Search

Objective: To investigate the influence of age at onset of spinal cord injury on length of stay, inpatient therapy and nursing hours, independence at discharge and risk of institutionalization.Design: Retrospective cohort study.Participants: A total of 250 patients with a newly acquired traumatic or non-traumatic spinal cord injury undergoing primary inpatient rehabilitation in a Swiss spinal cord injury specialized clinic between 2017 and 2019.Methods: Multiple regression analysis was used to determine if age, in addition to clinical characteristics (co-morbidities, secondary complications and spinal cord injury severity), affects inpatient rehabilitation parameters (length of stay, daily nursing hours and daily therapy hours), independence at discharge (Spinal Cord Independence Measure III) and place of discharge (private residence vs institution).Results: Chronological age correlated with the number of co-morbidities and secondary complications. Older age was associated with increased daily nursing care and reduced independence at discharge. However, both were also influenced by co-morbidities, secondary complications and severity of spinal cord injury. Length of stay and daily therapy hours were age-independent. Odds for institutionalization after discharge increased significantly, by 1.03-fold per year of age.Conclusion: Age at onset of spinal cord injury predicted inpatient nursing care, independence at discharge and the risk of institutionalization after primary inpatient rehabilitation. Co-morbidities, secondary complications and severity of spinal cord injury were also important influencing factors. LAY ABSTRACTThe age at which people have a spinal cord injury is increasing, and there has been a shift from traumatic towards more non-traumatic causes, particularly at an advanced age. The aim of this study was to determine the influence of age at onset of spinal cord injury on the inpatient rehabilitation process and on independence at discharge. A total of 250 patients, with a median age of 57.0 years, undergoing primary inpatient rehabilitation in a Swiss spinal cord injury specialized clinic were included in the study. Older age was associated with a higher number of co-morbidities and more secondary complications. Age significantly predicted daily nursing hours, but not length of stay or daily therapy hours. Moreover, older age was associated with reduced independence at discharge and increased the risk of institutionalization after discharge. In addition to age, co-morbidities, secondary complications and severity of spinal cord injury were important influencing factors.

Mastergradsoppgave i treningsfysiologi Bakgrunn: Prevalensen av fedme, hyperglykemi og diabetes øker rundt om i verden, derfor er det viktig å finne enkle og effektive metoder for å forhindre økning. Det finnes indikasjoner på at styrketrening bedrer glukosemetabolismen hos personer med fedme og diabetes type 2, men litteraturen viser sprikende funn. Formål: Formålet med denne studien er å undersøke effekten av 13 uker med styrketrening på forskjellige glukosemål hos personer med fedme. Metode: Tolv personer med fedme (50,3±4,2 år) i intervensjonsgruppen står til åtte personer i kontrollgruppen med fedme (43,6 ± 6,2 år). Intervensjonsgruppen gjennomførte 13 uker med progressiv styrketrening, to ganger i uken. Tilvenningstrening ble gjennomført i tre uker før 10 uker med styrketrening. En oral glukosetoleranse-test (OGTT) ble gjennomført syv uker før styrketreningsintervensjonen, rett før tilvenningsperioden og 48 timer etter siste gjennomførte treningsøkt, der blodglukoseverdier ble målt ved hjelp av fingerstikk. Resultat: Personer med fedme har redusert glukosetoleranse i forhold til personer med kroppsmasseindeks (KMI)

The COVID-19 pandemic severely upended cultural and creative production, consumption, and interactions in cities. Open green spaces, parks, forests, and gardens—green infrastructure—were instead utilized by citizens as a substitute for stimulating social interactions, sustainable tourism, and green growth. (1) The purpose of this research is to understand whether the availability of green infrastructure relates to the Cultural and Creative Cities Monitor (CCCM) benchmarking project developed by the Joint Research Centre of the European Commission performance. Does new evidence suggest revising the CCCM conceptual framework and related urban policies, especially in relation to the EU Green Deal? (2) Data from OpenStreetMap was used to count the amount of green infrastructure in 184 European Cities covered by the CCM and was then correlated with the sub-indices of the CCCM. (3) We found a moderately positive correlation of green infrastructure with the cultural vibrancy of a city and a weak positive correlation with the enabling environment of a city. (4) In light of the COVID-19 pandemic, the EU Green Deal and several other policy initiatives aimed at urban greening, we recommend that the CCCM include an Urban Nature sub-index as one of the performance indicators of the CCCM. An Urban Nature sub-index will broaden the goal of the CCCM by providing policymakers with a better understanding of actions and strategies to allow culture to contribute to social inclusion and green growth strategies in cities.

