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BackgroundRadial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding.MethodsPatients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days.ResultsIn the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; Pinteraction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; Pinteraction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant.ConclusionsOur findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because this was not a primary analysis, it should be considered hypothesis generating.

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Wire arc additive manufacturing (WAAM) is a method of metal 3D printing that can be used to complement traditional steel manufacturing techniques (e.g. hot-rolling and cold-forming), to produce hybrid structural elements of enhanced efficiency. The case of hot-rolled steel I-sections strengthened by the addition of WAAM stiffeners at the flange tips is the focus of the present study. In addition to the improved local buckling resistance and increased flexural rigidity achieved by the addition of the stiffeners, a further source of enhanced load-bearing capacity arises from the inversion, through thermal action, of the adverse residual stress pattern typically associated with hot-rolled I-sections. Thus, in contrast to previous studies, the aim of the present investigation is not to eliminate but to take benefit from residual stresses, by prestressing (pretensioning) specific parts (i.e. the flange tips) of steel sections against subsequent applied compressive loading, thereby delaying yielding and enhancing the load-bearing capacity. The described hypothesis is demonstrated in the present study through the manufacture of a series of hybrid WAAM-strengthened hot-rolled I-sections and the subsequent performance of residual stress measurements. Stiffeners of different dimensions were printed using ER70S-6 welding wire. A detailed description of the adopted experimental technique, which utilised the sectioning method, is provided, while the magnitude and distribution of the measured residual stresses are reported. The addition of WAAM stiffeners at the flange tips of hot-rolled I-sections is shown to lead to the generation of desirable (for structural stability) tensile residual stresses in their vicinity, with peak values reaching the yield strength of the material; self-equilibrating compressive residual stresses are induced in the web and around the web-to-flange junction.

<h3></h3> COPD is a heterogenous disease and there is ongoing need to identify biomarkers for treatable endotypes. Nasosorption is a non-invasive and safe way of sampling the respiratory tract to obtain undiluted endothelial lining fluid. This study investigates whether nasosorption can be used to characterise COPD. Nasosorption was performed on 23 non-smokers and 32 COPD patients and MSD (Mesoscale Discovery) used to measure an array of cytokines. IL-4 (NSm:3.06±1.49ng/ml, COPD:0.07±0.03ng/ml), IL-5 (NSm:8.2±2.51ng/ml, COPD:2.03±0.66ng/ml), IL-6 (NSm:20.00±2.73ng/ml, COPD:12.89±2.73ng/ml), CXCL-8 (NSm:4729.2±703.7ng/ml, COPD:2378.3±404.6ng/ml) and IFNγ (NSm:108.37±46.81ng/ml, COPD: 12.93±11.17ng/ml) were significantly lower in COPD than non-smokers. Eotaxin was higher in COPD (NSm:2.90±0.57ng/ml, COPD:6.53±1.12ng/ml). The COPD cohort was further analysed to look at commonly identified clinical phenotypes. Nasal eotaxin was raised in the high blood eosinophil cohort (&gt;300cells/100µl) compared to low eosinophil cohort (7.93±2.66ng/ml vs 2.91±1.14ng/ml, p&lt;0.05), but other TH2 cytokines such as IL-4, IL-5, IL-13 did not differ. 16% of COPD patients had co-existing bronchiectasis. These patients had significantly higher nasal IL-7 (109.7±6.0ng/ml vs 56.9±7.9ng/ml, p&lt;0.05), CXCL10 (4446.0±1540.0ng/ml vs 949.5±237.7ng/ml, p&lt;0.01), CXCL11 (6.41±5.32ng/ml vs 0.30±0.9ng/ml, p&lt;0.01) and CCL17 (56.1±6.8ng/ml vs 32.3±4.1ng/ml, p&lt;0.05). Comparing frequent (≥2 exacerbations/year) against infrequent exacerbators (&lt;2/year) there were non-significant trends of increased IL-6 (15.7±4.1ng/ml vs 7.68±2.81ng/ml) and reduced IL-13 (8.8±3.1ng/ml vs 17.9±3.9ng/ml) and IL-33(63.8±23.2ng/ml vs 144.1±63.1ng/ml) in frequent exacerbators. 16 COPD patients were sampled at exacerbation and &gt;4 weeks after recovery. IFNγ was higher during exacerbation than on recovery (729.6±591.2ng/ml vs 2.2±1.3ng/ml, p&lt;0.05), with a trend towards higher levels in viral vs non-viral exacerbations. Other markers known to be associated with viral infections such as IFNα, CXCL10 and TSLP were non-significantly increased in viral vs non-viral exacerbations. There was also a trend towards eotaxin levels being raised during exacerbation, with higher levels in non-bacterial rather than bacterial exacerbations (Non-bact:4.02±2.57ng/ml, Bact: 3.46±1.48ng/ml, p&lt;0.05). We show that nasosorption may identify differences in inflammatory profiles in COPD. As a non-invasive test, its potential for qualifying exacerbations in a less stable patient is particularly relevant. A larger study is needed to cohort COPD phenotypes based on nasal inflammation and assess its use as a diagnostic test during exacerbations.

Patients with chronic obstructive pulmonary disease (COPD) have increased susceptibility to respiratory tract infection, which contributes to disease progression and mortality, but mechanisms of increased susceptibility to infection remain unclear.

When a lesion is unstable, it may rupture and cause an acute thrombotic reaction. A rupture prone plaque contains a large lipid pool covered by a thin fibrous cap. Intravascular ultrasound (IVUS) elastography can assess the presence of lipid pools and identify high stress regions. The deformation of the tissue is determined using ultrasound. For intravascular purposes, the intraluminal pressure is used as the excitation force. The radial strain in the tissue is obtained by cross-correlation techniques on the radio frequency (rf) signal. The strain is colour-coded and plotted as a complimentary image to the IVUS echogram , or , in case of palpography, as a ring on the lumen vessel boundary.

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