Abstract
Background
Periprocedural stroke was believed to occur more frequently after coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). However, few clinical data ...have endorsed it.
Methods
The CREDO-Kyoto registry Cohort-1 and Cohort-2 are large-scale registries enrolling consecutive patients undergoing first coronary revascularization in the BMS era (2000–2002) for Cohort-1, or in the DES era (2005–2007) for Cohort-2 in Japan. Using the pooled individual patient-level data, the current study population consisted of 7774 patients who received PCI (PCI group) and 4392 patients who received CABG (CABG group).
Results
The cumulative 30-day incidence of stroke was significantly lower in the PCI group than in the CABG group (0.5% versus 1.7%, P<0.0001). Even after adjusting for baseline characteristics, the excess 30-day risk of the PCI group relative to the CABG group for stroke remained significant (hazard ratio HR: 0.34, 95% confidence interval CI: 0.23–0.52, P<0.0001). Similarly, the cumulative 10-year incidence of stroke was significantly lower in the PCI group than in the CABG group (13.2% versus 14.8%, P=0.046). However, after adjusting for confoundings, the excess 10-year risk of the PCI group relative to the CABG group for stroke was not higher than that of CABG (hazard ratio HR: 0.84, 95% confidence interval CI: 0.68–1.04, P=0.11).
Conclusions
CABG was associated with higher risk of periprocedural stroke than PCI in patients with complex coronary artery disease. However, the risk of stroke during 10-year follow-up was similar between the groups.
Abstract
Background/Introduction
In patients with three-vessel coronary artery disease (CAD) and/or left main (LM) CAD, individual risk prediction plays a key role in deciding between percutaneous ...coronary intervention (PCI) and coronary artery bypass grafting (CABG).
Purpose
The aim of this study was to assess whether these individualised revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors.
Methods
The present study consisted of patients enrolled in the SYNTAX study, which is a randomized trial comparing PCI and CABG in patients with complex coronary artery disease. ML algorithms were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG), and pre-specified effect-modifiers: disease type (3-vessel or LMCAD) and anatomical SYNTAX score. The model’s discriminative ability to predict the risk of 5-year death and treatment benefit between PCI and CABG was cross-validated in the SYNTAX trial (n=1800 patients) and externally validated in the CREDO-KYOTO registry (n=7362), and then compared to the original SYNTAX score II 2020 (SS2020).
Results
The gradient boosting ML model identified the top 10 prognostic factors at the time of decision making as: age, creatinine clearance, left ventricular ejection fraction, peripheral vascular disease, C-reactive protein, hemoglobin, HbA1c, glucose, systolic and diastolic pressure.
The ML model performed best for predicting 5-year all-cause death with C-indexes of 0.78 (95% CI 0.75-0.81) in cross-validation and 0.77 (95% CI 0.76-0.79) in external validation. The ML model discriminated 5-year mortality better than the SS2020 in the external validation cohort (vs C-index 0.72 for SS2020, p <0.001) and identified heterogeneity in the treatment benefit of CABG versus PCI (Figure).
Conclusions
An ML-based approach for identifying individuals who benefit from CABG or PCI is feasible and effective. Implementation of this model in health care systems—trained to collect large numbers of parameters—may harmonize decision making.Figure
 The search for efficient biocontrol agents in agriculture has been achieved in several pathosystems. Thus, we carried out experiments under controlled conditions in greenhouse and laboratory, ...involving the use of bacteria Bacillus alcalophilus, Bacillus cereus GC subgrupo B, Stenotrophomonas maltophilia, Yersinia bercovieri and Photorhabdus luminescens-luminescens obtained from biofertilizers and bovine and suine manure. The bacterial strains were multiplied in nutrient-agar medium (NA) for 48 hours to evaluate the efficiency in inhibiting the mycelial growth and the development of Sclerotinia sclerotiorum in antagonism assays in Petri dishes containing BDA medium; or in aqueous suspension adjusted in 109 ufc.mL-1 by Mac Farland scale, to seeds microbiolization and spraying the aerial parts of soybean plants, totalizing three assays. The bacterial strains BB-4 (Bacillus cereus GC subgrupo B), BS-3 (Photorhabdus luminescens-luminescens), BB-1 (Bacillus alcalophilus) and BB-6 (Yersinia bercovieri) tested were shown to be effective for inhibition of mycelial growth of the pathogen, with values between 31% and 46%, and disease development in soybean seeds and plants, with values above 50% and the same levels of control treatments with thiophanate methyl + fluazinan and thiophanate methyl. These results demonstrate the presence of promising strains in control of white mold alternatively the use of chemical fungicides
Abstract
Background
Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or ...hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated.
Purpose
To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization.
Methods
The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation.
Results
Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P<0.001). After adjusting for baseline confounders, the lower risk of SR-group relative to AF-group for death or HF was still statistically significant (HR: 2.05, 95% CI: 1.11–3.58, P=0.02).
Risks for a Composite of Death or HF
Hazard Ratio (95% CI)
Crude HR
P value
Adjusted HR
P value
AF recurrence
2.59 (1.43–4.43)
0.002
2.05 (1.11–3.58)
0.02
Age>75 years old
2.55 (1.56–4.10)
<0.001
2.32 (1.39–3.81)
0.002
Female
0.85 (0.49–1.43)
0.56
0.73 (0.40–1.25)
0.26
PeAF
1.25 (0.68–2.16)
0.45
0.98 (0.52–1.75)
0.94
LSAF
1.10 (0.46–2.23)
0.82
0.70 (0.28–1.53)
0.39
LVEF>50%
0.27 (0.16–0.48)
<0.001
0.57 (0.31–1.09)
0.09
Past history of HF
7.06 (4.18–11.6)
<0.001
4.67 (2.51–8.41)
<0.001
CKD
4.74 (2.08–9.39)
<0.001
2.23 (0.94–4.69)
0.07
AF, Atrial fibrillation; PeAF, Persistent AF; LSAF; Long standing AF; HF, Heart failure; CKD, Chronic kidney disease.
Figure 1
Conclusions
Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.
Respiration tracking in radiosurgery Schweikard, Achim; Shiomi, Hiroya; Adler, John
Medical physics (Lancaster),
October 2004, Volume:
31, Issue:
10
Journal Article
Peer reviewed
Respiratory motion is difficult to compensate for with conventional radiotherapy systems. An accurate tracking method for following the motion of the tumor is of considerable clinical relevance. We ...investigate methods to compensate for respiratory motion using robotic radiosurgery. In this system the therapeutic beam is moved by a robotic arm, and follows the moving target through a combination of infrared tracking and synchronized x-ray imaging. Infrared emitters are used to record the motion of the patient’s skin surface. The position of internal gold fiducials is computed repeatedly during treatment, via x-ray image processing. We correlate the motion between external and internal markers. From this correlation model we infer the placement of the internal target during time intervals where no x-ray images are taken. Fifteen patients with lung tumors have recently been treated with a fully integrated system implementing this new method. The clinical trials confirm our hypothesis that internal motion and external motion are indeed correlated. In a preliminar study we have extended our work to tracking without implanted fiducials, based on algorithms for computing deformation motions and digitally reconstructed radiographs.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Homoepitaxial growth of 4H–SiC
(0
3
3
̄
8)
by hot-wall chemical vapor deposition has been investigated. The 4H–SiC
(0
3
3
̄
8)
is inclined by 54.74° toward
0
1
1
̄
0
from (0
0
0
1), which is ...semi-equivalent to (0
0
1) in a zincblende structure. 4H–SiC homoepitaxial layers with a specular surface can be obtained on 4H–SiC
(0
3
3
̄
8)
without intentional off angle. The lowest donor concentration of undoped 4H–SiC
(0
3
3
̄
8)
epilayers was 3×10
14
cm
−3. The doping efficiency of nitrogen on 4H–SiC
(0
3
3
̄
8)
was similar to that on 4H–SiC
(1
1
2
̄
0)
, which is in between that on off-axis (0
0
0
1) and
(0
0
0
1
̄
)
faces. Growth results on this novel face are compared with those on off-axis {0
0
0
1} and
(1
1
2
̄
0)
from viewpoints of growth mechanism and impurity doping.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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