313 Probability of significant coronary artery disease in Southern France: A need for distinctive predictive models

Como podrá establecerse en el desarrollo de esta investigación, la búsqueda de derroteros para la solución a este grave problema de “falta de vivienda”, ha determinado que los estados se preocupen por integrar a sus cartas magnas los derechos de las personas a contar con el apoyo de ellos para la satisfacción de su necesidad de contar con una vivienda, y a los organismos internacionales así mismo a interesarse por apoyar a los estados, en el estudio de la problemática y a dispensar recursos humanos y económicos para coadyuvar en la solución sobre todo, en beneficio de los sectores económicamente menos favorecidos. Por otro lado hay que entender que el problema de la vivienda es estructural y por lo tanto debe ser enfrentado desde los aspectos, teóricos, poblacionales, de desarrollo urbano, diseño, tecnología, factores económicos, sociales, políticos y culturales y sobre todo del aprovechamiento los recursos adaptándolos a la realidad existente en un mundo tan velozmente cambiante por la globalización. Además hay que destacar la importancia que para los países, conlleva el establecimiento de políticas de vivienda con tecnologías apropiadas, sobre todo en la Vivienda de Interés Social, que de manera integral y pragmática determinen acciones novedosas y dinámicas, que sostenidas en el tiempo y el espacio se conviertan en Objetivo Nacional Permanente, que permita elevar el bienestar y el mejoramiento de las condiciones de vida de los pueblos.1. Antecedentes 2.Aspectos Normativos Institucionales 3.Situación de la Vivienda en el Ecuador durante los períodos censales 4. Política de Vivienda 5.Propuesta 6.Conclusiones y Recomendacione

056: Biological efficacy of a 600mg loading dose of clopidogrel in ST-elevation myocardial infarction

BackgroundOptimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600mg loading dose (LD) of clopidogrel.Methods and resultsWe performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50±23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p=0.03), with a higher BMI (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an ACS and with a high fibrinogen level compared to good responders (VASP<50%). In multivariate analysis BMI, omeprazole use, acute coronary syndrome and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003).ConclusionSTEMI is associated with high on-treatment platelet reactivity following 600mg of clopidogrel. The present results suggest that 600mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred

6-Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin Final Results of the ITALIC Trial (Is There a Life for DES After Discontinuation of Clopidogrel)

OBJECTIVES The aim of this study was to test the hypothesis that 6-month dual antiplatelet therapy (DAPT) is non-inferior to 24-month DAPT in aspirin-sensitive patients. BACKGROUND The ITALIC (Is There a Life for DES After Discontinuation of Clopidogrel) trial showed that rates of bleeding and thrombotic events at 1 year were much the same with 6 versus 12 months of DAPT after percutaneous coronary intervention with second-generation drug-eluting stents. In this report, 2-year follow-up is presented. METHODS In a multicenter randomized study, patients with confirmed nonresistance to aspirin undergoing drug-eluting stent implantation were allocated to 6 or 24 months of DAPT. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke, and major bleeding at 12 months post-percutaneous coronary intervention. The secondary endpoints comprised the same composite endpoint at 24 months and each individual component. RESULTS Overall, 2,031 patients from 70 centers were screened; 926 were randomized to 6-month and 924 to 24-month DAPT. Noninferiority was demonstrated for 6-versus 12-month DAPT, with an absolute risk difference of 0.11% (95% confidence interval: -1.04% to 1.26%; p = 0.0002). At 2 years, the composite endpoint was unchanged, at 3.5% for 6 months and 3.7% for 24 months (p = 0.79), and rates of myocardial infarction (1.3% vs. 1.0%; p = 0.51), stroke (0.6% vs. 0.8%; p = 0.77), and target vessel revascularization (1.0% vs. 0.3%; p = 0.09) were likewise similar. There was a trend toward higher mortality with longer DAPT (2.2% vs. 1.2%; p = 0.11). Four patients (0.4%) in the 24-month group and none in the 6-month group had major bleeding. CONCLUSIONS Two-year outcomes in the ITALIC trial confirmed the 1-year results and showed that patients receiving 6-month DAPT after percutaneous coronary intervention with second-generation drug-eluting stent have similar outcomes to those receiving 24-month DAPT. (C) 2017 by the American College of Cardiology Foundation

Design method for estimation of unit value of extrication works after an accident using selected special technologies for removing the traffic obstacle on a motorway

Abstrakt Tato diplomová práce je dílčí součástí celkového projektu na stanovení všeobecné metodiky výpočtu nákladů na vyproštění nákladního automobilu. Zabývá se legislativou související s vyproštěním nákladních vozidel, analýzou nákladů a vyčíslení nákladů v důsledku odtahů u vybrané speciální techniky po nehodě. Práce je vodítkem pro znalce z ústavu soudního inženýrství, kteří na základě podkladů mohou snadněji stanovit postup a jednotkovou cenu vyprošťovacích prací po nehodě. Poté se zrychlí určování této ceny např. při soudních jednání a vyplacení zisků odtahovým firmám.Abstract (example) This thesis is a minor part of the overall project on the establishment of a general methodology of calculation of the cost of rescuing a lorry. It deals with legislation related to goods vehicle extrication, analysis of costs and costs as a result of exhausts for selected special equipment after an accident. The work is a guide for experts from the Institute of forensic engineering, on the basis of who can more easily establish a procedure and the unit price recovery work after the accident. Then speeds up determining the prices for example during the court proceedings and the payment of the profits of a business.

Enrichment and Characterisation of a Mixed-Source Ethanologenic Community Degrading the Organic Fraction of Municipal Solid Waste Under Minimal Environmental Control

The utilisation of the organic fraction of municipal solid waste as feedstock for bioethanol production could reduce the need for disposal of the ever-increasing amounts of municipal solid waste, especially in developing countries, and fits with the integrated goals of climate change mitigation and transport energy security. Mixed culture fermentation represents a suitable approach to handle the complexity and variability of such waste, avoiding expensive and vulnerable closed-control operational conditions. It is widely accepted that the control of pH in these systems can direct the fermentation process toward a desired fermentation product, however, little empirical evidence has been provided in respect of lignocellulosic waste substrates and different environmental inocula sources. We evaluated ethanol production from the organic fraction of municipal solid waste using five different inocula sources where lignocellulose degradation putatively occurs, namely, compost, woodland soil, rumen, cow faeces and anaerobic granular sludge, when incubated in batch microcosms at either initially neutral or acidic pH and under initially aerobic or anaerobic conditions. Although ethanol was produced by all the inocula tested, their performance was different in response to the imposed experimental conditions. Rumen and anaerobic granular sludge produced significantly the highest ethanol concentrations (∼30 mM) under initially neutral and acidic pH, respectively. A mixed-source community formed by mixing rumen and sludge (R + S) was then tested over a range of initial pH. In contrast to the differences observed for the individual inocula, the maximal ethanol production of the mixed community was not significantly different at initial pH of 5.5 and 7. Consistent with this broader functionality, the microbial community analyses confirmed the R + S community enriched comprised bacterial taxa representative of both original inocula. It was demonstrated that the interaction of initial pH and inocula source dictated ethanologenic activity from the organic fraction of municipal solid waste. Furthermore, the ethanologenic mixed-source community enriched, was comprised of taxa belonging to the two original inocula sources (rumen and sludge) and had a broader functionality. This information is relevant when diverse inocula sources are combined for mix culture fermentation studies as it experimentally demonstrates the benefits of diversity and function assembled from different inocula

Long-Term Clinical Outcomes With Sirolimus-Eluting Coronary Stents Five-Year Results of the RAVEL Trial

ObjectivesThis study examined the clinical outcomes at 5 years in RAVEL (A Randomized Comparison of a Sirolimus-Eluting Stent With a Standard Stent for Coronary Revascularization), the first controlled trial of drug-eluting stents.BackgroundThe 6-month rate of angiographic coronary restenosis has been markedly lowered by sirolimus-eluting stents (SES). The long-term performance of drug-eluting stents, however, is under close scrutiny.MethodsThe trial included 238 patients (mean age 60.7 ± 10.4 years, 76% men) with a single, de novo native coronary artery lesion, randomly assigned to treatment with SES versus bare-metal stents (BMS). Rates of major adverse cardiac events (MACE), defined as all-cause mortality, myocardial infarction, and percutaneous or surgical revascularization up to 5 years of follow-up, and rates of stent thrombosis were compared between the 2 treatment groups.ResultsComplete datasets were available in 92.5% of patients treated with SES and 89.1% of patients assigned to BMS. The 1-, 3-, and 5-year rates of survival free from target lesion revascularization (TLR) were, respectively, 99.2%, 93.8%, and 89.7% in the SES group versus 75.9%, 75.0%, and 74.0% in the control group (p < 0.001; log-rank). Rates of all MACE at 5 years were 25.8% in patients treated with SES versus 35.2% in patients assigned to BMS (p = 0.03; log-rank). Rates of stent thrombosis, per protocol or by the Academic Research Consortium definitions, were similar in both groups.ConclusionsThe 5-year rate of TLR associated with SES was significantly lower than that with BMS. There was no apparent adverse effect associated with the use of SES, although the trial was not powered to examine uncommon complications

