Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Utdelningens betydelse : Har oväntade utdelningsförändringar något signalvärde?

Utdelningspolitiken har länge varit ett omdiskuterat och omstritt ämne och har på senare fått ett än större fokus då investerare söker efter alternativ till en stabil avkastning när räntemarknaden har blivit en mindre attraktiv plats för detta. Huruvida utdelningspolitik är något som företag kan använda sig av för att signalera till marknaden råder det inte konsensus om. Syftet med denna uppsats är att försöka ge ett svar på detta och se huruvida utdelningsförändringar påverkar företagets marknadsvärde. För att försöka besvara denna fråga har studien genomfört en eventstudie med marknadsmodellen som utgångspunkt. Studiens population består av samtliga företag som var noterade på Stockholmsbörsens Mid- och Largecap lista mellan åren 2010-2019. Urvalskriterierna som varit nödvändiga för studiens syfte resulterade i ett totalt urval om 136 observationer av avvikande utdelningsförändringar. Eventstudien visar att det förekommer en signifikant positiv abnormal avkastning vid tillkännagivandet av en höjd utdelningsnivå. Vid en sänkt utdelningsnivå förekommer dock ingen signifikant abnormal avkastning. Vidare kan studien statistiskt säkerställa att det föreligger skillnad mellan en höjd utdelning och en sänkt utdelning. Av resultaten att döma har slutsatsen av studien blivit att avvikande förändringar i företagets utdelningspolitik påverkar företagets värde vid höjning men inte vid sänkning. Således ger studiens resultat svaret att signalvärdet vid en höjd utdelning är effektivt och överensstämmer med teori och tidigare forskning, däremot påvisar sänkning inte ett starkt signalvärde, då marknaden av empirin att döma inte reagerar på denna information

Integrated thin film resistive sensors for in situ temperature measurements in an acoustic trap

This work presents an acoustic trap with integrated thin film sensors to monitor temperature variations during operation. The acoustic trap is wet-etched in glass with a thermally bonded glass lid and the thin-film sensors are integrated during fabrication. We evaluated the performance of the integrated temperature sensors and measured a temperature sensitivity of ±0.01 °C and confirmed that the read-out of the thin film sensors was not affected neither by the ionic conducitiviy of the solution nor the addition of microparticles into the acoustic trap. From the experiments we observed a temperature increase of the acoustic trap during operation as a result of the dissipative heating of the the piezoelectric element used to actuate the trap. We also showed that when external convective cooling was applied to the system, the temperature increase of the acoustic trap was higher than the temperature incresase of the piezoelectric element itself. This shows the importance of using integrated temperature sensors in acoustic trapping to monitor the environmental conditions

Integrated thin film resistive sensors for in situ temperature measurements in an acoustic trap

This work presents an acoustic trap with integrated thin film sensors to monitor temperature variations during operation. The acoustic trap is wet-etched in glass with a thermally bonded glass lid and the thin-film sensors are integrated during fabrication. We evaluated the performance of the integrated temperature sensors and measured a temperature sensitivity of ±0.01 °C and confirmed that the read-out of the thin film sensors was not affected neither by the ionic conducitiviy of the solution nor the addition of microparticles into the acoustic trap. From the experiments we observed a temperature increase of the acoustic trap during operation as a result of the dissipative heating of the the piezoelectric element used to actuate the trap. We also showed that when external convective cooling was applied to the system, the temperature increase of the acoustic trap was higher than the temperature incresase of the piezoelectric element itself. This shows the importance of using integrated temperature sensors in acoustic trapping to monitor the environmental conditions

Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial

Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P<0.01). Nerve visibility was significantly reduced in the axillary group (P=0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P<0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P<0.01). Block duration was significantly increased in the infraclavicular group (P<0.05). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure.

BACKGROUND Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target. METHODS In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days. RESULTS At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P = 0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P = 0.24). CONCLUSIONS Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days. (Funded by the Innovation Fund Denmark and others; HOT-ICU ClinicalTrials.gov number, NCT03174002.)