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Patients with high bleeding risk (HBR) are often treated with abbreviated dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) to reduce bleeding risk, however this strategy is associated with an increase in ischemic events, especially if the acute PCI result is suboptimal. We compared clinical outcomes among patients with HBR treated with 1-month DAPT who underwent intravascular ultrasound (IVUS)- or optical coherence tomography (OCT)-guided PCI versus those who underwent angiography-guided PCI without intravascular imaging. The Onyx ONE Clear study includes patients with HBR from the Onyx ONE US/Japan and Onyx ONE randomized studies who were treated with the Resolute Onyx zotarolimus-eluting stent. The primary endpoint was the composite of cardiac death (CD) or myocardial infarction (MI) between 1 month and 2 years after PCI. Propensity-score adjustments and matching were performed for differences in baseline and procedural characteristics between groups. Among the 1507 patients in Onyx ONE Clear, 271 (18.0 %) had IVUS or OCT used during PCI (Imaging-guided group) and 1236 (82.0 %) underwent Angiography-guided PCI (Angio-guided group). Imaging-guided patients were less likely to present with atrial fibrillation, acute coronary syndrome, and left ventricle ejection fraction ≤35 %. Conversely, Imaging-guided patients were more likely to have complex (ACC/AHA type B2/C), longer, and heavily calcified lesions. Between 1 month and 2 years, the composite rate of CD or MI was similar between Imaging-guided and Angio-guided patients (9.9 % vs. 12.4 %, P = 0.33). There was also no difference between groups after adjustment; (P = 0.56). However, CD was significantly lower among Imaging-guided patients (2.7 % vs. 6.1 %, P = 0.048). There were no between-group differences in MI or stent thrombosis. Propensity score matching results were similar. Despite higher lesion complexity, using intravascular imaging guidance for PCI between 1-month and 2-years follow-up had comparable outcomes with angiographic guidance alone in patients with HBR treated with 1-month DAPT. (ClinicalTrials.gov : Identifier: NCT03647475 and NCT03344653). BARC: Bleeding Academic Research Consortium; DAPT: dual antiplatelet therapy; DES: drug-eluting stent; HBR: high bleeding risk; IVUS: intravascular ultrasound; OCT: optical coherence tomography; SAPT: single antiplatelet therapy. • Balancing ischemic and bleeding risks after PCI remains challenging in HBR patients. • Imaging-guided HBR patients had more complex legions. • Outcomes were similar using imaging vs. angio-guided PCI. [ABSTRACT FROM AUTHOR]

This document is a special issue of the Journal of Clinical Medicine titled "Coronary Artery Disease Interventions." It aims to provide recent advances in the interventional and pharmacological strategies for patients with severe ischemic heart disease. The issue covers topics such as arterial access techniques, novel stents, optimal stenting techniques for bifurcation lesions, the impact of coronary calcification on outcomes, and the effect of complex percutaneous coronary interventions on ischemic and bleeding events. It also includes discussions on the use of extracorporeal membrane oxygenation in patients with cardiogenic shock and the long-term outcomes of ECMO survivors. The issue concludes with reviews on coronary microcirculation and coronary no-reflow after PCI. The authors express their gratitude to the reviewers, authors, and journal staff for their contributions. [Extracted from the article]

This article examines social debates on mass reading in Britain, linking them to the free public libraries movement of the mid-19th century. It argues that free public libraries were defended on the grounds of a piecemeal, eclectic, but nonetheless identifiable vernacular theory of ideology that emerged over the course of a century. This theory treated literary texts as containers of ideas and values that could be transmitted to readers. It responded to the social tensions emerging from industrial capitalist society, but located conflict in the realm of ideas, rather than in material reality. It thus offered an idealist account of class conflict, positing both that dissent was rooted in the new phenomenon of mass reading, and that it could be resolved by encouraging workers to consume particular texts. Our aim is to show that, while such a theory of ideology was demonstrably reductive and flawed, it was part of what compelled the British State to pass the Public Libraries Act in 1850 and therefore merits exposition. [ABSTRACT FROM AUTHOR]