Denne masteroppgaven er en integrert litteraturgjennomgang av musikkterapeutisk litteratur som omhandler musikkterapi og forebygging i grunnskolen. Forskningsspørsmålet er: Hva sier litteratur mellom(fra) 2008-2018 om forebyggende arbeid med musikkterapi med barn i grunnskolen (6-16 år)? Underproblemstillingen retter fokuset mot hvilket fokus den musikkterapeutiske litteraturen har hatt i forskningen frem til nå. Oppgaven begrenser seg, som det kommer frem av forskningsspørsmålet, til litteratur som har blitt publisert i løpet av de siste ti årene. Målet med studien er å få en bredere forståelse for hvilke forebyggende tiltak som allerede finnes i grunnskolen, og hva som kan være musikkterapien sitt tilskudd til dette. I teoridelen trekkes viktigere teoretiske perspektiver frem for definisjon av begrep men også belysning av fokusområde i oppgaven. Videre analyserer og drøfter jeg ulike fokusområder som kommer frem av resultatet i denne masteroppgaven. Disse fokusområdene blir gjennom en konstruktivistisk analyse av resultatdelen sett i lys av humanistiske, ressursorienterte, relasjonelle og teorier fra pedagogikken for å få frem nyanser i analyse og diskusjonsdel. Det kommer frem av resultatdelen at det finnes lite musikkterapeutisk forskning på forebyggende tiltak i grunnskolen, samtidig som analyse og diskusjonsdelen viser til et behov for flere tiltak ved tidlig innsats. Musikkterapeutisk forskning som allerede finnes, og som jeg vil presentere senere i oppgaven, baserer seg i hovedsak på sekundærforebyggende tiltak der målet er å henholdsvis stanse sykdomsutviklingen og bedre negative symptom. Studien konkluderer med et behov for mer forskning på området, for i nesteomgang skape en ny arena for musikkterapeutisk praksis. This master thesis is based upon an integrated literature review of music therapeutic literature and prevention in elementary school. The research question is: What does literature between 2008-2018 say regarding preventive work with music therapy with children in primary school (6-16 years)? I will try to find out what focus music therapeutic literature has had on research until now. The task, as stated by the research question, is limited to literature that has been published in the last ten years. The aim of this study is to get a broader understanding of what preventive measures already exist in elementary school, and what may be the contribution of music therapy. Furthermore, I will analyze and discuss different focus areas that emerge from the results of this Master Thesis. These focus areas, through a constructivist analysis of the results, are seen in the light of a humanistic and resource-oriented view in addition to theories from pedagogy, to bring out nuances in the analysis and discussion. It appears from the results that there has been little music therapy research on preventive measures in elementary school. The analysis and discussion section indicate a need for more early intervention efforts. The Music therapeutic research that already exists, and that I will present later on, is mainly based on secondary prevention measures, whose goal is to stop disease from developing. The study concludes with a need for more research in the field, to create a new arena for music therapeutic practice. Masteroppgave i musikkterapi MUTP350

AIMS Our aim was to compare the safety and efficacy of a novel, ultrathin strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin strut, durable polymer everolimus-eluting stent (DP-EES) in a pre-specified subgroup of patients with acute ST-segment elevation myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial. METHODS AND RESULTS The BIOSCIENCE trial is an investigator-initiated, single-blind, multicentre, randomised non-inferiority trial (NCT01443104). Randomisation was stratified according to the presence or absence of STEMI. The primary endpoint, target lesion failure (TLF), is a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularisation within 12 months. Between February 2012 and May 2013, 407 STEMI patients were randomly assigned to treatment with BP-SES or DP-EES. At one year, TLF occurred in seven (3.4%) patients treated with BP-SES and 17 (8.8%) patients treated with DP-EES (RR 0.38, 95% CI: 0.16-0.91, p=0.024). Rates of cardiac death were 1.5% in the BP-SES group and 4.7% in the DP-EES group (RR 0.31, 95% CI: 0.08-1.14, p=0.062); rates of target vessel myocardial infarction were 0.5% and 2.6% (RR 0.18, 95% CI: 0.02-1.57, p=0.082), respectively, and rates of clinically indicated target lesion revascularisation were 1.5% in the BP-SES group versus 2.1% in the DP-EES group (RR 0.69, 95% CI: 0.16-3.10, p=0.631). There was no difference in the risk of definite stent thrombosis. CONCLUSIONS In this pre-specified subgroup analysis, BP-SES was associated with a lower rate of target lesion failure at one year compared to DP-EES in STEMI patients. These findings require confirmation in a dedicated STEMI trial.

