Automatization of Individual Anti-thermal Protection of Rescuers in the Initial Period of Fire Suppression

The problem of protection of rescuers from thermal injuries at the initial stage of fire suppression was explored.The authors substantiated structural components of the autonomous device for individual protection of rescuers from thermal injuries at the initial stage of emergency elimination, mainly during the site reconnaissance, when means of fire suppression and thermal protection of rescuers are not deployed yet. The automatic autonomous thermoprotective device, the structural system of which contains hydraulic and automatic parts, was proposed. The hydraulic part includes: the tank, pipelines for feeding a cooling agent, the atomizer, and the shutter of the electromagnetic valve. The tank is filled with the cooling agent under pressure. The shutter of the valve is located on the neck of the tank and in the initial state overlaps the pipeline. The atomizer is fixed on a rescuer's helmet. The automatic part of the device consists of the control unit with the autonomous battery, located in the under-clothing space, the temperature sensor and the driving part of the electromagnetic valve.The model and the model sample of the autonomous thermoprotective device were tested under laboratory conditions. Testing results demonstrated workability of the proposed technical solution and possibility of operation in automatic mode. Effectiveness of cooling the rescuer's body by periodic sprinkling of the surface of special protective clothing was proved. The device timely reacted to the temperature change in the under-clothing space and automatically cooled down the surface of special firefighter clothing within five seconds. Pulse mode of device operation provides economical consumption of a cooling agent and an increase in the duration of rescuer's protection from thermal injuries.External sprinkling for the purpose of cooling helps counteract thermal destruction of fabric of the special clothes for firefighters and increase their operation ter

Highly Flexible Molecule “Chameleon”: Reversible Thermochromism and Phase Transitions in Solid Copper(II) Diiminate Cu[CF₃C(NH)CFC(NH)CF₃]₂

Three thermochromic phases (α, green; β, red; γ, yellow) and six polymorphic modifications (α₁, monoclinic, <i>P</i>2₁/<i>n</i>, <i>Z</i> = 2; β₁, monoclinic, <i>P</i>2₁/<i>c</i>, <i>Z</i> = 4; β₂, triclinic, <i>P</i>1̅, <i>Z</i> = 4; β₃, monoclinic, <i>P</i>2₁/<i>n</i>, <i>Z</i> = 4; γ₁ and γ₂, tetragonal, <i>P</i>4₂/<i>n</i>, <i>Z</i> = 4) have been found and structurally characterized for copper­(II) diiminate Cu­[CF₃C­(NH)CFC­(NH)CF₃]₂ (<b>1</b>). The α phase is stable under normal conditions, whereas the high-temperature β and γ phases are metastable at room temperature and transform slowly into the more stable α phase over several days or even weeks. X-ray diffraction study revealed that the title molecules adopt different conformations in the α, β, and γ phases, namely, staircase-like, twisted, and planar, respectively. The investigation of the α, β, and γ phases by differential scanning calorimetry showed that the three endothermic peaks in the range 283, 360, and 438 K are present on their thermograms upon heating/cooling. The two peaks at 283 and 360 K correspond to the solid–solid phase transitions, and the high-temperature peak at 438 K belongs to the melting process of <b>1</b>. The temperature and thermal effect of all the observed transitions depend on the prehistory of the crystalline sample obtained. A reversible thermochromic single-crystal-to-single-crystal α₁⇌β₁ phase transition occurring within a temperature interval of 353–358 K can be directly observed using a CCD video camera of the X-ray diffractometer. A series of other solid–solid α₁→γ₁, β₂→γ₁, β₃→γ₁, and γ₁⇌γ₂ phase transitions can be triggered in <b>1</b> by temperature. It has been suggested that, under equilibrium conditions, the α₁→γ₁ and β₂→γ₁ phase transitions should proceed stepwise through the α₁→β₁→β₂→β₃→γ₁ and β₂→β₃→γ₁ stages, respectively. The mechanism of the phase transitions is discussed on the basis of experimental and theoretical data

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes