Patients with multivessel coronary artery disease were randomly assigned to PCI with everolimus-eluting stents or CABG. At 2 years, the composite of death, myocardial infarction, or target-vessel ...revascularization occurred more frequently in the PCI group.
Randomized trials and observational studies have shown that the rates of most adverse clinical outcomes among patients with multivessel coronary artery disease are lower after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI).
1
–
7
Current clinical guidelines thus recommend CABG as the preferred revascularization strategy, particularly in patients with complex coronary lesions and without excessive operative risk.
8
,
9
However, previous trials may have been limited by their use of first-generation drug-eluting stents. Although these stents reduced the rate of restenosis, their use was associated with a relatively high rate of stent-related thrombotic events.
10
Results from the Synergy between . . .
In patients with acute myocardial infarction receiving potent antiplatelet therapy, the bleeding risk remains high during the maintenance phase. We sought data on a uniform unguided de-escalation ...strategy of dual antiplatelet therapy (DAPT) from ticagrelor to clopidogrel after acute myocardial infarction.
In this open-label, assessor-masked, multicentre, non-inferiority, randomised trial (TALOS-AMI), patients at 32 institutes in South Korea with acute myocardial infarction receiving aspirin and ticagrelor without major ischaemic or bleeding events during the first month after index percutaneous coronary intervention (PCI) were randomly assigned in a 1:1 ratio to a de-escalation (clopidogrel plus aspirin) or active control (ticagrelor plus aspirin) group. Unguided de-escalation without a loading dose of clopidogrel was adopted when switching from ticagrelor to clopidogrel. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or bleeding type 2, 3, or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months. A non-inferiority test was done to assess the safety and efficacy of de-escalation DAPT compared with standard treatment. The hazard ratio (HR) for de-escalation versus active control group in a stratified Cox proportional hazards model was assessed for non-inferiority by means of an HR margin of 1·34, which equates to an absolute difference of 3·0% in the intention-to-treat population and, if significant, a superiority test was done subsequently. To ensure statistical robustness, additional analyses were also done in the per-protocol population. This trial is registered at ClinicalTrials.gov, NCT02018055.
From Feb 26, 2014, to Dec 31, 2018, from 2901 patients screened, 2697 patients were randomly assigned: 1349 patients to de-escalation and 1348 to active control groups. At 12 months, the primary endpoints occurred in 59 (4·6%) in the de-escalation group and 104 (8·2%) patients in the active control group (pnon-inferiority<0·001; HR 0·55 95% CI 0·40–0·76, psuperiority=0·0001). There was no significant difference in composite of cardiovascular death, myocardial infarction, or stroke between de-escalation (2·1%) and the active control group (3·1%; HR 0·69; 95% CI 0·42–1·14, p=0·15). Composite of BARC 2, 3, or 5 bleeding occurred less frequently in the de-escalation group (3·0% vs 5·6%, HR 0·52; 95% CI 0·35–0·77, p=0·0012).
In stabilised patients with acute myocardial infarction after index PCI, a uniform unguided de-escalation strategy significantly reduced the risk of net clinical events up to 12 months, mainly by reducing the bleeding events.
ChongKunDang Pharm, Medtronic, Abbott, and Boston Scientific.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This study conducted a detection and attribution analysis of the observed global and regional changes in extreme temperatures during 1951–2015. HadEX3 observations were compared with multimodel ...simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) using an optimal fingerprinting technique. Annual maximum daily maximum and minimum temperatures (TXx and TNx; warm extremes) and annual minimum daily maximum and minimum temperatures (TXn and TNn; cold extremes) over land were analyzed considering global, continental, and subcontinental scales. Response patterns (fingerprints) of extreme temperatures to anthropogenic (ANT), greenhouse gases (GHG), aerosols (AA), and natural (NAT) forcings were obtained from CMIP6 forced simulations. The internal variability ranges were estimated from preindustrial control simulations. A two-signal detection analysis where the observations are regressed onto ANT and NAT fingerprints simultaneously reveals that ANT signals are robustly detected in separation from NAT over global and all continental domains (North and South America, Europe, Asia, and Oceania) for most of the extreme indices. ANT signals are also detected over many subcontinental regions, particularly for warm extremes (more than 60% of 33 subregions). A three-signal detection analysis that considers GHG, AA, and NAT fingerprints simultaneously demonstrates that GHG signals are detected in isolation from other external forcings over global, continental, and several subcontinental domains especially for warm extremes, explaining most of the observed warming. Moreover, AA influences are detected for warm extremes over Europe and Asia, indicating significant offsetting cooling contributions. Overall, human influences are detected more frequently, compared to previous studies, particularly for cold extremes, due to the extended period and the improved spatial coverage of observations.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Spin-orbit torques arising from the spin-orbit coupling of non-magnetic heavy metals allow electrical switching of perpendicular magnetization. However, the switching is not purely electrical in ...laterally homogeneous structures. An extra in-plane magnetic field is indeed required to achieve deterministic switching, and this is detrimental for device applications. On the other hand, if antiferromagnets can generate spin-orbit torques, they may enable all-electrical deterministic switching because the desired magnetic field may be replaced by their exchange bias. Here we report sizeable spin-orbit torques in IrMn/CoFeB/MgO structures. The antiferromagnetic IrMn layer also supplies an in-plane exchange bias field, which enables all-electrical deterministic switching of perpendicular magnetization without any assistance from an external magnetic field. Together with sizeable spin-orbit torques, these features make antiferromagnets a promising candidate for future spintronic devices. We also show that the signs of the spin-orbit torques in various IrMn-based structures cannot be explained by existing theories and thus significant theoretical progress is required.
Full text
Available for:
IJS, NUK, SBMB, UL, UM, UPUK
While the IPCC Fifth Assessment Working Group I report assessed observed changes in extreme precipitation on the basis of both absolute and percentile-based extreme indices, human influence on ...extreme precipitation has rarely been evaluated on the basis of percentile-based extreme indices. Here we conduct a formal detection and attribution analysis on changes in four percentile-based precipitation extreme indices. The indices include annual precipitation totals from days with precipitation exceeding the 99th and 95th percentiles of wet-day precipitation in 1961–90 (R99p and R95p) and their contributions to annual total precipitation (R99pTOT and R95pTOT). We compare these indices from a set of newly compiled observations during 1951–2014 with simulations from models participating in phase 6 of the Coupled Model Intercomparison Project (CMIP6). We show that most land areas with observations experienced increases in these extreme indices with global warming during the historical period 1951–2014. The new CMIP6 models are able to reproduce these overall increases, although with considerable over- or underestimations in some regions. An optimal fingerprinting analysis reveals detectable anthropogenic signals in the observations of these indices averaged over the globe and over most continents. Furthermore, signals of greenhouse gases can be separately detected, taking other forcing into account, over the globe and over Asia in these indices except for R95p. In contrast, signals of anthropogenic aerosols and natural forcings cannot be detected in any of these indices at either global or continental scales.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Fiber-optic-based localized surface plasmon resonance (FO-LSPR) sensors with three-dimensional (3D) nanostructures have been developed. These sensors were fabricated using zinc oxide (ZnO) nanowires ...and gold nanoparticles (AuNPs) for highly sensitive plasmonic biosensing. The main achievements in the development of the biosensors include: (1) an extended sensing area, (2) light trapping effect by nanowires, and (3) a simple optical system based on an optical fiber. The 3D nanostructure was fabricated by growing the ZnO nanowires on the cross-section of optical fibers using hydrothermal synthesis and via immobilization of AuNPs on the nanowires. The proposed sensor outputted a linear response according to refractive index changes. The 3D FO-LSPR sensor exhibited an enhanced localized surface plasmon resonance response of 171% for bulk refractive index changes when compared to the two-dimensional (2D) FO-LSPR sensors where the AuNPs are fixed on optical fiber as a monolayer. In addition, the prostate-specific antigen known as a useful biomarker to diagnose prostate cancer was measured with various concentrations in 2D and 3D FO-LSPR sensors, and the limits of detection (LODs) were 2.06 and 0.51 pg/ml, respectively. When compared to the 2D nanostructure, the LOD of the sensor with 3D nanostructure was increased by 404%.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Successive cold winters of severely low temperatures in recent years have had critical social and economic impacts on the mid-latitude continents in the Northern Hemisphere. Although these cold ...winters are thought to be partly driven by dramatic losses of Arctic sea-ice, the mechanism that links sea-ice loss to cold winters remains a subject of debate. Here, by conducting observational analyses and model experiments, we show how Arctic sea-ice loss and cold winters in extra-polar regions are dynamically connected through the polar stratosphere. We find that decreased sea-ice cover during early winter months (November-December), especially over the Barents-Kara seas, enhances the upward propagation of planetary-scale waves with wavenumbers of 1 and 2, subsequently weakening the stratospheric polar vortex in mid-winter (January-February). The weakened polar vortex preferentially induces a negative phase of Arctic Oscillation at the surface, resulting in low temperatures in mid-latitudes.
