Publications

Complete Percutaneous Revascularization for Multivessel Disease in Patients With Impaired Left Ventricular Function

Objectives The aim of this study was to investigate the effect of complete, incomplete, and unsuccessful revascularization by percutaneous coronary intervention (PCI) on left ventricular ejection fraction (EF) in patients with multivessel disease and impaired left ventricular function and assess the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) for improvement in EF. Background The effect of PCI for multivessel coronary artery disease on long-term myocardial function and the predictive value of cardiac MRI on global function are incompletely investigated. Methods Cardiac MRI was performed in patients with multivessel disease before and 6 months after complete revascularization (n = 34) or incomplete revascularization (n = 22) or in patients without successful revascularization (n = 15). For the prediction of recovery of EF, wall thickening was quantified on cine images at rest and during 5- and 10-μg/kg/min dobutamine. The transmural extent of infarction was quantified on delayed enhancement cardiac MRI. Results The EF improved significantly after complete revascularization (46 ± 12% to 51 ± 13%; p < 0.0001) but did not change after incomplete (49 ± 11% to 49 ± 10%; p = 0.88) or unsuccessful revascularization (49 ± 13% to 47 ± 13%; p = 0.11). Sensitivity, specificity, positive and negative predictive value for the prediction of improvement in EF of >4% after PCI were 100%, 75%, 74%, and 100%, respectively, for dobutamine-cardiac MRI and 70%, 77%, 70%, and 77%, respectively, for delayed enhancement-cardiac MRI. Conclusions Complete revascularization for multivessel coronary artery disease improves EF, whereas EF did not change in patients after incomplete or unsuccessful revascularization. Improvement in EF can be predicted by performing cardiac MRI before PCI.

Stability of prestressed stayed steel columns with a three branch crossarm system

Ultimate response of stainless steel continuous beams

Increased α- and Reduced <i>β</i>-Adrenoreceptor Numbers in Experimental Asthma

Conference Abstract| September 01 1980 Increased α- and Reduced β-Adrenoreceptor Numbers in Experimental Asthma P. J. Barnes; P. J. Barnes 1Department of Clinical Pharmacology, Royal Postgraduate Medical School, London Search for other works by this author on: This Site PubMed Google Scholar J. MacDermot; J. MacDermot 2Department of Clinical Pharmacology, Royal Postgraduate Medical School, London Search for other works by this author on: This Site PubMed Google Scholar C. T. Dollery C. T. Dollery 3Department of Clinical Pharmacology, Royal Postgraduate Medical School, London Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1980) 59 (3): 1P. https://doi.org/10.1042/cs059001P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation P. J. Barnes, J. MacDermot, C. T. Dollery; Increased α- and Reduced β-Adrenoreceptor Numbers in Experimental Asthma. Clin Sci (Lond) 1 September 1980; 59 (3): 1P. doi: https://doi.org/10.1042/cs059001P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1980 The Biochemical Society and the Medical Research Society1980 Article PDF first page preview Close Modal You do not currently have access to this content.

Energy Efficiency in Buildings and Excess Summer Mortality in the UK

One of the main objective of the building design is to provide comfort and safety to occupants, particularly during adverse weather conditions. In most part of the world, people stay indoors during adverse weather conditions, thus increasing energy consumption. In UK, vulnerable people such as the elderly are highly affected with mortality rate during extreme weather conditions. The 2003 heatwave reached average of 38.5° C in the UK resulting in the death toll of 2,234. The 10 days period of extreme heat is thought to be the warmest about the last 500 years. Across Europe, the 2003 heatwave resulted in 20,000 deaths; in France alone, the number reached 15,000. Similarly, the 2018 summer heatwaves, reached 35.5°C contributing to 863 deaths. Yet, there is little research regarding impact of energy efficiency in building and deaths caused by excessive heatwaves in the UK. The study aims to investigate the impact of energy efficiency in buildings and excessive heatwave deaths among elderly people in the UK. Research question asked is; do energy efficiency programmes and policies contribute to excessive summer deaths in the UK? .The study adopted quantitative research method with participants drawn from low/average income households, in west midlands part of UK, between 2003/04 to 2017/18. Initial findings show that there is a significant relationship between energy efficiency adoption, government policies and excessive summer deaths.

Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Objectives We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI). Background AR after TAVI is common but challenging to quantitate, especially in the cath‐lab. Methods In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video‐densitometric analysis of aortograms. Contrast time–density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT‐AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region. Results LVOT‐AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none‐trace, mild and moderate‐severe post‐TAVI AR as defined by echocardiography ( P &lt; 0.001) and a cutpoint of &gt;0.17 corresponded to moderate‐severe AR on echocardiography (area under the curve = 0.84). At follow‐up (median, 496 days), patients with LVOT‐AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95–148] vs. 140 [112–169] g/m 2 , P = 0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P = 0.001) compared to baseline. In patients with LVOT‐AR &gt; 0.17, LVMi (149 [121–178] vs. 166 [144–188] g/m 2 , P = 0.14) and the prevalence of LVH (74 vs. 87%, P = 0.23) did not show a significant change. Compared to patients with LVOT‐AR ≤ 0.17, those with LVOT‐AR &gt; 0.17 had an increased 30‐day (16.4% vs. 7.1%, P = 0.035) and one year mortality (32.9 vs. 14.2%, log rank P value = 0.001; HR: 2.690 [1.461–4.953], P = 0.001). Conclusions LVOT‐AR &gt; 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.

Augmentation of Wall Shear Stress Inhibits Neointimal Hyperplasia After Stent Implantation

Low wall shear stress (WSS) increases neointimal hyperplasia (NH) in vein grafts and stents. We studied the causal relationship between WSS and NH formation in stents by locally increasing WSS with a flow divider (Anti-Restenotic Diffuser, Endoart SA) placed in the center of the stent.In 9 rabbits fed a high-cholesterol diet for 2 months to induce endothelial dysfunction, 18 stents were implanted in the right and left external iliac arteries (1 stent per vessel). Lumen diameters were measured by quantitative angiography before and after implantation and at 4-week follow-up, at which time, macrophage accumulation and interruption of the internal elastic lamina was determined. Cross sections of stent segments within the ARED (S+ARED), outside the ARED (S[minus]ARED), and in corresponding segments of the contralateral control stent (SCTRL) were analyzed. Changes in WSS induced by the ARED placement were derived by computational fluid dynamics. Computational fluid dynamics analysis demonstrated that WSS increased from 0.38 to 0.82 N/m2 in the S+ARED immediately after ARED placement. This augmentation of shear stress was accompanied by (1) lower mean late luminal loss by quantitative angiography ([minus]0.23+/-0.22 versus [minus]0.58+/-0.30 mm, P=0.02), (2) reduction in NH (1.48+/-0.58, 2.46+/-1.25, and 2.36+/-1.13 mm2, P<0.01, respectively, for S+ARED, S[minus]ARED, and SCTRL), and (3) a reduced inflammation score and a reduced injury score. Increments in shear stress did not change the relationship between injury score and NH or between inflammation score and NH.The newly developed ARED flow divider significantly increases WSS, and this local increment in WSS is accompanied by a local reduction in NH and a local reduction in inflammation and injury. The present study is therefore the first to provide direct evidence for an important modulating role of shear stress in in-stent neointimal hyperplasia.

Coronary artery bypass graft surgery versus drug-eluting stent implantation for high-surgical-risk patients with left main or multivessel coronary artery disease

There are limited data comparing long-term outcomes of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with high surgical risk. We evaluated 5-year outcomes following CABG versus PCI with DES in 598 patients with left main or multivessel coronary artery disease (CAD) and a high surgical risk [EuroSCORE (European system for cardiac operative risk evaluation) ≥ 6].Databases were merged from the BEST, PRECOMBAT and SYNTAX trials. The primary outcome was a major adverse cardio-cerebral event (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke or repeat revascularization.During 5-year follow-up, the rates of MACCE were 29.4% in the CABG group and 43.8% in the PCI group [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49 - 0.84; P = 0.001]. The MACCE was significantly better with CABG than with PCI in patients with high and intermediate SYNTAX scores (34.9% vs 46.3%, P = 0.039, and 29.7% vs 47.6%, P = 0.010, respectively), but comparable between the two groups in those with low SYNTAX scores. The rates of all-cause death and stroke were similar between the two groups. However, CABG was associated with fewer myocardial infarctions (HR, 0.50; 95% CI, 0.27 - 0.93; P = 0.027) and repeat revascularizations (HR, 0.32; 95% CI, 0.20 - 0.52; P < 0.001).Among high surgical risk patients with left main or multivessel CAD, CABG compared to PCI with DES was associated with a lower rate of MACCE.

