Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

DETECTION OF AVIBACTERIUM PARAGALLINARUM IN COMMERCIAL POULTRY AND THEIR ANTIBIOGRAM

ABSTRAC

Nucleation Kinetics, Growth and Characterization Studies of a Diamagnetic Crystal-Zinc Sulphate Heptahydrate (ZSHH)

Solubility, metastable zone width and induction period measurements have been performed on zinc sulphate heptahydrate (ZSHH). Interfacial tension values determined from induction period measurements have been used for the evaluation of the nucleation parameters such as radius of critical nucleus and the free energy of formation of critical nucleus. ZSHH crystallizes in the orthorhombic structure. Crystals of diamagnetic zinc sulphate heptahydrate have been grown by temperature lowering solution growth technique with the optimized growth parameters. The as-grown ZSHH crystals were characterized by the powder X-ray diffraction, UV-VIS absorption and transmittance, FT-IR absorption, TG-DTA, microhardness and etching studies

Determination of Metastable Zone Width, Induction Period and Interfacial Energy of a Ferroelectric Crystal - Potassium Ferrocyanide Trihydrate (KFCT)

An order-disorder type potassium ferrocyanide trihydrate (KFCT) is a coordination compound forming lemon- yellow monoclinic ferroelectric crystals with curie temperature 251 K. KFCT crystals have been grown by temperature lowering solution growth technique. Solubility of KFCT has been determined for various temperatures. Metastable zone width, induction period and interfacial energy were determined for the aqueous solution of KFCT. Bulk crystal of potassium ferrocyanide trihydrate was grown with the optimized growth parameters. The grown crystal possesses good optical transmission in the entire UV-Visible regio

Synthesis and Characterization of Sri-Coated SFG1O Graphites as Negative Electrodes in Li-Ion Cells

ABSTRACT A Sri-coating study was undertaken with a commercial graphite, Timcal SFG1O, using an electroless deposition process. The pu~-ose of the work was to increase the reversible capacity and reduce the irreversible losses associated with this material when used as a negative electrode in Li-ion cells. The electrochemical performance of the Sri/C composite materials was improved over that for the bare (uncoated) graphite up to a Sn level of 15V0 when tested at rates between C/l 5 and 2C. The overall irreversible losses were greatly reduced under the same conditions, Corroboration of the improved performance was obtained through cyclic vokammetric experiments and by complex-impedance spectroscopy