This study evaluates global climate models participating in the Coupled Model Intercomparison Project phase 6 (CMIP6) for their performance in simulating the climate extreme indices defined by the ...Expert Team on Climate Change Detection and Indices (ETCCDI). We compare global climatology patterns of the indices simulated by the CMIP6 models with those from HadEX3 and four reanalysis datasets and the CMIP5 multi-model ensemble using root-mean-square errors for the 1981–2000 period. Regional evaluations are conducted for 41 sub-regions, defined for the Intergovernmental Panel on Climate Change Sixth Assessment Report. In particular, regional mean biases are analyzed for the 20-year return values (20RV) of the warmest day and coldest night temperatures (TXx and TNn) and annual maximum of daily precipitation (RX1day) using a Generalized Extreme Value (GEV) analysis. Results show that the CMIP6 models generally capture the observed global and regional patterns of temperature extremes with limited improvements compared to the CMIP5 models. Systematic biases like a cold bias in cold extremes over high-latitude regions remain even in stronger amplitudes. The CMIP6 model skills for the precipitation intensity and frequency indices are also largely comparable to those of CMIP5 models, but precipitation intensity simulations are found to be improved with reduced dry biases. The GEV analysis results indicate that the regional biases in 20RV of temperature extremes are dominated by GEV location parameter (related to mean intensity) with relatively small contribution from GEV scale/shape parameters (related to interannual variability). CMIP6-simulated 20RV of RX1day is characterized by dry biases over the tropics and subtropical rain band areas, as in the CMIP5 models, for which biases in both GEV location and scale/shape parameters are important.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Using the standardized precipitation evapotranspiration index, this study examines the combined effects of El Niño‐Southern Oscillation (ENSO) and Pacific Decadal Oscillation (PDO) on global droughts ...in terms of magnitude, timing, and duration. The ENSO‐affected drought hotspots are identified based on drought magnitude and probability of occurrence: five hotspots for El Niño (Amazon, India, central China, Indonesia, and eastern Australia) and four hotspots for La Niña (southeastern United States, southern South America, East Africa, and Southwest Asia). When ENSO and PDO are in phase, most of the hotspots exhibit an intensification and expansion of drought, more clearly at longer time scales (6–12 months), supporting previous studies. Interestingly, the in‐phase PDO advances El Niño‐induced drought onset by early summer of the previous year, whereas it delays the withdrawal of La Niña‐induced drought until the end of the event year. This asymmetric response is found to be in part associated with the earlier start and later end of El Niño itself during warm PDO, which does not hold for the La Niña/cold PDO composites. Further analyses of the responses of precipitation (P) and potential evapotranspiration (PET) to different ENSO‐PDO combinations suggest the important role of P reduction in determining drought magnitude and timing over most of the hotspots, with some contribution of enhanced PET to drier conditions over a few La Niña hotspots. It is also found that the PDO modulation of El Niño‐induced drought occurs primarily through the eastern Pacific El Niño with a limited influence on the central Pacific El Niño.
Using a multi‐scalar drought index of standardized precipitation evapotranspiration index (SPEI), this study examines the combined effects of El Niño‐Southern Oscillation (ENSO) and Pacific Decadal Oscillation (PDO) on global droughts in terms of magnitude, timing and duration. When ENSO and PDO are in phase, all nine drought hotspots experience an intensification and area expansion of drought. An asymmetric influence of in‐phase PDO is identified, advancing the El Niño‐induced drought onset while delaying the withdrawal of La Niña‐induced drought. The figure shows the comparisons of ENSO‐induced drought timing and duration between in‐phase and out‐of‐phase PDO conditions based on SPEI12 during (a) El Niño and (b) La Niña.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This article analyzes the effect of discretization in the frequency-adaptive flux observer (FAO). Although FAO has structural simplicity and ease of implementation, the discrete-time FAO has phase ...and gain errors in fundamental flux estimation. As a result, the estimated flux might be erroneous, especially in the high-speed region. For accurate flux estimation, this article analyzes how the voltage synthesis in the pulsewidth-modulation affects the stator flux. Through the analysis, the backward Euler method is selected for the primitive stator flux estimation. To mitigate the FAO's discretization error, the proposed FAO utilizes the integrators constructed at the rotor reference frame (RRF). Since the discretization error comes from the approximation error of the continuous-time integrator at the operating frequency, the proposed FAO conducts the fundamental flux extraction at the RRF, where the operating frequency components are treated as a dc signal. Thanks to the coordinate transformation, the FAO can be discretized with no error while keeping the structure of double integrators. The proposed method is verified through the computer simulation and experimental test.
PDF
