Clinical outcomes and costs of cardiac revascularisation in England and New York State

Objectives: Healthcare expenditure per-capita in the USA is higher than in England. We hypothesised that clinical outcomes after cardiac revascularisation are better in the USA. We compared costs and outcomes of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in England and New York State (NYS). Methods: Costs and total mortality were assessed using the Hospital Episode Statistics for England and the Statewide Planning and Research Cooperative System for NYS. Outcomes after a first CABG or PCI were assessed in patients undergoing a first CABG (n=142 969) or PCI (n=431 416). Results: After CABG, crude total mortality in England was 0.72% lower at 30 days and 3.68% lower at 1 year (both P<0.001). After PCI, crude total mortality was 0.35% lower at 30 days and 3.55% lower at 1 year (both P<0.001). No differences emerged in total mortality at 30 days after either CABG (England: HR 1.02,95% CI 0.94 to 1.10) or PCI (HR 1.04, 95% CI 0.99 to 1.09) after covariate adjustment. At 1 year, adjusted total mortality was lower in England after both CABG (HR 0.74, 95% CI 0.71 to 0.78) and PCI (HR 0.66, 95% CI 0.65 to 0.68). After adjustment for cost-to-charge ratios and purchasing power parities, costs in NYS amounted to uplifts of 3.8-fold for CABG and 3.6-fold for PCI. Conclusions: Total mortality after CABG and PCI was similar at 30 days and lower in England at 1 year. Costs were approximately fourfold higher in NYS

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Background Experimental evidence indicates that left ventricular (LV) apical pacing is hemodynamically superior to nonapical LV pacing. Some studies have shown that an LV apical lead position is unfavorable in cardiac resynchronization therapy. We sought to determine whether an apical LV lead position influences cardiac mortality after cardiac resynchronization therapy. Methods and Results In this retrospective observational study, the primary end point of cardiac mortality was assessed in relation to longitudinal (basal, midventricular, or apical) and circumferential (anterior, lateral, or posterior) LV lead positions, as well as right ventricular (apical or septal), assigned using fluoroscopy. Lead positions were assessed in 1189 patients undergoing cardiac resynchronization therapy implantation over 15 years. After a median follow‐up of 6.0 years (interquartile range: 4.4–7.7 years), an apical LV lead position was associated with lower cardiac mortality than a nonapical position (adjusted hazard ratio: 0.74; 95% confidence interval, 0.56–0.99) after covariate adjustment. There were no differences in total mortality or heart failure hospitalization. Death from pump failure was lower with apical than nonapical positions (adjusted hazard ratio: 0.69; 95% confidence interval, 0.51–0.94). Compared with a basal position, an apical LV position was also associated with lower risk of sudden cardiac death (adjusted hazard ratio: 0.34; 95% confidence interval, 0.13–0.93). No differences emerged between circumferential LV lead positions or right ventricular positions with respect to any end point. Conclusions In recipients of cardiac resynchronization therapy, an apical LV lead position was associated with better long‐term cardiac survival than a nonapical position. This effect was due to a lower risk of pump failure and sudden cardiac death

Effect of Salvianolic Acid b and Paeonol on Blood Lipid Metabolism and Hemorrheology in Myocardial Ischemia Rabbits Induced by Pituitruin

The purpose of this study was to determine the therapeutic effect of salvianolic acid b and paeonol on coronary disease. The ischemia myocardial animal model is induced by administering pituitrin (20 μg·kg−1) intravenously via the abdominal vein. A combination of salvianolic acid b and paeonol (CSAP) (5, 10 and 15 mg/kg BW) was administrated to experimental rabbits. Biochemical indices were evaluated during six weeks of intervention. We found that the compound of salvianolic acid b and paeonol (5, 10 and 15 mg/kg BW) can markedly and dose-dependently reduce fibrinogen and malonaldehyde levels, increase the HDL level, improve blood viscosity and plasma viscosity in rabbits. In addition, the medicine can still reduce the ratio of NO/ET and the contents of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) in a dose-dependent manner. This study demonstrates that compound of salvianolic acid b and paeonol (5, 10 and 15 mg/kg BW) can improve the blood hemorrheology, decrease oxidative injury and repair the function of blood vessel endothelium, and subsequently prevent the development of Coronary disease

Ethnic discordance in serum anti-Müllerian hormone in healthy women: a population study from China and Europe

