10,816 research outputs found

    Correspondence

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    TCT-66 Door to Impella Placement in Acute Coronary Syndrome Complicated by Cardiogenic Shock: An Updated Meta-analysis

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    Background: The impact of time to hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of mechanical circulatory support (MCS) with Impella. Methods: a systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella insertion, pre vs during/post PCI, were included. Primary end point was short-term mortality (≀30 days), while secondary end pointswere midterm mortality, device-related bleeding and limb ischemia. Results: Of 1,289 studies identified, 13 studies (6,810 patients; 2,970 patients identified as receiving Impella before PCI and 3,840 patients receiving Impella during/after PCI) were included in this analysis. Median age was 63.8 years (IQR 63-65.7 years), 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI Impella support, 37.2% vs 53.6% (RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI group, 47.9% vs 73% (RR 0.81; CI 0.68-0.97). The rates of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups. Conclusion: This analysis suggests that MCS placement with Impella prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI placement, with similar outcome in terms of safety. Categories: CORONARY: Hemodynamic Support and Cardiogenic Shoc

    Asymptotic symmetry and conservation laws in 2d Poincar\'e gauge theory of gravity

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    The structure of the asymptotic symmetry in the Poincar\'e gauge theory of gravity in 2d is clarified by using the Hamiltonian formalism. The improved form of the generator of the asymptotic symmetry is found for very general asymptotic behaviour of phase space variables, and the related conserved quantities are explicitly constructed.Comment: 22 pages, Plain Te

    Timing of impella placement in PCI for acute myocardial infarction complicated by cardiogenic shock: An updated meta-analysis

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    INTRODUCTION: The timing of hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of Impella initiation on early and midterm mortality. METHODS: A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella placement in AMICS were included. Meta-regression analysis and sensitivity analysis were performed on the primary endpoint, short-term mortality (≀30 days), and secondary endpoints (midterm mortality, device-related bleeding, and limb ischemia). RESULTS: Of 1289 studies identified, 13 studies (6810 patients; 2970 patients identified as receiving Impella pre-PCI and 3840 patients receiving Impella during/post-PCI) were included in this analysis. Median age was 63.8 years (IQR 63-65.7); 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI vs. during/post-PCI Impella support (37.2% vs 53.6%, RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI Impella group (47.9% vs 73%, RR 0.81; CI 0.68-0.97). The rate of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups. CONCLUSION: This analysis suggests that Impella placement prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI, with similar safety outcomes. Due to the observational nature of the included studies, further studies are needed to confirm this hypothesis (CRD42022300372)

    A new basic effect in retarding potential analyzers

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    The Retarding Potential Analyzer (RPA) is the standard instrument for in situ measurement of ion temperature and other ionospheric parameters. The fraction of incoming ions rejected by a RPA produces perturbations that reach well ahead of a thin Debye sheath, a feature common to all collisionless, hypersonic flows past ion-rejecting bodies. This phenomenon is here found to result in a correction to Whipple’s classical law for the current characteristic of an ideal RPA sheath thin; inverse ram ion Mach number M-1, and ram angle of RPA aperture u, small or moderately small

    Warming and elevated CO2 promote rapid incorporation and degradation of plant-derived organic matter in an ombrotrophic peatland

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    Rising temperatures have the potential to directly affect carbon cycling in peatlands by enhancing organic matter (OM) decomposition, contributing to the release of CO2 and CH4 to the atmosphere. In turn, increasing atmospheric CO2 concentration may stimulate photosynthesis, potentially increasing plant litter inputs belowground and transferring carbon from the atmosphere into terrestrial ecosystems. Key questions remain about the magnitude and rate of these interacting and opposing environmental change drivers. Here, we assess the incorporation and degradation of plant- and microbe-derived OM in an ombrotrophic peatland after 4 years of whole-ecosystem warming (+0, +2.25, +4.5, +6.75 and +9°C) and two years of elevated CO2 manipulation (500 ppm above ambient). We show that OM molecular composition was substantially altered in the aerobic acrotelm, highlighting the sensitivity of acrotelm carbon to rising temperatures and atmospheric CO2 concentration. While warming accelerated OM decomposition under ambient CO2, new carbon incorporation into peat increased in warming × elevated CO2 treatments for both plant- and microbe-derived OM. Using the isotopic signature of the applied CO2 enrichment as a label for recently photosynthesized OM, our data demonstrate that new plant inputs have been rapidly incorporated into peat carbon. Our results suggest that under current hydrological conditions, rising temperatures and atmospheric CO2 levels will likely offset each other in boreal peatlands
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