316) had a higher rate of reinfarction (9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p&lt;0.001). CONCLUSIONS: Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While refraining from more active therapy may often constitute the most humane and appropriate approach, we think it is important to also evaluate these patients and include them in registries and outcome evaluations. CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier: NCT01 305 785

An international study of the prevalence of substance use in patients with delusional infestation

To the Editor: Delusional infestation (DI) is a disorder characterised by the belief of being infested with living organisms or objects.1 Insects and worms are the most common concerns. Objects, such as fibers or threads, are increasingly reported by patients. DI can be primary or secondary to mental illness, physical illness, prescribed medication, and misuse of substances such as amphetamines, cannabis, codeine, cocaine, or opiates. Dermatologists are usually the specialists to whom a patient with DI is referred because patients believe that they have primarily a skin diseas

Beacon Signalling for Expedited Cell Search Procedures in NTN NB-IoT

Three cellular standards have been considered for Non-Terrestrial Networks (NTN): NB-IoT, eMTC and NR, each having had features introduced to accommodate the challenges of the NTN case. In Terrestrial Networks (TNs), it is reasonable to expect continuous coverage when a UE is stationary within reach of a base-station (eNB) with rare exceptions of downtime due to failures or catastrophic events. The same continuity cannot be assumed in NTN for sparse eNB constellations or during the rollout of dense eNB constellations. Therefore, a feature of the NTN IoT protocols - NTN NB-IoT & NTN eMTC - is the support of discontinuous RAN coverage. Cell search is a core task of NTN UEs serviced by non-geostationary (NGSO) constellations. Initially, when UEs are booted up, unless a recent ephemeris has been provisioned to it, the UE must first discover a valid eNB by employing repeated cell searching. UEs will have to keep doing cell search each time they wish to access a cell again after losing or dropping connectivity. Intermittent coverage gaps, which occur in dense constellations due to system failures, during rollout or inherently in sparse constellations, exaggerate the number of cell search attempts required by a UE before finding an appropriate cell to camp on. These latter cases of intermittent coverage can be mitigated by the coverage prediction features for discontinuous coverage. In this paper, a beacon signal, which can be transmitted within the white-spaces of stand-alone NB-IoT, is introduced. The beacon signal is designed to expedite the cell search procedure in NTN NB-IoT in NGSO constellations by: (1) Allowing for easy and early detection of the presence of a cell, (2) encoding preliminary information for the UE to assess whether to continue cell search at that early point and (3) providing helpful information to the synchronisation procedure. The performance of the beacon signal is simulated and evaluations show a fair improvement over utilizing legacy synchronization signals for cell detection both in terms of speed and SNR

Theoretical analysis of the electronic structure of the stable and metastable c(2x2) phases of Na on Al(001): Comparison with angle-resolved ultra-violet photoemission spectra

Using Kohn-Sham wave functions and their energy levels obtained by density-functional-theory total-energy calculations, the electronic structure of the two c(2x2) phases of Na on Al(001) are analysed; namely, the metastable hollow-site structure formed when adsorption takes place at low temperature, and the stable substitutional structure appearing when the substrate is heated thereafter above ca. 180K or when adsorption takes place at room temperature from the beginning. The experimentally obtained two-dimensional band structures of the surface states or resonances are well reproduced by the calculations. With the help of charge density maps it is found that in both phases, two pronounced bands appear as the result of a characteristic coupling between the valence-state band of a free c(2x2)-Na monolayer and the surface-state/resonance band of the Al surfaces; that is, the clean (001) surface for the metastable phase and the unstable, reconstructed "vacancy" structure for the stable phase. The higher-lying band, being Na-derived, remains metallic for the unstable phase, whereas it lies completely above the Fermi level for the stable phase, leading to the formation of a surface-state/resonance band-structure resembling the bulk band-structure of an ionic crystal.Comment: 11 pages, 11 postscript figures, published in Phys. Rev. B 57, 15251 (1998). Other related publications can be found at http://www.rz-berlin.mpg.de/th/paper.htm

Ab initio calculations for bromine adlayers on the Ag(100) and Au(100) surfaces: the c(2x2) structure

Ab initio total-energy density-functional methods with supercell models have been employed to calculate the c(2x2) structure of the Br-adsorbed Ag(100) and Au(100) surfaces. The atomic geometries of the surfaces and the preferred bonding sites of the bromine have been determined. The bonding character of bromine with the substrates has also been studied by analyzing the electronic density of states and the charge transfer. The calculations show that while the four-fold hollow-site configuration is more stable than the two-fold bridge-site topology on the Ag(100) surface, bromine prefers the bridge site on the Au(100) surface. The one-fold on-top configuration is the least stable configuration on both surfaces. It is also observed that the second layer of the Ag substrate undergoes a small buckling as a consequence of the adsorption of Br. Our results provide a theoretical explanation for the experimental observations that the adsorption of bromine on the Ag(100) and Au(100) surfaces results in different bonding configurations.Comment: 10 pages, 4 figure, 5 tables, Phys. Rev. B, in pres

Small Polarons in Transition Metal Oxides

The formation of polarons is a pervasive phenomenon in transition metal oxide compounds, with a strong impact on the physical properties and functionalities of the hosting materials. In its original formulation the polaron problem considers a single charge carrier in a polar crystal interacting with its surrounding lattice. Depending on the spatial extension of the polaron quasiparticle, originating from the coupling between the excess charge and the phonon field, one speaks of small or large polarons. This chapter discusses the modeling of small polarons in real materials, with a particular focus on the archetypal polaron material TiO2. After an introductory part, surveying the fundamental theoretical and experimental aspects of the physics of polarons, the chapter examines how to model small polarons using first principles schemes in order to predict, understand and interpret a variety of polaron properties in bulk phases and surfaces. Following the spirit of this handbook, different types of computational procedures and prescriptions are presented with specific instructions on the setup required to model polaron effects.Comment: 36 pages, 12 figure