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Objectives We aimed to compare modeling approaches to estimate the individual survival benefit of treatment with either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) for patients with complex coronary artery disease. Study Design and Setting We estimated survival with Cox regression models that included the treatment variable (CABG/PCI) interacting with either an internally developed overall prognostic index (PI) or with individual prognostic factors. We analyzed data of patients who were randomized in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery trial (1,800 patients, 178 deaths). Results A negligible interaction with the PI (P = 0.51) led to 4-year survival estimates in favor of CABG for all patients. In contrast, individual interactions indicated substantial relative treatment effect heterogeneity (overall interaction P = 0.004), and estimates of 4-year survival were numerically in favor of CABG for 1,275 of 1,800 patients (71%; 519 with 95% confidence). To test the more complex model with individual interactions, we first used penalized regression, resulting in smaller but largely consistent individual estimates of the survival difference between CABG and PCI. Second, strong treatment interactions were confirmed at external validation in 2,891 patients from a multinational registry. Conclusion Modeling strategies that omit interactions may result in misleading estimates of absolute treatment benefit for individual patients with the potential hazard of suboptimal decision making.

Background In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel or left main coronary artery disease (CAD) had improved long-term outcomes with coronary artery bypass graft (CABG) surgery compared with percutaneous coronary intervention (PCI) with drug-eluting stents (DES), improvements driven mainly by differences in myocardial infarction and repeat revascularization. Objectives This study compared the long-term quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel or left main CAD. Methods Between 2005 and 2007, the SYNTAX trial randomized 1,800 patients with 3-vessel or left main CAD to either CABG or DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and 60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item Short Form Health Survey. Results At 5-year follow-up, CABG was superior to DES-PCI on several SAQ domains including angina frequency and physical function, as well as the role physical and role emotional scales of the 36-Item Short Form Health Survey. Subgroup analysis demonstrated a significant interaction between angiographic complexity (as assessed by the SYNTAX score) and angina relief (mean difference in the SAQ angina frequency score for CABG vs. PCI of −0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p = 0.048 for interaction). Conclusions Among patients with 3-vessel or left main CAD, both CABG and DES-PCI were associated with substantial and sustained quality-of-life benefits over 5 years of follow-up. In general, CABG resulted in greater angina relief, although the absolute treatment benefit was small. Angina relief at 5 years was enhanced with CABG among patients with high SYNTAX scores, a finding reinforcing the recommendation that CABG should be strongly preferred for such patients. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972)

Abstract This paper presents an experimental investigation into the structural response of wire arc additively manufactured (WAAM) steel T‐stub connections subjected to tension. A total of fifty‐two T‐stub specimens of different printing strategies and geometric configurations were tested to failure. 3D laser scanning was employed to determine the specimen geometry, while digital image correlation was used to monitor the strain and displacement fields during testing. The structural response exhibited by the tested specimens was more complex than that reported in the literature for conventionally fabricated T‐stubs. Therefore, a new approach for the determination of the plastic resistance and failure modes of WAAM T‐stub connections was developed. Finally, the obtained results were used to evaluate the applicability of current design equations to WAAM T‐stub connections.

This article discusses how the COVID-19 pandemic has disrupted cardiovascular clinical trials and outlines recommendations for adapting trial procedures to maintain scientific validity amid new safety priorities.

We report the acute and 30 day results from the Tryton I first-in-man (FIM) study, a multicentre prospective single arm study evaluating the safety and feasibility of the Tryton Side-Branch StentTM when used in conjunction with standard drug eluting stent to treat de novo bifurcation lesions within the coronary vasculature.Clinically, stable patients with de novo coronary bifurcation lesions with side branch diameters 2.25-2.75 mm were treated. Clinical follow-up at 30 days, 9 months and one year is mandated in all patients. Angiographic and IVUS evaluation is performed at the completion of the case and at 6 months. A total of 30 patients (66.0+/-11.2 years old, 63% male) were treated. Approximately 76% of the treated lesions involved a left anterior descending-diagonal (LAD-Diag), with the remainder of lesions in the left circumflex-obtuse marginal (21%) and right coronary-posterior descending (4%) coronary arteries. Baseline angiographic disease in both main vessel (MV) and side branch (SB) was noted in 50% of patients. In 47% of patients, angiographic disease was limited to the MV, and in one patient (3%) to the SB ostium. Two major major adverse cardiac events (MACE) were noted (94% success Rate). All patients were treated via 6 Fr guides. Angiographic success including final kissing balloon inflation was achieved in all patients in whom the Tryton StentTM could be tracked to the lesion site (97% angiographic success). No additional MACE events were noted between hospital discharge and day 30.A dedicated two stent strategy utilising the Tryton Side-Branch StentTM to treat bifurcation lesions is feasible showing good acute and 30 day results.

We determined in rat lung whether ozone exposure was associated with the expression of the chemokine, cytokine‐induced neutrophil chemoattractant (CINC), and of the transcription factor, NF‐κB. CINC mRNA expression peaked at 2 h after cessation of ozone exposure, and returned to basal levels by 24 h. DNA‐binding activity of NF‐κB showed a marked increase after ozone, maximal at 2 h. Dexamethasone inhibited CINC mRNA and NF‐κB expression, together with neutrophilic inflammation. Our data supports the concept that ozone leads to NF‐κB activation which increases CINC mRNA expression. These series of events could lead to neutrophilic inflammation.

