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Protective or destructive: High wall shear stress and atherosclerosis.
This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.atherosclerosis.2016.05.04
Patent foramen ovale and neurosurgery in sitting position: a systematic review
We have conducted a systematic review of air embolism complications of neurosurgery in the sitting position and patent foramen ovale (PFO) closure. It assesses the risk and benefit of PFO closure before neurosurgery in the sitting position. The databases Medline, Embase, and Cochrane Controlled Trial Register were systematically searched from inception to November 2007 for keywords in both topics separately. In total, 4806 patients were considered for neurosurgery in sitting position and 5416 patients underwent percutaneous PFO closure. The overall rate of venous air embolism during neurosurgery in sitting position was 39% for posterior fossa surgery and 12% for cervical surgery. The rate of clinical and transoesophageal echocardiography detected paradoxical air embolism was reported between 0% and 14%. The overall success rate for PFO closure using new and the most common closure devices was reported 99%, whereas the average risk of major complications is <1%. On the basis of our systematic review, we recommend screening for PFO and considering closure in cases in which the sitting position is the preferred neurosurgical approach. Our proposed management including the time of PFO closure according to available data is presented. However, the conclusions from our systematic review may be limited due to the lack of level A evidence and from using data from observational cohort studies. Thus, definite evidence-based recommendations require prospective evaluation of the issue in well-designed studie
MORTALITY BENEFIT OF SPIRONOLACTONE IN DIABETIC VERSUS NON-DIABETIC PATIENTS WITH CONGESTIVE HEART FAILURE
The provision and experience of an accredited online programme for English language teacher training : an activity systems analysis
This thesis contributes to the literature on English language teacher training. Recent discussion in that literature has emphasised the need to move from a narrow focus on skills development towards understanding whole training programmes and how their provision prepares teachers for contemporary challenges. It has also specifically highlighted the need to understand how better to integrate technology use into training programmes. This thesis presents a case study of an online English language teacher training programme. The ‘Cambridge CELTA’ programme is a globally recognised English teacher training qualification which has only recently started to offer an online version. I use Activity Theory to analyse the activity systems of the programme and their contradictions, with a specific focus on identifying challenges in the integration of technology into language teacher training. Analysis draws on lesson observations, document analysis, and interviews with course candidates, tutors and managers. My findings highlight that the provision and experience of this programme are dependent on three closely related activity systems, whose objects are credentialised learning, pedagogical support and administrative support. My findings map these activity systems and the contradictions within and between them. A fourth activity system of executive support, external to the organisation providing the programme, also plays a role but can be sketched only briefly due to the boundaries of the case. My analysis highlights several core contradictions, such as a commodification of learning and equal policy resourcing. The analysis highlights how these contradictions are generated from within and between the four activity systems. My thesis contributes to the literature by introducing a new insight of an integrative model pedagogy to understand how language teacher training programmes intertwine theoretical and practical concerns and also proposing a technology in pedagogy proposition which is missing in the literature. In response to debates about challenges of integrating technology into language teacher training, my thesis concludes by contributing an online language teacher training programme framework which has been designed based on an analysis of the findings
TCT-22 Combination of High Wall Shear Stress, Plaque Burden, and Plaque Phenotype has Incremental Value for Prediction of Increased Plaque Vulnerability in Patients with Coronary Artery Disease
Impact of incomplete stent apposition on long-term clinical outcome after drug-eluting stent implantation
Aims Late acquired incomplete stent apposition (ISA) is more common after drug-eluting stent (DES) than bare metal stent (BMS) implantation and has been associated with vascular hypersensitivity and stent thrombosis (ST). We investigated the impact of incidentally discovered ISA as assessed by intravascular ultrasound (IVUS) 8 months after DES implantation on the long-term clinical outcome. Methods and results A total of 194 patients with 221 lesions were prospectively followed through 5 years. At 8 months, IVUS showed evidence of ISA among 37 patients with 39 lesions (18%) (mean ISAmax 4.7 ± 5.0 mm2), whereas no ISA was observed among 157 patients with 182 lesions. Incomplete stent apposition was more prevalent among segments treated with sirolimus-eluting (n = 103) than paclitaxel-eluting stents (n = 118) (27 vs. 9%, P = 0.001). Between IVUS investigation at the 8-month and 5-year follow-up, major adverse cardiac events occurred more frequently in patients with (18.9%, n = 7) than without ISA (7.0%, n = 11) (HR = 2.71, 95% CI: 1.05-6.96, P = 0.031). While there were no differences with respect to death, the rate of myocardial infarction was higher among patients with (13.5%, n = 5) than without ISA (1.9%, n = 3) (HR = 7.53, 95% CI: 1.79-31.6, P = 0.001). Very late ST was more common among patients with than without ISA [Academic Research Consortium-definite ST:13.5% (n = 5) vs. 0.6% (n = 1) HR = 23.2, 95% CI: 2.65-203, P < 0.001]. Conclusion In the present study, the presence of ISA as assessed by IVUS 8 months after DES implantation was associated with a higher rate of myocardial infarction and very late stent thrombosis during long-term follow-up. The prognostic impact of ISA on long-term clinical outcomes requires further investigatio
Giant right coronary artery aneurysm presenting with non-ST elevation myocardial infarction and severe mitral regurgitation: a case report
<p>Abstract</p> <p>Introduction</p> <p>Coronary artery aneurysms are seen in 1.5-5% of patients presenting for coronary angiography, but giant aneurysms, defined as being greater than 2 cm in diameter, are rare. Given the paucity of cases and limited experience in diagnosis and management of the disease, each case is a learning tool in itself.</p> <p>Case presentation</p> <p>We report the rare case of a 78-year-old Caucasian man who presented to a peripheral emergency department with chest pain and was subsequently found to have a giant right coronary artery aneurysm. Following initial investigation and treatment he was referred to our hospital for definitive management.</p> <p>Conclusion</p> <p>The case described illustrates one of the varied presentations and subsequent management of an ill-defined and heterogeneous disease process. Given the limited experience with giant aneurysms in the coronary circulation, this case provides valuable insight into the clinical presentation of the disease and gives an example of the management of the most recent such case at our hospital.</p
Modulation of Drug Craving in Crystalline-Heroin Users by Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex
Background: Drug craving, the main cause of relapse and a major motivator for drug use, is a challenging obstacle in substance use treatment. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulatory technique, has shown promising outcomes in treating different neuropsychiatric disorders such as drug addiction, more specifically on drug craving. The aim in the current study was to examine the effects of applying tDCS on dorsolateral prefrontal cortex (DLPFC) in reducing drug cravings in former crystalline-heroin users enrolled in methadone maintenance (MMT) programs. Methods: The present study was a semi-experimental, crossover study with pre/post-test, and a control group. 40 right-handed men were selected from former crystalline-heroin users enrolled in MMT programs in Tehran, Iran. They were then divided into two matched groups based on age, education, and age of onset crystalline-heroin abuse. Desire for Drug Questionnaire (DDQ) was administered two times to all of the subjects, before first brain stimulation, and at the end of the last session. Experimental group received TDCS on DLPFC, and sham stimulation was applied on control subjects. The data were analyzed by analysis of covariance (ANCOVA) method using SPSS software. Findings: The study results indicated anodal tDCS over right and cathodal TDCS over left DLPFC, and in parallel with sham, significantly decreased drug cravings among former crystalline-heroin users (P < 0.050). Conclusion: This study showed that applying TDCS on DLPFC of former crystalline-heroin users reduces drug craving. The findings of this study expanded the results of previous studies on effects of this neuromodulatory technique for drug craving reduction in other drug type settings
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