An influx of climate-driven, cross-border migration has begun in Southeast Asia, but these peoples are not considered refugees. They are at best economic migrants, and at worse stateless persons. They are displaced because of human-driven environmental decline, with limited protections due to the lack of an internationally accepted definition of their status: there is no agreed upon definition of what constitutes a person displaced by climate change. As such, there are no legal frameworks that accurately speak to the realities of this growing problem. Worse, there is limited understanding that the confluence of these omissions will lead to disastrous effects and a humanitarian toll unlike anything the world has seen. We propose a first step in addressing this challenge for Southeast Asian states--a legally binding definition. We submit that a "climate displacee" is one who is compelled to migrate due to the direct or related impact of changing climates. We propose a second step in addition to this definition--a Southeast Asian state regional climate migration framework that takes a human rights-based approach. This approach, based on existing international legal frameworks, is the only way to properly address the humanitarian challenges inherent to migration. We also propose a series of fundamental and operational principles as building blocks for such a regional framework. These principles consider human rights and address shortfalls with other frameworks. Southeast Asian states have an opportunity to develop the world's first cross-border climate migration framework, and we have drafted our recommendations to assist in that effort. [ABSTRACT FROM AUTHOR]

Materialist scholarship on postcolonial literature's relationship with global publishing industries has radically altered the ways in which we conceive of writers' and texts' postcolonial agency. Its interest in the foreclosures of the marketplace has made it difficult to identify texts and practices of reading alike as postcolonial, as textualist traditions have long done so. Yet, even if somewhat devalued by materialist postcolonialisms, reading remains valuable, particularly because it presents opportunities for self-reconstitution and political self-recognition. Indeed, it is precisely because reading is not material or textual, but hybrid, that it holds such ethical and political potential. This essay departs from materialist and textualist postcolonial scholars' tendency to prescribe strategies of reading, instead concerning itself with describing reading as it actually takes place. Drawing on Wolfgang Iser's reader-response theory, in conjunction with affect theory and theories of the ethics and politics of reading, the essay develops an innovative model of reading, which understands readers as comprising a reading self and a self-in-the-world. This model of reading reasserts postcolonial literatures' agencies at the site of consumption as well as democratizes reading by undermining prescriptions of reading and meaning. [ABSTRACT FROM AUTHOR]

This article proposes a literary canon founded on dialectical principles, using South Africa as our historical example. In order to do so, we first trace the development of dialectical thought, moving from Georg Wilhelm Friedrich Hegel to Karl Marx to Steve Biko; from Eurocentrism to class consciousness to Black Consciousness. Second, we plot the influence of Hegel and Marx as well as Sartre and Fanon on Biko's elaboration of dialectics for the Black Consciousness Movement. Third, and in response to Marxist critiques of Black Consciousness, we register the moment of class consciousness that underpins Biko's politics, especially his critique of institutions. Finally, and based on our exposition of Biko's reading of Hegel via Marx and Sartre, we suggest a 'polythetic' dialectic to rework the post-Apartheid literary canon and to accommodate intersectional complexity within it. The canon, in our model, does not emerge from a settled consensus, but instead re-coalesces on every occasion that it is submitted to contestation or is approached via conflicts in the social. A transitive or dialectical canon might variously retain or negate institutionally-privileged texts while still making them momentarily visible via the 'popular' traditions of struggle that contest institutional privilege. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to utilize unique qualitative data to determine the effects of sporadic international drug interdictions on drug trafficking, and to assess whether the responses of drug traffickers align with rational choice theory.Methods: Qualitative data obtained from 23 high-level United States Drug Enforcement Administration (DEA) informants, who are embedded in international drug trafficking groups, are examined to identify common responses to drug interdiction operations.Results: The findings indicate that sporadic counter-drug interdictions do not a have permanent deterrent effect on transnational drug smuggling operations. However, these types of law enforcement operations produce temporary alterations in drug trafficking, as traffickers adopted a variety of methods to thwart the efforts of law enforcement-often by relying on information acquired from corrupt local law enforcement. The results also indicate that while interdiction operations displaced trafficking activities (temporally, spatially, and methodological), there is little evidence that drug traffickers responded to such operations by moving into new areas (i.e., malign spatial displacement).Conclusion: Sporadic international drug interdiction programs do little to deter drug trafficking organizations (DTOs) from engaging in their illicit trade. Instead, DTOs adjust in a calculating manner to these operations to ensure that their illegal products reach consumer marketplaces, which is congruent with the rational choice theoretical perspective. [ABSTRACT FROM AUTHOR]

This paper discusses ergodic properties and circular statistical characteristics in neuronal spike trains. Ergodicity means that the average taken over a long time period and over smaller population should equal the average in less time and larger population. The objectives are to show simple examples of design and validation of a neuronal model, where the ergodicity assumption helps find correspondence between variables and parameters. The methods used are analytical and numerical computations, numerical models of phenomenological spiking neurons and neuronal circuits. Results obtained using these methods are the following. They are: a formula to calculate vector strength of neural spike timing dependent on the spike train parameters, description of parameters of spike train variability and model of output spiking density based on assumption of the computation realized by sound localization neural circuit. Theoretical results are illustrated by references to experimental data. Examples of neurons where spike trains have and do not have the ergodic property are then discussed. [ABSTRACT FROM AUTHOR]

