The effect of electrical neurostimulation on collateral perfusion during acute coronary occlusion

<p>Abstract</p> <p>Background</p> <p>Electrical neurostimulation can be used to treat patients with refractory angina, it reduces angina and ischemia. Previous data have suggested that electrical neurostimulation may alleviate myocardial ischaemia through increased collateral perfusion. We investigated the effect of electrical neurostimulation on functional collateral perfusion, assessed by distal coronary pressure measurement during acute coronary occlusion. We sought to study the effect of electrical neurostimulation on collateral perfusion.</p> <p>Methods</p> <p>Sixty patients with stable angina and significant coronary artery disease planned for elective percutaneous coronary intervention were split in two groups. In all patients two balloon inflations of 60 seconds were performed, the first for balloon dilatation of the lesion (first episode), the second for stent delivery (second episode). The Pw/Pa ratio (wedge pressure/aortic pressure) was measured during both ischaemic episodes. Group 1 received 5 minutes of active neurostimulation before plus 1 minute during the first episode, group 2 received 5 minutes of active neurostimulation before plus 1 minute during the second episode.</p> <p>Results</p> <p>In group 1 the Pw/Pa ratio decreased by 10 ± 22% from 0.20 ± 0.09 to 0.19 ± 0.09 (p = 0.004) when electrical neurostimulation was deactivated. In group 2 the Pw/Pa ratio increased by 9 ± 15% from 0.22 ± 0.09 to 0.24 ± 0.10 (p = 0.001) when electrical neurostimulation was activated.</p> <p>Conclusion</p> <p>Electrical neurostimulation induces a significant improvement in the Pw/Pa ratio during acute coronary occlusion.</p

American war, European struggle? Analyzing the influence of domestic politics on the ISAF contributions of EU Member States. College of Europe EU Diplomacy Paper 2011/03, March 2011

Member states of the European Union (EU) have contributed a substantial share to the International Security Assistance Force (ISAF) led by the North Atlantic Treaty Organization (NATO). However, the operation’s performance is likely to be constrained by the diverse approaches of the European contributors. This paper examines why and how the Afghan operations of different EU member states have differed from each other by looking at the respective motivations of their governments to participate in the ISAF mission. To that end, it analyzes the policies of France, Germany, the Netherlands and the United Kingdom. It is argued that domestic politics, that is the interaction between public opinion, domestic institutions and the framing of the mission by political elites, as well as broader considerations of foreign policy play an important role in shaping a country’s ISAF policy. By systematically looking at these factors, the paper concludes that European political elites have often endorsed ISAF participation not so much because they believe a secure Afghanistan serves their national security interest, but merely because participation itself serves larger foreign policy interests such as upholding transatlantic relations or European security politics. Yet governments have generally not been good at convincing their electorates of the necessity of ISAF participation. The resulting dwindling public support has often led to ISAF contributions that are risk-minimizing, inflexible, under resourced, or even a ‘showcase mission’