268 research outputs found
Sirolimus-eluting versus uncoated stents in acute myocardial infarction.
BACKGROUND: Sirolimus-eluting stents reduce rates of restenosis and reintervention, as compared with uncoated stents. Data are limited regarding the safety and efficacy of such stents in primary percutaneous coronary intervention (PCI) for acute myocardial infarction with ST-segment elevation. METHODS: We performed a single-blind, multicenter, prospectively randomized trial to compare sirolimus-eluting stents with uncoated stents in primary PCI for acute myocardial infarction with ST-segment elevation. The trial included 712 patients at 48 medical centers. The primary end point was target-vessel failure at 1 year after the procedure, defined as target-vessel-related death, recurrent myocardial infarction, or target-vessel revascularization. A follow-up angiographic substudy was performed at 8 months among 174 patients from selected centers. RESULTS: The rate of the primary end point was significantly lower in the sirolimus-stent group than in the uncoated-stent group (7.3% vs. 14.3%, P=0.004). This reduction was driven by a decrease in the rate of target-vessel revascularization (5.6% and 13.4%, respectively; P<0.001). There was no significant difference between the two groups in the rate of death (2.3% and 2.2%, respectively; P=1.00), reinfarction (1.1% and 1.4%, respectively; P=1.00), or stent thrombosis (3.4% and 3.6%, respectively; P=1.00). The degree of neointimal proliferation, as assessed by the mean (+/-SD) in-stent late luminal loss, was significantly lower in the sirolimus-stent group (0.14+/-0.49 mm, vs. 0.83+/-0.52 mm in the uncoated stent group; P<0.001). CONCLUSIONS: Among selected patients with acute myocardial infarction, the use of sirolimus-eluting stents significantly reduced the rate of target-vessel revascularization at 1 year. (ClinicalTrials.gov number, NCT00232830 [ClinicalTrials.gov].)
Análise ergonômica do trabalho agrícola familiar na produção de leite.
Este artigo trata da metodologia utilizada em uma intervenção ergonômica sobre organização do trabalho em Unidades de Produção Agrícola Familiar (UPAF) produtoras de leite de origem bovina, na região oeste da França. Apresenta-se a metodologia utilizada, uma combinação de jornadas de observação e análise do trabalho e jornadas de formação-ação. Discutem-se a Crônica de Ação e o Plano de Utilização das Instalações (PUI), bem como a utilização destes no processo de conscientização do agricultor sobre a complexidade de seu trabalho. Apresenta-se a análise da "supervisão do rebanho", devido ao seu alto grau de complexidade e importância para o desempenho da produção de leite, explorando de que forma certos arranjos espaciais podem favorecer as condições para a realização desta tarefa. Na análise do trabalho agrícola familiar privilegia-se o olhar complexo sobre a situação de trabalho, visando identificar os determinantes, as fontes de variabilidade e as estratégias adotadas
Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes
Importance: Approximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned.
Objective: To evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography.
Design, setting, and participants: This cross-sectional study used data from the PRIME-FFR study derived from the merger of the POST-IT study (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease [March 2012-November 2013]) and R3F study (French Study of FFR Integrated Multicenter Registries Implementation of FFR in Routine Practice [October 2008-June 2010]), 2 prospective multicenter registries that shared a common design. A population of all-comers for whom angiography disclosed ambiguous lesions was analyzed for rates, patterns, and outcomes associated with management reclassification, including revascularization deferral, in patients with vs without diabetes. Data analysis was performed from June to August 2018.
Main outcomes and measures: Death from any cause, myocardial infarction, or unplanned revascularization (MACE) at 1 year.
Results: Among 1983 patients (1503 [77%] male; mean [SD] age, 65 [10] years), 701 had diabetes, and FFR was performed for 1.4 lesions per patient (58.2% of lesions in the left anterior descending artery; mean [SD] stenosis, 56% [11%]; mean [SD] FFR, 0.81 [0.01]). Reclassification by FFR was high and similar in patients with and without diabetes (41.2% vs 37.5%, P = .13), but reclassification from medical treatment to revascularization was more frequent in the former (142 of 342 [41.5%] vs 230 of 730 [31.5%], P = .001). There was no statistical difference between the 1-year rates of MACE in reclassified (9.7%) and nonreclassified patients (12.0%) (P = .37). Among patients with diabetes, FFR-based deferral identified patients with a lower risk of MACE at 12 months (25 of 296 [8.4%]) compared with those undergoing revascularization (47 of 257 [13.1%]) (P = .04), and the rate was of the same magnitude of the observed rate among deferred patients without diabetes (7.9%, P = .87). Status of insulin treatment had no association with outcomes. Patients (6.6% of the population) in whom FFR was disregarded had the highest MACE rates regardless of diabetes status.
