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OBJECTIVE Anger may cause adverse cardiovascular responses, but the effects of anger management on clinical cardiovascular outcomes is insufficiently understood. We sought to assess the influence of anger management through a cognitive behavioral intervention on endothelial function in patients with a recent myocardial infarction (MI). METHODS Patients with ST-elevation Myocardial Infarction (STEMI) and a low anger control score were enrolled during hospitalization in a randomized, parallel, controlled clinical trial. Intervention was anger management with cognitive behavioral techniques implemented by a psychologist in two individual monthly sessions. The primary endpoint was the between group difference in the variation of flow mediated dilation (FMD) in the brachial artery from baseline to the 3-month follow-up. The second endpoint comprised major cardiovascular events at 24-months follow up. RESULTS A total of 43 patients (age = 56 ± 9 years; 23.3% women) were randomized to the intervention group and 47 patients (age = 58 ± 10 years; 19.1% women) to the control group. Baseline clinical characteristics were not statistically different between groups. Both groups showed a significant improvement in anger control from baseline to endpoint, however the difference in inter-group variation was not statistically significant. The difference in FMD variation from baseline to the 3 months follow-up was significantly higher in the intervention group. The partial eta-square was 0.057 (p 0.024), indicating a medium effect size. There was no difference between groups regarding major cardiovascular events. CONCLUSIONS Anger management by cognitive behavioral techniques may improve endothelial function in post-MI patients with low anger control, but it remains unclear via which mechanism these effects occurred. Further studies with larger numbers of patients, assessments of changes in anger, improved comparability of pre-intervention FMD, and longer follow-up are warranted.Trial RegistrationClinicalTrials.gov identifier: NCT02868216.

OBJECTIVES: To assess clinical and coronary angiographic characteristics, previous medical history, and clinical course, by age group, in older adults after myocardial infarction who underwent primary percutaneous coronary intervention (pPCI). METHODS: Single-center, cohort study that enrolled all patients with ST-segment elevation myocardial infarction who underwent pPCI at a specialized cardiology reference center in the South of Brazil. Older adults were defined as age ≥60 years, as set out in Brazilian legislation. Patients in the following age groups were compared: 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, and ≥80 years. Patients’ clinical course was assessed at initial hospital admissions and after 2 years of clinical follow-up. Data were analyzed using SPSS 19, and significance was established at p RESULTS: From December 2015 to December 2018, a total of 636 patients were enrolled consecutively. Angiographic success rates were around 90% in all age groups. There were no differences in medications used, except for glycoprotein IIb/IIIa inhibitors, which were more frequently used in patients of lower age groups. Older patients had more in-hospital acute renal failure and higher in-hospital mortality. Predictors of mortality were age over 75, chronic renal failure, need for ventilatory support, severe arrhythmia, and sepsis. CONCLUSIONS: pPCI in older adult patients is a safe procedure with a high success rate.

Background Periodontitis has been associated with coronary artery disease, but the impact of a periodontal treatment on the endothelial function of patients with a recent ST-segment elevation myocardial infarction (STEMI) was not investigated. Methods Randomized controlled trial ( NCT02543502 ). Patients admitted between August 2012 and January 2015 were included. Patients were screened during the index hospitalization for STEMI, and those with severe periodontal disease were randomized 2 weeks later to periodontal treatment or to control. The primary endpoint of this trial was the between group difference in the variation of flow-mediated vasodilation (FMD) in the brachial artery assessed by ultrasound from baseline to the 6-month follow-up. Secondary outcomes were cardiovascular events, adverse effects of periodontal treatment and inflammatory markers. Results Baseline characteristics were balanced between patients in the intervention (n = 24) and control groups (n = 24). There was a significant FMD improvement in the intervention group (3.05%; p = .01), but not in the control group (−0.29%; p = .79) (p = .03 for the intergroup comparison). Periodontal treatment was not associated with any adverse events and the inflammatory profile and cardiovascular events were not significantly different between both groups. Conclusions Treatment of periodontal disease improves the endothelial function of patients with a recent myocardial infarction, without adverse clinical events. Larger trials are needed to assess the benefit of periodontal treatment on clinical outcomes. Clinical trial registration NCT02543502 ( https://clinicaltrials.gov/ct2/show/NCT02543502?term=NCT02543502&rank=1 ).

Importance Cerebrospinal fluid (CSF) cytologic testing and flow cytometry are insensitive for diagnosing neoplasms of the central nervous system (CNS). Such clinical phenotypes can mimic infectious and autoimmune causes of meningoencephalitis. Objective To ascertain whether CSF metagenomic next-generation sequencing (mNGS) can identify aneuploidy, a hallmark of malignant neoplasms, in difficult-to-diagnose cases of CNS malignant neoplasm. Design, setting, and participants Two case-control studies were performed at the University of California, San Francisco (UCSF). The first study used CSF specimens collected at the UCSF Clinical Laboratories between July 1, 2017, and December 31, 2019, and evaluated test performance in specimens from patients with a CNS malignant neoplasm (positive controls) or without (negative controls). The results were compared with those from CSF cytologic testing and/or flow cytometry. The second study evaluated patients who were enrolled in an ongoing prospective study between April 1, 2014, and July 31, 2019, with presentations that were suggestive of neuroinflammatory disease but who were ultimately diagnosed with a CNS malignant neoplasm. Cases of individuals whose tumors could have been detected earlier without additional invasive testing are discussed. Main outcomes and measures The primary outcome measures were the sensitivity and specificity of aneuploidy detection by CSF mNGS. Secondary subset analyses included a comparison of CSF and tumor tissue chromosomal abnormalities and the identification of neuroimaging characteristics that were associated with test performance. Results Across both studies, 130 participants were included (median [interquartile range] age, 57.5 [43.3-68.0] years; 72 men [55.4%]). The test performance study used 125 residual laboratory CSF specimens from 47 patients with a CNS malignant neoplasm and 56 patients with other neurological diseases. The neuroinflammatory disease study enrolled 12 patients and 17 matched control participants. The sensitivity of the CSF mNGS assay was 75% (95% CI, 63%-85%), and the specificity was 100% (95% CI, 96%-100%). Aneuploidy was detected in 64% (95% CI, 41%-83%) of the patients in the test performance study with nondiagnostic cytologic testing and/or flow cytometry, and in 55% (95% CI, 23%-83%) of patients in the neuroinflammatory disease study who were ultimately diagnosed with a CNS malignant neoplasm. Of the patients in whom aneuploidy was detected, 38 (90.5%) had multiple copy number variations with tumor fractions ranging from 31% to 49%. Conclusions and relevance This case-control study showed that CSF mNGS, which has low specimen volume requirements, does not require the preservation of cell integrity, and was orginally developed to diagnose neurologic infections, can also detect genetic evidence of a CNS malignant neoplasm in patients in whom CSF cytologic testing and/or flow cytometry yielded negative results with a low risk of false-positive results.

