Randomized Comparison of Eptifibatide Versus Abciximab in Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction Results of the EVA-AMI Trial

ObjectivesThe aim of this study was to compare eptifibatide and abciximab as adjuncts to primary percutaneous coronary intervention (PCI).BackgroundThe glycoprotein (GP) IIb/IIIa receptor inhibitor abciximab as adjunct to primary PCI in patients with ST-segment elevation myocardial infarctions has been shown to reduce ischemic complications and improve clinical outcomes. So far, no trial has been performed to compare the efficacy of another GP IIb/IIIa receptor inhibitor, eptifibatide, and abciximab in primary PCI.MethodsA total of 427 patients with ST-segment elevation myocardial infarctions <12 h and planned primary PCI were randomized to double-bolus eptifibatide (n = 226) followed by a 24-h infusion or single-bolus abciximab (n = 201) followed by a 12-h infusion. In this noninferiority trial, the primary end point was the incidence of complete (≥70%) ST-segment resolution (STR) 60 min after PCI, a measure of myocardial reperfusion. The assumption was a 60% complete STR rate in the abciximab group. The noninferiority margin was set to 15%.ResultsThe incidence of complete STR at 60 min after PCI in the intention-to-treat analysis was 62.6% after eptifibatide and 56.3% after abciximab (adjusted difference: 7.1%; 95% confidence interval: 2.7% to 17.0%). All-cause mortality 6.2% versus 4.5% (p = 0.50); reinfarction 0.4% versus 3.5% (p = 0.03); target vessel revascularization 4.4% versus 6.5% (p = 0.40); the combined end point of death, nonfatal reinfarction, and target vessel revascularization 10.6% versus 10.9% (p = 0.90); stroke 0.5% versus 0.5% (p = 1.00) after 6 months; and Thrombolysis In Myocardial Infarction major bleeding complications 4.0% versus 2.0% (p = 0.20) after 30 days were observed after eptifibatide and abciximab, respectively.ConclusionsEptifibatide as an adjunct to primary PCI is equally as effective as abciximab with respect to STR. (Efficacy of Eptifibatide Compared to Abciximab in Primary Percutaneous Coronary Intervention [PCI] for Acute ST Elevation Myocardial Infarction [STEMI]; NCT00426751

Effects of Pumpkin Seed in Men with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia in the One-Year, Randomized, Placebo-Controlled GRANU Study

Introduction: The German Research Activities on Natural Urologicals (GRANU) study was a randomized, partially blinded, placebo-controlled, parallel-group trial that investigated the efficacy of pumpkin seed in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). Subjects and Methods: A total of 1,431 men (50-80 years) with BPH/LUTS were randomly assigned to either pumpkin seed (5 g b.i.d.), capsules with pumpkin seed extract (500 mg b.i.d.) or matching placebo. The primary response criterion was a decrease in International Prostate Symptom Score (IPSS) of >= 5 points from baseline after 12 months. Secondary outcome measures included IPSS-related quality of life, IPSS single items and diary-recorded nocturia. Results: After 12 months, the response rate (intention-to-treat/last-observation-carried-forward approach) did not differ between pumpkin seed extract and placebo. In the case of pumpkin seed (responders: 58.5%), the difference compared with placebo (responders: 47.3%) was descriptively significant. The study products were well tolerated. Overall, in men with BPH, 12 months of treatment with pumpkin seed led to a clinically relevant reduction in IPSS compared with placebo. Conclusion: In order to fully justify a recommendation for the use of pumpkin seed to treat moderate LUTS, these findings need to be substantiated in a confirmatory study or systematic review. (C) 2014 S. Karger AG, Base

Tunable Photovoltaics: Adapting Solar Cell Technologies to Versatile Applications

