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

Impact of infectious diseases consultation on the management of Staphylococcus aureus bacteraemia in children

OBJECTIVES: Infectious diseases consultation (IDC) in adults with Staphylococcus aureus bacteraemia (SAB) has been shown to improve management and outcome. The aim of this study was to evaluate the impact of IDC on the management of SAB in children. STUDY DESIGN: Observational cohort study of children with SAB. SETTING: Cambridge University Hospitals National Health Service (NHS) Foundation Trust, a large acute NHS Trust in the UK. PARTICIPANTS: All children with SAB admitted to the Cambridge University Hospitals NHS Foundation Trust between 16 July 2006 and 31 December 2012. METHODS: Children with SAB between 2006 and 31 October 2009 were managed by routine clinical care (pre-IDC group) and data were collected retrospectively by case notes review. An IDC service for SAB was introduced in November 2009. All children with SAB were reviewed regularly and data were collected prospectively (IDC group) until 31 December 2012. Baseline characteristics, quality metrics and outcome were compared between the pre-IDC group and IDC group. RESULTS: There were 66 episodes of SAB in 63 children-28 patients (30 episodes) in the pre-IDC group, and 35 patients (36 episodes) in the IDC group. The median age was 3.4 years (IQR 0.2-10.7 years). Patients in the IDC group were more likely to have echocardiography performed, a removable focus of infection identified and to receive a longer course of intravenous antimicrobial therapy. There were no differences in total duration of antibiotic therapy, duration of hospital admission or outcome at 30 or 90 days following onset of SAB. CONCLUSIONS: IDC resulted in improvements in the investigation and management of SAB in children

Modulation of the absorption coefficient at 1.3 mu m in Ge/SiGe multiple quantum well heterostructures on silicon

We report modulation of the absorption coefficient at 1.3 μm in Ge/SiGe multiple quantum well heterostructures on silicon via the quantum-confined Stark effect. Strain engineering was exploited to increase the direct optical bandgap in the Ge quantum wells. We grew 9 nm-thick Ge quantum wells on a relaxed Si0.22Ge0.78 buffer and a contrast in the absorption coefficient of a factor of greater than 3.2 was achieved in the spectral range 1290–1315 nm

Strain engineering of the electroabsorption response in Ge/SiGe multiple quantum well heterostructures

Many fibre-optic telecommunications systems exploit the spectral `window' at 1310 nm, which corresponds to zero dispersion in standard single-mode fibres (SMFs). In particular, several passive optical network (PON) architectures use 1310 nm for upstream signals,1 and so compact, low-cost and low-power modulators operating at 1310 nm that can be integrated into Si electronic-photonic integrated circuits would be extremely desireable for future fibre-to-the-home (FTTH) applications

High performance silicon optical modulators

In this work we present results from high performance silicon optical modulators produced within the two largest silicon photonics projects in Europe; UK Silicon Photonics (UKSP) and HELIOS. Two conventional MZI based optical modulators featuring novel self-aligned fabrication processes are presented. The first is based in 400nm overlayer SOI and demonstrates 40Gbit/s modulation with the same extinction ratio for both TE and TM polarisations, which relaxes coupling requirements to the device. The second design is based in 220nm SOI and demonstrates 40Gbits/s modulation with a 10dB extinction ratio as well modulation at 50Gbit/s for the first time. A ring resonator based optical modulator, featuring FIB error correction is presented. 40Gbit/s, 32fJ/bit operation is also shown from this device which has a 6um radius. Further to this slow light enhancement of the modulation effect is demonstrated through the use of both convention photonic crystal structures and corrugated waveguides. Fabricated conventional photonic crystal modulators have shown an enhancement factor of 8 over the fast light case. The corrugated waveguide device shows modulation efficiency down to 0.45V.cm compared to 2.2V.cm in the fast light case. 40Gbit/s modulation is demonstrated with a 3dB modulation depth from this device. Novel photonic crystal based cavity modulators are also demonstrated which offer the potential for low fibre to fibre loss. In this case preliminary modulation results at 1Gbit/s are demonstrated. Ge/SiGe Stark effect devices operating at 1300nm are presented. Finally an integrated transmitter featuring a III-V source and MZI modulator operating at 10Gbit/s is presented. © 2012 SPIE