ImportanceMalignant neoplasms of the central nervous system (CNS) are frequently not detected by cerebrospinal fluid (CSF) flow cytometry or cytology, and clinical phenotypes can overlap with inflammatory meningoencephalitis.ObjectiveTo determine whether an existing CSF metagenomic next-generation sequencing (mNGS) assay can identify a hallmark of malignant neoplasms — aneuploidy — in difficult-to-diagnose cases of CNS malignancy.DesignTwo retrospective, case-control studies included a total of 155 samples from patients with an eventual diagnosis of a CNS malignancy (n=59 patients) and controls with other CNS diseases (n=73 patients). The first study was used to evaluate test performance in positive and negative controls. The second study was used to assess the potential utility of aneuploidy detection in patients whose CSF was sent for mNGS because of suspected neuroinflammatory disease who were ultimately found to have a CNS malignancy.SettingThis is a single site study at a large tertiary care center, University of California San Francisco, that enrolled from 2014 to 2019.ParticipantsThe test performance case-control study enrolled positive control patients with a CNS malignancy (n=47 patients) and negative controls with other neurologic diseases (n=56 patients) who had had CSF flow cytometry and/or cytology performed. The second case-control study enrolled patients with suspected neuroinflammatory disease who were ultimately diagnosed with a CNS malignancy (n=12) and other neurologic disease controls (n=17).Main Outcome(s) and Measure(s)The primary outcome measures were the performance characteristics of detecting aneuploidy in CSF by a cell-free DNA mNGS assay compared to cytology and/or flow cytometry and the tumor fraction in CSF from patients with CNS malignancies.ResultsAcross the two case-control studies, the overall sensitivity of the CSF mNGS assay for detecting aneuploidy in patients ultimately diagnosed with a CNS malignancy was 75% (63-96%, 95% CI), and specificity was 100% (96-100%, 95% CI). Notably, CSF mNGS detected aneuploidy in 64% of the non-diagnostic cytology and flow cytometry cases in the test performance study and in 55% of the cases with suspected neuroinflammatory disease who were ultimately diagnosed with a CNS malignancy. Of the cases in whom aneuploidy was detected, 90% had multiple chromosomal copy number variants with tumor fractions ranging from 31% to 49%.Conclusions and RelevanceMetagenomic NGS of CSF, originally designed to diagnose neurologic infections, detects evidence of CNS malignancies (i.e., aneuploidy) in cases where CSF flow cytometry and/or cytology were negative with a low risk of false positive results.3 Key PointsQuestionCan CSF metagenomic NGS, a test designed to diagnose infections, also detect genetic signatures of cancer in patients with suspected neuroinflammatory disease?FindingsAcross two case-control studies of patients with negative CSF cytology and/or flow cytometry, CSF mNGS detected genetic evidence for a malignancy with a sensitivity of 75% (63-85%, 95% CI) and specificity of 100% (96-100%, 95% CI).MeaningCSF mNGS, an assay with low sample volume requirements that does not require the preservation of cell integrity, has the potential to complement cancer detection by CSF flow cytometry and cytology.

Background Metagenomic next-generation sequencing (mNGS) of body fluids is an emerging approach to identify occult pathogens in undiagnosed patients. We hypothesized that metagenomic testing can be simultaneously used to detect malignant neoplasms in addition to infectious pathogens. Methods From two independent studies (n = 205), we used human data generated from a metagenomic sequencing pipeline to simultaneously screen for malignancies by copy number variation (CNV) detection. In the first case-control study, we analyzed body fluid samples (n = 124) from patients with a clinical diagnosis of either malignancy (positive cases, n = 65) or infection (negative controls, n = 59). In a second verification cohort, we analyzed a series of consecutive cases (n = 81) sent to cytology for malignancy workup that included malignant positives (n = 32), negatives (n = 18), or cases with an unclear gold standard (n = 31). Results The overall CNV test sensitivity across all studies was 87% (55 of 63) in patients with malignancies confirmed by conventional cytology and/or flow cytometry testing and 68% (23 of 34) in patients who were ultimately diagnosed with cancer but negative by conventional testing. Specificity was 100% (95% CI 95–100%) with no false positives detected in 77 negative controls. In one example, a patient hospitalized with an unknown pulmonary illness had non-diagnostic lung biopsies, while CNVs implicating a malignancy were detectable from bronchoalveolar fluid. Conclusions Metagenomic sequencing of body fluids can be used to identify undetected malignant neoplasms through copy number variation detection. This study illustrates the potential clinical utility of a single metagenomic test to uncover the cause of undiagnosed acute illnesses due to cancer or infection using the same specimen.

A measurement of the double-polarization observable E for the reaction $$\gamma p\rightarrow \pi ^0 p$$ γ p → π 0 p is reported. The data were taken with the CBELSA/TAPS experiment at the ELSA facility in Bonn using the Bonn frozen-spin butanol (C$$_4$$ 4 H$$_9$$ 9 OH) target, which provided longitudinally-polarized protons. Circularly-polarized photons were produced via bremsstrahlung of longitudinally-polarized electrons. The data cover the photon energy range from $$E_\gamma =600$$ E γ = 600 to 2310 MeV and nearly the complete angular range. The results are compared to and have been included in recent partial wave analyses.

Data on the beam asymmetry Σ in the photoproduction of η mesons off protons are reported for tagged photon energies from 1130 to 1790 MeV (mass range from W=1748 MeV to W=2045 MeV). The data cover the full solid angle that allows for a precise moment analysis. For the first time, a strong cusp effect in a polarization observable has been observed that is an effect of a branch-point singularity at the pη^{'} threshold [E_{γ}=1447 MeV (W=1896 MeV)]. The latest BnGa partial wave analysis includes the new beam asymmetry data and yields a strong indication for the N(1895)1/2^{-} nucleon resonance, demonstrating the importance of including all singularities for a correct determination of partial waves and resonance parameters.

