6,963 publications from this institution
Optical coherence tomography (OCT) is a novel invasive imaging technology that allows in vivo assessment of the coronary wall with high resolution (approximately 15 micron). OCT offers a number of specific diagnostic features to study culprit lesions in patients suffering from acute coronary syndrome (ACS). Clinical OCT studies in patients presenting with ACS were able to confirm post mortem histopathology findings and shed light on the dynamic nature of atherosclerotic plaque formation, modification and rupture. OCT confirmed in vivo that the incidence of target lesion and remote TCFA varies with the clinical syndrome of the patients, being most pronounced in patients with acute myocardial infarction as compared to patients with stable angina. In culprit lesions where rupture of a fibrous cap has been documented, the fibrous cap thickness was in the range of 50 micron and macrophage density was elevated. Encouraging small scale clinical studies evaluated treatment effects in this population. OCT was used to demonstrate statin effects on fibrous cap thickness or the effects of different stent designs. The markedly improved image quality and user-friendliness of the second generation, Fourier-domain OCT, will allow large scale clinical application and thus, will increase our understanding of the pathophysiology and the prevention of ACS.
Click to increase image sizeClick to decrease image size Notes on contributorPeter Barnes: After graduating in psychology at the University of Nottingham, Peter Barnes continued there as a researcher in the Child Development Research Unit. In 1978, he joined the staff of The Open University in Milton Keynes, where he contributed to distance education courses in psychology and childhood studies. For several years before retiring in 2007, he was Director of the Centre for Childhood, Development and Learning.
THE LAST Goon Show radio script Spike Milligan wrote, No. 227, dealt with murder, betrayal, starvation, and cannibalism, with a passing reference to the Holocaust.
Objectives This study sought to evaluate the impact of SYNTAX score (SXscore), and compare its performance in isolation and combination with the PAMI (The Primary Angioplasty in Myocardial Infarction Study) score, for the prediction of 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background Patients with STEMI were excluded from the original SYNTAX score (SXscore) algorithm. Therefore, the utility of using the SXscore in this patient group remains undefined. Methods SXscore was calculated retrospectively in 807 patients with STEMI enrolled in the randomized STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) clinical trials. Clinical outcomes of all-cause death, reinfarction, and clinically driven target vessel revascularization were subsequently stratified according to SXscore tertiles: SXLOW ≤9 (n = 311), 9 < SXMID ≤16 (n = 234), SXHIGH >16 (n = 262). Results At 1-year follow-up, all clinical outcomes including mortality, mortality/reinfarction, major adverse cardiac events (MACE) (a composite of all-cause death, reinfarction and target vessel revascularization), and definite, definite/probable, and any stent thrombosis were all significantly higher in patients in the highest SXscore tertile. SXscore was identified as an independent predictor of mortality, MACE, and stent thrombosis out to 1-year follow-up. The combination SYNTAX-PAMI score led to a net reclassification improvement of 15.7% and 4.6% for mortality and MACE, respectively. The C-statistics for the SXscore, PAMI score, and the combined SYNTAX-PAMI score were 0.65, 0.81, and 0.73 for 1-year mortality, and 0.68, 0.64, and 0.69 for 1-year MACE, respectively. Conclusions SXscore does have a role in the risk stratification of patients with STEMI having primary percutaneous coronary intervention; however, this ability can be improved through a combination with clinical variables. (Multicentre 2×2 Factorial Randomised Study Comparing Tirofiban Versus Abciximab and SES Versus BMS in AMI; NCT00229515)
Asthma is one of the commonest chronic disease world-wide and anti-asthma medications are widely prescribed. Asthma is a complex chronic inflammatory disease, involving many cells, mediators and inflammatory responses. Current anti-asthma therapy is categorized as bronchodilator (β2-agonists, theophylline, anticholinergics) or anti-inflammatory (glucocorticosteroids, cromones, immunomodulators), although the distinction is not always clear-cut. Bronchodilators are believed to act predominately by relaxing airway smooth muscle, whereas anti-inflammatory drugs suppress the inflammatory response in asthmatic airways.
In the rat, plasma leakage in various vascular beds, including the whole lung, occurs after administration of lipopolysaccharide (LPS). LPS-induced microvascular plasma leakage in many organs is associated with an enhanced formation of nitric oxide (NO) after the induction of nitric oxide synthase (iNOS). However, there is limited information concerning the relationship between NO and plasma leakage into the airways. LPS (10 mg/kg, intravenously) caused a significant leakage of Evans blue dye, a marker of microvascular permeability, at 240 min in the trachea which was inhibited by the NOS inhibitor, NG-nitro-L-arginine methyl ester (L-NAME; 10 mg/kg, intravenously), or dexamethasone (1 mg/kg, intravenously). This effect was paralleled by an increase in calcium-independent iNOS activity, assessed by measuring the conversion of radiolabeled L-arginine to L-citrulline, in LPS-treated animals. In contrast, L-NAME significantly increased plasma leakage in the trachea of vehicle-treated rats and this effect was inhibited by indomethacin. These results suggest that under "physiological" conditions endogenous NO suppresses plasma leakage but when iNOS is expressed the increased production of NO enhances plasma leakage. These findings may implicate a role for NO in the maintenance of airway function and in the inflammatory process occurring in diseases such as asthma, where iNOS is known to be expressed.
Interventional cardiology is a dynamic speciality with on-going innovations to improve the devices and active research to enable practicing evidence-based medicine.This article summarises the main highlights of interventional cardiology research in the year 2014, particularly focusing on myocardial revascularisation for stable angina and acute coronary syndromes, adjunctive pharmacotherapy for patients undergoing percutaneous coronary intervention, and clinical trials of coronary stents and bioresorbable scaffolds.