Our goal was to evaluate the impact of the discontinuation times of dual antiplatelet therapy with clopidogrel, prasugrel or ticagrelor on postoperative bleeding rates and the use of blood products in patients undergoing isolated urgent coronary artery bypass grafting (CABG).We retrospectively analysed 334 patients with acute coronary syndrome undergoing urgent CABG at the University Hospital Basel. A total of 262 patients continued to take dual antiplatelet therapy during the surgery (72 received clopidogrel; 68, prasugrel; and 122, ticagrelor). They were stratified by the discontinuation time of dual antiplatelet therapy (24 h, 24-48 h, 48-72 h and72 h). Seventy-two patients taking acetylsalicylic acid (ASA) as monotherapy served as a comparison group.Median postsurgical bleeding rates were significantly higher with ticagrelor if it was discontinued24 h [1220 ml, interquartile range (IQR) 978-1520 ml; P 0.001], 24-48 h (1200 ml, IQR 800-1550 ml; P 0.001) and 48-72 h (1100 ml, IQR 845-1245 ml; P = 0.036) but not if discontinued72 h (700 ml, IQR 520-825 ml; P = 0.22) and with prasugrel if discontinued24 h (1320 ml, IQR 900-1950 ml; P 0.001) but not if discontinued 24-48 h (1050 ml, IQR 638-1438 ml; P = 0.089) or72 h (750 ml, IQR 488-1040; P = 0.63) compared to ASA monotherapy (800 ml, IQR 593-1043 ml). The postsurgical use of blood products compared to ASA monotherapy (0, IQR 0-2 units) was significantly higher with ticagrelor and prasugrel if discontinued24 h (2.5 units, IQR 0-6; P 0.001 and 2 units, IQR 1-6; P 0.001, respectively).Discontinuation of ticagrelor and prasugrel for more than 72 h before urgent CABG was not associated with higher bleeding rates compared to treatment with ASA monotherapy. In contrast, discontinuation for less than 24 h was associated with higher use of blood products. For ticagrelor, this study supports evidence and recent guidelines proposing a shorter discontinuation time of 3 days and raises the question of whether the same could be true for prasugrel.

AIMS A novel ultrathin-strut biodegradable polymer sirolimus-eluting stent (Orsiro™, Biotronik, Bülach, Switzerland; BP-SES) was shown to be superior to a thin-strut durable polymer everolimus-eluting stent (Xience™ Xpedition/Alpine, Abbott Vascular, Santa Clara, USA; DP-EES) with respect to the primary endpoint of target lesion failure (TLF) at 12 months in the prespecified subgroup of patients with ST-segment elevation myocardial infarction (STEMI) included in the BIOSCIENCE trial. We designed a large-scale, randomized, clinical trial to assess the clinical superiority of ultrathin-strut BP-SES over thin-strut DP-EES among patients with STEMI undergoing primary percutaneous coronary intervention. METHODS AND RESULTS BIOSTEMI (NCT02579031) is a prospective, multicentre, randomized, controlled, superiority trial that will randomly assign 1'250 patients with STEMI undergoing primary percutaneous coronary intervention to treatment with BP-SES or DP-EES. The primary endpoint of TLF, a composite of cardiac death, target vessel re-infarction, and clinically-indicated target lesion revascularisation within 12 months, will be analysed with Bayesian models applied to the BIOSTEMI dataset (n=1'250) using robustified historical priors to incorporate historical information from the BIOSCIENCE STEMI subgroup (n=407). CONCLUSIONS The BIOSTEMI trial will determine whether ultrathin-strut BP-SES are superior to thin-strut DP-EES with respect to TLF in patients with STEMI undergoing primary percutaneous coronary intervention.