Background: Prior studies have found that smokers with ST-segment elevation myocardial infarction (STEMI) are younger, have fewer coexisting high-features and lower mortality than nonsmokers. Objectives: To evaluate the relationship between cigarette smoking status and in-hospital outcomes of patients treated with STEMI at a tertiary hospital. Methods: Prospective cohort study of a single center. Patients admitted with STEMI between September 2016 and September 2019 were included. Smoking status was categorized as never-smokers, current smokers and former smokers. Clinical characteristics, length of stay, all-cause mortality and major cardiovascular events (MACE, defined as the composite of total mortality, re-infarction, stroke and cardiac arrest) during the in-hospital period were evaluated. Chi-square test, ANOVA and Tukey test, and the Kruskal-Wallis H test were used, as appropriate. P Results: Of the 230 patients hospitalized with STEMI in the period, 92 (40%) were currently smoking and 63 (27.3%) were former smokers. Current smokers (57.2±11.4 years) were younger than never-smokers (63.7±11.4 years) (p = 0.001) and former smokers (64.8±9.6 years) (p Conclusion: Compared to never-smokers and former smokers, current smoking is associated with the occurrence of STEMI at a younger age and with similar in-hospital mortality.

Data on the beam asymmetry Σ in the photoproduction of η mesons off protons are reported for tagged photon energies from 1130 to 1790 MeV (mass range from W=1748 MeV to W=2045 MeV). The data cover the full solid angle that allows for a precise moment analysis. For the first time, a strong cusp effect in a polarization observable has been observed that is an effect of a branch-point singularity at the pη^{'} threshold [E_{γ}=1447 MeV (W=1896 MeV)]. The latest BnGa partial wave analysis includes the new beam asymmetry data and yields a strong indication for the N(1895)1/2^{-} nucleon resonance, demonstrating the importance of including all singularities for a correct determination of partial waves and resonance parameters.

Objectives To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. Background CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. Methods An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. Results We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re-entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In-hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% CONCLUSIONS: CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

A measurement of the double-polarization observable E for the reaction \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\gamma p\rightarrow \pi ^0 p$$\end{document}γp→π0p is reported. The data were taken with the CBELSA/TAPS experiment at the ELSA facility in Bonn using the Bonn frozen-spin butanol (C\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_4$$\end{document}4H\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_9$$\end{document}9OH) target, which provided longitudinally-polarized protons. Circularly-polarized photons were produced via bremsstrahlung of longitudinally-polarized electrons. The data cover the photon energy range from \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$E_\gamma =600$$\end{document}Eγ=600 to 2310 MeV and nearly the complete angular range. The results are compared to and have been included in recent partial wave analyses.

BackgroundCytomegalovirus (CMV) infection is a risk factor for chronic lung allograft dysfunction (CLAD), which limits survival in lung allograft recipients. Natural killer (NK) cells that express the NKG2C receptor mediate CMV-specific immune responses. We hypothesized that NKG2C NK cells responding to CMV in the lung allograft would reduce CMV-related inflammation and would improve CLAD-free survival.MethodsWe prospectively followed 130 subjects who underwent lung transplantation from 2012 to 2016. Bronchoalveolar lavage (BAL) NK cells were immunophenotyped for NKG2C, maturation, and proliferation markers. CMV viral load, serologies, serial spirometry, and mortality were recorded from medical records. Natural killer cell subset association with CMV endpoints were made using generalized estimating equation-adjusted linear models. BAL NKG2C NK cell association with CLAD-free survival was assessed by Cox proportional hazards modeling.ResultsNKG2C NK cells were more mature and proliferative than NKG2C NK cells and represented a median of 7.8% of BAL NK cells. The NKG2C NK cell proportion increased prior to the first detection of viremia and was nearly tripled in subjects with high level viremia (>1000 copies/mL) compared with no detected viremia. Subjects with increased BAL NKG2C NK cells, relative to the median, had a significantly increased risk for CLAD or death (hazard ratio, 4.2; 95% confidence interval, 1.2-13.3).ConclusionsThe BAL NKG2C NK cell proportion may be a relevant biomarker for assessing risk of CMV viremia and quantifying potential CMV-related graft injury that can lead to CLAD or death.

Background Although diabetes mellitus (DM) is a predictor of poor outcomes in patients with ST-segment elevation myocardial infarction (STEMI), few studies have analyzed the impact of DM on the constituency of coronary thrombi. Objectives Comparing morphologic and histopathologic aspects of coronary thrombi in STEMI patients with and without DM who underwent primary percutaneous coronary intervention. Methods All consecutive patients with STEMI admitted to our institution between April 2010 and December 2012 (n = 1,548) were considered for inclusion. Thrombus material was obtained by aspiration thrombectomy; morphologic and histopathologic aspects were assessed by 3 independent pathologists blinded to clinical characteristics and outcomes. Patients with DM were compared with those without DM. A sensitivity analysis was performed using a propensity score. Results During the study period, coronary thrombi material from 259 patients was obtained, of whom 19% (n = 49) had diabetes. Diabetic patients were older ( P = .10), had a higher frequency of hypertension ( P P = .03), and had a trend to a longer time from the onset of chest pain to hospital arrival ( P = .08). The number of retrieved fragments, the size of the thrombi and its composition (leukocytes, fibrin, and erythrocytes percent), and thrombus age and color were similar between patients with or without DM. There were also no statistically significant differences in thrombus constituency of the propensity score–matched patients (n = 92). Conclusions In this study, morphologic and histopathologic constituency of coronary thrombi in the setting of a ST-elevation myocardial infarction was not significantly different between patients with or without DM. This finding was intriguing and deserves further investigation.