Solar photovoltaics (PV) offer viable and sustainable solutions to satisfy the growing energy demand and to meet the pressing climate targets. The deployment of conventional PV technologies is one of the major contributors of the ongoing energy transition in electricity power sector. However, the diversity of PV paradigms can open different opportunities for supplying modern systems in a wide range of terrestrial, marine, and aerospace applications. Such ubiquitous and versatile applications necessitate the development of PV technologies with customized design capabilities. This involves multifunctional characteristics such as aesthetic appearance, visual comfort, and heat insulation. To enable on-demand adaptation to the requirements of distributed applications, tunable solar cells (SC) feature exceptional degrees of freedom in the manipulation of their intrinsic properties via adjusted materials engineering. The pertinent tuning abilities include but are not limited to bandgap energy, transparency, color, and thermal management. In this review, the main principles of different tuning approaches are specified and an overview of relevant concepts of tunable SC technologies is presented. Then, the recent integrations of cutting-edge tunable PV adapted to versatile applications are systematically summarized. In addition, current challenges and insightful perspectives into potential future opportunities for omnipresent tunable PV are discussed

Inside Back Cover: Tunable Photovoltaics: Adapting Solar Cell Technologies to Versatile Applications

Tunable Photovoltaics In article number 2200713, Hosni Meddeb and co-workers present a comprehensive review on tunable photovoltaics with customized design capabilities covering different aspects such as bandgap energy, transparency and color attributes. The multifunctional characteristics including appearance, visual comfort and thermal management along with power generation enable the adaptation of solar cell technologies in versatile applications. Perspectives to guide relevant future integration scenarios are explored

SAfety of Fondaparinux in transoesophageal echocardiography-guided Electric cardioversion of Atrial Fibrillation (SAFE-AF) study: A pilot study

International audienceBACKGROUND:Current guidelines recommend unfractionated heparin (UFH) or low-molecular-weight heparin plus an oral anticoagulant for the prevention of thromboembolism in patients undergoing electric cardioversion of atrial fibrillation (AF). Selective factor Xa inhibitors, such as fondaparinux, which has a favourable benefit-risk profile in the prevention and treatment of venous thromboembolism and the management of acute coronary syndromes, have not been systematically evaluated in this setting.AIM:To evaluate the efficacy and safety of fondaparinux versus standard treatment in patients undergoing echocardiographically-guided cardioversion of AF.METHODS:In this multicentre, randomized, open-label, controlled, two-parallel-group, phase II pilot study, patients with AF undergoing electric cardioversion following transoesophageal echocardiography (TEE) were randomized to fondaparinux or standard therapy (UFH plus vitamin K antagonist [VKA]). Patients showing an atrial thrombus in the first TEE (clot-positive) were randomized to treatment with fondaparinux or standard care for 4 weeks before cardioversion.RESULTS:The primary endpoint (combined rate of cerebral neurological events, systemic thromboembolism, all-cause death and major bleeding events) occurred in 3 of 174 (1.7%) patients on fondaparinux and 2 of 170 (1.2%) patients on UFH+VKA. The rate of thrombus disappearance among clot-positive patients was higher in the fondaparinux arm (11 of 14; 78.6%) than in the UFH+VKA arm (7 of 14; 50.0%). Incidences of adverse events were similar (45.4% with fondaparinux and 46.5% with UFH+VKA).CONCLUSION:In this pilot study in patients with TEE-guided cardioversion, the use of fondaparinux appeared to be well tolerated, with similar efficacy to UFH+VKA. Furthermore, a trend to greater thrombus resolution was observed

Patient-centred assessment of COPD in primary care: experience from a cross-sectional study of health-related quality of life in Europe

Background: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking. Aims: To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes. Methods: This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data. Results: PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV1) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R-2=0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p Conclusions: PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV1-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries. (C) 2012 Primary Care Respiratory Society UK. All rights reserved. PW Jones et al. Prim Care Respir J 2012; 21(3): 329-336 http://dx.doi.org/10.4104/pcrj.2012.0006

Use of Fondaparinux Off-Label or Approved Anticoagulants for Management of Heparin-Induced Thrombocytopenia.

