6,963 publications from this institution
The European Respiratory Society (ERS), in order to serve better its members and achieve its mission objectives (table 1) [1], organised a Strategy Meeting to plan its core strategic priorities for the period 2013–2018, taking into account changes occurring both within the society and within the respiratory field in Europe and beyond. This meeting was held on July 3 and 4, 2013 in Lausanne, Switzerland to formulate future directions. We took into account the Executive Summary of the 2006–2007 Strategy Meeting [2] summarising the ERS pillars (fig. 1) and the recently published ERS Presidential plans as an operational guide [3–5]. View this table: Table 1– Objectives and means of action of the European Respiratory Society (ERS) Figure 1– The three pillars of the European Respiratory Society. The Strategy Meeting involved the ERS Leadership represented by the members of the Steering Committee (fig. 2). It was prepared by an ad hoc meeting preceding the event, involving the Past President and the Secretary General Elect (the officers designated to act as chair and moderator), as well as the Executive Director and the Head of the Executive Office. This was used as the starting point to develop the strategic meeting agenda. Participants were encouraged to express their opinions freely and to think “outside the box” in order to bring fresh ideas to the table. Whilst the focus of the exercise was definitely the future, the importance of the past as the basis of all change was emphasised by the presence of the former Executive Director who attended in an observer role to recall the history of the ERS and previous decisions. Figure 2– The European Respiratory Society Strategy Meeting in Lausanne, Switzerland. Operational minutes discussions were first drafted to allow an accurate summary of the decisions taken, which were then approved by the Steering and Executive Committees following ERS regulations. As it was felt that …
Recent work on localized buckling with different core bending theories in sandwich struts is adapted for a sandwich beam-column that combines the effects of bending and compression. The two distinct bifurcations present in the pure compression case are replaced by a single pitchfork bifurcation point that combines local and global buckling behaviour. Several models with a various number of degrees of freedom (DOFs) are developed to account for the explicit effect of end moments. All models are formulated using total potential energy and variational principles, which are used to derive the governing equations that are solved using the numerical continuation package Auto97. Results are validated with a finite element model formulated in the commercial package Abaqus. Comparisons with the interactive buckling profiles and the mechanical response in the nonlinear range are very favourable and the models with more DOFs are determined to be superior.
Immediate results and follow-up are reported on 118 patients with a diagnosis of myocardial infarction who were included in studies on intracoronary thrombolysis at the Thoraxcenter. Pilot studies included 37 patients treated with streptokinase, nine with urokinase and six with nitroglycerine and nifedipine. First results of the present on-going randomized trial are described from 34 patients allocated to streptokinase therapy and 32 allocated to conventional therapy in the coronary care unit. Urokinase, nitroglycerine and nifedipine were not effective for recanalization. Streptokinase resulted in recanalization of 22 out of 29 occluded arteries in the pilot studies (71%), as well as 19 out of 23 occluded arteries in the randomized trial (83%). Five patients died during angiography and attempted recanalization. In the pilot studies, four patients died during follow-up. In none of these had recanalization been achieved. On the other hand, angina and reinfarction were observed more frequently in patients after successful recanalization. In the randomized trial no differences were observed in mortality, reinfarction rate, angina or results of predischarge stress testing between patients allocated to streptokinase treatment or controls. However, cardiac -failure during follow-up seemed to be more prominent in controls. These preliminary data indicate that the clinical course in patients after attempted thrombolysis is similar to the course of patients treated by conventional methods. Both should be monitored carefully for signs of cardiac failure and episodes of myocardial ischemia and appropriate measures, including surgery, should be considered if these appear. Further randomized trials are warranted to determine whether patients after thrombolytic therapy have a better survival and fewer complications than patients treated conventionally.
To observe and characterise vessel injury after stenting using optical coherence tomography (OCT), to propose a systematic OCT classification for periprocedural vessel trauma, to evaluate its frequency in stable versus unstable patients and to assess its clinical impact during the hospitalisation period.Stenting causes vessel injury.All consecutive patients in whom OCT was performed after stent implantation were included in the study. Qualitative and quantitative assessment of tissue prolapse, intra-stent dissection and edge dissection were performed.Seventy-three patients (80 vessels) were analysed. Tissue prolapse within the stented segment was visible in 78/80 vessels (97.5%). Median number of tissue prolapse sites was 8 (IQR 4-19), mean (SD) area 1.04 (0.9) mm(2). Intra-stent dissection flaps were visible in 69/80 vessels (86.3%) (median number 3 (IQR 1.25-6), maximum flap length 450 (220) microm). Fifty-five out of 80 vessels (68.8%) showed dissection cavities (median number 2 (IQR 0-4.75), maximum depth 340 (170) microm). Edge dissection was visible in 20 vessels (mean (SD) length flap 744 (439) microm). The frequency of tissue prolapse or intra-stent dissection was similar in stable and unstable patients (95.6% vs 100%, p = 0.5 for tissue prolapse; 91.1% vs 82.9%, p = 0.3 for intra-stent dissection). There were no events during the hospitalisation period.OCT allows a detailed visualisation of vessel injury after stent implantation and enables a systematic classification and quantification in vivo. In this study, frequency of tissue prolapse or intra-stent dissections after stenting was high, irrespective of the clinical presentation of the patients, and was not associated with clinical events during hospitalisation.
