A number of health outcomes were affected by previous financial crises, e.g. suicides, homicides and transport accident mortality. Aim of this study was to analyse the effects of the current ...financial crisis on selected health outcomes at population level in Europe.
A mixed approach of ecologic and time trend design was applied, including correlation analysis. For eight countries, data on the economic situation (unemployment rate and economic growth) and health indicators (overall mortality, suicide and transport accident mortality) was drawn from EUROSTAT database for 2000-10. Spearman's rank correlation was applied to analyse the influence of social protection on the association between exposure and outcome variables.
The financial crisis had no visible effect on overall mortality in any of the eight countries until 2010. Transport accident mortality decreased in all eight countries, in the range of 18% in Portugal to 52% in Slovenia. In contrast, suicide mortality increased in Germany (+5.3%), Portugal (+5.2%), Czech Republic (+7.6%), Slovakia (+22.7%) and Poland (+19.3%). The effect of unemployment on suicide is higher in countries with lower social spending (Spearman's r = -0.83).
Clear cause-effect relations could not be established owing to the ecological study design and issues concerning data availability. However, there are clear changes in suicide and transport accident mortality after onset of the crisis, and findings are consistent with previous work. As part of this work, a comprehensive framework was developed, which can be applied to analyse health effects of financial crises in more detail.
For a biological agent operating under environmental pressure, energy consumption and reaction times are of critical importance. Similarly, engineered systems are optimized for short time-to-solution ...and low energy-to-solution characteristics. At the level of neuronal implementation, this implies achieving the desired results with as few and as early spikes as possible. With time-to-first-spike coding, both of these goals are inherently emerging features of learning. Here, we describe a rigorous derivation of a learning rule for such first-spike times in networks of leaky integrate-and-fire neurons, relying solely on input and output spike times, and show how this mechanism can implement error backpropagation in hierarchical spiking networks. Furthermore, we emulate our framework on the BrainScaleS-2 neuromorphic system and demonstrate its capability of harnessing the system’s speed and energy characteristics. Finally, we examine how our approach generalizes to other neuromorphic platforms by studying how its performance is affected by typical distortive effects induced by neuromorphic substrates.Spiking neural networks promise fast and energy-efficient information processing. The ‘time-to-first-spike’ coding scheme, where the time elapsed before a neuron’s first spike is utilized as the main variable, is a particularly efficient approach and Göltz and Kriener et al. demonstrate that error backpropagation, an essential ingredient for learning in neural networks, can be implemented in this scheme.
Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve ...implantation and formulated an anatomic and electrophysiological model.
Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM.
One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
We aimed to assess the use of enhanced stent visualisation (ESV) on outcomes, after PCI with overlapping stents, specifically using CLEARstent technology.
Stent underexpansion and overlap are both ...significant risk factors for restenosis and stent thrombosis. Enhanced stent visualisation (e.g. CLEARstent) systems could provide important data to reduce under-expansion and stent overlap.
This was a cohort study based on this institution's percutaneous coronary intervention (PCI) registry. A total of 2614 patients who had PCI for stable angina or acute coronary syndromes (ACS, excluding cardiogenic shock) with overlapping 2nd generation drug eluting stents (DES) in the same vessel between May 2015 and January 2018 were included in the analysis. Patients were divided into ESV (n = 1354) and no ESV guided intervention (n = 1260). The primary end-point was major adverse cardiovascular events (MACE: target vessel revascularisation, target vessel myocardial infarction and all-cause mortality) recorded at a median follow up of 2.4 years.
Groups were comparable for patient characteristics (age, diabetes mellitus, ACS presentation). A significant difference in MACE was observed between patients who underwent ESV-guided PCI (9.5%) compared with patients who underwent Standard PCI (14.4%, p = .018). This difference was mainly driven by reduced rates of target vessel revascularisation and recurrent myocardial infarction. Overall this difference persisted after multivariate Cox analysis (HR 0.86, 95% CI: 0.73–0.98) and propensity matching (HR = 0.88, 95% CI: 0.69–0.99).
We suggest that routine clinical use of ESV technology during PCI can be useful, and is associated with better medium-term angiographic and clinical outcomes. Further study is required to build on this promising signal.
•Stent underexpansion, underdeployment and geographical miss remain risk factors for stent complications in the DES era.•ESV systems are easy to install and use, adding a few extra contrast free seconds onto standard image acquisition.•In this large study of over 2500 patients, we found a significant association between ESV use and MACE rates compared to standard PCI alone (9.5% vs 14.4% (p = .0018)).•This suggests that the routine use of this simple, quick, cheap and widely available technology may improve patient outcomes after PCI Further randomized trials are needed to see whether the routine use of ESV technology replicates this promising signal.
Aims A new generation of multidetector-row CT (MDCT) scanners allows complete coronary coverage using retrospective ECG gating and 1mm slices. The purpose of this study was to investigate the ...potential of high resolution MDCT angiography with retrospective gating for detection of coronary artery stenoses. Methods and Results A total of 102 patients underwent both conventional and MDCT coronary angiography. After intravenous injection of a non-ionic contrast medium the entire heart was scanned within a single breath hold using 1mm slices. All MDCT data sets were reconstructed with retrospective gating at 20% to 80% in increments of 10% relative to the cardiac cycle. Two blinded independent reviewers analysed image quality for segments 1–4 (right coronary artery), 5–8 (left main, left anterior descending), and 11, 12 (left circumflex). These segments were evaluated for the presence or absence of significant (≥50%) stenoses. The results were compared with those of invasive coronary angiography in a blinded fashion. Overall sensitivity for the detection of significant stenoses (≥50%) were 0·86 (reader 1) and 0·93 (reader 2), specificity 0·96 (reader 1) and 0·97 (reader 2), negative predictive value 0·98 (reader 1) and 0·99 (reader 2). Conclusions High resolution MDCT angiography with retrospective gating permits the non-invasive detection of coronary artery stenoses with high accuracy if image quality is optimized for each of the three major coronary arteries. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Surgical correction of congenital aortic coarctation can lead to a number of important problems including late pseudoaneurysm formation. Redo surgery has a significant risk. Endovascular stent graft ...repair is increasingly used but there are limited data regarding this indication. We describe the experience of two UK congenital referral centres.
Retrospective analysis of patients treated with endovascular aortic stent grafting for late pseudoaneurysms.
Two UK congenital heart centres, Bristol Heart Institute and Leeds General Infirmary.
17 patients were treated 2006-2012. This represents all patients treated with this technique.
Procedural and postprocedure success and complications.
The average time from index repair to endovascular repair of pseudoaneurysm was 24.6 years. The majority (70.6%) had patch aortoplasty as the original surgical procedure and 41.2% were not under follow-up or discharged. Stent grafting procedural success rate was 100%. Median hospital stay postprocedure was 3 days. There was no procedural mortality or immediate complication. There were four minor early and three minor late complications. Imaging follow-up was available for an average of 31.6 months (range 6-65 months). All patients have demonstrated positive remodelling of the pseudoaneurysm with no incidence of continued expansion or stent graft failure up to 5 years following implant.
Endovascular stent graft treatment of pseudoaneurysms show promising results in a population who have a high risk of surgical re-intervention. Complication rates appear to be low and recovery is quick. Longer-term data remain essential to scrutinise stent graft performance in this situation.
Background: Hemodialysis (HD) grafts often fail because of stenosis at the venous anastomosis and thrombotic occlusion. Percutaneous management relies on thrombolysis with plasminogen activators, ...mechanical removal of thrombus, and angioplasty of the stenotic lesion. Objectives: This report describes a phase I trial using Plasmin (Human) TAL 05‐00018, a direct‐acting fibrinolytic agent, to evaluate safety and, secondarily, to establish effective thrombolytic dosing. Patients/Methods: Six cohorts of five patients with acute HD graft occlusion documented by angiography were treated with escalating dosages of plasmin (1, 2, 4, 8, 12, and 24 mg) infused over 30 min via criss‐crossed pulse‐spray catheters within the graft. The primary efficacy endpoint was ≥50% thrombolysis, as determined by comparison of pre‐plasmin and 30‐min post‐plasmin fistulograms. Results: Of 31 subjects who received study drug (safety population), one withdrew and 30 completed the trial (evaluable for efficacy). There was no significant change in plasma α‐2 antiplasmin or fibrinogen concentration, major bleeding did not occur, and there were no deaths. Serious adverse events in four patients were not related to the study drug. There was a dose–response relationship for the primary efficacy endpoint, all five subjects receiving 24 mg achieving >75% lysis. Conclusions: This first phase I study of Plasmin (Human) TAL 05‐00018, infused into thrombosed HD grafts, documents safety at dosages of 1–24 mg and an effective thrombolytic dosage of 24 mg. The results establish a foundation for further clinical study of catheter‐based plasmin administration in thrombotic disorders.
Background Peripheral endothelial dysfunction (ED) quantified by the determination of flow-mediated dilation (FMD%) of the brachial artery with the use of high-resolution ultrasound is an early ...marker of atherosclerosis. Although a positive correlation with coronary artery disease (CAD) has been reported, the unanswered clinical question is the validity of FMD% as a screening test in patients with clinical suspicion of CAD. Thus the aim of this study was to determine the predictive value of FMD% compared with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging.
Methods and Results In this pilot study, we measured ED in 122 patients scheduled for coronary angiography by using high-resolution ultrasound (13 MHz). We defined ED as FMD% ≤4.5%. The presence of CAD was defined as angiographically detectable atherosclerotic vessel alterations of any degree. Exercise electrocardiography and myocardial perfusion imaging had been performed on an outpatient basis. Statistical analysis was conducted by analysis of variance and Mantel-Haenszel chi-square test. Patients with CAD (n = 101) had a significantly lower FMD% than patients without CAD (n = 21; 3.7% ± 4.1% vs 7.01% ± 3.5%,
P < .001). A sensitivity of 71%, a specificity of 81% with a positive predictive value of 0.95 (72 of 76), and a negative predictive value of 0.41 (17 of 46) was calculated. In comparison to angina pectoris (sensitivity 95%, specificity 47.6%), exercise electrocardiography (sensitivity 82.4%, specificity 57.1%) and myocardial perfusion imaging (sensitivity in our study group 100%) had the best specificity, and a high sensitivity for FMD% was found.
Conclusions The determination of ED was found to be a sensitive and specific screening test to predict the presence of CAD. Because this is a noninvasive, nonradioactive, and cost-effective approach, it warrants further evaluation to determine its value in daily clinical practice as an additional screening test in the diagnosis of CAD. (Am Heart J 1999;138:731-9.)
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