Percutaneous coronary revascularization in patients with formerly "refractory angina pectoris in end-stage coronary artery disease" – Not "end-stage" after all

<p>Abstract</p> <p>Background</p> <p>Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coronary artery disease for feasible options of myocardial revascularization.</p> <p>Methods</p> <p>Thirty-four Patients formerly characterized as having end stage coronary artery disease with refractory angina pectoris were retrospectively followed for coronary interventions.</p> <p>Results</p> <p>Of those 34 patients 21 (61.8%) were eventually revascularized with percutaneous interventional revascularization (PCI). Due to complex coronary morphology (angulation, chronic total occlusion) PCI demanded an above-average amount of time (66 ± 42 minutes, range 25–206 minutes) and materials (contrast media 247 ± 209 ml, range 50–750 ml; PCI guiding wires 2.0 ± 1.4, range 1–6 wires). Of PCI patients 7 (33.3%) showed a new lesion as a sign of progression of atherosclerosis. Clinical success rate with a reduction to angina class II or lower was 71.4% at 30 days. Surgery was performed in a total of8 (23.5%) patients with a clinical success rate of 62.5%. Based on an intention-to-treat 2 patients of originally 8 (25%) demonstrated clinical success. Mortality during follow-up (1–18 months) was 4.8% in patients who underwent PCI, 25% in patients treated surgically and 25% in those only treated medically.</p> <p>Conclusion</p> <p>The majority of patients with end-stage coronary artery disease can be treated effectively with conventional invasive treatment modalities. Therefore even though it is challenging and demanding PCI should be considered as a first choice before experimental interventions are considered.</p

Electrocardiographic features of immune checkpoint inhibitor associated myocarditis

Background Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis. Methods From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested. Results Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39). Conclusions The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification

Improving training outcomes: the significance of motivation when learning about new shipboard technology

This paper reports on some of the findings from a study of new technology and training in shipping. It identifies the key significance of motivation in the learning process and identifies potential factors that motivate or demotivate seafarers when undertaking training about new equipment. It shows that seafarers’ motivation is likely to be impacted by confidence that training is good for the job as well as for promotion. It demonstrates that companies can facilitate and encourage individuals to initiate learning activities but that they may equally adopt strategies which discourage learning. Enabling factors include: establishing a positive learning environment; adopting clear policies; allowing seafarers to identify their own training needs and allowing seafarers to request support for specific courses. Conversely, companies may demotivate some seafarers in relation to training by shifting the burden of training ‘costs’, such as time and money, onto them

Embracing Bewilderment: Responding to technological disruption in heterogeneous market environments

In an age of rapid advances in technology, understanding how firms can respond to emergence of disruptive technologies is paramount for survival. While prior research on incumbents’ responses to disruptive technologies assumes demand homogeneity, many firms, including multinational enterprises (MNEs), need to respond to technological disruption in heterogeneous markets. To address this lacuna in our understanding, we study how Ericsson tried to respond to the emergence of Cloud computing, a digital platform technology, across its operations in more than 170 countries. We reveal how incumbents need to match diverging customer demands with a complex innovation process, involving different approaches to experiments and trials, deployment strategy, and ecosystem development. We also find that the success of incumbents’ responses depends on their capability for misalignment, which allows them to manage the inconsistencies in strategic direction, structure, and resource configuration associated with a complex innovation process

Measuring personal networks and their relationship with scientific production

The analysis of social networks has remained a crucial and yet understudied aspect of the efforts to measure Triple Helix linkages. The Triple Helix model aims to explain, among other aspects of knowledge-based societies, ¿the current research system in its social context. This paper develops a novel approach to study the research system from the perspective of the individual, through the analysis of the relationships among researchers, and between them and other social actors. We develop a new set of techniques and show how they can be applied to the study of a specific case (a group of academics within a university department). We analyse their informal social networks and show how a relationship exists between the characteristics of an individual¿s network of social links and his or her research output

The Innofusion of Electronic Banking in Indonesia

Even though financial innovation plays an important role in the modern economy, surprisingly there have been few empirical literatures. In developing countries, electronic banking (e-banking), for example, received relatively little attention although has been deployed for years. Indonesia presents unique case of Asian tiger economies, especially after experiencing crisis, financial recession, and economic reform. This research address how e-banking being developed in Indonesia, how it diffused from time to time, what factors that drives and influences the e-banking implementation, how banks manage their e-banking, and what lessons can we learn from it. This study concludes by summarising the case of innofusion of electronic banking in Indonesia. Customers and competitors play an important role in influencing e-banking services adoption. There is also an indication that bigger and older banks are not as innovative and dynamic as their smaller and newer peers. Interestingly, the unavailability of legal protection does not discourage them to partner and cooperate with each other and probably true that it is only 'those' people who drive innovation among Indonesian banks