Background\ud\udProphylaxis for gastrointestinal stress ulceration is frequently given to patients in the intensive care unit (ICU), but its risks and benefits are unclear.\udMethods\ud\udIn this European, multicenter, parallel-group, blinded trial, we randomly assigned adults who had been admitted to the ICU for an acute condition (i.e., an unplanned admission) and who were at risk for gastrointestinal bleeding to receive 40 mg of intravenous pantoprazole (a proton-pump inhibitor) or placebo daily during the ICU stay. The primary outcome was death by 90 days after randomization.\udResults\ud\udA total of 3298 patients were enrolled; 1645 were randomly assigned to the pantoprazole group and 1653 to the placebo group. Data on the primary outcome were available for 3282 patients (99.5%). At 90 days, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died (relative risk, 1.02; 95% confidence interval [CI], 0.91 to 1.13; P=0.76). During the ICU stay, at least one clinically important event (a composite of clinically important gastrointestinal bleeding, pneumonia, Clostridium difficile infection, or myocardial ischemia) had occurred in 21.9% of patients assigned to pantoprazole and 22.6% of those assigned to placebo (relative risk, 0.96; 95% CI, 0.83 to 1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, as compared with 4.2% in the placebo group. The number of patients with infections or serious adverse reactions and the percentage of days alive without life support within 90 days were similar in the two groups.\udConclusions\ud\udAmong adult patients in the ICU who were at risk for gastrointestinal bleeding, mortality at 90 days and the number of clinically important events were similar in those assigned to pantoprazole and those assigned to placebo. (Funded by Innovation Fund Denmark and others; SUP-ICU ClinicalTrials.gov number, NCT02467621. opens in new tab.)

AIMS A novel ultrathin-strut biodegradable polymer sirolimus-eluting stent (Orsiro™, Biotronik, Bulach, Switzerland; BP-SES) was shown to be superior to a thin-strut durable polymer everolimus-eluting stent (Xience™ Xpedition/Alpine, Abbott Vascular, Santa Clara, USA; DP-EES) with respect to the primary endpoint of target lesion failure (TLF) at 12 months in the prespecified subgroup of patients with ST-segment elevation myocardial infarction (STEMI) included in the BIOSCIENCE trial. We designed a large-scale, randomized, clinical trial to assess the clinical superiority of ultrathin-strut BP-SES over thin-strut DP-EES among patients with STEMI undergoing primary percutaneous coronary intervention. METHODS AND RESULTS BIOSTEMI (NCT02579031) is a prospective, multicentre, randomized, controlled, superiority trial that will randomly assign 1'250 patients with STEMI undergoing primary percutaneous coronary intervention to treatment with BP-SES or DP-EES. The primary endpoint of TLF, a composite of cardiac death, target vessel re-infarction, and clinically-indicated target lesion revascularisation within 12 months, will be analysed with Bayesian models applied to the BIOSTEMI dataset (n=1'250) using robustified historical priors to incorporate historical information from the BIOSCIENCE STEMI subgroup (n=407). CONCLUSIONS The BIOSTEMI trial will determine whether ultrathin-strut BP-SES are superior to thin-strut DP-EES with respect to TLF in patients with STEMI undergoing primary percutaneous coronary intervention.

AIMS We sought to assess the performance of drug-eluting stents combining an ultrathin cobalt-chromium platform with a biodegradable polymer across categories of increasing SYNTAX score (SS). METHODS AND RESULTS Patients included in the BIOSCIENCE trial and randomly allocated to treatment with biodegradable polymer sirolimus-eluting stents (BP-SES) or durable polymer everolimus-eluting stents (DP-EES) were categorised according to SS tertiles (low 15). The primary endpoint, target lesion failure (TLF), was defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularisation. The patient-oriented endpoint (POCE) included death, myocardial infarction, or any repeat revascularisation. The SS was available in 2,041 out of 2,119 patients (96.3%). At two-year follow-up, patients with an SS >15 experienced higher rates of both TLF and POCE as compared to patients with medium and low SS (14.5% vs. 8.1% and vs. 5.9%, p

