Comparison of clinical and angiographic prognostic risk scores in elderly patients presenting with acute coronary syndrome and referred for percutaneous coronary intervention.

BACKGROUND: Multiple risk prediction models have been validated in all-age patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI); however, they have not been validated specifically in the elderly. METHODS: We calculated the GRACE (Global Registry of Acute Coronary Events) score, the logistic EuroSCORE, the AMIS (Acute Myocardial Infarction Swiss registry) score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in a consecutive series of 114 patients ≥75 years presenting with ACS and treated with PCI within 24 hours of hospital admission. Patients were stratified according to score tertiles and analysed retrospectively by comparing the lower/mid tertiles as an aggregate group with the higher tertile group. The primary endpoint was 30-day mortality. Secondary endpoints were the composite of death and major adverse cardiovascular events (MACE) at 30 days, and 1-year MACE-free survival. Model discrimination ability was assessed using the area under receiver operating characteristic curve (AUC). RESULTS: Thirty-day mortality was higher in the upper tertile compared with the aggregate lower/mid tertiles according to the logistic EuroSCORE (42% vs 5%; odds ratio [OR] = 14, 95% confidence interval [CI] = 4-48; p <0.001; AUC = 0.79), the GRACE score (40% vs 4%; OR = 17, 95% CI = 4-64; p <0.001; AUC = 0.80), the AMIS score (40% vs 4%; OR = 16, 95% CI = 4-63; p <0.001; AUC = 0.80), and the SYNTAX score (37% vs 5%; OR = 11, 95% CI = 3-37; p <0.001; AUC = 0.77). CONCLUSIONS: In elderly patients presenting with ACS and referred to PCI within 24 hours of admission, the GRACE score, the EuroSCORE, the AMIS score, and the SYNTAX score predicted 30 day mortality. The predictive value of clinical scores was improved by using them in combination

A novel LMNA mutation (R189W) in familial dilated cardiomyopathy: evidence for a 'hot spot' region at exon 3: a case report

We describe a case of a patient with idiopathic dilated cardiomyopathy and cardiac conduction abnormalities who presented a strong family history of sudden cardiac death. Genetic screening of lamin A/C gene revealed in proband the presence of a novel missense mutation (R189W), near the most prevalent lamin A/C mutation (R190W), suggesting a "hot spot" region at exon 3

The intrapreneurial state: Singapore's emergence in the smart and sustainable urban solutions field

The East Asian developmental state model and the Anglo-American entrepreneurial state model profile varied ways in which the state continues to intervene in economic development. These models are developed by different disciplines and against diverse contexts to capture extrasocietal state responses to neoliberalism and globalization but leave the intrasocietal preconditions for state evolution little explored. We elaborate the concept of state intrapreneurialism as one way of understanding the interrelationship between economic and state transformation – one ingredient of the intrasocietal preconditions underpinning the responses to extrasocietal changes emphasized in the post-developmental state literature. Drawing on the case of Singapore's emergence in the field of smart/sustainable urban solutions, the subsidiary contributions of this paper are to suggest intrapreneurship as a specific and enduring advantage within the developmental state model, especially when set against its limitations signalled in the post-developmental state literature

The metamorphosis of Supernova SN2008D/XRF080109: a link between Supernovae and GRBs/Hypernovae

The only supernovae (SNe) to have shown early gamma-ray or X-ray emission thus far are overenergetic, broad-lined Type Ic SNe (Hypernovae - HNe). Recently, SN 2008D shows several novel features: (i) weak XRF, (ii) an early, narrow optical peak, (iii) disappearance of the broad lines typical of SNIc HNe, (iv) development of He lines as in SNeIb. Detailed analysis shows that SN 2008D was not a normal SN: its explosion energy (KE ~ 6*10^{51} erg) and ejected mass (~7 Msun) are intermediate between normal SNeIbc and HNe. We derive that SN 2008D was originally a ~30Msun star. When it collapsed a black hole formed and a weak, mildly relativistic jet was produced, which caused the XRF. SN 2008D is probably among the weakest explosions that produce relativistic jets. Inner engine activity appears to be present whenever massive stars collapse to black holes.Comment: 22 pages, 7 figures. Accepted for publication in Scienc

Supporting quality in science communication: insights from the QUEST project

How to promote quality is a critical aspect to consider when re-examining science communication, analysed in the research carried out in QUEST project presented in this paper. Engaging key stakeholders in a co-design process - through interviews, focus groups, workshops and surveys - the research identified barriers to quality science communication and on the basis of these, proposes a series of tools and supporting documents that can serve as incentives toward quality science communication for different stakeholders across the fields of journalism, social media, and museum communication. Among these particularly important is training to also promote professionalism of communicators

Doubly heterozygous LMNA and TTN mutations revealed by exome sequencing in a severe form of dilated cardiomyopathy

Familial dilated cardiomyopathy (DCM) is a heterogeneous disease; although 30 disease genes have been discovered, they explain only no more than half of all cases; in addition, the causes of intra-familial variability in DCM have remained largely unknown. In this study, we exploited the use of whole-exome sequencing (WES) to investigate the causes of clinical variability in an extended family with 14 affected subjects, four of whom showed particular severe manifestations of cardiomyopathy requiring heart transplantation in early adulthood. This analysis, followed by confirmative conventional sequencing, identified the mutation p.K219T in the lamin A/C gene in all 14 affected patients. An additional variant in the gene for titin, p.L4855F, was identified in the severely affected patients. The age for heart transplantation was substantially less for LMNA:p.K219T/TTN:p.L4855F double heterozygotes than that for LMNA:p.K219T single heterozygotes. Myocardial specimens of doubly heterozygote individuals showed increased nuclear length, sarcomeric disorganization, and myonuclear clustering compared with samples from single heterozygotes. In conclusion, our results show that WES can be used for the identification of causal and modifier variants in families with variable manifestations of DCM. In addition, they not only indicate that LMNA and TTN mutational status may be useful in this family for risk stratification in individuals at risk for DCM but also suggest titin as a modifier for DCM