The polarization observables T , E , P , H , and G in photoproduction of η mesons off protons are measured for photon energies from threshold to W = 2400 MeV (T), 2280 MeV (E), 1620 MeV ( P , H ), or 1820 MeV (G), covering nearly the full solid angle. The data are compared to predictions from the SAID, MAID, JuBo, and BnGa partial-wave analyses. A refit within the BnGa approach including further data yields precise branching ratios for the Nη decay of nucleon resonances. A Nη-branching ratio of 0.33 ± 0.04 for N ( 1650 ) 1 / 2 − is found, which reduces the large and controversially discussed Nη-branching ratio difference of the two lowest mass J P = 1 / 2 − -resonances significantly.

Background: The literature demonstrates that anger is associated with cardiovascular disease, but the underlying physiological mechanisms remain undefined. Endothelial dysfunction, present in atherosclerosis, has also been associated with anger. Purpose: To examine the association between anger and endothelial function measured by flow-mediated dilatation (FMD) of the brachial artery. Methods: Patients were assessed during hospitalization after acute myocardial infarction answered the Spielberger Trait-State Anger inventory (STAXI). After discharge, patients were submitted to ultrasound of the brachial artery, the FMD technique, which was calculated by the maximum percentual of change in the diameter of the brachial artery from baseline to peak of dilation after deflation of the cuff. Results: The study included 90 patients, 86% caucasian, with 57 ± 10 years old, 73% male, 48% smokers, 57% with hypertension, 32% with dyslipidemia, 23% with diabetes, and 21% with a family history of arterial disease coronary artery disease. The mean dilation of this group was 6.70 ± 4.64. The presence of endothelial dysfunction was evaluated by the percentage of arterial dilation below 8.0%. In the multivariate analysis, only the anger reaction was associated with endothelial dysfunction. At each point of anger reaction increases 31% the chance of endothelial dysfunction (p = 0.008). Conclusions: In this sample of infarcted patients with anger score below average, the anger reaction is related to endothelial dysfunction.

The production of $\eta^{\prime}$ mesons in coincidence with forward-going protons has been studied in photon-induced reactions on 12C and on a liquid hydrogen (LH2) target for incoming photon energies of 1.3-2.6 GeV at the electron accelerator ELSA. The $\eta^{\prime}$ mesons have been identified via the $\eta^{\prime} \rightarrow \pi^{0} \pi^{0}\eta \rightarrow 6 \gamma$ decay registered with the CBELSA/TAPS detector system. Coincident protons have been identified in the MiniTAPS BaF2 array at polar angles of $2^{\circ} \le \theta_{p} \le 11^{\circ}$ . Under these kinematic constraints the $\eta^{\prime}$ mesons are produced with relatively low kinetic energy ( $\approx 150$ MeV) since the coincident protons take over most of the momentum of the incident-photon beam. For the C-target this allows the determination of the real part of the $\eta^{\prime}$ -carbon potential at low meson momenta by comparing with collision model calculations of the $\eta^{\prime}$ kinetic energy distribution and excitation function. Fitting the latter data for $\eta^{\prime}$ mesons going backwards in the center-of-mass system yields a potential depth of $V = -(44 \pm 16(stat) \pm 15(syst))$ MeV, consistent with earlier determinations of the potential depth in inclusive measurements for average $\eta^{\prime}$ momenta of $\approx 1.1$ GeV/c. Within the experimental uncertainties, there is no indication of a momentum dependence of the $\eta^{\prime}$ -carbon potential. The LH2 data, taken as a reference to check the data analysis and the model calculations, provide differential and integral cross sections in good agreement with previous results for $\eta^{\prime}$ photoproduction off the free proton.

Background: In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. Objective: To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. Methods: All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. Results: A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. Conclusion: Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals. Resumo Fundamento: Em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST), o tempo decorrido desde o início dos sintomas até a busca por atendimento médico é um dos principais preditores de mortalidade. Objetivo: Identificar preditores independentes de apresentação tardia em pacientes com IAMCSST representativos da prática clínica diária. Métodos: Todos os pacientes admitidos com diagnóstico de IAMCSST em um centro de referência, no período de dezembro de 2009 a novembro de 2014, foram avaliados e prospectivamente acompanhados, durante a hospitalização e por 30 dias após a alta. A apresentação tardia foi definida como tempo maior que 6 horas desde o início da dor torácica até a chegada ao hospital. Análise de regressão logística múltipla foi usada para identificar os preditores independentes de apresentação tardia. Foi considerado estatisticamente significativo p < 0,05. Resultados: Foram incluídos 1.297 pacientes, com idade média de 60,7 ± 11,6 anos, 71% do sexo masculino, 85% da raça branca, 72% com renda média menor que cinco salários mínimos e 66% com hipertensão arterial sistêmica. A mediana do tempo de apresentação clínica foi de 3,00 [1,40-5,48] horas, sendo que aproximadamente um quarto dos pacientes apresentou-se tardiamente, e a mortalidade deles foi significativamente maior. Os preditores independentes de apresentação tardia foram raça negra, baixa renda e diabetes melito, e história de doença cardíaca prévia foi fator protetor. Conclusão: Raça negra, baixa renda e diabetes melito são preditores independentes de apresentação tardia no IAMCSST. A identificação de subgrupos de pacientes propensos à apresentação tardia pode auxiliar a estimular políticas de prevenção nestes indivíduos de alto risco.

The first measurements of the beam-target-helicity-asymmetries $E$ and $G$ in the photoproduction of $\omega$-mesons off protons at the CBELSA/TAPS experiment are reported. $E$ ($G$) was measured using circularly (linearly) polarised photons and a longitudinally polarised target. $E$ was measured over the photon energy range from close to threshold ($E_\gamma = 1108$~MeV) to $E_\gamma = 2300$~MeV and $G$ at a single energy interval of $1108 < E_\gamma, Comment: 6 pages, 6 figures

RESUMO Introducao : E cada vez mais prevalente o numero de idosos submetidos a intervencao coronariana percutânea primaria (ICPp). Historicamente, essa populacao apresenta pior prognostico quando comparada aos mais jovens. Nosso objetivo foi comparar as caracteristicas e os desfechos clinicos em 30 dias de pacientes ≥ 80 anos aos Metodos Estudo de coorte observacional, prospectivo, extraido do banco de dados do Instituto de Cardiologia do Rio Grande do Sul, entre 2009 e 2013. Resultados Foram incluidos 1.970 pacientes, sendo 122 (6,2%) com idade ≥ 80 anos. Os mais idosos mostraram predominio do sexo feminino (50% vs. 29%; p Conclusoes Nesta analise contemporânea, pacientes ≥ 80 anos submetidos a ICPp apresentaram perfil clinico e angiografico mais grave, tempo porta‐balao mais prolongado, menor Blush 3 final, com maiores taxas de complicacoes hospitalares e mortalidade em 30 dias, quando comparados aos pacientes mais jovens.

