are drug eluting stents superior to bare metal stents in patients with unprotected non bifurcational left main disease insights from a multicentre registry

Aims To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered. Methods and results The GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006. From the registry, a total of 479 consecutive patients with ostial and shaft lesions who underwent DES ( n = 334) or BMS ( n = 145) implantation were analysed with extensive multivariable and propensity score adjustments. At 3-year follow-up, risk-adjusted survival rates were higher in patients treated with DES than in those treated with BMS. The adjusted hazard ratio (HR) for the risk of mortality after DES implantation relative to BMS implantation was 0.37 (95% CI: 0.15–0.96, P = 0.04). The adjusted HR for the risk of cardiac mortality was 0.31 (95% CI: 0.09–1.04, P = 0.06). The adjusted 3-year rates of target lesion revascularization (TLR) were not significantly lower in the DES group than in the BMS group ( P = 0.60). Conclusion In a large population of patients with lesions located at the ostium or the shaft of the left main in a real-world setting, DES were associated with favourable clinical outcomes when compared with BMS, although there was no evidence of a significant reduction in TLR with DES vs. BMS

advanced intrahepatic cholangiocarcinoma icca treated with arterial directed therapies adt outcomes and safety from a multicenter italian experience

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How to increase technology transfers to developing countries: a synthesis of the evidence

The existing United Nations Framework Convention on Climate Change (UNFCCC) has failed to deliver the rate of low-carbon technology transfer (TT) required to curb GHG emissions in developing countries. This failure has exposed the limitations of universalism and renewed interest in bilateral approaches to TT. Gaps are identified in the UNFCCC approach to climate change TT: missing links between international institutions and the national enabling environments that encourage private investment; a non-differentiated approach for (developing) country and technology characteristics; and a lack of clear measurements of the volume and effectiveness of TTs. Evidence from econometric literature and business experience on climate change TT is reviewed, so as to address the identified pitfalls of the UNFCCC process. Strengths and weaknesses of different methodological approaches are highlighted. International policy recommendations are offered aimed at improving the level of emission reductions achieved through TT

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Aborted myocardial infarction: a clinical-magnetic resonance correlation

This report illustrates a magnetic resonance image of aborted myocardial infarction after primary angioplasty. Myocardial oedema in the absence of late enhancement seems to be the magnetic resonance marker of the myocardium at risk of infarction that has been reperfused within 30 minutes and aborted in the clinic

Electronegativity, resonance, and steric effects and the structure of monosubstituted benzene rings: an ab initio MO study.

The deformation of the carbon skeleton of the benzene ring under substituent impact has been analyzed from the structures of 74 monosubstituted derivatives, as determined by ab initio MO calculations. The geometry of the substituted ring is shown to contain valuable information on the electronegativity, resonance, and steric effects of the substituent, and also on other, more subtle effects, affecting primarily the length of the Cipso-Cortho bonds. The results obtained substantially augment previous knowledge from the analysis of experimental geometries (Domenicano, A.; Murray-Rust, P.; Vaciago, A. Acta Crystallogr., Sect. B 1983, 39, 457). Varying the electronegativity of the substituent causes a concerted change of the ring angles at the ipso, ortho, and para positions, coupled with a change in the Cipso-Cortho bond length. The values of the ipso angle span a remarkably wide range, 113-126°. Enhancing the resonance interaction between a substituent and the ring causes a complex pattern of angular distortions, arising from the superposition of two separate effects. The first originates from the decreased length of the C-X bond, and consists primarily in a concerted change of the ipso and ortho angles. It occurs irrespective of whether the substituent is a π donor or a π acceptor. The second effect is associated with π-charge alternation on the ring carbons. It involves all the internal ring angles, and depends on the substituent being a π donor or a π acceptor. These angular changes are generally accompanied by changes in all C-C bond lengths, as expected from an enhanced contribution of polar canonical forms to the electronic structure of the molecule. By using symmetry coordinates, we have derived two orthogonal linear combinations of the internal ring angles, SE and SR, measuring the electronegativity and resonance effects of a substituent, respectively, as seen from their impact on the ring geometry. SE and SR values are affected in a typical way by steric effects