Is there a role for oral triple therapy in patients with acute coronary syndromes without atrial fibrillation?

© 2018 Bentham Science PublishersBACKGROUND: Acute coronary syndrome (ACS) patients, despite treatment with dual antiplatelet therapy (DAPT), have up to 10% risk of recurrent major adverse cardiac events (MACE) in the short term. METHODS: Here we review studies using more potent antithrombotic agent combinations to reduce this risk, namely triple therapy (TT) with the addition of an oral anticoagulant, PAR-1 antagonist, or cilostazol to DAPT (mainly aspirin and clopidogrel), and discuss the limitations of trials to date. RESULTS: Generally speaking, TT leads to an increase in bleeding. Vorapaxar showed a signal for reducing ischaemic events, but increased intracranial haemorrhage 3-fold in the subacute phase of ACS, although remains an option for secondary prevention beyond the immediate subacute phase, particularly if prasugrel or ticagrelor are not available. Non-vitamin K oral anticoagulants (NOACs) all increased bleeding, with only modest reduction in MACE noted with low dose rivaroxaban. Rivaroxaban can be considered combined with aspirin and clopidogrel in ACS patients at high ischaemic and low bleeding risk, without prior stroke/TIA. The combination of P2Y12 inhibitor and NOAC, without aspirin, looks promising. DAPT may be replaced, not by TT, but by dual therapy comprising a NOAC with a P2Y12 inhibitor. CONCLUSION: More potent antithrombotic regimens increase bleeding and should only be considered on an individual basis, after careful risk stratification. Accurate risk stratification of ACS patients, for both ischaemic and bleeding risk, is essential to allow individualised treatment.Peer reviewe

Use of bioresorbable vascular scaffold : a meta-analysis of patients with coronary artery disease

BACKGROUND: Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies. METHODS: A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model. RESULTS: In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001). CONCLUSIONS: Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.Peer reviewedFinal Published versio

Investigating Sustainability of the Traditional Courtyard Houses Using Deep Beauty Framework

In Pakistan, power outages have become frequent over the past two decades, due to a continuing energy crisis. Reliance on machines for thermal comfort of buildings has led to high energy demands of the increasing population. The negative impacts of artificial environments have, also, diminished the sense of place, biophilia and cultural values. Moreover, globalization has standardized the built environments, causing a lack of regional identity and an absence of climate sensitivity in design. Keeping all these issues in focus, this article re-examines the fundamental aspects of traditional architecture and aims to stimulate architects and designers to create sustainable and life-enriching designs, which are appropriate for contemporary times. In this research, the first two levels of Deep Beauty (functional and typological) are used, as a conceptual framework for sustainable design, to analyse a representative of a traditional courtyard house. In conjunction with the theoretical underpinnings of the Deep Beauty framework, the analysis utilizes photographs, drawings, and diagrams to support the arguments. The research shows that the traditional courtyard house possesses numerous attributes of sustainable design, which can be incorporated into contemporary house design

Towards Modelling Trust in Voice at Zero Acquaintance

Trust is essential in many human relationships, especially where there is an element of inter-dependency. However, humans tend to make quick judgements about trusting other individuals, even those met at zero acquaintance. Past studies have shown the significance of voice in perceived trustworthiness, but research associating trustworthiness and different vocal features such as speech rate and fundamental frequency (f0) has yet to yield consistent results. Therefore, this paper proposes a method to investigate 1) the association between trustworthiness and different vocal features, 2) the vocal characteristics that Malaysian ethnic groups base their judgement of trustworthiness on and 3) building a neural network model that predicts the degree of trustworthiness in a human voice. In the method proposed, a reliable set of audio clips will be obtained and analyzed with SoundGen to determine the acoustical characteristics. Then the audio clips will be distributed to a large group of untrained respondents to rate their degree of trust in the speakers of each audio clip. The participants will be able to choose from 30 sets of audio clips which will consist of 6 audio clips each. The acoustic characteristics will be analyzed and com-pared with the ratings to determine if there are any correlations between the acoustic characteristic and the trustworthiness ratings. After that, a neural network model will be built based on the collected data. The neural network model will be able to predict the trustworthiness of a person’s voice. Keywords—prosody, trust, voice, vocal cues, zero acquaintance