A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization

BACKGROUND: The need for repeated treatment of restenosis of a treated vessel remains the main limitation of percutaneous coronary revascularization. Because sirolimus (rapamycin) inhibits the proliferation of lymphocytes and smooth-muscle cells, we compared a sirolimus-eluting stent with a standard uncoated stent in patients with angina pectoris. METHODS: We performed a randomized, double-blind trial to compare the two types of stents for revascularization of single, primary lesions in native coronary arteries. The trial included 238 patients at 19 medical centers. The primary end point was in-stent late luminal loss (the difference between the minimal luminal diameter immediately after the procedure and the diameter at six months). Secondary end points included the percentage of in-stent stenosis of the luminal diameter and the rate of restenosis (luminal narrowing of 50 percent or more). We also analyzed a composite clinical end point consisting of death, myocardial infarction, and percutaneous or surgical revascularization at 1, 6, and 12 months. RESULTS: At six months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01+/-0.33 mm) than in the standard-stent group (0.80+/-0.53 mm, P<0.001). None of the patients in the sirolimus-stent group, as compared with 26.6 percent of those in the standard-stent group, had restenosis of 50 percent or more of the luminal diameter (P<0.001). There were no episodes of stent thrombosis. During a follow-up period of up to one year, the overall rate of major cardiac events was 5.8 percent in the sirolimus-stent group and 28.8 percent in the standard-stent group (P<0.001). The difference was due entirely to a higher rate of revascularization of the target vessel in the standard-stent group. CONCLUSIONS: As compared with a standard coronary stent, a sirolimus-eluting stent shows considerable promise for the prevention of neointimal proliferation, restenosis, and associated clinical events

Impact of the Pandemic on NonInfected Cardiometabolic Patients: A Survey in Countries of Latin America—Rationale and Design of the CorCOVID LATAM Study

Background: The first case of coronavirus 2019 (COVID-19) in Latin America was detected on February 26th, 2020, in Brazil. Later, in June, the World Health Organization announced that the focus of the outbreak had shifted to Latin America, where countries already had poor control of indicators of noncommunicable diseases (NCDs). Concerns about coronavirus infection led to a reduced number of visits and hospitalizations in patients with NCDs, such as cardiovascular disease, diabetes, and cancer. There is a need to determine the impact of the COVID-19 pandemic on patients who have cardiometabolic diseases but do not have clinical evidence of COVID-19 infection. Methods: The CorCOVID LATAM is a cross-sectional survey of ambulatory cardiometabolic patients with no history or evidence of COVID-19 infection. The study will be conducted by the Interamerican Society of Cardiology. An online survey composed of 38 questions using Google Forms will be distributed to patients of 13 Latin American Spanish-speaking countries from June 15th to July 15th, 2020. Data will be analyzed by country and regions. Seven clusters of questions will be analyzed: demographics, socioeconomic and educational level, cardiometabolic profile, lifestyle and habits, body-weight perception, medical follow-up and treatments, and psychological symptoms. Results: Final results will be available upon completion of the study. Conclusions: The present study will provide answers regarding the impact of the COVID-19 pandemic on noninfected cardiometabolic patients. Data on this topic are scarce, as it is an unprecedented threat, without short-term solutions.Fil: Lopez Santi, Ricardo. Hospital Italiano de La Plata; ArgentinaFil: Piskorz, Daniel Leonardo. No especifíca;Fil: Marquez, Manlio F.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Ramirez Ramos, Cristhian. Centro de Medicina del Ejercicio y Rehabilitación Cardíaca; ColombiaFil: Renna, Nicolas Federico. Hospital Espanol de Mendoza; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: Ibarrola, Martin. No especifíca;Fil: Wyss, Fernando Stuardo. Servicios y Tecnología Cardiovascular de Guatemala; GuatemalaFil: Naranjo Dominguez, Adrián. Instituto de Cardiologia y Cirugia Cardiovascular; CubaFil: Perez, Gonzalo Emanuel. No especifíca;Fil: Farina, Juan María. No especifíca;Fil: Forte, Ezequiel. Centro Diagnóstico Cardiovascular; ArgentinaFil: Juarez Lloclla, Jorge Paul. Hospital de Apoyo II Santa Rosa; PerúFil: Flores de Espinal, Emma. Hospital Nacional San Juan De Dios; El SalvadorFil: Puente Barragan, Adriana. Instituto Mexicano del Seguro Social; MéxicoFil: Ruise, Mauro Gabriel. Clínica Yunes; ArgentinaFil: Delgado, Diego. University of Toronto; CanadáFil: Baranchuk, Adrian. Queens University; Canad