Background It remains unclear whether the superiority of primary percutaneous coronary intervention (PPCI) over thrombolysis for the treatment of ST elevation myocardial infarction (STEMI) extends to ...the very elderly. Furthermore, the deliverability and efficacy of PPCI in over the 80s has not been investigated in a real-world setting. The aim of this study was to compare outcome from STEMI in patients aged ≥80 before and after the introduction of routine 24/7 PPCI. Methods Retrospective observational analysis of all patients aged ≥80 presenting with STEMI to 2 neighboring hospitals in the 3-year period after the introduction of a 24/7 PPCI service and in the preceding 2 years when reperfusion therapy was by thrombolysis. Results Two hundred fifty-six STEMI patients aged ≥80 were included. After the introduction of PPCI, 84% (136/161) received reperfusion therapy, 73% PPCI, and 12% thrombolysis, compared to 77% (73/95 1% PPCI, 76% thrombolysis) previously. Mortality after inception of PPCI was reduced at 12 months (29% vs 41%, P = .04) and 3 years (43% vs 58%, P = .02). Improved outcome was attributable to treatment by PPCI, which was associated with numerically lower 12-month (26% vs 37%, P = .07) and significantly reduced 3-year (42% vs 55%, P = .05) mortality compared to thrombolysis. Conclusions Primary PCI can be effectively delivered to very elderly patients presenting with ST elevation MI in a real-world setting and leads to a substantial reduction in mortality compared to patients treated by thrombolysis.
Metal components with applications across a range of industrial sectors can be manufactured by selective laser melting (SLM). A particular strength of SLM is its ability to manufacture components ...incorporating periodic lattice structures not realisable by conventional manufacturing processes. This enables the production of advanced, functionally graded, components. However, for these designs to be successful, the relationships between lattice geometry and performance must be established. We do so here by examining the mechanical behaviour of uniform and graded density SLM Al-Si10-Mg lattices under quasistatic loading. As-built lattices underwent brittle collapse and non-ideal deformation behaviour. The application of a microstructure-altering thermal treatment drastically improved their behaviour and their capability for energy absorption. Heat-treated graded lattices exhibited progressive layer collapse and incremental strengthening. Graded and uniform structures absorbed almost the same amount of energy prior to densification, 6.3±0.2 MJ/m3 and 5.7±0.2 MJ/m3, respectively, but densification occurred at around 7% lower strain for the graded structures. Several characteristic properties of SLM aluminium lattices, including their effective elastic modulus and Gibson-Ashby coefficients, C1 and α, were determined; these can form the basis of new design methodologies for superior components in the future.
In this study we sought factors that determine the survival of human colonic epithelial cells. Normal colonic epithelial cells are dependent on cell-cell contacts and survival factors for the ...inhibition of apoptosis whereas, during colorectal tumorigenesis, cells develop mechanisms to evade these controls. The ability to survive loss of cell-cell contacts and/or growth factor deprivation is a marker of tumour progression. Many adenoma (premaligant) cultures survive only if cell-cell contacts are maintained in vitro and die by apoptosis if trypsinized to single cells. This also occurs in adenomas derived from familial adenomatous polyposis (FAP) patients, therefore APC mutations do not confer resistance to cell death in response to loss of cell-cell contacts. We show here that if cell-cell contacts are maintained such cells are capable of survival in suspension. Adenoma cells also undergo apoptosis in response to removal of serum and growth factors from the medium. After removal of serum and growth factors c-myc is down-regulated within 2 h. Therefore, the induction of apoptosis is not an inappropriate response of the cells due to a deregulated c-myc gene. The apoptotic response is also p53 independent. Such cultures have been used to determine specific survival factors for colonic epithelial cells. Insulin, the insulin-like growth factors I and II, hydrocortisone and epidermal growth factor (EGF) protect cells from the induction of apoptosis in the absence of serum over a short-term period of 24 h. This approach may give insight into the factors governing growth and survival of colonic epithelial cells in vivo. This is the first report of specific growth factors protecting against apoptosis in human colonic epithelial cells.
Abstract Background context Gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, ...correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings. Purpose To evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica. Study design Prospective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up. Patients sample Patients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year. Outcome measures Patients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability. Methods In total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data. Results Poor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain. Conclusions Reliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.
Atropine hypersensitivity is a rarely reported condition. However, in the military environment, such reactions are of significant concern given the threat of chemical warfare and the use of atropine ...as a nerve agent antidote. Upon deployment to regions where chemical attacks are a threat, each service member is issued three 2-mg intramuscular autoinjectors of atropine for self-treatment. In the case presented here, an active duty service member presented to his Aid Station to request red dog tags for a previously identified allergy to atropine. Sensitivity testing revealed a significant reaction to <0.03 mg of intradermal atropine. This rarely reported reaction, in the military environment, poses a unique question regarding the suitability of deploying military members to areas where exposure to chemical warfare agents is possible.
Background Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) provided it can be delivered within 90 minutes of ...hospital admission. In clinical practice this target is difficult to achieve. We aimed to determine the effect of direct ambulance admission to the cardiac catheterization laboratory on door-to-balloon and call-to-balloon times in primary PCI. Methods We performed a prospective evaluation of a new system of paramedic electrocardiogram diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory for primary PCI. Door-to-balloon and call-to-balloon times were recorded for all patients. Direct admissions were compared with admissions via the emergency room of the interventional center and of 2 referring hospitals. All times are quoted as medians. Results Five hundred and seventy-seven patients (70% male, age 63 ± 13 years) underwent primary PCI between April 2005 and May 2007. After February 2006, 172 (44%) of 387 patients were admitted directly from the ambulance to the catheterization laboratory. Directly admitted patients had significantly reduced door-to-balloon (58 vs 105 minutes, P < .001) and call-to-balloon times (105 vs 143 minutes, P < .001). The 90-minute target for door-to-balloon time was achieved in 94% of direct admissions compared to 29% of patients referred from the emergency room. Conclusions Direct admission of patients with suspected STEMI from the ambulance service to the catheterization laboratory significantly reduces time to treatment in primary PCI and allows the 90-minute door-to-balloon time target to be reliably achieved.