Data on the polarization observables T, P, and H for the reaction gamma p -> p pi(0) are reported. Compared to earlier data from other experiments, our data are more precise and extend the covered range in energy and angle substantially. The results were extracted from azimuthal asymmetries measured using a transversely polarized target and linearly polarized photons. The data were taken at the Bonn electron stretcher accelerator ELSA with the CBELSA/TAPS detector. Within the Bonn-Gatchina partial wave analysis, the new polarization data lead to a significant narrowing of the error band for the multipoles for neutral-pion photoproduction. (C) 2015 The Authors. Published by Elsevier B.V.

RESUMOIntroduçãoEm nosso, país estima‐se que aproximadamente 27% das mulheres em idade fértil utilizem anticoncepcional oral (ACO). A apresentação e a evolução clínica do infarto agudo do miocárdio (IAM) nessas mulheres ainda não foi descrita em nosso meio. O objetivo do presente estudo foi analisar o perfil clínico, as características angiográficas, os aspectos técnicos do procedimento e os desfechos de usuárias de ACO que tiveram IAM e foram encaminhadas à intervenção coronariana percutânea (ICP) primária.MétodosMulheres < 55 anos que apresentaram IAM com supradesnivelamento do segmento ST e foram encaminhadas à ICP primária foram sequencialmente incluídas e categorizadas em dois grupos: com e sem uso atual de ACO.ResultadosIncluímos 257 pacientes, sendo que 19 (7,4%) usavam ACO. Estas eram mais jovens (42,3±6,2 anos vs. 48,4±5,7 anos; p < 0,001), com menos fatores de risco tradicionais para doença arterial coronariana, mas apresentavam proteína C‐reativa e fibrinogênio séricos mais elevados. O delta T foi semelhante (4,00 [1,25 a 6,86] horas vs. 4,50 [2,50 a 7,64] horas; p=0,54), mas o tempo porta‐balão foi maior nas pacientes em uso de ACO (1,41 [0,58 a 1,73] hora vs. 1,16 [0,91 a 1,51] hora; p=0,02). Estas pacientes foram mais frequentemente submetidas à tromboaspiração (52,6% vs. 25,6%; p=0,04). Após o evento índice, elas não apresentaram desfechos aterotrombóticos em até 2 anos de acompanhamento (0 vs. 15,2%; p=0,08).ConclusõesNeste estudo, encontramos perfil clínico e desfechos diferentes entre mulheres em idade reprodutiva, usuárias ou não de ACO, e submetidas à ICP primária. Estudos com maior número de pacientes são necessários para confirmar tais resultados.ABSTRACTBackgroundIn Brazil, it is estimated that approximately 27% of women of childbearing age use oral contraceptives (OC). The presentation and clinical course of acute myocardial infarction (AMI) in these women has yet to be described in Brazil. The aim of this study was to analyze the clinical profile, angiographic characteristics, technical aspects of the procedure, and the outcomes in women using OC who had an AMI and were submitted to primary percutaneous coronary intervention (PCI).MethodsWomen aged < 55 years who had acute ST segment elevation myocardial infarct and were referred to primary PCI were sequentially included and categorized into two groups: with and without current use of OC.ResultsWe have included 257 patients, of whom 19 (7.4%) used OC. These patients were younger (42.3±6.2 years vs. 48.4±5.7 years; p < 0.001), with fewer traditional risk factors for coronary artery disease, but had higher serum levels of C‐reactive protein and fibrinogen. The delta T was similar (4.00 [1.25 to 6.86] hours vs. 4.50 [2.50 to 7.64] hours; p=0.54), but the door‐to‐balloon time was longer in patients taking OC (1.41 [0.58 to 1.73] hour vs. 1.16 [0.91 to 1.51] hour, p=0.02). These patients were more frequently submitted to thrombus aspiration (52.6% vs. 25.6%; p=0.04). After the index event, they had no atherothrombotic outcomes in up to 2 years of follow‐up (0 vs. 15.2%; p=0.08).ConclusionsIn this study, different clinical profiles and outcomes were found among women of reproductive age, users or non‐users of OC, and submitted to primary PCI. Studies with a larger number of patients are required to confirm these results.

BackgroundIn Brazil, it is estimated that approximately 27% of women of childbearing age use oral contraceptives (OC). The presentation and clinical course of acute myocardial infarction (AMI) in these women has yet to be described in Brazil. The aim of this study was to analyze the clinical profile, angiographic characteristics, technical aspects of the procedure, and the outcomes in women using OC who had an AMI and were submitted to primary percutaneous coronary intervention (PCI).MethodsWomen aged < 55 years who had acute ST segment elevation myocardial infarct and were referred to primary PCI were sequentially included and categorized into two groups: with and without current use of OC.ResultsWe have included 257 patients, of whom 19 (7.4%) used OC. These patients were younger (42.3 ± 6.2 years vs. 48.4 ± 5.7 years; p < 0.001), with fewer traditional risk factors for coronary artery disease, but had higher serum levels of C-reactive protein and fibrinogen. The delta T was similar (4.00 [1.25 to 6.86] hours vs. 4.50 [2.50 to 7.64] hours; p = 0.54), but the door-to-balloon time was longer in patients taking OC (1.41 [0.58 to 1.73] hours vs. 1.16 [0.91 to 1.51] hour, p = 0.02). These patients were more frequently submitted to thrombus aspiration (52.6% vs. 25.6%; p = 0.04). After the index event, they had no atherothrombotic outcomes in up to 2 years of follow-up (0 vs. 15.2%; p = 0.08).ConclusionsIn this study, different clinical profiles and outcomes were found among women of reproductive age, users or non-users of OC, and submitted to primary PCI. Studies with a larger number of patients are required to confirm these results.

