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Reducing driving forces for pressed-in piles
Pile jacking techniques use static loading to install sheet piles with minimal environmental effects, such as noise and ground vibrations, which are often associated with other methods of driven piling. This paper describes a series of 20g centrifuge tests conducted to investigate two methods of reducing the large driving forces that can be associated with jacked sheet piles in stiff clay. In practice, pre-auguring at the clutch positions and water jetting techniques are routinely carried out prior to the installation of sheet piling in order to reduce the driving forces. However, these methods are known to contribute to ground movements and can detract from the advantages of jacked sheet piles. The tests involved driving model sheet piles, which were modified either by installing driving shoes to the base of the pile, or by ribbing the profile of the pile shaft. The driving forces of the modified piles were compared with those of a plain pile. The tests showed that the use of driving shoes and ribs can lead to the reduction of driving forces at greater depth
Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes
Background: Patients with acute coronary syndrome (ACS) associated to high C-reactive protein (CRP) levels exhibit a higher risk of future acute ischemic events. Yet, the positive predictive value of CRP is too low to guide a specific treatment. Our study aims to identify a high-risk patient subset who might mostly benefit from anti-inflammatory treatment on the basis of the combination of optical coherence tomography (OCT) assessment of the culprit vessel and CRP serum levels.Methods: Patients admitted for ACS and undergoing pre-interventional OCT assessment of the culprit vessel were selected from "Agostino Gemelli" Hospital OCT Registry. The primary end-point was recurrent ACS (re-ACS). CRP levels >= 2 mg/L were considered abnormal.Results: The overall study population consisted of 178 patients. Among these, 156 patients were included in the primary end-point analysis. The re-ACS rate was 23% at 3-year follow-up. High CRP (2.587, 95% CI: 1.345-10.325, p = 0.031), plaque rupture (3.985, 95% CI: 1.698-8.754, p = 0.009), macrophage infiltration (3.145, 95% CI: 1.458-9.587, p = 0.012) and multifocal atherosclerosis (2.734, 95% CI: 1.748-11.875, p = 0.042) were independent predictors of re-ACS. All patients (14/14) with high CRP and with all OCT high-risk features had re-ACS. At the other extreme, only 4 of the 82 patients with low CRP levels and lack of high-risk features at OCT examination exhibited re-ACS at follow-up.Conclusions: The combination of systemic evidence of inflammation and OCT findings in the culprit plaque identifies very high-risk ACS. Future studies are warranted to confirm these findings and to test an anti-inflammatory treatment in this patient subset. (C) 2019 Elsevier B.V. All rights reserved