Patients with unprotected left main coronary artery stenosis were assigned to either CABG or PCI with sirolimus-eluting stents. At 1 year, with a wide prespecified noninferiority margin, PCI was ...found to be noninferior to CABG.
Anumber of registry reports, as well as a substudy from a large, randomized trial, have indicated that percutaneous coronary intervention (PCI) may be an acceptable alternative to coronary-artery bypass grafting (CABG) in some patients with unprotected left main coronary artery stenosis.
1
–
11
Recent clinical guidelines have accordingly stated that elective PCI can be considered for patients who have unprotected left main coronary artery disease, although they suggest that the aggregated evidence favors CABG.
12
,
13
Whether the outcomes after PCI are similar to those after CABG remains uncertain, however, owing to the lack of large, randomized clinical trials. Registry results have . . .
Atherosclerosis is an inflammatory process, and inflammatory biomarkers have been identified as useful predictors of clinical outcomes. The prognostic value of leukocyte count in patients with ...ST-segment elevation myocardial infarctions who undergo primary percutaneous coronary intervention is not clearly defined. In 325 patients with STEMIs treated with primary percutaneous coronary intervention, total and differential leukocyte counts, once at admission and 24 hours thereafter, were measured. The neutrophil/lymphocyte ratio (NLR) was calculated as the ratio of neutrophil count to lymphocyte count. The primary end point was all-cause death. Twenty-five patients (7.7%) died during follow-up (median 1,092 days, interquartile range 632 to 1,464). The total leukocyte count decreased (from 11,853 ± 3,946/μl to 11,245 ± 3,979/μl, p = 0.004) from baseline to 24 hours after admission. Patients who died had higher neutrophil counts (9,887 ± 5,417/μl vs 8,399 ± 3,639/μl, p = 0.061), lower lymphocyte counts (1,566 ± 786/μl vs 1,899 ± 770/μl, p = 0.039), and higher NLRs (8.58 ± 7.41 vs 5.51 ± 4.20, p = 0.001) at 24 hours after admission. Baseline leukocyte profile was not associated with outcomes. The best cut-off value of 24-hour NLR to predict mortality was 5.44 (area under the curve 0.72, 95% confidence interval CI 0.52 to 0.82). In multivariate analysis, a 24-hour NLR ≥5.44 was an independent predictor of mortality (hazard ratio 3.12, 95% CI 1.14 to 8.55), along with chronic kidney disease (hazard ratio 4.23, 95% CI 1.62 to 11.1) and the left ventricular ejection fraction (hazard ratio 0.94 for a 3% increase, 95% CI 0.76 to 0.93). In conclusion, NLR at 24 hours after admission can be used for risk stratification in patients with STEMIs who undergo primary PCI. Patients with STEMIs with 24-hour NLRs ≥5.44 are at increased risk for mortality and should receive more intensive treatment.
The purpose of this study was to investigate the effect of administering intermittent parathyroid hormone (iPTH) before tooth extraction versus after tooth extraction on the risk of developing MRONJ ...in experimental animal model. Twenty-five ovariectomized rats received 6 weeks of bisphosphonate therapy. They were classified into 3 groups, based on the timing of the medication, as Control, Pre-PTH and Post-PTH groups. For Control group, normal saline was administered before and after tooth extraction. iPTH was administered during 4 weeks before tooth extraction for Pre-PTH group and after tooth extraction for Post-PTH group. The animals were euthanized 8 weeks after tooth extraction. Macroscopic, histological, micro-computed tomography (micro-CT), and histomorphometric examinations were conducted. The incidences of impaired healing were 11.11% both in Pre-PTH and Post-PTH groups, which was lower than the Control group (42.86%). Bone healing in the extraction socket, based on micro-CT and histomorphometry evaluations, was best in Post-PTH and worst in Control group. The Pre-PTH group showed moderate healing pattern. Despite of limitations in this study, the authors identified Pre-PTH group seems to have positive effect on extraction socket healing. With regard to timing, administering iPTH after tooth extraction was superior to applying it before tooth extraction.
Acute coronary syndromes are commonly caused by the rupture of vulnerable plaque, which often appear angiographically not severe. Although pharmacologic management is considered standard therapy for ...stabilizing plaque vulnerability, the potential role of preventive local treatment for vulnerable plaque has not yet been determined. The PREVENT trial was designed to compare preventive percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) with OMT alone in patients with functionally nonsignificant high-risk vulnerable plaques.
The PREVENT trial is a multinational, multicenter, prospective, open-label, active-treatment-controlled randomized trial. Eligible patients have at least 1 angiographically significant stenosis (diameter stenosis >50% by visual estimation) without functional significance (fractional flow reserve FFR >0.80). Target lesions are assessed by intracoronary imaging and must meet at least 2 imaging criteria for vulnerable plaque; (1) minimal lumen area <4.0 mm2; (2) plaque burden >70%; (3) maximal lipid core burden index in a 4 mm segment >315 by near infrared spectroscopy; and (4) thin cap fibroatheroma as determined by virtual histology or optical coherence tomography. Enrolled patients are randomly assigned in a 1:1 ratio to either preventive PCI with either bioabsorbable vascular scaffolds or metallic everolimus-eluting stents plus OMT or OMT alone. The primary endpoint is target-vessel failure, defined as the composite of death from cardiac causes, target-vessel myocardial infarction, ischemic-driven target-vessel revascularization, or hospitalization for unstable or progressive angina, at 2 years after randomization.
Enrollment of a total of 1,608 patients has been completed. Follow-up of the last enrolled patient will be completed in September 2023 and primary results are expected to be available in early 2024.
The PREVENT trial is the first large-scale, randomized trial to evaluate the effect of preventive PCI on non–flow-limiting vulnerable plaques containing multiple high-risk features that is appropriately powered for clinical outcomes. PREVENT will provide compelling evidence as to whether preventive PCI of vulnerable plaques plus OMT improves patient outcomes compared with OMT alone.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02316886.
The PREVENT trial is the first, large-scale randomized clinical trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaque with high-risk features. It will provide compelling evidence to determine whether PCI of focal vulnerable plaques on top of OMT improves patient outcomes.
As the importance of measuring electron density has become more significant in the material fabrication industry, various related plasma monitoring tools have been introduced. In this paper, the ...development of a microwave probe, called the measurement of lateral electron density (MOLE) probe, is reported. The basic properties of the MOLE probe are analyzed via three-dimensional electromagnetic wave simulation, with simulation results showing that the probe estimates electron density by measuring the surface wave resonance frequency from the reflection microwave frequency spectrum (S11). Furthermore, an experimental demonstration on a chamber wall measuring lateral electron density is conducted by comparing the developed probe with the cutoff probe, a precise electron density measurement tool. Based on both simulation and experiment results, the MOLE probe is shown to be a useful instrument to monitor lateral electron density.
The optimal duration of dual antiplatelet therapy (DAPT) after implantation of drug-eluting coronary stents remains undetermined. We aimed to test whether 6-month DAPT would be noninferior to ...12-month DAPT after implantation of drug-eluting stents.
We randomly assigned 1443 patients undergoing implantation of drug-eluting stents to receive 6- or 12-month DAPT (in a 1:1 ratio). The primary end point was a target vessel failure, defined as the composite of cardiac death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Rates of target vessel failure at 12 months were 4.8% in the 6-month DAPT group and 4.3% in the 12-month DAPT group (the upper limit of 1-sided 95% confidence interval, 2.4%; P=0.001 for noninferiority with a predefined noninferiority margin of 4.0%). Although stent thrombosis tended to occur more frequently in the 6-month DAPT group than in the 12-month group (0.9% versus 0.1%; hazard ratio, 6.02; 95% confidence interval, 0.72-49.96; P=0.10), the risk of death or myocardial infarction did not differ in the 2 groups (2.4% versus 1.9%; hazard ratio, 1.21; 95% confidence interval, 0.60-2.47; P=0.58). In the prespecified subgroup analysis, target vessel failure occurred more frequently in the 6-month DAPT group than in the 12-month group (hazard ratio, 3.16; 95% confidence interval, 1.42-7.03; P=0.005) among diabetic patients.
Six-month DAPT did not increase the risk of target vessel failure at 12 months after implantation of drug-eluting stents compared with 12-month DAPT. However, the noninferiority margin was wide, and the study was underpowered for death or myocardial infarction. Our results need to be confirmed in larger trials.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00698607.
An acoustic plasmon mode in a graphene-dielectric-metal structure has recently been spotlighted as a superior platform for strong light-matter interaction. It originates from the coupling of graphene ...plasmon with its mirror image and exhibits the largest field confinement in the limit of a sub-nm-thick dielectric. Although recently detected in the far-field regime, optical near-fields of this mode are yet to be observed and characterized. Here, we demonstrate a direct optical probing of the plasmonic fields reflected by the edges of graphene via near-field scattering microscope, revealing a relatively small propagation loss of the mid-infrared acoustic plasmons in our devices that allows for their real-space mapping at ambient conditions even with unprotected, large-area graphene grown by chemical vapor deposition. We show an acoustic plasmon mode that is twice as confined and has 1.4 times higher figure of merit in terms of the normalized propagation length compared to the graphene surface plasmon under similar conditions. We also investigate the behavior of the acoustic graphene plasmons in a periodic array of gold nanoribbons. Our results highlight the promise of acoustic plasmons for graphene-based optoelectronics and sensing applications.
Micelle silymarin (MS) is recognized for its diverse range of beneficial properties, which encompass anti-inflammatory, antioxidant, hepatoprotective, and antidiabetic effects. The main objective of ...this study was to examine the effects of micelle silymarin on the performance, egg quality, blood profile, and absorption rate of silymarin in laying hens. In experiment 1: 288 Hy-Line brown laying hens, 28 wk old, were utilized for this experiment. The hens were randomly allocated into 3 dietary treatment groups, with each group comprising eight replicates of 12 hens, each housed in individual pens with access to feed and water. Over a 12-wk feeding trial, the hens were provided with a basal diet supplemented with different levels of MS: 0, 0.03, and 0.06%. In experiment 2: For this experiment, 192 Hy-Line Brown laying hens were divided into 2 dietary treatment groups, with each group comprising eight replications of 12 hens. The dietary treatments were: TRT1, basal diet + powder silymarin 4%; TRT2, basal diet + MS 4%. From the first experiment, the findings revealed that incorporating micelle silymarin (MS) into the hens' diet significantly increased egg weight at wk 6 (P < 0.05). Similarly, at wk 12 and throughout the entire experiment, significant effects were observed on downgraded egg count, egg production, egg weight, and feed conversion ratio (FCR) (P < 0.05). Moreover, Haugh Units (HU) and albumen height showed a linear improvement (P < 0.05) at wk 4 with MS supplementation. Furthermore, there was a linear increase in egg yolk color, albumen height, and eggshell thickness at wk 8 with MS supplementation (P < 0.05). Furthermore, a layers-fed diet supplemented with MS showed a linear increase (P < 0.05) in HU, egg weight, yolk color, albumen height, eggshell strength, and eggshell thickness in wk 12. Regarding blood profile parameters, the study revealed linear reductions for aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) (P < 0.05), whereas there was a tendency for albumin, triglyceride, and cholesterol (P < 0.10). In the second experiment, it was observed that the blood absorption rate of silymarin was higher in TRT2 compared to TRT1 at 2- and 4-h intervals following administration. In summary, increasing MS supplementation in the diet of laying hens enhanced egg production, egg quality, and blood profile. Additionally, silymarin absorption was higher in its micelle form than in its powder form.
This study focuses on the performance validation of a wave energy converter (WEC) equipped with resonant frequency adjustment capability. Achieving resonance with the oscillation period of waves is ...crucial for maximizing the efficiency of wave energy conversion systems. For this purpose, we introduce a variable moment of inertia (VMI) device that allows for tuning of the resonant frequency by adjusting the position of the mass. For validation of the proposed approach, performance verification experiments were conducted using a vibration platform. Through free vibration experiments, we identified the system’s resonant frequency and characteristics. In our forced vibration tests considering the wave frequency band of the coastal area, harmonic vibration experiments were performed over a range of 0.4–0.8 Hz. In these experiments, we considered three separate cases by adjusting the distance from the reel’s center to the mass. As a result, we found that the resonant frequency of the WEC can be adjusted from 0.65 Hz when the mass is furthest away to 0.55 Hz when it is closer. This research confirms the benefits obtained by utilizing VMI to adjust the resonant frequency of WECs without changing the mass or springs. This offers a promising opportunity to enhance the energy conversion efficiency of resonant-type WECs utilizing wave energy.
Aims
We compared long‐term clinical outcomes between patients treated with Orsiro sirolimus‐eluting stent (O‐SES) and those treated with durable biocompatible polymer Resolute Integrity ...zotarolimus‐eluting stent (R‐ZES).
Methods and Results
The ORIENT trial was a randomized controlled noninferiority trial to compare angiographic outcomes between O‐SES and R‐ZES. We performed a post hoc analysis of 3‐year clinical outcomes and included 372 patients who were prospectively enrolled and randomly assigned to O‐SES (n = 250) and R‐ZES (n = 122) groups in a 2:1 ratio. The primary endpoint was target lesion failure defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. At 3 years, target lesion failure occurred in 4.7% and 7.8% of O‐SES and R‐ZES groups, respectively (hazard ratio, 0.58; 95% confidence intervals, 0.24–1.41; p = .232 by log‐rank test). Secondary endpoints including cardiac death, myocardial infarction, and target lesion revascularization showed no significant differences between the groups. Stent thrombosis occurred in two patients in R‐ZES group (0.0% vs. 1.6%, p = .040).
Conclusion
This study confirms long‐term safety and efficacy of the two stents. We found a trend for lower target lesion failure with O‐SES compared to R‐ZES, although statistically insignificant.
PDF