ResumoIntroduçãoNa prática clínica, os tipos 1 (trombose coronariana) e 2 (desequilíbrio entre a demanda e oferta de oxigênio) de infarto agudo do miocárdio (IAM) não são claramente distinguidos. O objetivo deste estudo foi avaliar a prevalência e a etiologia do IAM tipo 2, e comparar seu perfil com o do tipo 1.MétodosForam analisados pacientes admitidos com IAM com supradesnivelamento do segmento ST (IAMCST) com < 12 horas, encaminhados para coronariografia, no período de 2009 a 2013.ResultadosForam incluídos 1.960 pacientes, sendo 1.817 analisados, dos quais 1.786 (98,3%) com IAM tipo 1 e 31 (1,7%) do tipo de 2. Todos os pacientes com IAM tipo 2 apresentaram coronárias sem lesões significativas e, em 36% dos casos, discinesia apical. Os pacientes com IAM tipo 2 apresentaram, em geral, perfil clínico e laboratorial semelhante aos do tipo 1, com exceção da idade mais jovem, menores níveis de marcadores de necrose miocárdica, maior probabilidade de apresentarem fluxo TIMI 3 pré e maior fração de ejeção do ventrículo esquerdo. Aos 30 dias, a mortalidade (3,2 vs. 9,0%; p=0,23) e a ocorrência de morte, reinfarto ou necessidade de revascularização do vaso‐alvo (3,2 vs. 13,0%; p=0,09) foram numericamente menores no IAM tipo 2.ConclusõesUma pequena fração de pacientes com IAMCST foi classificada como de tipo 2; exibiram anormalidades estruturais isoladas ou associadas à ausência de lesões significativas; mostraram poucas diferenças no perfil clínico e laboratorial, e desfechos clínicos semelhantes aos 30 dias, comparados aos pacientes com IAM tipo 1.AbstractBackgroundIn clinical practice, type‐1 (coronary thrombosis) and type‐2 (imbalance between oxygen demand and supply) acute myocardial infarction (AMI) are not clearly differentiated. The aim of this study was to evaluate the prevalence and etiology of type‐2 AMI and compare its profile with that of type‐1 AMI.MethodsPatients admitted with ST‐segment elevation AMI (STEMI) < 12hours of symptom onset, and referred for coronary angiography, from 2009 to 2013, were analyzed.ResultsThere were 1,960 patients included; 1,817 were analyzed, of whom 1,786 (98.3%) had type‐1 AMI, and 31 (1.7%), type‐2. All patients with type‐2 AMI showed no significant coronary lesions, and 36% of the cases had apical dyskinesia. Type‐2 AMI patients had, in general, a clinical and laboratory profile that was similar to those with type‐1, except for the younger age, lower levels of myocardial necrosis markers, higher probability of having pre‐TIMI 3 flow and higher left ventricular ejection fraction. At 30 days, mortality (3.2 vs. 9.0%; p=0.23) and the occurrence of death, reinfarction, or need for target‐vessel revascularization (3.2 vs. 13.0%; p=0.09) were numerically lower in type‐2 AMI.ConclusionsFew patients with STEMI were classified as type‐2; they had structural abnormalities, isolated or associated with the absence of significant lesions; showed little difference regarding the clinical and laboratory profile, and similar clinical outcomes at 30 days, when compared to patients with type‐1 AMI.

BackgroundIn clinical practice, type-1 (coronary thrombosis) and type-2 (imbalance between oxygen demand and supply) acute myocardial infarction (AMI) are not clearly differentiated. The aim of this study was to evaluate the prevalence and etiology of type-2 AMI and compare its profile with that of type-1 AMI.MethodsPatients admitted with ST-segment elevation AMI (STEMI)

ResumoIntroduçãoHistoricamente, pacientes com cirurgia de revascularização do miocárdio (CRM) prévia submetidos à intervenção coronária percutânea (ICP) primária têm pior prognóstico que pacientes sem CRM prévia. No entanto, análises mais contemporâneas contestam esses achados. Nosso objetivo foi avaliar os desfechos clínicos de 30 dias em pacientes com e sem CRM prévia submetidos à ICP primária.MétodosEstudo de coorte prospectivo extraído do banco de dados do Instituto de Cardiologia do Rio Grande do Sul, contendo 1.854 pacientes submetidos à ICP primária.ResultadosPacientes com CRM prévia (3,8%) mostraram perfil clínico, em geral, mais grave. O tempo de início dos sintomas até a chegada ao hospital foi menor nesse grupo (2,50 horas [1,46‐3,66] vs. 3,99 horas [1,99‐6,50]; p < 0,001) e o tempo porta‐balão foi semelhante (1,33 hora [0,85‐2,07] vs. 1,16 hora [0,88‐1,58]; p = 0,12). O acesso femoral foi mais usado no grupo com CRM prévia (91,5% vs. 62,5%; p < 0,001). O uso de tromboaspiração manual foi menor nesse grupo (16,9% vs. 31,1%; p = 0,007), mas não houve diferença no uso de inibidor da glicoproteína IIb/IIIa (28,2% vs. 32,4%; p = 0,28). O sucesso angiográfico foi menor no grupo com CRM prévia (80,3% vs. 93,3%; p = 0,009). Aos 30 dias, pacientes com CRM prévia apresentaram taxas similares de eventos cardíacos adversos maiores (14,1% vs. 11,2%; p = 0,28), e a mortalidade, embora numericamente mais alta, não foi estatisticamente significativa (13,2% vs. 7,0%; p = 0,07).ConclusõesNessa análise contemporânea, pacientes com CRM prévia submetidos à ICP primária apresentaram perfil clínico mais grave e menor sucesso angiográfico, porém não mostraram diferenças nos desfechos clínicos em 30 dias.AbstractBackgroundHistorically, patients with prior coronary artery bypass graft (CABG) surgery undergoing primary percutaneous coronary intervention (PCI) have a worse prognosis than patients without prior CABG. However, more contemporary analyses have contested these findings. This study's aim was to evaluate the 30‐day clinical outcomes in patients with and without prior CABG submitted to primary PCI.MethodsProspective cohort study, extracted from the database of Instituto de Cardiologia do Rio Grande do Sul, containing 1,854 patients undergoing primary PCI.ResultsPatients with prior CABG (3.8%) showed, in general, a more severe clinical profile. The time of symptom onset until arrival at the hospital was shorter in this group (2.50hours [1.46 to 3.66] vs. 3.99 hour [1.99 to 6.50]; p < 0.001), while the door‐to‐balloon time was similar (1.33 hour [0.85 to 2.07] vs. 1.16 hour [0.88 to 1.58]; p = 0.12). Femoral access was more often used in the group with prior CABG (91.5% vs. 62.5%; p < 0.001). Manual thrombus aspiration was less often performed in this group (16.9% vs. 31.1%; p = 0.007), but there was no difference regarding the use of glycoprotein IIb/IIIa inhibitors (28.2% vs. 32.4%, p = 0.28). Angiographic success was lower in the group with prior CABG (80.3% vs. 93.3%; p = 0.009). At 30 days, patients with prior CABG had similar rates of major adverse cardiac events (14.1% vs. 11.2%; p = 0.28), and mortality, although numerically higher, was not statistically significant (13.2% vs. 7.0%, p = 0.07).ConclusionsIn this contemporary analysis, patients with prior CABG undergoing primary PCI had a more severe clinical profile and lower angiographic success, but showed no differences regarding 30‐day clinical outcomes.