Direct strength prediction of innovative corrugated columns

This paper responds to the need for a theoretical model to describe the structural strength capacity of innovative hollow corrugated columns consisting of four cold-formed corrugated mild steel plates. Interest in these columns has been growing over a number of years, due to high ratio of axial load bearing capacity to weight. The paper utilises the Direct Strength Method (DSM) to calculate the axial strength of aforementioned columns while the results are compared with those obtained from experiments and finite element models. Existing formulations are extended to predict local failure of these columns over a vast range of slenderness with a good degree of accuracy. The results show the appropriateness of this method as an alternative for analytical capacity prediction of innovative corrugated columns.

Short-Term Outcomes of ACURATE neo2

Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs. This report reviews data on short-term clinical and echocardiographic outcomes of ACURATE neo2. A PubMed search yielded 13 studies, including 5 single arm and 8 nonrandomized comparative studies with other THVs which reported in-hospital or 30-day clinical and echocardiographic outcomes. In-hospital or 30-day all-cause mortality was ≤3.3%, which is comparable to other contemporary THVs. The rates of postprocedural ≧moderate PVL ranged 0.6%-4.7%. In multicenter propensity-matched analyses, neo2 significantly reduced the rate of ≧moderate PVL compared to neo (3.5% vs. 11.3%, p < 0.01), whereas rates were comparable to Evolut Pro/Pro+ (Neo2: 2.0% vs. Pro/Pro+: 3.1%, p = 0.28) and SAPIEN 3 Ultra (Neo2: 0.6% vs. Ultra: 1.1%, p = 0.72). The rate of permanent pacemaker implantation with neo2 was consistently low (3.3%-8.6%) except in one study, and in propensity-matched analyses were significantly lower than Evolut Pro/Pro+ (6.7% vs. 16.7%, p < 0.01), and comparable to SAPIEN 3 Ultra (8.1% vs. 10.3%, p = 0.29). In conclusion, ACURATE neo2 showed better short-term performance by considerably reducing PVL compared to its predecessor, with short-term clinical and echocardiographic outcomes comparable to contemporary THVs.

Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies

Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects of statin therapy on VH-IVUS parameters have been inconclusive. Consequently, we performed a systematic review and meta-analysis to investigate the impact of statin therapy on plaque volume and its composition using VH-IVUS.

Clinical Outcome of Patients With and Without Diabetes Mellitus After Percutaneous Coronary Intervention With the Resolute Zotarolimus-Eluting Stent

Objectives The aim of this study was to describe the process to obtain Food and Drug Administration (FDA) approval for the expanded indication for treatment with the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Inc., Santa Rosa, California) in patients with coronary artery disease and diabetes. Background The R-ZES is the first drug-eluting stent specifically indicated in the United States for percutaneous coronary intervention in patients with diabetes. Methods We pooled patient-level data for 5,130 patients from the RESOLUTE Global Clinical Program. A performance goal prospectively determined in conjunction with the FDA was established as a rate of target vessel failure at 12 months of 14.5%. In addition to the FDA pre-specified cohort of less complex patients with diabetes (n = 878), we evaluated outcomes of the R-ZES in all 1,535 patients with diabetes compared with all 3,595 patients without diabetes at 2 years. Results The 12-month rate of target vessel failure in the pre-specified diabetic cohort was 7.8% (upper 95% confidence interval: 9.51%), significantly lower than the performance goal of 14.5% (p < 0.001). After 2 years, the cumulative incidence of target lesion failure in patients with noninsulin-treated diabetes was comparable to that of patients without diabetes (8.0% vs. 7.1%). The higher risk insulin-treated population demonstrated a significantly higher target lesion failure rate (13.7%). In the whole population, including complex patients, rates of stent thrombosis were not significantly different between patients with and without diabetes (1.2% vs. 0.8%). Conclusions The R-ZES is safe and effective in patients with diabetes. Long-term clinical data of patients with noninsulin-treated diabetes are equivalent to patients without diabetes. Patients with insulin-treated diabetes remain a higher risk subset. (The Medtronic RESOLUTE Clinical Trial; NCT00248079; Randomized, Two-arm, Non-inferiority Study Comparing Endeavor-Resolute Stent With Abbot Xience-V Stent [RESOLUTE-AC]; NCT00617084; The Medtronic RESOLUTE US Clinical Trial (R-US); NCT00726453; RESOLUTE International Registry: Evaluation of the Resolute Zotarolimus-Eluting Stent System in a ‘Real-World’ Patient Population [R-Int]; NCT00752128; RESOLUTE Japan–The Clinical Evaluation of the MDT-4107 Drug-Eluting Coronary Stent [RJ]; NCT00927940).