Conclusions and relevance: Routine integration of FFR for the management of coronary artery disease in patients with diabetes may be associated with a high rate of treatment reclassification. Management strategies guided by FFR, including revascularization deferral, may be useful for patients with diabetes.info:eu-repo/semantics/publishedVersio
Measurement of the neutron magnetic form factor from inclusive quasielastic scattering of polarized electrons from polarized 3He
We report a measurement of the asymmetry in spin-dependent quasielastic scattering of longitudinally polarized electrons from a polarized 3He target. The neutron magnetic form factor GMn has been extracted from the measured asymmetry based on recent PWIA calculations using spin-dependent spectral functions. Our determination of GMn at Q2=0.19 (GeV/c)2 agrees with the dipole parametrization. This experiment represents the first measurement of the neutron magnetic form factor using spin-dependent electron scattering
Hadron Energy Reconstruction for the ATLAS Calorimetry in the Framework of the Non-parametrical Method
This paper discusses hadron energy reconstruction for the ATLAS barrel
prototype combined calorimeter (consisting of a lead-liquid argon
electromagnetic part and an iron-scintillator hadronic part) in the framework
of the non-parametrical method. The non-parametrical method utilizes only the
known ratios and the electron calibration constants and does not require
the determination of any parameters by a minimization technique. Thus, this
technique lends itself to an easy use in a first level trigger. The
reconstructed mean values of the hadron energies are within of the
true values and the fractional energy resolution is . The value of the ratio
obtained for the electromagnetic compartment of the combined calorimeter is
and agrees with the prediction that for this
electromagnetic calorimeter. Results of a study of the longitudinal hadronic
shower development are also presented. The data have been taken in the H8 beam
line of the CERN SPS using pions of energies from 10 to 300 GeV.Comment: 33 pages, 13 figures, Will be published in NIM
Second Generation Leptoquark Search in p\bar{p} Collisions at = 1.8 TeV
We report on a search for second generation leptoquarks with the D\O\
detector at the Fermilab Tevatron collider at = 1.8 TeV.
This search is based on 12.7 pb of data. Second generation leptoquarks
are assumed to be produced in pairs and to decay into a muon and quark with
branching ratio or to neutrino and quark with branching ratio
. We obtain cross section times branching ratio limits as a function
of leptoquark mass and set a lower limit on the leptoquark mass of 111
GeV/c for and 89 GeV/c for at the 95%\
confidence level.Comment: 18 pages, FERMILAB-PUB-95/185-
Jet Production via Strongly-Interacting Color-Singlet Exchange in Collisions
A study of the particle multiplicity between jets with large rapidity
separation has been performed using the D{\O}detector at the Fermilab Tevatron
Collider operating at TeV. A significant excess of
low-multiplicity events is observed above the expectation for color-exchange
processes. The measured fractional excess is , which is consistent with a strongly-interacting
color-singlet (colorless) exchange process and cannot be explained by
electroweak exchange alone. A lower limit of 0.80% (95% C.L.) is obtained on
the fraction of dijet events with color-singlet exchange, independent of the
rapidity gap survival probability.Comment: 15 pages (REVTeX), 3 PS figs (uuencoded/tar compressed, epsf.sty)
Complete postscript available at http://d0sgi0.fnal.gov/d0pubs/journals.html
Submitted to Physical Review Letter
Quantitative assessment of harmonic power doppler myocardial perfusion imaging with intravenous levovist™ in patients with myocardial infarction: comparison with myocardial viability evaluated by coronary flow reserve and coronary flow pattern of infarct-related artery
BACKGROUND: Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. AIM: To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. METHODS: Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR). Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. RESULTS: Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time ≧ 600 msec, Group B; 10 pts with deceleration time < 600 msec). In acute phase, there were no significant differences in left ventricular end-diastolic volume and ejection fraction (Left ventricular end-diastolic volume 112 ± 33 vs. 146 ± 38 ml, ejection fraction 50 ± 7 vs. 45 ± 9 %; group A vs. B). However, left ventricular end-diastolic volume in Group B was significantly larger than that in Group A (192 ± 39 vs. 114 ± 30 ml, p < 0.01), and ejection fraction in Group B was significantly lower than that in Group A (39 ± 9 vs. 52 ± 7%, p < 0.01) at 6 months. PIR and coronary flow velocity reserve of Group A were higher than Group B (PIR, at rest: 0.668 ± 0.178 vs. 0.248 ± 0.015, p < 0.0001: during hyperemia 0.725 ± 0.194 vs. 0.295 ± 0.107, p < 0.0001; coronary flow velocity reserve, 2.60 ± 0.80 vs. 1.31 ± 0.29, p = 0.0002, respectively). CONCLUSION: The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction
Design and implementation of the Front End Board for the readout of the ATLAS liquid argon calorimeters
The ATLAS detector has been designed for operation at CERN's Large Hadron Collider. ATLAS includes a complex system of liquid argon calorimeters. The electronics for amplifying, shaping, sampling, pipelining, and digitizing the calorimeter signals is implemented on the Front End Boards (FEBs). This paper describes the design, implementation and production of the FEBs and presents measurement results from testing performed at several stages during the production process
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