Background No data are available on the long‐term performance of ultrathin strut biodegradable polymer sirolimus‐eluting stents ( BP ‐ SES ). We reported 2‐year clinical outcomes of the BIOSCIENCE (Ultrathin Strut Biodegradable Polymer Sirolimus‐Eluting Stent Versus Durable Polymer Everolimus‐Eluting Stent for Percutaneous Coronary Revascularisation) trial, which compared BP ‐ SES with durable‐polymer everolimus‐eluting stents ( DP ‐ EES ) in patients undergoing percutaneous coronary intervention. Methods and Results A total of 2119 patients with minimal exclusion criteria were assigned to treatment with BP ‐ SES (n=1063) or DP ‐ EES (n=1056). Follow‐up at 2 years was available for 2048 patients (97%). The primary end point was target‐lesion failure, a composite of cardiac death, target‐vessel myocardial infarction, or clinically indicated target‐lesion revascularization. At 2 years, target‐lesion failure occurred in 107 patients (10.5%) in the BP ‐ SES arm and 107 patients (10.4%) in the DP ‐ EES arm (risk ratio [ RR ] 1.00, 95% CI 0.77–1.31, P =0.979). There were no significant differences between BP ‐ SES and DP ‐ EES with respect to cardiac death ( RR 1.01, 95% CI 0.62–1.63, P =0.984), target‐vessel myocardial infarction ( RR 0.91, 95% CI 0.60–1.39, P =0.669), target‐lesion revascularization ( RR 1.17, 95% CI 0.81–1.71, P =0.403), and definite stent thrombosis ( RR 1.38, 95% CI 0.56–3.44, P =0.485). There were 2 cases (0.2%) of definite very late stent thrombosis in the BP ‐ SES arm and 4 cases (0.4%) in the DP ‐ EES arm ( P =0.423). In the prespecified subgroup of patients with ST ‐segment elevation myocardial infarction, BP ‐ SES was associated with a lower risk of target‐lesion failure compared with DP ‐ EES ( RR 0.48, 95% CI 0.23–0.99, P =0.043, P interaction =0.026). Conclusions Comparable safety and efficacy profiles of BP ‐ SES and DP ‐ EES were maintained throughout 2 years of follow‐up. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 01443104.

Among patients with acute ST-segment elevation myocardial infarction (STEMI), early-generation drug-eluting stents (DES) have been associated with a reduction in target-vessel revascularization compared with bare-metal stents after primary percutaneous coronary intervention. However, this early

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957)

BackgroundDual antiplatelet therapy (DAPT) prevents thrombotic events after coronary stent implantation but may induce bleedings, specifically in elderly patients. However, a competitive risk analysis is lacking.ObjectivesTo assess the determinants of major bleeding and the balance between the competing risks of major bleeding and thrombotic events during prasugrel-based DAPT after stent implantation.MethodsOverall, 2,291 patients randomized to drug-eluting or bare metal stents and treated with prasugrel 10mg/day for 1 year were followed over 2 years for major bleeding (BARC 3/5) and thrombotic events (cardiac death, myocardial infarction, definitive/probable stent thrombosis). Prasugrel dose was reduced to 5mg in patients >75 years and/or ResultsTwo-year rates of major bleeding and thrombotic events were 2.9% and 9.0%, respectively. The only independent predictor of major bleeding was age (hazard ratio per year increase 1.05 [1.02,1.07], pConclusionsIn prasugrel-based DAPT, age is the strongest risk factor for major bleeding, increasing exponentially >65 years. In younger patients, thrombotic events represent a higher risk than bleeding, while thrombotic and bleeding risks were similar in older patients. Important clinical implications relate to prasugrel dose in the elderly, duration of DAPT and the competing risk balance necessitating individualized treatment decisions.

Background— Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) proved noninferior to durable polymer everolimus-eluting stents (DP-EES) for a composite clinical end point in a population with minimal exclusion criteria. We performed a prespecified subgroup analysis of the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation (BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in patients with diabetes mellitus. Methods and Results— BIOSCIENCE trial was an investigator-initiated, single-blind, multicentre, randomized, noninferiority trial comparing BP-SES versus DP-EES. The primary end point, target lesion failure, was a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target lesion revascularization within 12 months. Among a total of 2119 patients enrolled between February 2012 and May 2013, 486 (22.9%) had diabetes mellitus. Overall diabetic patients experienced a significantly higher risk of target lesion failure compared with patients without diabetes mellitus (10.1% versus 5.7%; hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.27–2.56; P =0.001). At 1 year, there were no differences between BP-SES versus DP-EES in terms of the primary end point in both diabetic (10.9% versus 9.3%; HR, 1.19; 95% CI, 0.67–2.10; P =0.56) and nondiabetic patients (5.3% versus 6.0%; HR, 0.88; 95% CI, 0.58–1.33; P =0.55). Similarly, no significant differences in the risk of definite or probable stent thrombosis were recorded according to treatment arm in both study groups (4.0% versus 3.1%; HR, 1.30; 95% CI, 0.49–3.41; P =0.60 for diabetic patients and 2.4% versus 3.4%; HR, 0.70; 95% CI, 0.39–1.25; P =0.23, in nondiabetics). Conclusions— In the prespecified subgroup analysis of the BIOSCIENCE trial, clinical outcomes among diabetic patients treated with BP-SES or DP-EES were comparable at 1 year. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01443104.

