To describe the long-term mortality of a complete national cohort of acute coronary syndrome (ACS) patients enrolled in 2002, to compare this with a national age, sex and Māori ethnicity matched ...population, and to assess the influence of baseline factors on the 12-year mortality.
We reviewed 721 patients with a discharge diagnosis of an ACS who were enrolled in the first New Zealand ACS audit group cohort over 14days in May 2002. We matched the cohort to the national mortality database using each patient’s unique national identity number.
Over a median follow-up of 12.7 years of 721 patients discharged with an ACS, overall mortality was 52%: ST-elevation myocardial infarction (STEMI) (58%), non-ST-elevation myocardial infarction (NSTEMI) (61%) and unstable angina pectoris (UAP) (42%) patients, p<0.0001. In an age-adjusted survival model, males had a 29% increased mortality rate compared to females with a hazard ratio of 1.29 (95% CI 1.04, 1.61, p=0.019). Over 12 years there were 339 (47%) deaths, compared to 284 (39%) deaths observed in the matched population. The standardised mortality ratio for patients admitted with an ACS in New Zealand is 1.3 (95% CI 1.2, 1.5) with eight patients per 100 not surviving to 12 years compared to this matched population.
The high mortality rate in this ACS cohort is a stark reminder of the prognostic implications of a presentation with an ACS. It emphasises the on-going need for optimal management of these patients throughout every stage of their initial treatment and subsequent on-going care.
Regenerative converter for PWM AC drives Braun, D.H.; Gilmore, T.P.; Maslowski, W.A.
IEEE transactions on industry applications,
09/1994, Letnik:
30, Številka:
5
Journal Article
Recenzirano
Since the PWM induction motor drive has become the industrial drive of choice, applications involving four-quadrant operation for AC drives have become more common. To satisfy such applications, a ...regenerative AC/DC converter that is robust is needed to allow bidirectional power flow between the load and power distribution system. A robust technology that is well understood is the 6 SCR converter operating in the inverting mode. However, the typical 6 SCR converter will either limit the maximum DC bus voltage or require a step-up transformer. The proposed regenerative converter allows the SCR power structure to operate as a synchronous line commutator, while a two-transistor series/shunt chopper, with a power resistor, controls the regenerative power flow, and offers an emergency braking capability. In addition, SCR commutation is accomplished by the line voltage and diversion of bus current. Both simulation and experimental results are given.< >
This study investigated the safety and efficacy of doxazosin treatment in a large population of patients (n = 336) with essential hypertension and assessed the effect of doxazosin on the serum lipid ...profile and the calculated risk of developing coronary heart disease. Patients were assigned to two groups: those with a baseline diastolic blood pressure greater than or equal to 95 mm Hg (group 1) and those with a baseline diastolic blood pressure less than 95 mm Hg (group 2) that was controlled by previous antihypertensive therapy. Doxazosin treatment (monotherapy in 76.2% of patients) significantly (p less than 0.05) reduced the blood pressure of patients in group 1 (-23/-17 mm Hg) after 10 weeks and maintained the control of blood pressure for patients in group 2. Heart rate was essentially unchanged in both groups. Mean final daily doses of 3.6 and 3.2 mg were achieved in groups 1 and 2, respectively. Treatment with doxazosin improved the severity category of hypertension for 88.4% of patients in group 1; 87.3% of patients were considered a therapy success. Doxazosin had a favorable effect on the serum lipid profile in both groups of patients. The majority of lipid changes achieved statistical significance and resulted in a significant 27% decrease in the calculated risk of developing coronary heart disease. Doxazosin was well tolerated; only 24.1% of patients had side effects that were related or possibly related to treatment. In nine (2.7%) patients the dose of doxazosin was reduced and 26 (7.7%) patients withdrew from doxazosin therapy because of side effects.
OBJECTIVE--To investigate the hypothesis that the magnitude of the life saving effect of aspirin in the second international study of infarct survival (ISIS-2) trial cannot be explained solely by ...prevention of late reocclusion of the infarct related artery. The aim of this study was to discover whether or not aspirin in combination with streptokinase had an adjuvant thrombolytic effect. DESIGN--Aspirin (150 mg) or placebo was given at the start of streptokinase infusion to 200 patients seen within six hours of the start of prolonged ischaemic cardiac pain and ST segment elevation. All patients received active aspirin at three hours. Patency of the infarct related artery was assessed non-invasively by the normalised rise of creatine kinase activity at three hours after starting streptokinase in these 200 patients and in a further 52 patients who had already taken aspirin within one week of the start of infarction. MAIN OUTCOME MEASURE--Rise in creatine kinase activity from baseline to > or = 20% or < 20% of the peak rise of activity in blood taken at three hours after starting infusion of streptokinase. This correlates with patency or occlusion of the infarct related coronary artery at about 2.5 hours after starting streptokinase. RESULTS--Assessed in this way, patency of the infarct related artery was 60% in patients given aspirin, 63% in those given placebo, and 62% in patients who had already taken aspirin within one week of infarction. CONCLUSION--The magnitude of the life saving effect of aspirin remains unexplained. Further investigation is needed into the mechanism of action of antiplatelet treatment in relation to thrombolytic treatment.
The cause of hypertension in primary hyperparathyroidism and its response to corrective surgery remains a matter of controversy. We therefore studied blood pressure, vasoactive hormones and plasma ...calcium responses to parathyroidectomy in six hypertensive and two normotensive patients with primary hyperparathyroidism. Twenty-four-hour intra-arterial pressure recordings, together with hourly blood sampling for plasma renin activity (PRA), aldosterone, cortisol, catecholamines and calcium levels, were undertaken in each patient before surgery and were repeated under identical conditions 3-6 months after parathyroidectomy. Mean plasma calcium was 3.03 +/- 0.1 before, and 2.35 +/- 0.02 mmol/l after, parathyroidectomy. Changes in arterial pressure were small and variable in individual patients. Group mean arterial pressures before and after surgery were identical. Plasma cortisol and PRA were significantly higher in the hypercalcaemic state (P less than 0.01 and P less than 0.05, respectively) but there was no significant difference in plasma aldosterone or catecholamine levels. No correlations between changes in plasma calcium or parathyroid hormone levels and concomitant changes in plasma concentration of other hormones were observed. Our findings show that correction of primary hyperparathyroidism has no systematic effect on arterial pressure in a heterogeneous group, including some patients with probable background essential hypertension, when evaluated 3-6 months after surgery. Compared with values after corrective surgery, mean levels of PRA and cortisol-but not aldosterone or catecholamines--are elevated in patients with primary hyperparathyroidism. These findings are consistent with an inhibitory effect of raised ionic calcium concentration on the response of the adrenal glomerulosa to angiotensin and adrenocorticotrophic hormone.
To determine whether moderate restriction of dietary sodium content or supplementation of potassium intake reduces blood-pressure in patients with mild essential hypertension, twelve patients were ...put on three different diets--a control diet (180 mmol sodium/day), a sodium restricted diet (80 mmol/day). Each diet was taken for at least 4 weeks and the sequence of the regimens was randomised. At the completion of each regimen intra-arterial pressure was recorded continuously, and vasoactive hormones were measured hourly, for 24 h, under standardised conditions, in hospital. Compared with the control diet, sodium restriction was associated with lower blood-pressure readings in seven patients, higher levels in five, and an overall reduction in mean pressures of only 4.0/3.0 mm Hg (not significant). Individual differences in blood-pressure between these two diets correlated closely with concomitant differences in plasma renin activity (r = 0.75). Potassium supplementation also resulted in variable changes in arterial pressure, and the mean difference in pressure recordings (0.1/0.8 mm Hg) was insignificant. The results show that moderate restriction of sodium intake or supplementation of dietary potassium has variable effects on arterial pressure in individuals with mild essential hypertension, and that overall the blood-pressure changes induced are very small. Responsiveness of the renin-angiotensin system may limit the fall in blood-pressure induced by sodium restriction.
The objective of the investigations carried out at the Department of Mechanical and Robotic Engineering at the Academy of Mining and Metallurgy in Krakow was to assess the effect of the pressure ...increase, occurring in the course of the hyperbaric welding process, on the quality and mechanical properties of joints under both static and dynamic loading conditions. Experimental joints were made under laboratory conditions in a chamber simulating immersion in 60 m deep water. Two grades of steel were selected for these investigations, namely a low-carbon St3M (Polish Standard PN-79/H-92146), and a higher-strength 15G2ANb (PN-86 /H-84018) steel. The former steel is widely used in bridge structures, and the latter for building structures immersed in water and for ship hulls. The work was concerned with investigating the properties of 12 mm thick butt joints welded automatically by MAG in a downhand position with 1.2 mm diameter SPG3S1 (PN-77/M-69420) electrode wire. Within the investigated range of depth of 0-60 m, the welding current parameters, i.e. voltage and current, increase linearly with increasing pressure. The mechanical strength, and the quality of the joints made by the hyperbaric method in St3M and 15G2ANb steels fulfill the requirements postulated by the maritime classification associations such as PRS, and Det Norske Veritas. Fatigue strength of the welded joints deteriorates with increasing depth. The reasons for this lies in the increase in stress concentrations caused by a large convexity, and non-uniformity of the weld face and root.
We are using a novel perfusion system to examine the effects of radiation on a model respiratory tissue. Tracheas taken from young adult male Fischer 344 rats are embedded in a growth factor-enriched ...agarose matrix that is mounted in a special apparatus designed to allow growth medium to periodically wash the epithelial surface of the lumen. A comparison of the microarray expression profiles of freshly harvested tracheas and tracheas maintained in perfusion culture for 24 h shows no significant difference except for an increase in expression of a few metabolism- and surfactant-related genes. Perfusion culture samples exposed to 4 Gy of X rays show a lower than expected increase in expression for some cell cycle- and repair-related genes.
There are various indices used to assess the effect of thermal processing conditions on nutritional value, however, there are only little analyses the results of which refer to the content of ...reactive lysine. The following was determined in seeds of 3 soybean types (Augusta, Aldana, and Progres): content of basic components, amino acids, and reactive lysine; composition of fatty acids and mineral components; and ureasic activity. The seeds were autoclaved at a temperature of 121 degree C during 10, 20, 30, and 2x30 minute periods and the content of reactive lysine was determined therein. After the seeds of the Progress variety have been exposed to the processing conditions for 20 minutes, statistically significant losses of reactive lysine were found in those seeds, whereas in the seeds of the Augusta and Aldana varieties showed such losses after having been autoclaved for 30 minutes. It was found that the autoclaving process of soybean resulted in a significant decrease in the ureasic activity
The treatment of primary pulmonary hypertension is unsatisfactory. Since, in animals, experimental pulmonary vasoconstriction may be mediated in part by angiotensin II, we treated five primary ...pulmonary hypertensive patients with captopril for four days. To ensure accuracy of haemodynamic and hormone data, the patients were studied under conditions of constant body posture, regulated dietary sodium and potassium intake, and unchanged diuretic therapy. Captopril reduced mean pulmonary arterial pressure in parallel with plasma angiotensin II levels. Right ventricular ejection fraction recordings increased considerably in three of four patients. Systemic arterial pressure fell, but there was no change in right atrial pressure, cardiac output, or heart rate. The decline in plasma (and urine) aldosterone levels presumably contributed to the positive cumulative potassium balance and the rise in plasma potassium (mean 0.7 mmol/1). These encouraging results suggest that converting enzyme inhibitors warrant a formal trial with prolonged follow up in the treatment of primary pulmonary hypertension.
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