Restenosis, reocclusion and adverse cardiovascular events after successful balloon angioplasty of occluded versus nonoccluded coronary arteries: Results from the multicenter american research trial with cilazapril after angioplasty to prevent transluminal coronary obstruction and restenosis (MARCATOR)

OBJECTIVES: This study sought to compare the frequency of restenosis, reocclusion and adverse cardiovascular events after angioplasty of occluded versus nonoccluded coronary arteries. BACKGROUND: Angioplasty of chronically occluded coronary arteries is believed to be associated with a higher frequency of restenosis and reocclusion than angioplasty of subtotal stenoses. Whether this leads to adverse cardiovascular events is unknown. METHODS: The Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Restenosis (MARCATOR) was a placebo-controlled trial with angiographic follow-up to determine the effect of the angiotensin-converting enzyme inhibitor cilazapril on the frequency of restenosis. In this trial, restenosis was defined as 1) angiographic reduction of minimal lumen diameter > or = 0.72 mm between angioplasty and the follow-up visit; and 2) > 50% diameter stenosis on the follow-up angiogram. We identified

DTI Strategic Environmental Assessment Area 6, Irish Sea, seabed and surficial geology and processes

Hydrocarbons prospectivity • The East Irish Sea Basin is at a mature exploration phase. • The hydrocarbons-prospective sedimentary basins are characterised by source rocks, an abundance of structured regional petroleum reservoir and seal rocks and by suitable timing of geothermal events for generation and transfer of petroleum products from the source rocks to the reservoir rocks. • SEA6 has regionally diverse seabed habitats which vary significantly from area to area in currently licensed acreages in the eastern Irish Sea. The variations in seabed habitats have been systematically related to the sedimentary processes driven by quantifiable patterns of mean seabed stress. Sedimentary Processes • Open shelf seabed sedimentary processes are driven by seabed stress originating from interaction of the seabed with strong currents generated by tidal streams and by waves. • The scale of the stress imposed on the seabed and the related seabed habitat variability varies from regional (between mainlands, varying shelter around headlands) to macroscopic (around boulders and pebbles). • During the fair to moderate weather conditions characteristic of the late spring, summer and early autumn seasons, the seabed sediment types on the open continental shelf are dominated by the stress imposed on the seabed by the strengths and flow directions of the peak tidal currents. In this setting most of the regional variations in seabed sediment types are dominated by the effects of the coastal configurations on the tidal streams. • In areas where the seabed stress from waves is dominant, the seabed sediments coarsen with exposure to the increasing seabed stress generated when the waves interact with the seabed. Seabed stress from waves is dependent on wave power that varies with weather, wave fetch, seabed slope, wave direction and water depth. • There are knowledge gaps on possible regional variations of seabed properties when the seabed is stressed during extreme weather events associated with storm surge and storm waves. • In the most highly stressed seabed environments, exposed bedrock and strongly cohesive unsorted gravelly, sandy and muddy sediments are often swept clean of unconsolidated muds, sands, granular gravel and pebbles. Parts of the seabed in these areas may consist of cobbles and boulders. Environments of least seabed stress are characterised by fine-grained muddy sediments. Mobile sandwaves are characteristic of areas where sediments are being transported along the seabed in environments that are situated between the areas of extremely high seabed stress and very low seabed stress. The sense of regional seabed sediment transfer is from and across areas of high seabed stress to areas of lower seabed stress. The observations summarised above indicate that if large-scale disruptions to the natural seabed habitat are to be avoided, new development scenarios should avoid barriers that could have a significant effect on the regional patterns of seabed stress. • As elsewhere on the UKCS, glacigenic sediments and relict static glacigenic bedforms have had significant regional and local effects on the patchiness of the distribution patterns of seabed sediments and seabed habitats. • There is a knowledge gap in the research evidence required to securely link subregional increases in the percentage of biogenic carbonate in the sand fraction of the Irish Sea Mud Belt with increased biological productivity of surface waters, with methane expulsion from shallow and seabed sediments or with processes of bedload carbonate transport. • Investigations of shipwrecks and artificial continuous barriers indicate that the amount of seabed scour is much larger than the profile of large seabed obstacles presented to near-bed current flow. The observations reveal patterns of scour asymmetry consistent with model predictions of mean peak tidal current speeds and the interpretations of the directions of regional sediment transport based on the geometries of seabed bedforms. Wreck studies could therefore be used to calibrate modelling on the likely long term effects of future seabed development scenarios. Shipwrecks have also contributed to seabed diversity. • Active pockmarks, bioherms, banks in less than 20m water depth and some shipwrecks are already regulated by conservation measures. The following geological features are also worthy of consideration for preservation because they are irreplaceable: Static bedforms — sarns, pingos, upstanding rock outcrops in mud belts Mobile bedforms — banner banks, estuary banks and spits • A gateway for sand exchange between the open shelf and the eastern Irish Sea coast off England appears to be defined by a zone situated between North Wales and the southern limit of the Eastern Irish Sea Mudbelt. Although the current prospects for large oil and gas developments in this area are very small, any developments that could the patterns of sand exchange through this environmentally sensitive area should be avoided

Clopidogrel: A Pharmacogenomic Perspective on its Use in Coronary Artery Disease

The thienopyridine antiplatelet agent clopidogrel is an effective drug for the prevention of vascular events. However, data has accumulated over time to suggest it is prone to significant interpatient variability. While there are several factors that contribute to this, one of the most important is variability in forming the active metabolite necessary for clopidogrel function. Several enzymes are involved in formation of this metabolite, and two, CYP2C19 and P-glycoprotein, appear to have alleles that both occur frequently in the population and have a clinically significant impact. Patients carrying these alleles can be identified, but it remains to be determined if this information is necessary or sufficient for risk stratification. Furthermore, if patients with high-risk alleles are identified, it is unclear how treatment should be adjusted

The rationale for heart team decision-making for patients with stable, complex coronary artery disease

Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable co

Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.

