We present a measurement of the angular power spectrum of the cosmic microwave background (CMB) using data from the South Pole Telescope (SPT). The data consist of 790 deg2 of sky observed at 150 GHz ...during 2008 and 2009. Here we present the power spectrum over the multipole range 650 < l < 3000, where it is dominated by primary CMB anisotropy. We combine this power spectrum with the power spectra from the seven-year Wilkinson Microwave Anisotropy Probe (WMAP) data release to constrain cosmological models. We find that the SPT and WMAP data are consistent with each other and, when combined, are well fit by a spatially flat, Delta *LCDM cosmological model. The SPT+WMAP constraint on the spectral index of scalar fluctuations is ns = 0.9663 ? 0.0112. We detect, at ~5 Delta *s significance, the effect of gravitational lensing on the CMB power spectrum, and find its amplitude to be consistent with the Delta *LCDM cosmological model. We explore a number of extensions beyond the Delta *LCDM model. Each extension is tested independently, although there are degeneracies between some of the extension parameters. We constrain the tensor-to-scalar ratio to be r < 0.21 (95% CL) and constrain the running of the scalar spectral index to be dns /dln k = --0.024 ? 0.013. We strongly detect the effects of primordial helium and neutrinos on the CMB; a model without helium is rejected at 7.7 Delta *s, while a model without neutrinos is rejected at 7.5 Delta *s. The primordial helium abundance is measured to be Yp = 0.296 ? 0.030, and the effective number of relativistic species is measured to be N eff = 3.85 ? 0.62. The constraints on these models are strengthened when the CMB data are combined with measurements of the Hubble constant and the baryon acoustic oscillation feature. Notable improvements include ns = 0.9668 ? 0.0093, r < 0.17 (95% CL), and N eff = 3.86 ? 0.42. The SPT+WMAP data show a mild preference for low power in the CMB damping tail, and while this preference may be accommodated by models that have a negative spectral running, a high primordial helium abundance, or a high effective number of relativistic species, such models are disfavored by the abundance of low-redshift galaxy clusters.
Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the ...treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both).
We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry.
Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003).
CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (ClinicalTrials.gov number, NCT00114972.)
Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been ...established, but their relevance for the risk of subsequent AVM hemorrhage remains unclear.
The authors analyzed follow-up data on 622 consecutive patients from the prospective Columbia AVM database, limited to the period between initial AVM diagnosis and the start of treatment (i.e., any endovascular, surgical, or radiation therapy). Univariate and multivariate logistic regression and Cox proportional hazard models were applied to analyze the effect of patient age, gender, AVM size, anatomic location, venous drainage pattern, and associated arterial aneurysms on the risk of intracranial hemorrhage at initial presentation and during follow-up.
The mean pretreatment follow-up was 829 days (median: 102 days), during which 39 (6%) patients experienced AVM hemorrhage. Increasing age (hazard ratio HR 1.05, 95% CI 1.03 to 1.08), initial hemorrhagic AVM presentation (HR 5.38, 95% CI 2.64 to 10.96), deep brain location (HR 3.25, 95% CI 1.30 to 8.16), and exclusive deep venous drainage (HR 3.25, 95% CI 1.01 to 5.67) were independent predictors of subsequent hemorrhage. Annual hemorrhage rates on follow-up ranged from 0.9% for patients without hemorrhagic AVM presentation, deep AVM location, or deep venous drainage to as high as 34.4% for those harboring all three risk factors.
Hemorrhagic arteriovenous malformation (AVM) presentation, increasing age, deep brain location, and exclusive deep venous drainage appear to be independent predictors for AVM hemorrhage during natural history follow-up. The risk of spontaneous hemorrhage may be low in AVMs without these risk factors.
Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist.
The purpose of this study ...was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial.
PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression.
PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these “enzyme-driven events” on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year.
The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival SYNTAXES; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries SYNTAX; NCT00114972)
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Uncertainty in the mass-observable scaling relations is currently the limiting factor for galaxy cluster based cosmology. Weak gravitational lensing can provide a direct mass calibration and reduce ...the mass uncertainty. We present new ground-based weak lensing observations of 19 South Pole Telescope (SPT) selected clusters and combine them with previously reported space-based observations of 13 galaxy clusters to constrain the cluster mass scaling relations with the Sunyaev-Zel'dovich effect (SZE), the cluster gas mass $M_\mathrm{gas}$, and $Y_\mathrm{X}$, the product of $M_\mathrm{gas}$ and X-ray temperature. We extend a previously used framework for the analysis of scaling relations and cosmological constraints obtained from SPT-selected clusters to make use of weak lensing information. Here, we introduce a new approach to estimate the effective average redshift distribution of background galaxies and quantify a number of systematic errors affecting the weak lensing modelling. These errors include a calibration of the bias incurred by fitting a Navarro-Frenk-White profile to the reduced shear using $N$-body simulations. We blind the analysis to avoid confirmation bias. We are able to limit the systematic uncertainties to 6.4% in cluster mass (68% confidence). Our constraints on the mass-X-ray observable scaling relations parameters are consistent with those obtained by earlier studies, and our constraints for the mass-SZE scaling relation are consistent with the the simulation-based prior used in the most recent SPT-SZ cosmology analysis. We can now replace the external mass calibration priors used in previous SPT-SZ cosmology studies with a direct, internal calibration obtained on the same clusters.
We report the 2018 self-consistent values of constants and conversion factors of physics and chemistry recommended by the Committee on Data of the International Science Council (CODATA). The ...recommended values can also be found at physics.nist.gov/constants. The values are based on a least-squares adjustment that takes into account all theoretical and experimental data available through 31 December 2018. A discussion of the major improvements as well as inconsistencies within the data is given. The former include a decrease in the uncertainty of the dimensionless fine-structure constant and a nearly two orders of magnitude improvement of particle masses expressed in units of kg due to the transition to the revised International System of Units (SI) with an exact value for the Planck constant. Further, because the elementary charge, Boltzmann constant, and Avogadro constant also have exact values in the revised SI, many other constants are either exact or have significantly reduced uncertainties. Inconsistencies remain for the gravitational constant and the muon magnetic-moment anomaly. The proton charge radius puzzle has been partially resolved by improved measurements of hydrogen energy levels.
Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with ...complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization.
This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years.
A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 95% CI, 0.73-0.97;
=0.021; in MCS adjusted hazard ratio, 0.85 95% CI, 0.76-0.95;
=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS
=0.033, MCS
=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 95% CI, 1.55-5.30;
=0.001), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction (
=0.002).
Among patients with left-main CAD or 3-vessel disease, patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI. Assessment of self-reported physical and mental health is important when selecting the optimal revascularization strategy.
URL: https://www.
gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www.
gov; SYNTAX Unique identifier: NCT00114972.
It is unknown whether warfarin or aspirin therapy is superior for patients with heart failure who are in sinus rhythm.
We designed this trial to determine whether warfarin (with a target ...international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean ±SD, 3.5±1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause.
The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval CI, 0.79 to 1.10; P=0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P=0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P=0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P=0.82).
Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized. (Funded by the National Institute of Neurological Disorders and Stroke; WARCEF ClinicalTrials.gov number, NCT00041938.).
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