Very high-energy gamma-ray emission from PKS 0447-439 was detected with the H.E.S.S. Cherenkov telescope array in December 2009. This blazar is one of the brightest extragalactic objects in the Fermi ...Bright Source List and has a hard spectrum in the MeV to GeV range. In the TeV range, a photon index of 3.89 +- 0.37 (stat) +- 0.22 (sys) and a flux normalisation at 1 TeV, Phi(1 TeV) = (3.5 +- 1.1 (stat) +- 0.9 (sys)) x 10^{-13} cm^{-2} s^{-1} TeV^{-1}, were found. The detection with H.E.S.S. triggered observations in the X-ray band with the Swift and RXTE telescopes. Simultaneous UV and optical data from Swift UVOT and data from the optical telescopes ATOM and ROTSE are also available. The spectrum and light curve measured with H.E.S.S. are presented and compared to the multi-wavelength data at lower energies. A rapid flare is seen in the Swift XRT and RXTE data, together with a flux variation in the UV band, at a time scale of the order of one day. A firm upper limit of z < 0.59 on the redshift of PKS 0447-439 is derived from the combined Fermi-LAT and H.E.S.S. data, given the assumptions that there is no upturn in the intrinsic spectrum above the Fermi-LAT energy range and that absorption on the Extragalactic Background Light (EBL) is not weaker than the lower limit provided by current models. The spectral energy distribution is well described by a simple one-zone Synchrotron Self-Compton (SSC) scenario, if the redshift of the source is less than z <~ 0.4.
Objectives This study prospectively investigated the impact of integration of a multidetector computed tomography (MDCT) annular area sizing algorithm on transcatheter aortic valve replacement (TAVR) ...outcomes. Background Appreciation of the 3-dimensional, noncircular geometry of the aortic annulus is important for transcatheter heart valve (THV) sizing. Methods Patients being evaluated for TAVR in 4 centers underwent pre-procedural MDCT. Recommendations for balloon-expandable THV size selection were based on an MDCT sizing algorithm with an optimal goal of modest annulus area oversizing (5% to 10%). Consecutive patients who underwent TAVR with the algorithm (MDCT group) were compared with consecutive patients without the algorithm (control group). The primary endpoint was the incidence of more than mild paravalvular regurgitation (PAR), and the secondary endpoint was the composite of in-hospital death, aortic annulus rupture, and severe PAR. Results Of 266 patients, 133 consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and 133 consecutive patients were in the control group. More than mild PAR was present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in the control group (p = 0.032). The combined secondary endpoint occurred in 3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control group (p = 0.02), driven by the difference of severe PAR. Conclusions The implementation of an MDCT annulus area sizing algorithm for TAVR reduces PAR. Three-dimensional aortic annular assessment and annular area sizing should be considered for TAVR.
The phase stability and structure of water-in-oil microemulsions stabilized by the surfactant Aerosol OT have been examined in the low molecular weight silicone oils hexamethyldisiloxane (HMDS) and ...diphenyltetramethyldisiloxane (DPTMDS). The solubilization capacity ωmax (where ω = H2O/AOT) determined as a function of temperature defines a limited single phase microemulsion region with relatively low water solubilization (ωmax < 40). Addition of NaCl shifts this single phase region to a higher temperature. SANS and dynamic light scattering measurements show the presence of strong attractive interdroplet interactions in HMDS, which are relatively absent in DPTMDS. Addition of n-octanol as a cosurfactant dramatically increases the solubilization of water in HMDS, giving an optimal solubilization capacity at a specific cosurfactant:surfactant molar ratio, x. Small-angle neutron scattering (SANS) measurements made close to the optimized condition show elimination of attractive interactions. A Porod analysis of the SANS data demonstrates an increase in the area of the surfactant/cosurfactant layer and commensurate reduction in droplet size with increasing x.
Gamma-ray line signatures can be expected in the very-high-energy (VHE; E_\gamma > 100 GeV) domain due to self-annihilation or decay of dark matter (DM) particles in space. Such a signal would be ...readily distinguishable from astrophysical \gamma-ray sources that in most cases produce continuous spectra which span over several orders of magnitude in energy. Using data collected with the H.E.S.S. \gamma-ray instrument, upper limits on line-like emission are obtained in the energy range between ~500 GeV and ~25 TeV for the central part of the Milky Way halo and for extragalactic observations, complementing recent limits obtained with the Fermi-LAT instrument at lower energies. No statistically significant signal could be found. For monochromatic \gamma-ray line emission, flux limits of (2x10^-7 - 2x10^-5) m^-2 s^-1 sr^-1 and (1x10^-8 - 2x10^-6) m^-2 s^-1 sr^-1 are obtained for the central part of the Milky Way halo and extragalactic observations, respectively. For a DM particle mass of 1 TeV, limits on the velocity-averaged DM annihilation cross section < \sigma v >(\chi\chi -> \gamma\gamma) reach ~10^-27 cm^3 s^-1, based on the Einasto parametrization of the Galactic DM halo density profile.
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