Trapping citronellal in a microporous polyethylene matrix

The Flory–Huggins theory was used to model the phase behaviour of linear low density polyethylene– citronellal binary mixtures. The model parameters were obtained from fitting the bimodal phase envelope using data points from cloud point determinations. This allowed the prediction of the melting point depression curve as well as the location of the spinodal region. A microporous polyethylene matrix was obtained by quenching homogeneous liquid mixtures at temperatures well below the spinodal phase boundary. This strategy makes it possible to trap, and effectively solidify, large amounts of citronellal in a polyethylene (LLDPE) matrix. This has potential implications for the development of long-lasting insect repellent bracelets and anklets.Dr Leo Braack, the Centre for Sustainable Malaria Control at University of Pretoria and the National Research Foundation of South Africa.http://www.elsevier.com/locate/tca2016-08-10hb201

Različitost interferona-α-A (IFN-α-A) u jaka (Bos grunniens) iz Pakistana

Among the various species of livestock, the domestic yak (Bos grunniens) belongs to the class Bovidae and is specially adapted for survival at high altitudes under extreme climatic conditions. Yak is a very useful species due to the multiple products it provides, such as meat, hide, milk and other dairy products. Like other livestock species, domestic yak is also in danger of infection by microbial infections. However, multiple immunity genes encode special protein products to fight infection. One of these immunity genes is interferon-α-A (IFN-α-A), which encodes proteins that belongs to cytokines and fights viral infections. The current study analysed the genetic variation and phylogenetic analysis of the IFN-α-A gene in domestic yak, with comparisons to other mammalian species to investigate immune diversity level, with the aim of designing molecular selection strategies for better disease resistant animals.Među različitim vrstama stoke, jedna je vrsta i jak (Bos grunniens). Ova životinja pripada obitelji Bovidae. Ova je vrsta prilagođena je preživljavanju na velikim visinama i u ekstremnim klimatskim uvjetima. Jak je vrlo korisna životinja zbog brojnih proizvoda koje od njega dobivamo, poput mesa, kože, mlijeka i mliječnih proizvoda. Kao i druge vrste stoke i jak je u opasnosti od infekcije brojnim mikrobnim infekcijama. Međutim, mnogo je imunogena koji kodiraju posebne proteinske proizvode za borbu protiv infekcija. Jedan od tih imunogena je interferon-α-A (IFN-α-A) koji kodira proteine koji pripadaju citokinima i bori se protiv virusnih infekcija. Ova studija osmišljena je za analizu genetske varijacije i filogenetsku analizu IFN-α –A gena u jaka (Bos grunniens) te njegovu usporedbu s drugim vrstama sisavaca u svrhu istraživanja razine različitosti imunosti za osmišljenja strategija molekularnog odabira za veću otpornost životinja na bolesti

Fabrication of photo-electrochemical biosensors for ultrasensitive screening of mono-bioactive molecules: the effect of geometrical structures and crystal surfaces

The controlled design of biosensors based on the photo-electrochemical technique with high selectivity, sensitivity, and rapid response for monitoring of mono-bioactive molecules, particularly dopamine (DA) levels in neuronal cells is highly necessary for clinical diagnosis. Hierarchical carbon-, nitrogen-doped (CN) nickel oxide spear thistle (ST) flowers associated in single-heads (S), and symmetric and asymmetric-double heads (D and A, respectively) that are tightly connected through a micrometric dipole-like rod or trunk were fabricated by using a simple synthetic protocol. The CN-ST flower heads were decorated with dense nano-tubular like hedgehog needle skins in vertical alignments. These designated architectures are key features for creating biosensor surface electrodes for photo-electrochemical, ultrasensitive screening of mono-bioactive molecules. The exceptional electrode designs produced numerous catalytically active sites, large surface area, and high electron-transfer mobility. The active coating of carbon–nitrogen nanospheres significantly enhanced the photo-electrocatalytic activity of the prepared biosensor electrodes and prevented leakage of photocatalytic activity under long-term exposure to irradiation. Among all photo-electrochemical assays, the biosensors showed significant sensitivity and selectivity for DA in the presence of interfering molecules such as ascorbic acid (AA), uric acid (UA), adrenaline (A), and noradrenaline (NA). The photo-electrochemical property of the CN-SST-{110} crystal surface electrode showed significant sensing performance for DA in terms of unimpeded diffusion pathways, a wide concentration-detection range, and a low detection limit, even in the presence of potentially interfering molecules compared with other electrode-modified CN-DST-{111} and CN-AST-{101} crystal surfaces. Furthermore, the CN-SST photo-biosensor electrode shows potential in the selective and sensitive determination of DA in real samples, such as human serum and secreted DA from living cells. This finding indicates that the hierarchical ST biosensor may enable analytical discrimination and monitoring of DA and can be employed for clinical diagnosis application