Pharmacosimulation of delays and interruptions during administration of tirofiban: a systematic comparison between EU and US dosage regimens.

Tirofiban is a glycoproteine (GP) IIb/IIIa receptor antagonist, which inhibits platelet-platelet aggregation and is a potential adjunctive antithrombotic treatment in patients with acute coronary syndromes (ACS) or high-risk percutaneous coronary interventions (PCI). It is administered intravenously as a bolus followed by continuous infusion. However, the dosage recommendations in the United States (US) and European Union (EU) differ considerably. Furthermore, in routine clinical practice, deviations from the recommendations may occur. The objective of the present study was to investigate the impact of different alterations on tirofiban plasma concentrations in US and EU administration regimens and to give suggestions for delay management in clinical practice. We therefore mathematically simulated the effects of different bolus-infusion delays and infusion interruptions in different scenarios according to the renal function. Here, we provide a systematic assessment of concentration patterns of tirofiban in the US versus EU dosage regimens. We show that differences between the two regimens have important effects on plasma drug levels. Furthermore, we demonstrate that deviations from the proper administration mode affect the concentration of tirofiban. Additionally, we calculated the optimal dosage of a second bolus to rapidly restore the initial concentration without causing overdosage. In conclusion, differences in tirofiban dosing regimens between the U.S and EU and potential infusion interruptions have important effects on drug levels that may impact on degrees of platelet inhibition and thus antithrombotic effects. Thus, the findings of our modelling studies may help to explain differences in clinical outcomes observed in previous clinical trials on tirofiban

Symmetry characterization of eigenstates in opal-based photonic crystals

The complete symmetry characterization of eigenstates in bare opal systems is obtained by means of group theory. This symmetry assignment has allowed us to identify several bands that cannot couple with an incident external plane wave. Our prediction is supported by layer-KKR calculations, which are also performed: the coupling coefficients between bulk modes and externally excited field tend to zero when symmetry properties mismatch.Comment: 7 pages, 5 figures, submitted to Physical Review

Radiative energy transfer in disordered photonic crystals

The difficulty of description of the radiative transfer in disordered photonic crystals arises from the necessity to consider on the equal footing the wave scattering by periodic modulations of the dielectric function and by its random inhomogeneities. We resolve this difficulty by approaching this problem from the standpoint of the general multiple scattering theory in media with arbitrary regular profile of the dielectric function. We use the general asymptotic solution of the Bethe-Salpeter equation in order to show that for a sufficiently weak disorder the diffusion limit in disordered photonic crystals is presented by incoherent superpositions of the modes of the ideal structure with weights inversely proportional to the respective group velocities. The radiative transfer and the diffusion equations are derived as a relaxation of long-scale deviations from this limiting distribution. In particular, it is shown that in general the diffusion is anisotropic unless the crystal has sufficiently rich symmetry, say, the square lattice in 2D or the cubic lattice in 3D. In this case, the diffusion is isotropic and only in this case the effect of the disorder can be characterized by the single mean-free-path depending on frequency.Comment: 27 pages, 4 figure

High platelet reactivity in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Randomised controlled trial comparing prasugrel and clopidogrel

Background: Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. Objectives: To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome (ACS). Patients: Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer, i.e. “poor responders” were randomised to prasugrel (60 mg loading and 10 mg maintenance dose) or clopidogrel (600 mg reloading and 150 mg maintenance dose). The primary outcome measure was proportion of patients with platelet reactivity <40 AUC 4 hours after loading with study medication, and also at one hour (secondary outcome). 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors. Results: At 4 hours after study medication 100% of patients treated with prasugrel compared to 91% of those treated with clopidogrel had platelet reactivity <40 AUC (p = 0.49), while at 1 hour the proportions were 95% and 64% respectively (p = 0.02). Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 (p = 0.005) and 19 versus 34 (p = 0.01) respectively. Conclusions: Routine platelet function testing identifies patients with high residual platelet reactivity (“poor responders”) on clopidogrel. A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity. Future trials need to identify if this translates into clinical benefit

Scattering of elastic waves by periodic arrays of spherical bodies

We develop a formalism for the calculation of the frequency band structure of a phononic crystal consisting of non-overlapping elastic spheres, characterized by Lam\'e coefficients which may be complex and frequency dependent, arranged periodically in a host medium with different mass density and Lam\'e coefficients. We view the crystal as a sequence of planes of spheres, parallel to and having the two dimensional periodicity of a given crystallographic plane, and obtain the complex band structure of the infinite crystal associated with this plane. The method allows one to calculate, also, the transmission, reflection, and absorption coefficients for an elastic wave (longitudinal or transverse) incident, at any angle, on a slab of the crystal of finite thickness. We demonstrate the efficiency of the method by applying it to a specific example.Comment: 19 pages, 5 figures, Phys. Rev. B (in press

Ultrafast Nonlinear Optical Response of Strongly Correlated Systems: Dynamics in the Quantum Hall Effect Regime

We present a theoretical formulation of the coherent ultrafast nonlinear optical response of a strongly correlated system and discuss an example where the Coulomb correlations dominate. We separate out the correlated contributions to the third-order nonlinear polarization, and identify non-Markovian dephasing effects coming from the non-instantaneous interactions and propagation in time of the collective excitations of the many-body system. We discuss the signatures, in the time and frequency dependence of the four-wave-mixing (FWM) spectrum, of the inter-Landau level magnetoplasmon (MP) excitations of the two-dimensional electron gas (2DEG) in a perpendicular magnetic field. We predict a resonant enhancement of the lowest Landau level (LL) FWM signal, a strong non-Markovian dephasing of the next LL magnetoexciton (X), a symmetric FWM temporal profile, and strong oscillations as function of time delay, of quantum kinetic origin. We show that the correlation effects can be controlled experimentally by tuning the central frequency of the optical excitation between the two lowest LLs.Comment: 21 pages, 10 figure

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme