Aortic valve replacement in octogenarians

<p>Abstract</p> <p>Background and Aims</p> <p>As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR) in octogenarians.</p> <p>Methods</p> <p>68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37) underwent isolated AVR whilst 46% (31) underwent combined AVR and CABG.</p> <p>Results</p> <p>Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm². The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p < 0.05). Survival was not adversely affected by the addition of coronary artery bypass grafts to aortic valve replacement, the presence of peripheral vascular disease, hypertension or diabetes. In this study duration of cross clamp or bypass time were not found to reach significance as independent predictors of mortality.</p> <p>Conclusion</p> <p>Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.</p

Prioritizing micronutrients for the purpose of reviewing their requirements: a protocol developed by EURRECA

Background: The EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence (http://www.eurreca.org) is working towards the development of aligned recommendations. A protocol was required to assign resources to those micronutrients for which recommendations are most in need of alignment. Methods: Three important 'a priori' criteria were the basis for ranking micronutrients: (A) the amount of new scientific evidence, particularly from randomized controlled trials; (B) the public health relevance of micronutrients; (C) variations in current micronutrient recommendations. A total of 28 micronutrients were included in the protocol, which was initially undertaken centrally by one person for each of the different population groups defined in EURRECA: infants, children and adolescents, adults, elderly, pregnant and lactating women, and low income and immigrant populations. The results were then reviewed and refined by EURRECA's population group experts. The rankings of the different population groups were combined to give an overall average ranking of micronutrients. Results: The 10 highest ranked micronutrients were vitamin D, iron, folate, vitamin B12, zinc, calcium, vitamin C, selenium, iodine and copper. Conclusions: Micronutrient recommendations should be regularly updated to reflect new scientific nutrition and public health evidence. The strategy of priority setting described in this paper will be a helpful procedure for policy makers and scientific advisory bodies. European Journal of Clinical Nutrition (2010) 64, S19-530; doi:10.1038/ejcn.2010.5

An exploration of the tension between tradition and innovation.

This chapter will present an exploration of the tension between tradition and innovation. Terms and meanings will first be defined and delineated. Tradition will be delineated by way of a consideration of folk culture in extremis, and innovation by way of a personological understanding of creativity, again in extremis. The exploration will take place within a framework expounded by folklorist Bausinger in ‘Folk culture in a world of technology’ (Bausinger, 1961). By revisiting his concepts, and utilising his notions of spatial expansion, temporal expansion and social expansion as lenses, I will reconsider folk culture, and the relationships it has with multi-dimensional topological theories of creativity in a world of digital technology. Several tensions extant in the concept of culture have been posited by previous writers, such as Elliot (1948), Dundes (Dundes, 2002), and Dewey (Dewey, 1938). These tensions are often seen as dichotomies, divisions or contrasts, which are represented as being opposed or entirely different, as a binary construct. Such constructs might serve the creative practitioner better if reframed instead as spectrums of tension. These two extremes, existing in a state of equilibrium, might benefit the creative practitioner, creative act and culture and society more broadly. Exploring these tensions, will make help contribute to the themes and discourses of creativity and culture. Reconsidering each expansion will in turn present new perspectives and ways forward, through the examination of the supposed tensions, and the values and ideas that each expansion deals with. The chapter concludes with thoughts on what the ramifications of these tensions might be; and on the implications for future creative and traditional practice: I am mindful here of the purpose of Bausinger’s original concepts concerned with uncovering new folkloric perspectives and potential standpoints. The chapter therefore has three aims, first to propose an alternative way of being, and knowing the world, that suggests by connecting with, or knowing the past and our cultural traditions, practitioners, professionals or workers can engage in a more personally and socially meaningful creative practice in the digital world. A secondary aim is to reflect upon how this standpoint promotes identity formation and broader social cohesion. And, finally how it might in itself represent a folk realpolitik

Thrombin-receptor antagonist vorapaxar in acute coronary syndromes

BACKGROUND Vorapaxar is a new oral protease-activated–receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. METHODS In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan–Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P = 0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. CONCLUSIONS In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage