Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Eco-evolutionary cyclic dominance among predators, prey, and parasites.

Predator-prey interactions are one of ecology's central research themes, but with many interdisciplinary implications across the social and natural sciences. Here we consider an often-overlooked species in these interactions, namely parasites. We first show that a simple predator-prey-parasite model, inspired by the classical Lotka-Volterra equations, fails to produce a stable coexistence of all three species, thus failing to provide a biologically realistic outcome. To improve this, we introduce free space as a relevant eco-evolutionary component in a new mathematical model that uses a game-theoretical payoff matrix to describe a more realistic setup. We then show that the consideration of free space stabilizes the dynamics by means of cyclic dominance that emerges between the three species. We determine the parameter regions of coexistence as well as the types of bifurcations leading to it by means of analytical derivations as well as by means of numerical simulations. We conclude that the consideration of free space as a finite resource reveals the limits of biodiversity in predator-prey-parasite interactions, and it may also help us in the determination of factors that promote a healthy biota

Delayed evolutionary model for public goods competition with policing in phenotypically variant bacterial biofilms

The emergence and abundance of public goods cooperation in the face of selfish “cheaters” is an enduring puzzle in the realm of evolutionary biology. The synergistic and antagonistic interactions within and between cooperators and free riders have an immense impact on the sustenance of cooperation, which often maintains biodiversity in nature. We, therefore, address the problem to formulate and theoretically analyze the effects of social interactions on population dynamics of cooperators in a primitive natural population, such as phenotypically variant monospecies pathogenic microbial biofilms, where cooperators often inhibit the defective exploitation of produced goods by active punishment (policing). To make the proposed model more realistic, we introduce two discrete time delays, which are a combined form of quorum sensing delay and the period between secretion and reception of exoenzymes. In the present letter, our primary objectives are to illustrate i) the significance of the policing effect towards the evolutionary stability of cooperation and ii) the impact of delay(s) on the nature of coexistence. We find that the varying costs of policing can divulge four well-known cases, namely, domination of defection, domination of cooperation, bistability, and the stable coexistence of cooperative and defective individuals. Interestingly, the consideration of asymmetric non-zero time delays in receiving the cooperative exoproducts towards kin and non-kin additionally unveils the occurrence of chaotic coexistence between cooperators and free riders which happens through interior crisis

Real-time underwater image enhancement: An improved approach for imaging with AUV-150

An RGB YCbCr Processing method (RYPro) is proposed for underwater images commonly suffering from low contrast and poor color quality. The degradation in image quality may be attributed to absorption and backscattering of light by suspended underwater particles. Moreover, as the depth increases, different colors are absorbed by the surrounding medium depending on the wavelengths. In particular, blue/green color is dominant in the underwater ambience which is known as color cast. For further processing of the image, enhancement remains an essential preprocessing operation. Color equalization is a widely adopted approach for underwater image enhancement. Traditional methods normally involve blind color equalization for enhancing the image under test. In the present work, processing sequence of the proposed method includes noise removal using linear and non-linear filters followed by adaptive contrast correction in the RGB and YCbCr color planes. Performance of the proposed method is evaluated and compared with three golden methods, namely, Gray World (GW), White Patch (WP), Adobe Photoshop Equalization (APE) and a recently developed method entitled “Unsupervised Color Correction Method (UCM)”. In view of its simplicity and computational ease, the proposed method is recommended for real-time applications. Suitability of the proposed method is validated by real-time implementation during the testing of the Autonomous Underwater Vehicle (AUV-150) developed indigenously by CSIR-CMERI

Targeting aloe active compounds to <i>c-KIT</i> promoter G-quadruplex and comparative study of their anti proliferative property

Small molecules targeting G-quadruplex of oncogene promoter is considered as a promising anticancer therapeutics approach. Natural aloe compounds aloe emodin, and its glycoside derivative aloe emodin-8-glucoside and aloin have anticancer activity and also have potential DNA binding ability. These three compounds have promising binding ability towards quadruplex structures particularly c-KIT G-quadruplex. Here, this study demonstrates complete biophysical study of these compounds to c-KIT quadruplex structure. Aloe emodin showed highest binding stabilization with c-KIT which has been proved by absorbance, fluorescence, dye displacement, ITC and SPR studies. Moreover, comparative study of these compounds with HCT 116 cells line also agreed to their anti proliferative property which may be helpful to establish these aloe compounds as potential anticancer drugs. This study comprises a complete biophysical study along with their anti proliferative property and demonstrates aloe emodin as a potent c-KIT binding molecule. Communicated by Ramaswamy H. Sarma</p

Time delays shape the eco-evolutionary dynamics of cooperation.

We study the intricate interplay between ecological and evolutionary processes through the lens of the prisoners dilemma game. But while previous studies on cooperation amongst selfish individuals often assume instantaneous interactions, we take into consideration delays to investigate how these might affect the causes underlying prosocial behavior. Through analytical calculations and numerical simulations, we demonstrate that delays can lead to oscillations, and by incorporating also the ecological variable of altruistic free space and the evolutionary strategy of punishment, we explore how these factors impact population and community dynamics. Depending on the parameter values and the initial fraction of each strategy, the studied eco-evolutionary model can mimic a cyclic dominance system and even exhibit chaotic behavior, thereby highlighting the importance of complex dynamics for the effective management and conservation of ecological communities. Our research thus contributes to the broader understanding of group decision-making and the emergence of moral behavior in multidimensional social systems

Time delays shape the eco-evolutionary dynamics of cooperation

We study the intricate interplay between ecological and evolutionary processes through the lens of the prisoner’s dilemma game. But while previous studies on cooperation amongst selfish individuals often assume instantaneous interactions, we take into consideration delays to investigate how these might affect the causes underlying prosocial behavior. Through analytical calculations and numerical simulations, we demonstrate that delays can lead to oscillations, and by incorporating also the ecological variable of altruistic free space and the evolutionary strategy of punishment, we explore how these factors impact population and community dynamics. Depending on the parameter values and the initial fraction of each strategy, the studied eco-evolutionary model can mimic a cyclic dominance system and even exhibit chaotic behavior, thereby highlighting the importance of complex dynamics for the effective management and conservation of ecological communities. Our research thus contributes to the broader understanding of group decision-making and the emergence of moral behavior in multidimensional social systems