ResumoIntroduçãoA epidemiologia do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) tem se modificado nos últimos anos, com incidência maior em jovens. Nosso objetivo foi comparar o perfil clínico, laboratorial e angiográfico, e os desfechos clínicos em 30 dias de pacientes ≤ 40 anos àqueles > 40 anos submetidos à intervenção coronária percutânea primária (ICPp).MétodosEstudo de coorte prospectivo com pacientes consecutivos submetidos à ICPp entre 2009 e 2011.ResultadosNo período, 1.055 pacientes foram incluídos, sendo identificados 3,3% com ≤ 40 anos. Pacientes jovens eram mais frequentemente negros, tabagistas e com história familiar de doença coronária, e menos frequentemente hipertensos e dislipidêmicos. Nos pacientes ≤ 40 anos, a dosagem de leucócitos e da troponina ultrassensível na admissão foi maior, e a lipoproteína de alta densidade‐colesterol, menor. A artéria descendente anterior como vaso culpado e a fração de ejeção do ventrículo esquerdo não foram diferentes entre os grupos. Apesar de o fluxo TIMI 3 pré ser similar, os jovens mostraram maior prevalência de blush miocárdico 3 pré‐procedimento. O tempo porta‐balão foi menor nos pacientes mais jovens (1,0 hora [0,8‐1,4 hora] vs. 1,3 hora [0,9‐1,7 hora]; p = 0,03). Em 30 dias, os pacientes ≤ 40 anos apresentaram mortalidade de 0% vs. 8,8% nos pacientes > 40 anos (p = 0,07).ConclusõesPacientes ≤ 40 anos com IAMCST e submetidos à ICPp apresentam diferenças nos perfis clínico, angiográfico e do procedimento quando comparados àqueles > 40 anos. Nesta análise, representativa da prática médica atual, a mortalidade em 30 dias desses pacientes foi muito baixa.AbstractBackgroundThe epidemiology of acute myocardial infarction with ST‐segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30‐day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein‐cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre‐intervention was similar, young people showed higher prevalence of myocardial blush 3 pre‐procedure. The door‐to‐balloon time was lower in younger patients (1.0 hour [0.8‐1.4 hour] vs. 1.3 hour [0.9‐1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30‐day mortality of these patients was very low.

Background: Anger control was significantly lower in patients with coronary artery disease (CAD), regardless of traditionally known risk factors, occurrence of prior events or other anger aspects in a previous study of our research group. Objective: To assess the association between anger and CAD, its clinical course and predictors of low anger control in women submitted to coronary angiography. Methods: This is a cohort prospective study. Anger was assessed by use of Spielberger’s State-Trait Anger Expression Inventory (STAXI). Women were consecutively scheduled to undergo coronary angiography, considering CAD definition as ≥ 50% stenosis of one epicardial coronary artery. Results: During the study, 255 women were included, being divided into two groups according to their anger control average (26.99). Those with anger control below average were younger and had a family history of CAD. Patients were followed up for 48 months to verify the occurrence of major cardiovascular events. Conclusion: Women with CAD undergoing coronary angiography had lower anger control, which was associated with age and CAD family history. On clinical follow-up, event-free survival did not significantly differ between patients with anger control above or below average. Resumo Fundamento: O controle da raiva mostrou-se significativamente mais baixo em pacientes com doença arterial coronariana (DAC), independentemente dos fatores de risco tradicionais conhecidos, da ocorrência de eventos prévios, ou de outros aspectos da raiva em estudo prévio do nosso grupo. Objetivo: Avaliar a associação entre raiva e DAC, sua evolução clínica e preditores de baixo controle de raiva em mulheres submetidas a coronariografia. Métodos: Trata-se de estudo de coorte prospectivo. Avaliou-se raiva com o Inventário de Expressão de Raiva como Estado e Traço de Spielberger (STAXI). Todas as mulheres agendadas para realização de angiografia coronariana durante o período de estudo foram abordadas consecutivamente. Definiu-se DAC como estenose de uma artéria coronária epicárdica ≥ 50%. Resultados: Este estudo incluiu 255 mulheres, que foram divididas em dois grupos, acima e abaixo da média do controle de raiva (26,99). Aquelas com controle abaixo da média eram mais jovens e tinham história familiar de DAC. As pacientes foram seguidas por 48 meses para verificar a ocorrência de eventos cardiovasculares maiores. Conclusão: As mulheres com DAC submetidas a coronariografia apresentaram menor controle de raiva, que se associou com idade e história familiar de DAC. No seguimento clínico, a sobrevida livre de evento não diferiu significativamente entre pacientes com controle de raiva acima da média e aquelas com controle abaixo.