The aim of the present study was to investigate the effect of the initial protein and mineral composition on the formation of whey protein microgels at a protein concentration of 4 wt%. As a model system, both demineralized α-lactalbumin (α-la) and β-lactoglobulin (β-lg) were mixed at 20/80, 50/50 and 80/20 α-la/β-lg ratios and heated (85 °C, 15 min) in the pH range 5.7–6.2. Pure dispersions of α-la were not forming microgels but rather precipitates (12%) and a majority of soluble aggregates (83%). Upon mixing with β-lg, microgels were only obtained for the 20/80 ratio at pH 5.7 or for pure β-lg at pH 5.8. Interestingly, the latter ratio was close to the natural composition occurring in most of the commercial whey protein isolates (WPIs). For higher ratios, particles were more or less aggregated and not spherical. As for α-la alone, most of the denatured proteins formed soluble aggregates. These results might be explained by the fact that α-la reduced the hydrophobic attractive forces involved in microgel formation, shifting the equilibrium towards the soluble aggregates pathway. This assumption was confirmed by the very low surface hydrophobicity of the soluble aggregates determined by ANS binding experiments. The conversion yield from native protein into microgels was about 51% for the 20/80 α-la/β-lg model mixture, whereas it was higher (70–85%) for commercial WPIs under similar experimental conditions. To test the possible effect of the initial mineral composition of the commercial WPIs, these products were demineralized and their ability to form microgels was tested again. After demineralisation, WPIs behaved very similarly to the 20/80 α-la/β-lg model system, the yield of conversion into microgels dropping to about 65% at pH 5.7. It was therefore concluded that in addition to the α-la/β-lg mixing ratio that was controlling hydrophobic interactions between denatured proteins that was accounting for about 50% of the microgel conversion yield, the initial mineral composition of WPIs contributed to another 20–35% yield as it was modulating the repulsive forces between the denatured proteins, promoting aggregation.

The out-of-plane permeability of 25 mm-long chopped glass fibre bundle beds was measured. These bundles, used in sheet moulding compound (SMC) composites, have an elliptical cross-section with the major axis perpendicular to the flow direction. An adapted experimental set-up was developed, which prevented flow along the sides of the packed bundle bed. The set-up was tested with needled glass fibre mats, and satisfactory agreement was found with previous results. The transverse permeability of the loose SMC bundle beds was then measured and linked to the bundle sizing type, geometry and volume fraction. Finally, the results could be well described by models taking into account the elliptical nature of the bundles.

Drug eluting stents with biodegradable polymer have been developed to address the risk of very late adverse events. COMPARE II is one of the largest randomized studies comparing the biodegradable polymer-coated biolimus-eluting stent (BES; Nobori®) with second-generation durable polymer-coated