Nasal contribution to exhaled nitric oxide during exhalation against resistance or during breath holding

The concentration of nitric oxide (NO) is increased in the exhaled air of patients with inflammation of the airways, suggesting that this may be a useful measurement to monitor inflammation in diseases such as asthma. However, there have been concerns that exhaled NO may be contaminated by the high concentrations of NO derived from the upper airways, and that this may account for differences in reported values of exhaled NO using different techniques. A study was performed, with argon as a tracer, to determine the extent of nasal contamination of exhaled NO using different expiratory manoeuvres.Exhaled and nasal NO were measured by a chemiluminescence analyser. Argon (4.8%) was delivered continuously to the nose. Gas was sampled from the posterior oropharynx and argon and carbon dioxide were measured by mass spectrometry at the same time as NO.During a single expiration against a low resistance and during breath holding there was no evidence for nasal contamination, whereas during exhalation without resistance argon concentration in the oropharynx was increased from 0.91% (95% CI 0.84% to 0.98%) in ambient air to 1.28% (0.9% to 2.24%, p < 0.0001) during a single breath or 2.37% (2.29% to 2.51%, p < 0.0001) during tidal breathing.Collection of exhaled NO in a reservoir during tidal breathing is likely to be contaminated by NO derived from the nose and this may underestimate any increases in NO derived from the lower respiratory tract in inflammatory diseases. However, with slow expiration against a resistance and created back pressure to close the soft palate, there is no contamination of exhaled air which then reflects concentrations of NO in the lower airways.

Effect of nedocromil sodium on down-regulation of pulmonary β-adrenoceptors

1. We have studied the effect of the anti-inflammatory anti-asthma drug, nedocromil sodium, on down-regulation of pulmonary β-adrenoceptors in guinea-pig lung. 2. Incubation of minced lung with isoprenaline (10 μmol/l) resulted in a reduction in maximum binding capacity of [125I]iodocyanopindolol to lung membranes from 246 ± 4 to 169 ± 6 fmol/mg of protein (mean ± sem, P &amp;lt; 0.01, n = 18). 3. Nedocromil sodium, which had no direct effect on [125I]iodocyanopindolol binding, prevented isoprenaline-induced down-regulation, giving complete protection at a dose of 100 μmol/l. 4. The mechanism of this effect is not certain, but nedocromil sodium may interfere with the internalization of β-adrenoceptors in pulmonary parenchymal cells. This may have some therapeutic relevance.

ROBUST OPTICAL AUTOFOCUS SYSTEM UTILIZING NEURAL NETWORKS APPLIED TO AUTOMATED MULTIWELL PLATE STORM MICROSCOPY

We present a robust, low-cost neural network-based optical autofocus system that can operate over a range of ±100µm with submicron precision, enabling automated high-content super-resolved imaging with a 1.3 NA objective lens

Extended reality in cardiovascular care: a systematic review

Abstract Extended reality (XR) is an emerging technology currently finding its way into various medical fields. This systematic review aimed to compile a comprehensive overview of the current data on XR in cardiovascular medicine. To identify the currently available evidence of the applications of XR in cardiology, we searched PubMed and Web of Science until 31 July 2024 using predefined keywords. After screening, a total of 164 studies were included. Overall, the publications were characterized by very heterogeneous study designs. From the published data, it can already be deduced that XR can support every area of cardiology, from education (n = 31) and training (n = 36) to peri-procedural care (n = 78) and rehabilitation (n = 16). Extended reality offers a wide range of applications, and the aim of using these technologies is to optimize the clinical practice. However, these technologies are still in development, and randomized controlled trials are urgently needed to identify their benefits and limitations.

Four-year clinical follow-up of the ABSORB everolimus-eluting bioresorbable vascular scaffold in patients with de novo coronary artery disease: the ABSORB trial

The first-in-man ABSORB Cohort A trial demonstrated the bioresorption of the ABSORB BVS (Abbott Vascular, Santa Clara, CA, USA) at two years. This report describes the 4-year clinical outcomes.The ABSORB Cohort A trial enrolled 30 patients with a single de novo native coronary artery lesion. Clinical follow-up was available in 29 patients since one patient withdrew consent after the six month follow-up. At four years, the hierarchical ID-MACE of 3.4% remained unchanged. Clopidogrel therapy had been discontinued in all patients.Four-year clinical results demonstrate a sustained low MACE rate (3.4%) without any late complications such as stent thrombosis.

Asthma and COPD