Background: In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown.Objectives: This study sought to investigate the relationship between FFR values and vessel-related clinical outcome.Methods: We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR.Results: MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]).Conclusions: In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495). [ABSTRACT FROM AUTHOR]

Pressure wire-based fractional flow reserve is considered the standard of reference for evaluation of the ischemic potential of coronary stenoses and the expected benefit from revascularization. Accordingly, its application in daily practice or for research purposes has to be as standardized as possible to avoid technical or operator-related artifacts in pressure recordings. This document proposes a standardized way of acquiring, recording, interpreting, and archiving the pressure tracings for daily practice and for the purpose of clinical research involving a core laboratory. Proposed standardized steps enhance the uniformity of clinical practices and data interpretation. [ABSTRACT FROM AUTHOR]

While heart failure is one of the leading causes of mortality and morbidity, our tools to provide ultimate treatment solutions are still limited. Recent developments in new devices are designed to fill this therapeutic gap. The scope of this review is to focus on two particular targets, namely (1) left ventricular geometric restoration and (2) atrial depressurization. (1) Reduction of the wall stress by shrinking the ventricular cavity has been traditionally attempted surgically. Recently, the Parachute device (CardioKinetix Inc., Menlo Park, CA, USA) has been introduced to restore ventricular geometry and cardiac mechanics. The intervention aims to partition distal dysfunctional segments that are non-contributory to the ventricular mechanics and forward cardiac output. (2) Diastolic heart failure is characterized by abnormal relaxation and chamber stiffness. The main therapeutic goal achieved should be the reduction of afterload and diastolic pressure load. Recently, new catheter-based approaches were proposed to reduce left atrial pressure and ventricular decompression: the InterAtrial Shunt Device (IASDTM) (Corvia Medical Inc., Tewksbury, MA, USA) and the V-Wave Shunt (V-Wave Ltd, Or Akiva, Israel). Both are designed to create a controlled atrial septal defect in symptomatic patients with heart failure. While the assist devices are aimed at end-stage heart failure, emerging device-based percutaneous or minimal invasive techniques comprise a wide spectrum of innovative concepts that target ventricular remodeling, cardiac contractility or neuro-humoral modulation. The clinical adoption is in the early stages of the initial feasibility and safety studies, and clinical evidence needs to be gathered in appropriately designed clinical trials. [ABSTRACT FROM AUTHOR]

Localization of sound source azimuth within horizontal plane uses interaural time differences (ITDs) between sounds arriving through the left and right ear. In mammals, ITDs are processed primarily in the medial superior olive (MSO) neurons. These are the first binaural neurons in the auditory pathway. The MSO neurons are notable because they possess high time precision in the range of tens of microseconds. Several theories and experimental studies explain how neurons are able to achieve such precision. In most theories, neuronal coincidence detection processes the ITDs and encodes azimuth in ascending neurons of the auditory pathway using modalities that are more tractable than the ITD. These modalities have been described as firing rate codes, place codes (labeled line codes) and similarly. In this theoretical model it is described how the ITD is processed by coincidence detection and converted into spikes by summing the postsynaptic potentials. Particular postsynaptic conductance functions are used in order to obtain an analytical solution in a closed form. Specifically, postsynaptic response functions are derived from the exponential decay of postsynaptic conductances and the MSO neuron is modeled as a simplified version of the Spike Response Model (SRM 0 ) which uses linear summations of the membrane responses to synaptic inputs. For plausible ratios of time constants, an analytical solution used to describe properties of coincidence detection window is obtained. The parameter space is then explored in the vicinity of the analytical solution. The variation of parameters does not change the solution qualitatively. [ABSTRACT FROM AUTHOR]

Background: Although the satellite cell (SC) is a key regulator of muscle growth during development and muscle adaptation following exercise, the regulation of human muscle SC function remains largely unexplored. STAT3 signalling mediated via interleukin-6 (IL-6) has recently come to the forefront as a potential regulator of SC proliferation. The early response of the SC population in human muscle to muscle-lengthening contractions (MLC) as mediated by STAT3 has not been studied. Methodology/Principal Findings: Twelve male subjects (21±2 y; 83±12 kg) performed 300 maximal MLC of the quadriceps femoris at 180°-1 over a 55° range of motion with muscle samples (vastus lateralis) and blood samples (antecubital vein) taken prior to exercise (PRE), 1 hour (T1), 3 hours (T3) and 24 hours (T24) post-exercise. Cytoplasmic and nuclear fractions of muscle biopsies were purified and analyzed for total and phosphorylated STAT3 (p-STAT3) by western blot. p-STAT3 was detected in cytoplasmic fractions across the time course peaking at T24 (p<0.01 vs. PRE). Nuclear total and p-STAT3 were not detected at appreciable levels. However, immunohistochemical analysis revealed a progressive increase in the proportion of SCs expressing p-STAT3 with ,60% of all SCs positive for p-STAT3 at T24 (p<0.001 vs. PRE). Additionally, cMyc, a STAT3 downstream gene, was significantly up-regulated in SCs at T24 versus PRE (p<0.05). Whole muscle mRNA analysis revealed induction of the STAT3 target genes IL-6, SOCS3, cMyc (peaking at T3, p<0.05), IL-6Ra and GP130 (peaking at T24, p<0.05). In addition, Myf5 mRNA was up-regulated at T24 (p<0.05) with no appreciable change in MRF4 mRNA. Conclusions/Significant Findings: We demonstrate that IL-6 induction of STAT3 signaling occurred exclusively in the nuclei of SCs in response to MLC. An increase in the number of cMyc+ SCs indicated that human SCs were induced to proliferate under the control of STAT3 signaling. [ABSTRACT FROM AUTHOR]

In humans, muscle satellite cell (SC) enumeration is an important measurement used to determine the myogenic response to various stimuli. To date, the standard practice for enumeration is immunohistochemistry (IHC) using antibodies against common SC markers (Pax7, NCAM). Flow cytometry (FC) analysis may provide a more rapid and quantitative determination of changes in the SC pool with potential for additional analysis not easily achievable with standard IHC. In this study, FC analysis revealed that the number of Pax7+ cells per milligram isolated from ∼50 mg of fresh tissue increased 36% 24 h after exercise-induced muscle injury (300 unilateral maximal eccentric contractions). IHC analysis of Pax7 and neural cell adhesion molecule (NCAM) appeared to sufficiently and similarly represent the expansion of SCs after injury (28–36% increase). IHC and FC data illustrated that Pax7 was the most widely expressed SC marker in muscle cross-sections and represented the majority of positive cells, while NCAM was expressed to a lesser degree. Moreover, FC and IHC demonstrated a similar percentage change 24 h after injury (36% increase, Pax7; 28% increase, NCAM). FC analysis of isolated SCs revealed that the number of Pax7+ cells per milligram in G2/M phase of the cell cycle increased 202% 24 h after injury. Number of cells per milligram in G0/G1 and cells in S-phase increased 32% and 59% respectively. Here we illustrate the use of FC as a method for enumerating SC number on a per milligram tissue basis, providing a more easily understandable relation to muscle mass ( vs. percentage of myonuclei or per myofibre). Although IHC is a powerful tool for SC analysis, FC is a fast, reliable and effective method for SC quantification as well as a more informative method for cell cycle kinetics of the SC population in humans. [ABSTRACT FROM AUTHOR]

Abstract: A new method to measure the activity of lipid-metabolizing enzymes is described. Subsequent to an enzymatic reaction, a two-phase system (organic/aqueous) is established by the addition of a phase partition scintillation fluid (PPSF). The PPSF serves as a scintillation fluid, a phase partition agent, and a carrier/separator of an organic-soluble radiolabeled reaction substrate or product. Applying an empirically derived set of conditions typically enhances the separation of substrate from product whereby one species is effectively solubilized in the PPSF. In situ partitioning of the radionuclide-containing organic/lipid phase from the aqueous phase occurs within individual wells of 96-well or 384-well density PPSF-resistant microtiter plates without the requirement for multiple organic solvent extractions and aspirations, making this method applicable to high-throughput screening. The utility of this method for both kinetic characterization and high-throughput screening is demonstrated with acetyl-CoA carboxylase and fatty acid synthase. [Copyright &y& Elsevier]

This paper supports quick and accurate prediction of the flutter onset speed of an F-16 Block 40/50 configured with external stores in the transonic flight regime. Current flutter prediction methods are reviewed and hypothesized mechanisms for limit cycle oscillation (LCO) are summarized. New efforts to correlate transonic small disturbance (TSD) theory methods with flight tests are outlined. Vibration analysis and structural optimization of an F-16 finite element model were used to match ground vibration testing results. Frequency tuning was found to be critical for accurate flutter speed predictions. Sensitivity to nonlinear aerodynamic effects and store modeling was examined. [ABSTRACT FROM AUTHOR]

Background: As a preventive procedure, minimizing periprocedural risk is crucially important during left atrial appendage closure (LAAC). Methods: We included consecutive patients receiving LAAC at nine centres and assessed the relationship between baseline characteristics and the acute procedural outcome. Major procedural complications were defined as all complications requiring immediate invasive intervention or causing irreversible damage. Logistic regression was performed and included age and left-ventricular function. Furthermore, the association between acute complications and long-term outcomes was evaluated. Results: A total of 405 consecutive patients with a median age of 75 years (37% female) were included. 47% had a history of stroke. Median CHA2DS2-VASc score was 4 (interquartile range, 3–5) and the median HAS-BLED score was 3 (2–4). Major procedural complications occurred in 7% of cases. Low haemoglobin (OR 0.8, 95% CI 0.65–0.99 per g/dL, p = 0.040) and end-stage kidney disease (OR 13.0, CI 2.5–68.5, p = 0.002) remained significant in multivariate analysis. Anaemia (haemoglobin < 12 and < 13 g/dL in female and male patients) increased the risk of complications 2.2-fold. Conclusions: The major complication rate was low in this high-risk patient population undergoing LAAC. End-stage kidney disease and low baseline haemoglobin were independently associated with a higher major complication rate. [ABSTRACT FROM AUTHOR]

Long-term data on ustekinumab in real-life Crohn's disease patients are still missing, though randomized controlled trials demonstrated it as a favorable therapeutic option. We aimed to evaluate ustekinumab's clinical efficacy, drug sustainability, and safety in a prospective, nationwide, multicenter Crohn's disease patient cohort with a three-year follow-up. Crohn's disease patients on ustekinumab treatment were consecutively enrolled from 9 Hungarian Inflammatory Bowel Disease centers between January 2019 and May 2020. Patient and disease characteristics, treatment history, clinical disease activity (Harvey Bradshaw Index (HBI)), biomarkers, and endoscopic activity (Simple Endoscopic Score for Crohn's Disease (SES-CD)) were collected for three-years' time. A total of 148 patients were included with an overall 48.9% of complex behavior of the Crohn's disease and 97.2% of previous anti-TNF exposure. The pre-induction remission rates were 12.2% (HBI), and 5.1% (SES-CD). Clinical remission rates (HBI) were 52.2%, 55.6%, and 50.9%, whereas criteria of an endoscopic remission were fulfilled in 14.3%, 27.5%, and 35.3% of the subjects at the end of the first, second, and third year, respectively. Dose intensification was high with 84.0% of the patients on an 8-weekly and 29.9% on a 4-weekly regimen at the end of year 3. Drug sustainability was 76.9% during the follow-up period with no serious adverse events observed. Ustekinumab in the long-term is an effective, sustainable, and safe therapeutic option for Crohn's disease patients with severe disease phenotype and high previous anti-TNF biological failure, requiring frequent dose intensifications. [ABSTRACT FROM AUTHOR]

(1) Background: Mechanical circulatory support (MCS) in myocardial infarction-associated cardiogenic shock is subject to debate. This analysis aims to elucidate the impact of MCS's timing on patient outcomes, based on data from the PREPARE CS registry. (2) Methods: The PREPARE CS prospective registry includes patients who experienced cardiogenic shock (SCAI classes C–E) and were subsequently referred for cardiac catheterization. Our present analysis included a subset of this registry, in whom MCS was used and who underwent coronary intervention due to myocardial infarction. Patients were categorized into an Upfront group and a Procedural group, depending on the timing of MCS's introduction in relation to their PCI. The endpoint was in-hospital mortality. (3) Results: In total, 71 patients were included. MCS was begun prior to PCI in 33 (46%) patients (Upfront), whereas 38 (54%) received MCS during or after the initiation of PCI (Procedural). The groups' baseline characteristics and hemodynamic parameters were comparable. The Upfront group had a higher utilization of the Impella® device compared to extracorporeal membrane oxygenation (67% vs. 33%), while the Procedural group exhibited a balanced use of both (50% vs. 50%). Most patients suffered from multi-vessel disease in both groups (82% vs. 84%, respectively; p = 0.99), and most patients required a complex PCI procedure; the latter was more prevalent in the Upfront group (94% vs. 71%, respectively; p = 0.02). Their rates of complete revascularization were comparable (52% vs. 34%, respectively; p = 0.16). Procedural CPR was significantly more frequent in the Procedural group (45% vs. 79%, p < 0.05); however, in-hospital mortality was similar (61% vs. 79%, respectively; p = 0.12). (4) Conclusions: The upfront implantation of MCS in myocardial infarction-associated CS did not provide an in-hospital survival benefit. [ABSTRACT FROM AUTHOR]

Background: Cardiogenic shock (CS) exhibits high (~50%) in-hospital mortality. The recently published Extracorporeal life Support in Cardiogenic Shock (ECLS-SHOCK) trial demonstrated the neutral effects of the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) on all-cause death, as well as on all secondary outcomes in subjects presenting with myocardial-infarction (MI)-related CS. Here, we compared ECLS-SHOCK eligibility criteria with a real-world cohort of CS patients. Methods and Results: ECLS-SHOCK eligibility criteria were applied to a prospective single-center CS registry (the PREPARE CS registry) consisting of 557 patients who were consecutively admitted to the catheterization laboratory (cath lab) of the Medical University of Graz, Austria, due to CS (SCAI C-E). Overall use of mechanical circulatory support (MCS) in this cohort was 19%. Sixty-nine percent of the entire cohort had MI-related CS, 38% of whom would have met ECLS-SHOCK eligibility criteria, thus representing only 27% of the PREPARE CS registry. Exclusion from the ECLS-SHOCK trial was based on patients with initial lactate values below 3 mmol/L (n = 168; 43.6%), aged over 80 years (n = 65; 16.9%), and with a duration of cardiopulmonary resuscitation (CPR) exceeding 45 min (n = 22; 5.7%). The 30-day mortality of patients of the PREPARE CS registry who met the ECLS-SHOCK eligibility criteria was 57.0%, compared to 48.4% of patients in the ECLS-SHOCK trial. The patients' baseline characteristics, however, differed considerably with respect to type of infarction, age, and gender. Conclusions: In a real-world cohort of patients with MI-related CS, only 38% of patients met the eligibility criteria of the ECLS-SHOCK trial. Thus, the impact of the use of VA-ECMO on outcome parameters in MI-related CS, as observed in the ECLS-SHOCK trial, may differ in a more heterogeneous real-world CS population of the PREPARE CS registry. [ABSTRACT FROM AUTHOR]

BACKGROUND: Limited information is available on the comparative efficacy and safety of different stent platforms in patients at high bleeding risk undergoing an abbreviated dual antiplatelet therapy duration after percutaneous coronary intervention (PCI). The aim of this study was to compare the safety and effectiveness of the biodegradable-polymer sirolimus-eluting stent with the durable-polymer zotarolimus-eluting stent in patients at high bleeding risk receiving 1 month of dual antiplatelet therapy after PCI. METHODS: The Bioflow-DAPT Study is an international, randomized, open-label trial conducted at 52 interventional cardiology hospitals in 18 countries from February 24, 2020, through September 20, 2021. Patients with a clinical indication to PCI because of acute or chronic coronary syndrome who fulfilled 1 or more criteria for high bleeding risk were eligible for enrollment. Patients were randomized to receive either biodegradable-polymer sirolimus-eluting stents or durable-polymer, slow-release zotarolimus-eluting stents after successful lesion preparation, followed by 1 month of dual antiplatelet therapy and thereafter single antiplatelet therapy. The primary outcome was the composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year, and was powered for noninferiority, with an absolute margin of 4.1% at 1-sided 5% alpha. RESULTS: A total of 1948 patients at high bleeding risk were randomly assigned (1:1) to receive biodegradable-polymer sirolimus-eluting stents (969 patients) or durable-polymer zotarolimus-eluting stents (979 patients). At 1 year, the primary outcome was observed in 33 of 969 patients (3.6%) in the biodegradable-polymer sirolimus-eluting stent group and in 32 of 979 patients (3.4%) in the durable-polymer zotarolimus-eluting stent group (risk difference, 0.2 percentage points; upper boundary of the 1-sided 95% CI, 1.8; upper boundary of the 1-sided 97.5% CI, 2.1; P<0.0001 for noninferiority for both tests). CONCLUSIONS: Among patients at high risk for bleeding who received 1 month of dual antiplatelet therapy after PCI, the use of biodegradable-polymer sirolimus-eluting stents was noninferior to the use of durable-polymer zotarolimus-eluting stents with regard to the composite of death from cardiac causes, myocardial infarction, or stent thrombosis. [ABSTRACT FROM AUTHOR]

