Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Range expansion of the tick Amblyomma triguttatum triguttatum, an Australian vector of Q fever

Copyright © 2000 Published by Elsevier Science Ltd. All rights reservedThe tick Amblyomma triguttatum triguttatum has previously been reported from Western Australia, Queensland and New South Wales. A viable population of this species, including all developmental stages, has now been discovered on the southern end of Yorke Peninsula, South Australia. Species determination was carried out morphologically and using 18S and 16S rRNA. The data for 16S rRNA are the first published for this species. Amblyomma t. triguttatum is significant through its involvement in the natural, Australian cycle of Coxiella burnetti, the pathogen causing Q fever. The environment of Yorke Peninsula contains all of the components required for a natural Q fever cycle and three cases of this disease have been reported from this area since 1995. These findings reinforce the need to put in place effective mechanisms to monitor parasite distributions at a time of large scale global change.http://www.sciencedirect.com/science/journal/0020751

Establishment of a reproducible model of chronic-phase chronic myeloid leukemia in NOD/SCID mice using blood-derived mononuclear or CD34+ cells

An animal model of chronic myeloid leukemia (CML) will help characterize leukemic and normal stem cells and also help evaluate experimental therapies in this disease. We have established a model of CML in the NOD/SCID mouse. Infusion of > or = 4 x 10(7) chronic-phase CML peripheral blood cells results in engraftment levels of > or = 1% in the bone marrow (BM) of 84% of mice. Engraftment of the spleen was seen in 60% of mice with BM engraftment. Intraperitoneal injection of recombinant stem cell factor produced a higher level of leukemic engraftment without increasing Philadelphia-negative engraftment. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor did not increase the level of leukemic or residual normal engraftment. Assessment of differential engraftment of normal and leukemic cells by fluorescence in situ hybridization analysis with bcr and abl probes showed that a median of 35% (range, 5% to 91%) of engrafted cells present in the murine BM were leukemic. BM engraftment was multilineage with myeloid, B-cell, and T-cell engraftment, whereas T cells were the predominant cell type in the spleen. BM morphology showed evidence of eosinophilia and increased megakaryocytes. We also assessed the ability of selected CD34+ CML blood cells to engraft NOD/SCID mice and showed engraftment with cell doses of 7 to 10 x 10(6) cells. CD34- cells failed to engraft at cell doses of 1.2 to 5 x 10(7). CD34+ cells produced myeloid and B-cell engraftment with high levels of CD34+ cells detected. Thus, normal and leukemic stem cells are present in CD34+ blood cells from CML patients at diagnosis and lead to development of the typical features of CML in murine BM. This model is suitable to evaluate therapy in CML

Looking Backward, Looking Forward: MLA Members Speak

In 1997 I was asked to organize humanities outreach activities at the University of California, Irvine. The result was the formation of Humanities Out There (HOT). In our workshops, faculty members and graduate students supervise teams of undergraduates in order to take the methods and materials of the university into the larger community.I believe that programs like these will  become increasingly important in the next century, as economic, cultural, and educational divisions deepen in the wake of the demise of affirmative action and as the humanities fight to define their missions in a world driven by technology and its discontents. In this brave new world, what I call the new outreach may have a role to play in responding to social crises as they are visited on the life of the university. The new outreach will be driven by intellectual content, not public relations.It will take its orientation from the faculty rather than administrators. It will engage all the research disciplines rather than remain the purview of education departments. It will be integrated into the professional lives of its participants rather than rely on the spirit of volunteerism alone

Looking Backward, Looking Forward: MLA Members Speak

In 1997 I was asked to organize humanities outreach activities at the University of California, Irvine. The result was the formation of Humanities Out There (HOT). In our workshops, faculty members and graduate students supervise teams of undergraduates in order to take the methods and materials of the university into the larger community.I believe that programs like these will  become increasingly important in the next century, as economic, cultural, and educational divisions deepen in the wake of the demise of affirmative action and as the humanities fight to define their missions in a world driven by technology and its discontents. In this brave new world, what I call the new outreach may have a role to play in responding to social crises as they are visited on the life of the university. The new outreach will be driven by intellectual content, not public relations.It will take its orientation from the faculty rather than administrators. It will engage all the research disciplines rather than remain the purview of education departments. It will be integrated into the professional lives of its participants rather than rely on the spirit of volunteerism alone