Research question: Chinese women are known to have an earlier age of natural menopause than their European counterparts, but whether they also have a lower functional ovarian reserve is unknown. This study was designed to assess whether there are ethnic differences in anti-Müllerian hormone (AMH) concentrations in women of reproductive age. Design: Women in China and Europe with regular menstrual cycles, not on hormonal contraception and with no medical history of note, were recruited to provide a day 2–5 early follicular phase sample. AMH concentration was determined using the Roche Elecsys assay. Decline in AMH was modelled with linear, quadratic and quadratic with interaction on age equations to assess the impact of ethnicity. Results: A total of 887 European and 461 Chinese women participated in the study. Despite the Chinese population being slightly younger (34.1 ± 8.4 years) than their European counterparts (34.8±8.9 years), their median AMH was lower, at 1.87 ng/ml (interquartile range [IQR] 0.28–3.64) compared with 2.11 ng/ml (IQR 0.73–3.96), with evidence of increasing discordance from age 25 years. In all regression models of the age-related decline in AMH, there was evidence of a difference between Chinese and European women. Although AMH was 28.1% (95% confidence interval [CI] 18.2–36.7%) lower in the Chinese population at age 30, this decline increased to 79.4% (95% CI 75.4– 82.9%) at age 45. Conclusions: There were independent effects of age and ethnicity on serum AMH concentrations, with Chinese women having a substantially lower AMH in adult life than their European counterparts from age 25 onwards

Recent Advances in Synthetic Bioelastomers

This article reviews the degradability of chemically synthesized bioelastomers, mainly designed for soft tissue repair. These bioelastomers involve biodegradable polyurethanes, polyphosphazenes, linear and crosslinked poly(ether/ester)s, poly(ε-caprolactone) copolymers, poly(1,3-trimethylene carbonate) and their copolymers, poly(polyol sebacate)s, poly(diol-citrates) and poly(ester amide)s. The in vitro and in vivo degradation mechanisms and impact factors influencing degradation behaviors are discussed. In addition, the molecular designs, synthesis methods, structure properties, mechanical properties, biocompatibility and potential applications of these bioelastomers were also presented

A Data Mining Application: Analysis of Problems Occurring During a Software Project Development Process

Data mining techniques provide people with new power to research and manipulate the existing large volume of data. A data mining process discovers interesting information from the hidden data that can either be used for future prediction and/or intelligently summarising the details of the data. There are many achievements of applying data mining techniques in various areas such as marketing, medical, and financial, although few of them can be currently seen in software engineering domain. In this paper, a proposed data mining application in software engineering domain is explained and experimented. The empirical results demonstrate the capability of data mining techniques in software engineering domain and the potential benefits in applying data mining in this area

Use of Data Mining in System Development Life Cycle

This volume provides a snapshot of the current state of the art in data mining, presenting it both in terms of technical developments and industrial applications. The collection of chapters is based on works presented at the Australasian Data Mining conferences and industrial forums. Authors include some of Australia's leading researchers and practitioners in data mining. The volume also contains chapters by regional and international authors. The original papers were initially reviewed for the workshops, conferences and forums. The 25 articles in this state-of-the-art survey were carefully reviewed and selected from numerous contributions during at least two rounds of reviewing and improvement for inclusion in the book. They provide an interesting and broad update on current research and development in data mining. The book is divided into two parts. It starts with state-of-the-art research papers organized in topical sections on methodological advances, data linkage, text mining, and temporal and sequence mining. The second part comprises papers on state-of-the-art industrial applications from the fields of health, finance and retail

Variability of Particle Size Distributions in the Bohai Sea and the Yellow Sea

Particle size distribution (PSD) is an important parameter that is relevant to many aspects of marine ecosystems, such as phytoplankton functional types, optical absorption and scattering from particulates, sediment fluxes, and carbon export. However, only a handful of studies have documented the PSD variability in different regions. Here, we investigate the PSD properties and variability in two shallow and semi-enclosed seas (the Bohai Sea (BS) and Yellow Sea (YS)), using in situ laser diffraction measurements (LISST-100X Type C) and other measurements at 79 stations in November 2013. The results show large variability in particle concentrations (in both volume and number concentrations), with volume concentrations varying by 57-fold. The median particle diameter (Dv50) from each of the water samples also covers a large range (22.4–307.0 μm) and has an irregular statistical distribution, indicating complexity in the PSD. The PSD slopes (2.7–4.5), estimated from a power-law model, cover nearly the entire range reported previously for natural waters. Small mineral particles (with large PSD slopes) are characteristic of near-shore waters prone to sediment resuspension by winds and tides, while large biological particles (with small PSD slopes) dominate the total suspended particulates for waters away from the coast. For the BS and YS, this study provides the first report on the properties and spatial variability of the PSD, which may influence the optical properties of the ocean surface and remote sensing algorithms that are based on estimations of particle concentrations and sizes