Rhetorical pattern of political advertisement in Aceh

The Indonesian government has adapted the genre-based approach designing curriculum, thus both English teachers and students need to master the genre aspects: the objective or social function of a text, text structure, and language features. This study aimed at describing the rhetorical pattern of Irwandi Yusuf – Nova Iriansyah’s posters during the gubernatorial election in 2017.  The object of this study was the strategies used to convince the argument or namely rhetorical pattern. The design of this study was descriptive qualitative research. To obtain the data the researchers used document as an instrument in this study. The result of this study revealed that the posters applied ten strategies: form-based strategy, emotion-based strategy, attention management strategy: use of dramatic statement, using repetition in the form of image and slogan, sketch model participation, detailed benefit change, self-efficacy realized via image, offer further information or services strategy: indirect offers, use slogan, refers to a broader picture, refer to the legal status of the campaign. These strategies that were implemented in the candidates’ poster was to convince the message relied on the poster to the target readers. Further, the strategies implied have followed some strategy offered by Barron (2012). Therefore, different advertisement, as well as a poster from the different region, have a different pattern in organizing the ideas and in convincing the target readers. In conclusion, by exploring the rhetoric of the local advertisement, it can expand the material of teaching text structure, language feature and social function of the advertisement text from a different region or country due to the genre is socially constructed

Controversial imaging diagnosis of cardiac cause of recurrent pulmonary embolism

A 44 years old lady with a past medical history of asthma and pulmonary emboli receiving adjuvant cytotoxic chemotherapy via a PICC line for a triple negative grade 3 invasive ductal carcinoma of right breast, presented to emergency with acute shortness of breath. She was managed initially as asthma, but 2 days latter was hospitalised due to worsening symptoms. An urgent V/Q scan confirmed further multiple pulmonary emboli despite therapy dose low molecular weight heparin. A trans-thoracic echocardiography revealed a large 2.6 x 2.5cm mass attached to the tricuspid valve. Inflammatory markers were elevated and a blood culture and sensitivity confirmed coagulase-negative staphylococcus which, in the presence of PICC line (Fig 2) raised the suspicion of endocarditis. A trans-oesophageal echocardiogram (Fig 1,2,3,4) and CT chest were both in favour of possible intra cardiac neoplasm or metastases. Further investigation with cardiac MRI and PET were not in favour of metastasis or primary neoplasm. The patient was treated for PICC line infection with i.v. antibiotics and i.v. heparin resulting initially in reduced mass size but subsequent progression. Despite adequate anticoagulation the patient had further pulmonary embolism and subsequently proceeded to surgical removal of the mass. The histopathology analysis at the tertiary care centre confirmed fibrin core and large amount of neutrophils consistent with thrombus with no features of neoplasm or malignancy. The patient made good post-operative recovery and was commenced on long term low molecular weight heparin as per protocol

Substance p for evaluation of coronary endothelial function after cardiac transplantation

AbstractThe endothelium-dependent vasodilator substance P dilates normal and diseased coronary vessels in humans in vivo and produces a maximal response similar to that seen with intracoronary isosorbide dinitrate. Twelve cardiac transplant recipients underwent intracoronary infusion of substance P after routine annual investigations. All patients were well, with no evidence of rejection and with angiographically normal coronary arteries. Substance P was infused at 2 ml/min for 2 min into the coronary artery, starting at a dose of 1.4 pmol/min and increasing by doubling increments, and followed by isosorbide dinitrate (1 mg/min) infused over 2 min. Coronary artery diameter was measured in 23 vessel segments from 12 transplant recipients.The following doses were infused: saline solution (1 ml/min), substance P (0.7 [three patients], 1.4, 2.8, 5.6, 11.2, 22.4 pmol/ min) and isosorbide dinitrate (1 mg/min). The mean percent increase in diameter (± SEM) in response to increasing doses of substance P was as follows: 0. 6.5 ± 2.9%, 10.9 ± 2.9%, 12.1 ±2.9%, 16.5 ± 2.6%, 19.2 ± 3.1% and 25.8 ± 2.2%, respectively. Half maximal dilation was produced with 1.4 to 2.8 pmol/min of substance P; the maximal response (mean percent diameter change) was 22 ± 2.5%. This was not significantly different from that achieved with isosorbide dinitrate.It is concluded that coronary endothelial function as assessed by response to substance P is preserved in cardiac transplant recipients with angiographically normal coronary arteries. Substance P may be a suitable agent for testing endothelial function in these patients

Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine Administration:Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study)

ObjectivesThis study sought to determine if adenosine administration is required for the pressure-only assessment of coronary stenoses.BackgroundThe instantaneous wave-free ratio (iFR) is a vasodilator-free pressure-only measure of the hemodynamic severity of a coronary stenosis comparable to fractional flow reserve (FFR) in diagnostic categorization. In this study, we used hyperemic stenosis resistance (HSR), a combined pressure-and-flow index, as an arbiter to determine when iFR and FFR disagree which index is most representative of the hemodynamic significance of the stenosis. We then test whether administering adenosine significantly improves diagnostic performance of iFR.MethodsIn 51 vessels, intracoronary pressure and flow velocity was measured distal to the stenosis at rest and during adenosine-mediated hyperemia. The iFR (at rest and during adenosine administration [iFRa]), FFR, HSR, baseline, and hyperemic microvascular resistance were calculated using automated algorithms.ResultsWhen iFR and FFR disagreed (4 cases, or 7.7% of the study population), HSR agreed with iFR in 50% of cases and with FFR in 50% of cases. Differences in magnitude of microvascular resistance did not influence diagnostic categorization; iFR, iFRa, and FFR had equally good diagnostic agreement with HSR (receiver-operating characteristic area under the curve 0.93 iFR vs. 0.94 iFRa and 0.96 FFR, p = 0.48).ConclusionsiFR and FFR had equivalent agreement with classification of coronary stenosis severity by HSR. Further reduction in resistance by the administration of adenosine did not improve diagnostic categorization, indicating that iFR can be used as an adenosine-free alternative to FFR. (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study [CLARIFY]; NCT01118481

Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave–Intensity Analysis Results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) Study

ObjectivesThe purpose of this study was to develop an adenosine-independent, pressure-derived index of coronary stenosis severity.BackgroundAssessment of stenosis severity with fractional flow reserve (FFR) requires that coronary resistance is stable and minimized. This is usually achieved by administration of pharmacological agents such as adenosine. In this 2-part study, we determine whether there is a time when resistance is naturally minimized at rest and assess the diagnostic efficiency, compared with FFR, of a new pressure-derived adenosine-free index of stenosis severity over that time.MethodsA total of 157 stenoses were assessed. In part 1 (39 stenoses), intracoronary pressure and flow velocity were measured distal to the stenosis; in part 2 (118 stenoses), intracoronary pressure alone was measured. Measurements were made at baseline and under pharmacologic vasodilation with adenosine.ResultsWave-intensity analysis identified a wave-free period in which intracoronary resistance at rest is similar in variability and magnitude (coefficient of variation: 0.08 ± 0.06 and 284 ± 147 mm Hg s/m) to those during FFR (coefficient of variation: 0.08 ± 0.06 and 302 ± 315 mm Hg s/m; p = NS for both). The resting distal-to-proximal pressure ratio during this period, the instantaneous wave-free ratio (iFR), correlated closely with FFR (r = 0.9, p < 0.001) with excellent diagnostic efficiency (receiver-operating characteristic area under the curve of 93%, at FFR <0.8), specificity, sensitivity, negative and positive predictive values of 91%, 85%, 85%, and 91%, respectively.ConclusionsIntracoronary resistance is naturally constant and minimized during the wave-free period. The instantaneous wave-free ratio calculated over this period produces a drug-free index of stenosis severity comparable to FFR. (Vasodilator Free Measure of Fractional Flow Reserve [ADVISE]; NCT01118481