Photoproduction of $\eta$ mesons from neutrons} \abstract{Results from measurements of the photoproduction of $\eta$ mesons from quasifree protons and neutrons are summarized. The experiments were performed with the CBELSA/TAPS detector at the electron accelerator ELSA in Bonn using the $\eta\to3\pi^{0}\to6\gamma$ decay. A liquid deuterium target was used for the measurement of total cross sections and angular distributions. The results confirm earlier measurements from Bonn and the MAMI facility in Mainz about the existence of a narrow structure in the excitation function of $\gamma n\rightarrow n\eta$. The current angular distributions show a forward-backward asymmetry, which was previously not seen, but was predicted by model calculations including an additional narrow $P_{11}$ state. Furthermore, data obtained with a longitudinally polarized, deuterated butanol target and a circularly polarized photon beam were analyzed to determine the double polarization observable $E$. Both data sets together were also used to extract the helicity dependent cross sections $\sigma_{1/2}$ and $\sigma_{3/2}$. The narrow structure in the excitation function of $\gamma n\rightarrow n\eta$ appears associated with the helicity-1/2 component of the reaction.

Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

In a search for $\omega$ mesic states, the production of $\omega$-mesons in coincidence with forward going protons has been studied in photon induced reactions on $^{12}$C for incident photon energies of 1250 - 3100 MeV. The $\pi^0 \gamma$ pairs from decays of bound or quasi-free $\omega$-mesons have been measured with the CBELSA/TAPS detector system in coincidence with protons registered in the MiniTAPS forward array. Structures in the total energy distribution of the $\pi^0 \gamma$ pairs, which would indicate the population and decay of bound $\omega~^{11}$B states, are not observed. The $\pi^0 \gamma$ cross section of 0.3 nb/MeV/sr observed in the bound state energy regime between -100 and 0 MeV may be accounted for by yield leaking into the bound state regime because of the large in-medium width of the $\omega$-meson. A comparison of the measured total energy distribution with calculations suggests the real part $V_0$ of the $\omega~^{11}$B potential to be small and only weakly attractive with $V_0(\rho=\rho_0) = -15\pm$ 35(stat) $\pm$20(syst) MeV in contrast to some theoretical predictions of attractive potentials with a depth of 100 - 150 MeV., Comment: 13 pages, 8 figures

BackgroundPrevious studies have shown that primary percutaneous coronary interventions carried off-hours are related to a worse prognosis. The objective of this study was to evaluate the outcomes of patients undergoing on- and off-hours primary percutaneous coronary interventions performed at a reference cardiology center.MethodsProspective cohort study, including 1,108 consecutive patients with ST elevation myocardial infarction divided into a group of primary percutaneous coronary intervention performed during regular working hours (on-hours: 8:00am to 8:00pm) and primary percutaneous coronary intervention during non-regular working hours group (off-hours: 8:00pm to 8:00am).ResultsThe sample included 680 patients in the on-hours group and 428 in the off-hours group. Baseline demographic data, risk factors and Killip classification were similar in both groups; however door-to-balloon time was significantly longer in the off-hours group (84 ± 66 minutes vs. 102 ± 98 minutes; p < 0.01). Culprit vessels and pre- and post-procedure TIMI flows were not different between groups. There were no significant differences for in-hospital mortality (7.6% vs. 10.2%; p = 0.16), stent thrombosis (2.8% vs. 2.4%; p = 0.69) or major bleeding (1.9% vs. 2.1%; p = 0.50). One-year mortality was also similar (9.5% vs. 12.6%; p = 0.12). The main predictor of mortality at 1 year was Killip III/IV (OR, 10.02; 95% CI, 5.8-17.1; p < 0.01).ConclusionsPatients with myocardial infarction have similar in-hospital clinical outcomes regardless of the time when primary percutaneous coronary intervention is performed. However, door-to-balloon time is significantly longer in patients treated during off-hours.

Comparisons between dedicated risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in real-world clinical practice are scarce. The aim of this study was to assess the diagnostic performance of the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores in STEMI patients undergoing pPCI in contemporary clinical practice.This was a prospective cohort study of consecutive patients with STEMI undergoing pPCI between December 2009 and November 2010 in a high-volume tertiary referral centre. The outcomes assessed were major cardiovascular events (MACEs) and death within 30 days. The diagnostic accuracy of the scores was assessed using receiver operating characteristic curves, and scores were compared using the DeLong method.During the study period, 501 patients were included. Within 30 days, 62 patients (12.4%) presented a MACE and 39 individuals (7.8%) died. All scores were statistically associated with death and MACE within 30 days (P0.01). The c-statistic and 95% confidence intervals for 30-day mortality were: GRACE, 0.84 (0.78-0.90); TIMI, 0.81 (0.74-0.87); Zwolle, 0.80 (0.73-0.87); and PAMI, 0.75 (0.68-0.82) (P0.01). There was no statistically significant difference regarding the accuracy of the TIMI, GRACE, and Zwolle scores for 30-day mortality, but the GRACE score was superior to the PAMI score (P0.01).The TIMI, GRACE, and Zwolle scores performed equally well as predictors of mortality in patients who underwent pPCI in current practice. These results suggest that these scores are suitable options for risk assessment in a real-world setting.

Purpose Cytomegalovirus (CMV) mediates clinical outcomes in lung allograft recipients. The NKG2C receptor on natural killer (NK) cells is encoded by the KLRC2 gene and recognizes CMV with memory-like capabilities. We hypothesized that NKG2C+ NK cells in bronchoalveolar lavage (BAL) would be associated with CMV burden and decreased chronic lung allograft dysfunction (CLAD)-free survival. Methods BAL cells were prospectively collected from 130 lung transplant recipients at a single center, with a median 391 days follow up time. NKG2C+ and - NK cell populations in BAL were compared for markers of maturation (NKG2A, CD16, KIR), propagation (Ki67), and KLRC2 genotype (rs2734561) by Student's t-test or ANOVA. CMV viremia was defined as negative, low ( 1000 copies/mL). NKG2C+ NK cell association with CMV viremia was determined using generalized linear modeling, and association with CLAD-free survival was determined by Cox proportional hazards models adjusted for transplant characteristics, KLRC2genotype, CMV viremia, and CMV serostatus. Results BAL NKG2C+ NK cells were more mature (NKG2A-CD16+, 25.8% vs 18.4%, p Conclusion BAL NKG2C+ NK cells were more mature than NKG2C- NK cells and expression differed between KLRC2 genotypes. NKG2C+ NK cells increased prior to viremia and higher NKG2C+ NK cell frequencies were associated with worse CLAD-free survival. Measurement of NKG2C+ NK cells in BAL may be a useful tool for assessing CMV disease burden in this population.