Background: Percutaneous closure of patent foramen ovale (PFO) is conventionally performed under continuous transesophageal echocardiographic (TEE) guidance. We aimed to evaluate whether a simplified procedural approach, including pure fluoroscopy‐guidance and final TEE control, as well as an aimed 'next‐day‐discharge' is comparable with the conventional TEE‐guided procedure in terms of periprocedural and intermediate‐term outcomes. Methods: All patients who underwent a PFO closure at our center between 2010 and 2022 were retrospectively included. Prior to June 2019 cases were performed with continuous TEE guidance (TEE‐guided group). Since June 2019, only pure fluoroscopy‐guided PFO closures have been performed with TEE insertion and control just prior to device release (fluoroscopy‐guided group). We analyzed procedural aspects, as well as long term clinical and echocardiographic outcomes. Results: In total 291 patients were included in the analysis: 197 in the TEE‐guided group and 94 in the fluoroscopy‐guided group. Fluoroscopy‐guided procedures were markedly shorter (48 ± 20 min vs. 25 ± 9 min; p <.01). There was no difference in procedural complications, including death, major bleeding, device dislodgement, stroke or clinically relevant peripheral embolization between the two groups (.5% vs. 0%; p =.99). Hospital stay was also shorter with the simplified approach (2.5 ± 1.6 vs. 3.5 ± 1.2 days; p <.01), allowing 85% same‐day discharges during the last 12 months of observation period. At 6 ± 3 months echocardiographic follow‐up a residual leakage was described in 8% of the TEE‐guided cases and 2% of the fluoroscopy‐guided cases (p =.08). Conclusion: While a complete TEE‐free PFO closure might have potential procedural risks, our approach of pure fluoroscopy‐guided with a brisk final TEE check seems to be advantageous in terms of procedural aspects with no sign of any acute or intermediate‐term hazard and it could offer an equitable compromise between the two worlds: a complete TEE procedure and a procedure without any TEE. [ABSTRACT FROM AUTHOR]

BACKGROUND: Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractiona flow reserve (FFR) in predicting natural history. METHODS: The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%). RESULTS: The rate of VOCE was highest in the positive concordance group (log rank: Χ²=80.96; P=0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; P=0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; P=0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; P=0.067). CONCLUSIONS: In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS). CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "A Skeptical Review of Religious Prosociality Research" in the June/July 2013 issue is presented.

MicroRNAs are small non-coding RNAs, involved in the post-transcriptional regulation of gene expression, intensely studied for their usefulness as biomarkers. Their high stability in various biological fluids is one of the main rationale behind the attempts to introduce them in clinical practice in general and, given the increased requirement of early, non-invasive diagnostics of pregnancy associated pathologies, in obstetrics in particular. Among these pathologies, pre-eclampsia was one of the most studied, for its major impact on fetal and maternal morbidity. In the present article, we review the data on circulating placenta-specific microRNAs, as well as their involvement in the pathogenesis of pre-eclampsia, with the aim of evaluating their possible role as non-invasive biomarkers. [ABSTRACT FROM AUTHOR]

Fractional flow reserve (FFR) has never been investigated in patients with aortic stenosis (AS). From 2002 to 2010, we identified 106 patients with AS and coronary artery disease with at least one intermediate lesion treated according to FFR guidance. We matched 212 contemporary control patients with AS in which revascularization was decided on angiography only. More patients in the FFR-guided group underwent percutaneous coronary intervention (24% vs 13%; p = 0.019), whereas there was a trend toward less coronary artery bypass grafting (CABG) performed. After FFR, the number of diseased vessels was downgraded within the FFR-guided group (from 1.85 ± 0.97 to 1.48 ± 1; p <0.01) and compared with the angio-guided group (1.48 ± 1 vs 1.8 ± 0.97; p <0.01). Less aortic valve replacement was reported in the FFR-guided group (46% vs 57%; p = 0.056). In patients who underwent CABG, less venous conduits (0.5 ± 0.69 vs 0.73 ± 0.76; p = 0.05) and anastomoses (0.61 ± 0.85 vs 0.94 ± 1; p = 0.032) were necessary in the FFR-guided group. Up to 5 years, we found no difference in major adverse cardiac events (38% vs 39%; p = 0.98), overall death (32% vs 31%; p = 0.68), nonfatal myocardial infarction (2% vs 2%; p = 0.79), and revascularization (8% vs 7%; p = 0.76) between the 2 groups. In conclusion, FFR guidance impacts the management of selected patients with moderate or severe AS and coronary artery disease by resulting into deferral of aortic valve replacement, more patients treated with percutaneous coronary intervention, and in patients treated with CABG, into less venous grafts and anastomoses without increasing adverse event rates up to 5 years. [ABSTRACT FROM AUTHOR]

Background. Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods. This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results. A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p = 0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p = 0.02). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion. RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected. [ABSTRACT FROM AUTHOR]

