956-114 The Use of Invasive Coronary Procedures Have Increased and Prognosis Improved in Patients Ineligible for Thrombolysis in Israel

Patients (pts) with acute myocardial infarction (AMI) ineligible for thrombolytic therapy (TTX) are at increased risk. Invasive coronary procedures (ICP) have been recommended for these pts. In 3 surveys performed in the CCU's of Israel during 1990, ‘92 and ‘94 the use of TTX was 35, 46 and 43% respectively. The characteristics and management of excluded pts from TTX in the respective surveys were as follows:Characteristics (%)1990 (n=267)1992 (n=546)1992 (n=567)Men687569Age (mean + SD)65±11 yrs65±12 yrs65±12 yrs>75 yrs212522First MI666360ICP(%)Coronaro-angiography151827PTCA<1611CABG<125Mortality (%) (17days)13108Conclusions1) ICP use is steadily increasing in MI pts ineligible for TTX in Israel; 2) increased ICP rates are associated with decrease of early death among MI patients ineligible for TTX

Early maturation processes in coal. Part 1: Pyrolysis mass balances and structural evolution of coalified wood from the Morwell Brown Coal seam

In this work, we develop a theoretical approach to evaluate maturation process of kerogen-like material, involving molecular dynamic reactive modeling with a reactive force field to simulate the thermal stress. The Morwell coal has been selected to study the thermal evolution of terrestrial organic matter. To achieve this, a structural model is first constructed based on models from the literature and analytical characterization of our samples by modern 1-and 2-D NMR, FTIR, and elemental analysis. Then, artificial maturation of the Morwell coal is performed at low conversions in order to obtain, quantitative and qualitative, detailed evidences of structural evolution of the kerogen upon maturation. The observed chemical changes are a defunctionalization of the carboxyl, carbonyl and methoxy functional groups coupling with an increase of cross linking in the residual mature kerogen. Gaseous and liquids hydrocarbons, essentially CH4, C4H8 and C14+ liquid hydrocarbons, are generated in low amount, merely by cleavage of the lignin side chain

Long-term effects of peroxisome proliferator-activated receptor ligand bezafibrate on N-terminal pro-B type natriuretic peptide in patients with advanced functional capacity impairment

<p>Abstract</p> <p>Background</p> <p>The effects of pan-peroxisome proliferator-activated receptor (PPAR) ligand bezafibrate on N-terminal pro-B type natriuretic peptide (ProBNP) level in patients with coronary artery disease (CAD) is unknown. The current study aimed to investigate the long-term effects of bezafibrate on ProBNP level in patients with pre-existing CAD and advanced functional capacity impairment.</p> <p>Methods</p> <p>Metabolic and inflammatory parameters were analyzed from stored frozen serum samples obtained from 108 patients enrolled in the Bezafibrate Infarction Prevention (BIP) Study. They presented with New York Heart Association (NYHA) functional class III, comprising 58 patients in the bezafibrate group and 50 in the placebo groups, and completed a 2-year prospective, double-blind, placebo-controlled follow-up.</p> <p>Results</p> <p>During follow-up ProBNP level did not change significantly in the placebo group, whereas it increased slightly in the bezafibrate group, which was older and with lower baseline ProBNP values. No significant differences between the groups were found for ProBNP levels after 2 year of follow-up. Analysis-of-covariance (ANCOVA) -taking into account age and baseline ProBNP level- showed that bezafibrate was not associated with longitudinal ProBNP changes during the follow-up period (p = 0.3).</p> <p>Conclusion</p> <p>Long-term treatment by bezafibrate was not associated with longitudinal ProBNP changes in patients with pre-existing CAD and advanced functional capacity impairment.</p

Does the lipid-lowering peroxisome proliferator-activated receptors ligand bezafibrate prevent colon cancer in patients with coronary artery disease?

<p>Abstract</p> <p>Background</p> <p>Epidemiologic studies have suggested that hypertriglyceridemia and insulin resistance are related to the development of colon cancer. Nuclear peroxisome proliferator-activated receptors (PPAR), which play a central role in lipid and glucose metabolism, had been hypothesized as being involved in colon cancerogenesis. In animal studies the lipid-lowering PPAR ligand bezafibrate suppressed colonic tumors. However, the effect of bezafibrate on colon cancer development in humans is unknown. Therefore, we proposed to investigate a possible preventive effect of bezafibrate on the development of colon cancer in patients with coronary artery disease during a 6-year follow-up.</p> <p>Methods</p> <p>Our population included 3011 patients without any cancer diagnosis who were enrolled in the randomized, double blind Bezafibrate Infarction Prevention (BIP) Study. The patients received either 400 mg of bezafibrate retard (1506 patients) or placebo (1505 patients) once a day. Cancer incidence data were obtained by matching a subject's identification numbers with the National Cancer Registry. Each matched record was checked for correct identification.</p> <p>Results</p> <p>Development of new cancer (all types) was recorded in 177 patients: in 79 (5.25%) patients from the bezafibrate group vs. 98 (6.51%) from the placebo group. Development of colon cancer was recorded in 25 patients: in 8 (0.53%) patients from the bezafibrate group vs. 17 (1.13%) from the placebo group, (Fisher's exact test: one side p = 0.05; two side p = 0.07).</p> <p>A difference in the incidence of cancer was only detectable after a 4 year lag and progressively increased with continued follow-up. On multivariable analysis the colon cancer risk in patients who received bezafibrate tended to be lower with a hazard ratio of 0.47 and 95% confidence interval 0.2–1.1.</p> <p>Conclusion</p> <p>Our data, derived from patients with coronary artery disease, support the hypothesis regarding a possible preventive effect of bezafibrate on the development of colon cancer.</p

Calcium antagonists and mortality in patients with coronary artery disease: A Cohort study of 11,575 patients

AbstractObjectives. This study sought to establish the risk ratio for mortality associated with calcium antagonists in a large population of patients with chronic coronary artery disease.Background. Recent reports have suggested that the use of short-acting nifedipine may cause an increase in overall mortality in patients with coronary artery disease and that a similar effect may be produced by other calcium antagonists, in particular those of the dihydropyridine type.Methods. Mortality data were obtained for 11,575 patients screened for the Bezafibrate Infarction Prevention study (5,843 with and 5,732 without calcium antagonists) after a mean follow-up period of 3.2 years.Results. There were 495 deaths (8.5%) in the calcium antagonist group compared with 410 in the control group (7.2%). The age-adjusted risk ratio for mortality was 1.08 (95% confidence interval [CI] 0.95 to 1.24). After adjustment for the differences between the groups in age and gender and the prevalence of previous myocardial infarction, angina pectoris, hypertension, New York Heart Association functional class, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and current smoking, the adjusted risk ratio declined to 0.97 (95% CI 0.84 to 1.11). After further adjustment for concomintant medication, the risk ratio was estimated at 0.94 (95% CI 0.82 to 1.08).Conclusions. The current analysis does not support the claim that calcium antagonist therapy in patients with chronic coronary artery disease, whether myocardial infarction survivors or others, harbors an increased risk of mortality

Evaluating Educational Interventions in Emergency Medicine

This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine ( EM ) knowledge, skills, and attitudes outside of the clinical setting. The objective was to summarize both medical and nonmedical education literature and report the consensus formation methods and results. The authors present final statements to guide future research aimed at evaluating the best methods for understanding and developing successful EM curricula using all types of educational interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94811/1/acem12022.pd