BACKGROUND Life-threatening heparin-induced thrombocytopenia (HIT) is treated with the alternative nonheparin anticoagulants argatroban, lepirudin, or danaparoid. Frequently, the pentasaccharide fondaparinux is used off-label. OBJECTIVES The authors sought to investigate the safety and efficacy of the different anticoagulants for treating HIT. METHODS In a national, multicenter registry study, hospitalized patients who were diagnosed with HIT, an at least intermediate clinical HIT-risk (4Ts score ≥4 points), and received treatment with ≥1 dose of the aforementioned anticoagulants were included. Main outcome measures were the incidences of HIT-specific complications (thromboembolic venous/arterial events, amputations, recurrent/persistent thrombocytopenia, skin lesions) and bleedings. RESULTS Of 195 patients, 46 (23.6%), 4 (2.1%), 61 (31.3%), and 84 (43.1%) had been treated first-line with argatroban, lepirudin, danaparoid, and fondaparinux, respectively. The composite endpoint of HIT-specific complications (thromboembolic events, amputation, skin necrosis) occurred in 11.7% of patients treated with approved alternative anticoagulation and in 0.0% of fondaparinux-treated patients. The all-cause in-hospital mortality rates were 14.4% during approved alternative anticoagulation and 0.0% during fondaparinux treatment. Bleeding complications occurred in alternatively anticoagulated patients and in fondaparinux-treated patients in 6.3% and 4.8%, respectively. Post hoc analysis of clinical and laboratory features confirmed "true" HIT in at least 74 of 195 (38.0%) patients; 35 of 74 (47.3%) were treated with fondaparinux. CONCLUSIONS Fondaparinux is effective and safe in suspected acute HIT; no HIT-specific complications occurred in the fondaparinux-treated patients, even among those with a high clinical HIT probability. Further data from randomized controlled trials are urgently needed because lepirudin was recalled from the market; danaparoid access has been limited and is not approved in the United States; and argatroban is contraindicated in patients with impaired liver function, and activated partial thromboplastin time confounding may interfere with monitoring. (Retrospective Registry of Patients With Acute Heparin-induced Thrombocytopenia Type II; NCT01304238)

Concept for a Gossamer solar power array using thin‑film photovoltaics

The power demand for future satellite applications will continue to rise. Geostationary telecom-munication satellites currently approach a power level of up to 20 kW. Future spacecraft will provide yet more transponders and/or direct mobile-satellite services. Electric propulsion is in-creasingly used for station keeping, attitude control and GEO circularization. Interplanetary mis-sions already use kW-range electric propulsion. Space Tugs are studied for several fields. Suitable engines require 100 kW or more. The envisaged use of such engines and the operation of future GEO satellites lead to a renewed interest in large, deployable and ultra-lightweight power gen-erators in space. Within the GoSolAr (Gossamer Solar Array) activity, DLR develops a new photovoltaic array technology for power generation. It is based on the DLR Gossamer approach using lightweight, deployable CFRP booms and a polymer membrane covered with thin-film CIGS photovoltaics. The booms are arranged in a crossed configuration with a central deployment unit. The photovol-taic area is composed of one large square membrane with double folding using two-dimensional deployment. Even though the efficiency of thin-film photovoltaics is currently only about 1/3 of that of con-ventional photovoltaics, a membrane based array can already achieve better mass/power ratios. A 50 kW array requires an area of approximately 20 m x 20 m. In a first step, DLR develops a fully functional 5 m x 5 m demonstrator partially covered with thin-film photovoltaics, using the DLR small satellite platform S2TEP. Space compatible thin-film photovoltaics need to be select-ed and tested. They are integrated on standardized generator modules that will be assembled into a large, foldable and deployable membrane. A controlled deployment of structure and membrane, and a sufficiently stiff support structure for operation are key development topics. We present the conceptual design of the GoSolAr demonstrator, the main requirements, prelimi-nary technical budgets and the development strategy. An overview will be given on the selection and the maturity of the key technologies and subsystems, such as deployable membrane with in-tegrated photovoltaic generators; deployable CFRP booms including deployment mechanisms; photovoltaic cell selection and integration to generator units; the array harness concept as well as the electronics concept, for operation and photovoltaics characterization. Furthermore, an over-view of the first manufactured breadboard models and their testing will be presented, e.g. com-bined testing of booms and mechanically representative generator arrays to evaluate deployment and interface forces for the preliminary design