GeoGOBLIN, a novel environmental impact and land balance assessment tool, builds upon the GOBLIN biophysical land use emissions model for Ireland, offering enhanced resolution and system-level detail. It combines remotely sensed data and national agricultural census data to model climate change, air quality, and eutrophication emissions at the catchment level. Integration of the CBM-CFS3 forest carbon modelling framework (utilised in Ireland's National Inventory Report) increases alignment with national emissions reporting. GeoGOBLIN disaggregates emissions by life cycle assessment impact categories, making it a valuable tool for policymakers and researchers evaluating environmental and economic trade-offs associated with land-use scenarios. Illustrative scenarios demonstrate GeoGOBLIN's ability to assess the multifaceted impacts of alternative land uses, supporting informed decision-making for sustainable land use, food production, and a circular bioeconomy. • Land balance model for the assessment of environmental impacts from land use/cover change at the catchment level. • Spatially specific land cover and environmental impact assessment. • Assessment of multiple life cycle impact categories at the catchment level. • Rules based assessment for scenario result prioritization. [ABSTRACT FROM AUTHOR]

Gambling on sporting events is an illegal activity in Iran, and this phenomenon is widespread. Taking its point of departure from Control and Rational Choice Theories, this study examines the effects of self-control, social bonding, and rational choice on both gambling behavior and pro-gambling orientations. From a sample of 417 gamblers from the city of Rasht (the capital city of the Guilan province, one of Iran's largest cities) and using structural modeling analysis, we investigated how various theoretically derived parameters predict gambling behavior and gambling orientations. The results showed significant, negative associations between our latent variables (self-control, social bonding, and rational choice) and respondents' self-reported gambling behavior and pro-gambling orientations. Moreover, self-control, social bonding, and rational choice combined to account for 54% of the variance of self-reported gambling and 49% of the variance in respondents' pro-gambling orientations. Measures of the total standardized effects showed that self-control was more strongly associated with both gambling behavior and a pro-gambling orientation than either social bonding or rational choice. [ABSTRACT FROM AUTHOR]

A 62-year-old female patient is described who developed toxic epidermal necrolysis (TEN) after medication with phenytoin and oxazepam. Initially phenytoin was discontinued and dexamethasone pulse therapy (1.5 mg/kg on 3 consecutive days) was initiated on the tenth day of skin disease. This resulted in clinical improvement. Histologically re-epithelialization could be demonstrated below the necrotic epidermis. However, on the eighteenth day of skin disease (10 days after discontinuation of phenytoin and 8 days after the start of dexamethasone pulse therapy), a histologically verified rebound-TEN developed with a detachment of 95%. Oxazepam was stopped and a second series of dexamethasone pulse therapy was given. Re-epithelialization began within 24 h of the start of the second series of dexamethasone pulse therapy, and continued to almost complete recovery within 1 week. [ABSTRACT FROM AUTHOR]

Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) reflects residual atherosclerotic burden and is associated with future events. How much post-PCI FFR can be predicted based on baseline basic information and the clinical relevance have not been investigated. We compiled a multicenter registry of patients undergoing pre- and post-PCI FFR. Machine-learning (ML) algorithms were designed to predict post-PCI FFR levels from baseline demographics, quantitative coronary angiography, and pre-PCI FFR. FFR deviation was defined as actual minus ML-predicted post-PCI FFR levels, and its association with incident target vessel failure (TVF) was evaluated. Median (IQR) pre- and post-PCI FFR values were 0.71 (0.61, 0.77) and 0.88 (0.84, 0.93), respectively. The Spearman correlation coefficient of the actual and predicted post-PCI FFR was 0.54 (95% CI: 0.52, 0.57). FFR deviation was non-linearly associated with incident TVF (HR [95% CI] with Q3 as reference: 1.65 [1.14, 2.39] in Q1, 1.42 [0.98, 2.08] in Q2, 0.81 [0.53, 1.26] in Q4, and 1.04 [0.69, 1.56] in Q5). A model with polynomial function of continuous FFR deviation indicated increasing TVF risk for FFR deviation ≤0 but plateau risk with FFR deviation >0. An ML-based algorithm using baseline data moderately predicted post-PCI FFR. The deviation of post-PCI FFR from the predicted value was associated with higher vessel-oriented event. [Display omitted] • A machine-learning algorithm moderately predicted post-PCI FFR. • Discrepancy of actual and predicted post-PCI FFR was associated with TVF. • No additional benefit would be expected by achieving higher than the predicted FFR. [ABSTRACT FROM AUTHOR]

Discusses the fabrication and electrical performance of an all refractory niobium-nitrogen medium scale integrated circuit process. Fabrication of Josephson junctions; Plasma etching of in situ radio frequency sputter deposited trilayers of niobium-nitrogen/magnesium-oxygen/niobium-nitrogen; Use of a deposited silicon dioxide film for wiring and resistor insulation.

Background: Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractional flow reserve (FFR) in predicting natural history.Methods: The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%).Results: The rate of VOCE was highest in the positive concordance group (log rank: X2=80.96; P=0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; P=0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; P=0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; P=0.067).Conclusions: In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS).Clinical Trial Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495. [ABSTRACT FROM AUTHOR]