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Rationale: The treatment effect of golimumab, a human monoclonal antibody against tumor necrosis factor (TNF)-α, in severe persistent asthma is unknown.Objectives: To assess the safety and efficacy of golimumab in a large population of patients with uncontrolled, severe persistent asthma.Methods: From 2004 to 2006, 309 patients with severe and uncontrolled asthma, despite high-dose inhaled corticosteroids and long-acting β2 agonists, were randomized 1:1:1:1 to monthly subcutaneous injections of placebo or golimumab (50, 100, or 200 mg) through Week 52. Coprimary endpoints were the change from baseline through Week 24 in prebronchodilator percent-predicted FEV1 and the number of severe asthma exacerbations through Week 24.Measurements and Main Results: No significant differences were observed for the change in percent-predicted FEV1 (least squares mean: placebo, 2.44 [95% confidence interval (CI) −0.574 to 5.461]; combined 100-mg and 200-mg, 2.91 [0.696–5.116]) or severe exacerbations (mean ± SD: placebo, 0.5 ± 1.07 vs. combined 100-mg and 200-mg 0.5 ± 0.97) through week 24. Through Week 24, 2.6% of patients treated with placebo vs. 19.5% of those treated with golimumab discontinued the study agent, and 1.3% and 7.8% discontinued study participation, respectively. An unfavorable risk–benefit profile led to early discontinuation of study-agent administration after the Week-24 database lock. Through Week 76, 20.5% of patients treated with placebo and 30.3% of patients treated with golimumab experienced serious adverse events, with serious infections occurring more frequently in golimumab-treated patients. One death and all eight malignancies occurred in the active groups.Conclusions: Overall, treatment with golimumab did not demonstrate a favorable risk–benefit profile in this study population of patients with severe persistent asthma.Clinical trial registered with www.clinicaltrials.gov (NCT00207740).
To determine the safety and effectiveness of CYPHER(R) sirolimus-eluting stent implantation in patients with multivessel disease; and to compare outcomes against the historical results of the two arms of the Arterial Revascularisation Therapies Study (ARTS I).ARTS II is a 45 center, 607 patient single arm trial; the1-year outcomes were compared to the historical controls of the ARTS I trial, using conventional and Bayesian statistical methods. Patients were stratified by clinical site to ensure that at least one-third had 3-vessel disease to achieve the number of treatable lesions per patient comparable to ARTS I. Multivessel stenting was performed with sirolimus-eluting stents according to local institutional practice with the goal of achieving complete revascularisation. The majority of patients (53.5%) had 3-vessel disease and diabetes was present in 26.2%. Mean stented length was 72.5mm, with 3.7 stents implanted per patient. The 1-year survival rate was 99.0%, the composite of death / stroke and MI-free survival was 96.9%, freedom from revascularisation was 91.5% and the composite endpoint of MACCE-free survival was 89.5% (the primary endpoint). Diabetic patients treated with sirolimus-eluting stents were more likely to undergo repeat revascularisation (RR 1.97, 95% CI 1.16 - 3.34) and experience a MACCE (RR 1.85, 95% CI 1.16 - 2.97) than non-diabetics at 1-year. In the unadjusted comparison with the historical control arms of ARTS-I-CABG and ARTS-I-PCI, the respective relative risks (RR) and associated 95% confidence intervals (CI) for the endpoints were: (1) freedom from repeat revascularisation RR 2.03 (1.23-3.34) and RR 0.44 (0.31-0.61) respectively; and (2) MACCE free survival RR 0.89 (0.65-1.23) and RR 0.39 (0.30-0.51) respectively.The low incidence of MACCE and repeat revascularisation in ARTS II suggests that contemporary PCI with sirolimus-eluting stents is safe and efficacious for the treatment of multivessel coronary artery disease. Compared to the historical population of ARTS I, surgery still afforded a lower need for repeat revascularisation although overall MACCE rates in ARTS II approached the surgical results and were significantly better than bare stenting in ARTS I.
The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] – [predicted CABG mortality]). The level of agreement was evaluated with Bland–Altman plots and Cohen’s Kappa. The mean age was 66.2 ± 9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1 ± 11.5 and 35.6 ± 11.4 (p = 0.751), respectively. The Bland–Altman analysis showed mean differences of − 0.26 and − 0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen’s κ coefficients of 0.672 and 0.551. There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.