Over the past century, coronary artery disease (CAD) has remained a leading cause of death worldwide, managed with enormous progress by medicine, from the development of advanced drugs to highly sophisticated revascularization modalities. Among them, as confirmed by recent studies, bioresorbable scaffolds (BRSs) have shown to have the potential to overtake conventional stents. This review presents their material composition and properties, those currently used in clinical evaluation, and their current limitations and potential improvements.

Conference Abstract| December 01 1989 Dilator Action of Ligustrazine on Human and Rat Pulmonary Arteries SF Liu; SF Liu 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar LY Rui; LY Rui 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar YN Cai; YN Cai 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar PJ Barnes; PJ Barnes 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar TW Evans; TW Evans 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar GR Barer GR Barer 1Department of Experimental Medicine, University of Sheffield; Department of Thoracic Medicine, National Heart and Lung Institute, London and Institute of Basic Medical Science, CAMS, Beijing, China Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1989) 77 (s21): 27P. https://doi.org/10.1042/cs077027Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation SF Liu, LY Rui, YN Cai, PJ Barnes, TW Evans, GR Barer; Dilator Action of Ligustrazine on Human and Rat Pulmonary Arteries. Clin Sci (Lond) 1 December 1989; 77 (s21): 27P. doi: https://doi.org/10.1042/cs077027Pb 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. © 1989 The Biochemical Society and the Medical Research Society1989 Article PDF first page preview Close Modal You do not currently have access to this content.

<h3>Background:</h3> Chronic obstructive pulmonary disease (COPD) is characterised by an abnormal inflammatory response mainly to cigarette smoke that flares up during exacerbations of the disease (ECOPD). Reduced activity of histone deacetylases (HDAC) contributes to enhanced inflammation in stable COPD. It was hypothesised that HDAC activity is further reduced during ECOPD and that theophylline, an HDAC activator, potentiates the anti-inflammatory effect of steroids in these patients. A study was performed to investigate HDAC activity during ECOPD and the effects of theophylline on the anti-inflammatory effects of steroids in a randomised single-blind controlled study. <h3>Methods:</h3> 35 patients hospitalised with ECOPD and treated according to international guidelines (including systemic steroids) were randomised to receive or not to receive low-dose oral theophylline (100 mg twice daily). Before treatment and 3 months after discharge, HDAC and nuclear factor-κB (NF-κB) activity in sputum macrophages, the concentration of nitric oxide in exhaled air (eNO) and total antioxidant status (TAS), tumour necrosis factor α (TNFα), interleukin (IL)-6 and IL8 levels in sputum supernatants were measured. <h3>Results:</h3> Patients receiving standard therapy showed decreased NF-κB activity, eNO concentration and sputum levels of TNFα, IL6 and IL8, as well as increased TAS during recovery of ECOPD, but HDAC activity did not change. The addition of low-dose theophylline increased HDAC activity and further reduced IL8 and TNFα concentrations. <h3>Conclusions:</h3> During ECOPD, low-dose theophylline increases HDAC activity and improves the anti-inflammatory effects of steroids. <h3>Trial registration number:</h3> NCT00671151

Mitral regurgitation (MR) poses a significant clinical burden in the adult population, which is expected to increase even more with the ever prolonging life expectancies in developed countries. New technology has brought MR, once exclusively the arena of cardiac surgeons, to the attention of interventional cardiologists. A variety of device-oriented transcatheter strategies have evolved in recent years. A comprehensive understanding of mitral valvular anatomy is crucial for the selection of patients, the implementation of devices, and further refinements of these transcatheter techniques if they are eventually to produce procedural and clinical success. The aim of this review is to elucidate the morphology of the mitral valvular complex, integrating key anatomical features into the developing transcatheter options for the treatment of MR.

<b>Background:</b> COPD is associated with accelerated lung aging and cellular senescence, caused by increased levels of oxidative stress, mainly due to inhalation of cigarette smoke. HuR, a RNA-binding protein, has been shown to modulate the expression of sirtuin-1 and cellular senescence markers p16 and p21. However, the role of HuR in regulating the senescence-associated secretory phenotype (SASP) is unclear. <b>Aim:</b> To investigate the effects of HuR knockdown in the presence and absence of oxidative stress (H₂O₂) on senescence-associated secretory phenotype (SASP) in airway epithelial cells. <b>Methods:</b> Bronchial epithelial cells (BEAS2B) and primary small airway epithelial cells (SAEC, non-smokers) were transfected with siRNA against HuR +/- 100μM H₂O₂ mRNA levels were determined using qPCR. Matrix metalloprotease (MMP) activity in SAEC was assessed by zymography. <b>Results:</b> Gene silencing of HuR in BEAS2B increased mRNA expression of p16 (2-fold, p&lt;0.01), p21 (2-fold), IL-6 (10-fold, p&lt;0.01), CXCL-8 (4-fold, p&lt;0.01), MMP-2 (22-fold, p&lt;0.001) and reduced sirtuin-1 expression by 30% (n=6). HuR knockdown in the presence of H₂O₂ further elevated the expression of p16 (3-fold), IL-6 (39-fold, p&lt;0.01), CXCL-8 (10-fold, p&lt;0.05) and reduced sirtuin-1 expression by 46% (n=6). Gene silencing of HuR increased MMP-2 and MMP-9 activity in the presence and absence of oxidative stress, in SAECs (n=4). <b>Conclusion:</b> Gene silencing of HuR in the presence and absence of oxidative stress results in increased expression of inflammatory mediators, MMPs and senescence markers, suggesting HuR may play a role in regulation of the SASP in COPD.