Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31758 patients treated between 2000 and 2007

<p>Background: The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time.</p> <p>Methods and Results: The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, χ2 test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ2 test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (χ2 test for trend, P=0.142) or overall (χ2 test for trend, P=0.083).</p> <p>Conclusions: Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.</p&gt

The Polonnaruwa meteorite: oxygen isotope, crystalline and biological composition

Results of X-Ray Diffraction (XRD) analysis, Triple Oxygen Isotope analysis and Scanning Electron Microscopic (SEM) studies are presented for stone fragments recovered from the North Central Province of Sri Lanka following a witnessed fireball event on 29 December 2012. The existence of numerous nitrogen depleted highly carbonaceous fossilized biological structures fused into the rock matrix is inconsistent with recent terrestrial contamination. Oxygen isotope results compare well with those of CI and CI-like chondrites but are inconsistent with the fulgurite hypothesis.Comment: 7 pages, 7 figures, 4 table

Fractional flow reserve versus angiography in guiding management to optimize outcomes in non–ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial

<p>Background: In patients with acute non–ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care.</p> <p>Methods and design: A prospective multicenter parallel-group 1:1 randomized controlled superiority trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% severity (threshold for FFR measurement) will be conducted. Patients will be randomized immediately after coronary angiography to the FFR-guided group or angiography-guided group. All patients will then undergo FFR measurement in all vessels with a coronary stenosis ≥30% severity including culprit and nonculprit lesions. Fractional flow reserve will be disclosed to guide treatment in the FFR-guided group but not disclosed in the “angiography-guided” group. In the FFR-guided group, an FFR ≤0.80 will be an indication for revascularization by percutaneous coronary intervention or coronary artery bypass surgery, as appropriate. The primary outcome is the between-group difference in the proportion of patients allocated to medical management only compared with revascularization. Secondary outcomes include the occurrence of cardiac death or hospitalization for myocardial infarction or heart failure, quality of life, and health care costs. The minimum and average follow-up periods for the primary analysis are 6 and 18 months, respectively.</p> <p>Conclusions: Our developmental clinical trial will address the feasibility of FFR measurement in NSTEMI and the influence of FFR disclosure on treatment decisions and health and economic outcomes.</p&gt

Reducing in-stent restenosis therapeutic manipulation of miRNA in vascular remodeling and inflammation

Background: Drug-eluting stents reduce the incidence of in-stent restenosis, but they result in delayed arterial healing and are associated with a chronic inflammatory response and hypersensitivity reactions. Identifying novel interventions to enhance wound healing and reduce the inflammatory response may improve long-term clinical outcomes. Micro–ribonucleic acids (miRNAs) are noncoding small ribonucleic acids that play a prominent role in the initiation and resolution of inflammation after vascular injury.<p></p> Objectives: This study sought to identify miRNA regulation and function after implantation of bare-metal and drug-eluting stents.<p></p> Methods: Pig, mouse, and in vitro models were used to investigate the role of miRNA in in-stent restenosis.<p></p> Results: We documented a subset of inflammatory miRNAs activated after stenting in pigs, including the miR-21 stem loop miRNAs. Genetic ablation of the miR-21 stem loop attenuated neointimal formation in mice post-stenting. This occurred via enhanced levels of anti-inflammatory M2 macrophages coupled with an impaired sensitivity of smooth muscle cells to respond to vascular activation.<p></p> Conclusions: MiR-21 plays a prominent role in promoting vascular inflammation and remodeling after stent injury. MiRNA-mediated modulation of the inflammatory response post-stenting may have therapeutic potential to accelerate wound healing and enhance the clinical efficacy of stenting

A thermodynamic framework to develop rate-type models for fluids without instantaneous elasticity

In this paper, we apply the thermodynamic framework recently put into place by Rajagopal and co-workers, to develop rate-type models for viscoelastic fluids which do not possess instantaneous elasticity. To illustrate the capabilities of such models we make a specific choice for the specific Helmholtz potential and the rate of dissipation and consider the creep and stress relaxation response associated with the model. Given specific forms for the Helmholtz potential and the rate of dissipation, the rate of dissipation is maximized with the constraint that the difference between the stress power and the rate of change of Helmholtz potential is equal to the rate of dissipation and any other constraint that may be applicable such as incompressibility. We show that the model that is developed exhibits fluid-like characteristics and is incapable of instantaneous elastic response. It also includes Maxwell-like and Kelvin-Voigt-like viscoelastic materials (when certain material moduli take special values).Comment: 18 pages, 5 figure

Well-posedness of Hydrodynamics on the Moving Elastic Surface

The dynamics of a membrane is a coupled system comprising a moving elastic surface and an incompressible membrane fluid. We will consider a reduced elastic surface model, which involves the evolution equations of the moving surface, the dynamic equations of the two-dimensional fluid, and the incompressible equation, all of which operate within a curved geometry. In this paper, we prove the local existence and uniqueness of the solution to the reduced elastic surface model by reformulating the model into a new system in the isothermal coordinates. One major difficulty is that of constructing an appropriate iterative scheme such that the limit system is consistent with the original system.Comment: The introduction is rewritte

Convective Nonlinearity in Non-Newtonian Fluids

In the limit of infinite yield time for stresses, the hydrodynamic equations for viscoelastic, Non-Newtonian liquids such as polymer melts must reduce to that for solids. This piece of information suffices to uniquely determine the nonlinear convective derivative, an ongoing point of contention in the rheology literature.Comment: 4 page

Nanoparticulate nickel sulfides formed in low temperature aqueous solutions

The nature of the nickel sulfides formed in low temperature aqueous solutions is not well-understood. The material has some intrinsic interest to mineralogy, geochemistry and materials science as well as to biogeochemisty, especially as a possible catalyst involved in the origin and early evolution of life. We synthesized Ni sulfide under anoxic conditions at 25 C: (1) chemically, by the addition of 50 mL of 0.1 M NiSO4Æ7H2O to 100 mL of 0.05M Na2SÆ9H2O; (2) electrochemically, with a Ni foil and H2S gas. At pH 6 5, millerite (b-NiS) was produced electrochemically and NiS mixtures, including heazlewoodite (Ni3S2) and polydymite (Ni3S4), were obtained chemically. At pH >11, a- NiS was obtained from the chemical reaction. At pH 6–9, the product produced only two broad peaks (d = ca. 2.7 and 1.8 ) with conventional and synchrotron XRPD which could be assigned to a number of Ni sulfides. It has previously been referred to as ‘‘amorphous NiS’’ Jeong and Manthiram, 2001. Eight SAED reflections were collected which identified the material as godlevskite, orthorhombic NiS. HRTEM shows that the godlevskite particles are ca. 30 nm in diameter and plate-like. SAXS analyses show that the material is 6–8.5 nm thick. Godlevskite is structurally related to makinawite, tetragonal FeS, and is found naturally in similar parageneses-associated with the monosulfide solid solution products of high temperature nickel ores. Mackinawite is the black FeS precipitate from the reaction between Fe(II) and S(-II) in aqueous solution. It appears that, geochemically, godlevskite is the Ni analogue of mackinawite