Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Magnetic imaging of vortices in superconducting β-Bi2Pd

Trabajo presentado en la conferencia Fuerzas y Túnel (FyT2016), celebrada en Girona del 5 al 7 de septiembre de 2016.Direct visualization and manipulation of magnetic structures in superconductors with high spatial resolution and sensitivity is at the aim of state-of-the-art research in fundamental and applied physics. The possibility of imaging the evolution of the vortex lattice provides valuable information on microscopic properties such as the symmetry of the superconducting order parameters or the pinning strength. Here we discuss the observation of superconducting vortices in β-Bi2Pd (Tc=5K[1]) up to fields of 600 Oe combining Magnetic Force Microscopy (MFM) and Squid On the Tip Microscopy (SOT). The combination of both techniques allows investigating the vortex lattice in two different regimes, not accessible with each microscopy alone: from very low fields (~1 Oe) up to higher fields (~600 Oe). We use a commercial MFM (Nanomagnetics Ltd.) in a home-made three axis superconducting coil system [2] that cools down to 2K. Experiments at Weizmann are made at 4.2K in a SOT [3]. We discuss in detail the pinning process of the vortex lattice, the evolution of the magnetic contrast with the temperature and the applied magnetic field. We find that the superconducting parameters of β-Bi2Pd are excellent to allow vortex lattice observation in a large field range. Furthermore, in MFM experiments, interesting new vortex shapes have been observed in the images, that will be discussed in terms of the magnetic interaction between tip and sample, and the different magnetic domain configuration of the MFM tip.N