BACKGROUND: Coronary artery bypass surgery (CABG) has been considered the therapy of choice for patients with unprotected left main (ULMT) coronary stenoses. Selected single-center reports suggest that the results of percutaneous intervention may now approach those of CABG. METHODS AND RESULTS: To assess the results of percutaneous ULMT treatment from a wide variety of experienced interventional centers, we requested data on consecutive patients treated after January 1, 1994, from 25 centers. One hundred seven patients were identified who were treated either electively (n=91) or for acute myocardial infarction (n=16). Of patients treated electively, 25% were considered inoperable, and 27% were considered high risk for bypass surgery. Primary treatment included stents (50%), directional atherectomy (24%), and balloon angioplasty (20%). Follow-up was 98.8% complete at 15+/-8 months. Results varied considerably, depending on presentation and treatment. For patient

Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

BACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral agent tranilast has been shown to decrease the frequency of angiographic restenosis after PCI. METHODS AND RESULTS: In this double-blind, randomized, placebo-controlled trial of tranilast (300 and 450 mg BID for 1 or 3 months), 11 484 patients were enrolled. Enrollment and drug were initiated within 4 hours after successful PCI of at least 1 vessel. The primary end point was the first occurrence of death, myocardial infarction, or ischemia-driven target vessel revascularization within 9 months and was 15.8% in the placebo group and 15.5% to 16.1% in the tranilast groups (P=0.77 to 0.81). Myocardial infarction was the only component of major adverse cardiovascular events to show some evidence of a reduction with tranilast (450 mg BID for 3 months): 1.1% versus 1.8% with placebo (P=0.061 for intent-to-treat population). The primary reason for not completing treatment was > or =1 hepatic laboratory test abnormality (11.4% versus 0.2% with placebo, P<0.01). In the angiographic substudy composed of 2018 patients, minimal lumen diameter (MLD) was measured by quantitative coronary angiography. At follow-up, MLD was 1.76+/-0.77 mm in the placebo group, which was not different from MLD in the tranilast groups (1.72 to 1.78+/-0.76 to 80 mm, P=0.49 to 0.89). In a subset of these patients (n=1107), intravascular ultrasound was performed at follow-up. Plaque volume was not different between the placebo and tranilast groups (39.3 versus 37.5 to 46.1 mm(3), respectively; P=0.16 to 0.72). CONCLUSIONS: Tranilast does not improve the quantitative measures of restenosis (angiographic and intravascular ultrasound) or its clinical sequelae

Measurement of D*+/- meson production in jets from pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

This paper reports a measurement of D*+/- meson production in jets from proton-proton collisions at a center-of-mass energy of sqrt(s) = 7 TeV at the CERN Large Hadron Collider. The measurement is based on a data sample recorded with the ATLAS detector with an integrated luminosity of 0.30 pb^-1 for jets with transverse momentum between 25 and 70 GeV in the pseudorapidity range |eta| < 2.5. D*+/- mesons found in jets are fully reconstructed in the decay chain: D*+ -> D0pi+, D0 -> K-pi+, and its charge conjugate. The production rate is found to be N(D*+/-)/N(jet) = 0.025 +/- 0.001(stat.) +/- 0.004(syst.) for D*+/- mesons that carry a fraction z of the jet momentum in the range 0.3 < z < 1. Monte Carlo predictions fail to describe the data at small values of z, and this is most marked at low jet transverse momentum.Comment: 10 pages plus author list (22 pages total), 5 figures, 1 table, matches published version in Physical Review

Ecological Invasion, Roughened Fronts, and a Competitor's Extreme Advance: Integrating Stochastic Spatial-Growth Models

Both community ecology and conservation biology seek further understanding of factors governing the advance of an invasive species. We model biological invasion as an individual-based, stochastic process on a two-dimensional landscape. An ecologically superior invader and a resident species compete for space preemptively. Our general model includes the basic contact process and a variant of the Eden model as special cases. We employ the concept of a "roughened" front to quantify effects of discreteness and stochasticity on invasion; we emphasize the probability distribution of the front-runner's relative position. That is, we analyze the location of the most advanced invader as the extreme deviation about the front's mean position. We find that a class of models with different assumptions about neighborhood interactions exhibit universal characteristics. That is, key features of the invasion dynamics span a class of models, independently of locally detailed demographic rules. Our results integrate theories of invasive spatial growth and generate novel hypotheses linking habitat or landscape size (length of the invading front) to invasion velocity, and to the relative position of the most advanced invader.Comment: The original publication is available at www.springerlink.com/content/8528v8563r7u2742

Using behavior-analytic implicit tests to assess sexual interests among normal and sex-offender populations

The development of implicit tests for measuring biases and behavioral predispositions is a recent development within psychology. While such tests are usually researched within a social-cognitive paradigm, behavioral researchers have also begun to view these tests as potential tests of conditioning histories, including in the sexual domain. The objective of this paper is to illustrate the utility of a behavioral approach to implicit testing and means by which implicit tests can be built to the standards of behavioral psychologists. Research findings illustrating the short history of implicit testing within the experimental analysis of behavior are reviewed. Relevant parallel and overlapping research findings from the field of social cognition and on the Implicit Association Test are also outlined. New preliminary data obtained with both normal and sex offender populations are described in order to illustrate how behavior-analytically conceived implicit tests may have potential as investigative tools for assessing histories of sexual arousal conditioning and derived stimulus associations. It is concluded that popular implicit tests are likely sensitive to conditioned and derived stimulus associations in the history of the test-taker rather than 'unconscious cognitions', per se