Refinements in stent design affecting strut thickness, surface polymer, and drug release have improved clinical outcomes of drug-eluting stents. We aimed to compare the safety and efficacy of a novel, ultrathin strut cobalt-chromium stent releasing sirolimus from a biodegradable polymer with a thin strut durable polymer everolimus-eluting stent.We did a randomised, single-blind, non-inferiority trial with minimum exclusion criteria at nine hospitals in Switzerland. We randomly assigned (1:1) patients aged 18 years or older with chronic stable coronary artery disease or acute coronary syndromes undergoing percutaneous coronary intervention to treatment with biodegradable polymer sirolimus-eluting stents or durable polymer everolimus-eluting stents. Randomisation was via a central web-based system and stratified by centre and presence of ST segment elevation myocardial infarction. Patients and outcome assessors were masked to treatment allocation, but treating physicians were not. The primary endpoint, target lesion failure, was a composite of cardiac death, target vessel myocardial infarction, and clinically-indicated target lesion revascularisation at 12 months. A margin of 3·5% was defined for non-inferiority of the biodegradable polymer sirolimus-eluting stent compared with the durable polymer everolimus-eluting stent. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT01443104.Between Feb 24, 2012, and May 22, 2013, we randomly assigned 2119 patients with 3139 lesions to treatment with sirolimus-eluting stents (1063 patients, 1594 lesions) or everolimus-eluting stents (1056 patients, 1545 lesions). 407 (19%) patients presented with ST-segment elevation myocardial infarction. Target lesion failure with biodegradable polymer sirolimus-eluting stents (69 cases; 6·5%) was non-inferior to durable polymer everolimus-eluting stents (70 cases; 6·6%) at 12 months (absolute risk difference -0·14%, upper limit of one-sided 95% CI 1·97%, p for non-inferiority0·0004). No significant differences were noted in rates of definite stent thrombosis (9 [0·9%] vs 4 [0·4%], rate ratio [RR] 2·26, 95% CI 0·70-7·33, p=0·16). In pre-specified stratified analyses of the primary endpoint, biodegradable polymer sirolimus-eluting stents were associated with improved outcome compared with durable polymer everolimus-eluting stents in the subgroup of patients with ST-segment elevation myocardial infarction (7 [3·3%] vs 17 [8·7%], RR 0·38, 95% CI 0·16-0·91, p=0·024, p for interaction=0·014).In a patient population with minimum exclusion criteria and high adherence to dual antiplatelet therapy, biodegradable polymer sirolimus-eluting stents were non-inferior to durable polymer everolimus-eluting stents for the combined safety and efficacy outcome target lesion failure at 12 months. The noted benefit in the subgroup of patients with ST-segment elevation myocardial infarction needs further study.Clinical Trials Unit, University of Bern, and Biotronik, Bülach, Switzerland.

Aims To assess the effects of an NT-proBNP-guided medical management on 18-month outcomes in patients with heart failure (HF) and preserved LVEF (HFpEF). Methods and results Patients with HFpEF (LVEF >45%; n = 123) and HF with reduced LVEF (HFrEF; LVEF ≤45%; n = 499) with age ≥60 years, NYHA class ≥ II, and elevated NT-proBNP (>400 ng/L or >800 ng/L depending on age) were randomized to medical therapy titrated only to reduce symptoms to NYHA ≤II (symptom-guided) or also to reduce NT-proBNP below the inclusion threshold (NT-proBNP-guided) during a 6-month period. Patients were followed for an additional 12 months. Despite similar treatment escalation, NT-proBNP reduction and symptom relief were less in HFpEF than in HFrEF. Hospitalization-free survival at 18 months was worse in HFpEF than in HFrEF (P = 0.02), while survival and HF hospitalization-free survival did not differ. Among HFpEF patients, NT-proBNP reduction and symptom relief were similar in the symptom-guided (n = 59) and NT-proBNP-guided (n = 64) group despite more aggressive treatment in the NT-proBNP-guided group. In contrast to effects in HFrEF, NT-proBNP-guided management tended to worsen 18-month outcomes in HFpEF, with P-values for the interactions between LVEF stratum and management strategy of 0.2 for hospitalization-free survival, 0.03 for survival, and 0.01 for HF hospitalization-free survival. Conclusions Outcomes in HFpEF were not better than in HFrEF, and opposite effects of NT-proBNP-guided management were observed in HFpEF compared with HFrEF. These preliminary findings suggest that, in contrast to HFrEF, NT-proBNP-guided therapy may not be beneficial in HFpEF. Trial registration ISRCTN43596477.

Background: Acute decompensated heart failure (ADHF) causes a substantial burden for health care systems. Data to rationally define the need for hospitalization or the appropriate length of stay (LOS) is limited. Our aim was to personalize length of stay in patients admitted to hospital for acute decompensated heart failure. Methods: Consecutive patients with ADHF presenting to our emergency department were prospectively followed. We daily conducted a multidisciplinary risk assessment and compared proposed with actually observed triage decisions. Results: At presentation, all patients required hospitalization. Median LOS was 11 days including 1 day after reaching medical stability. In 42.7% of patients, hospitalization was prolonged after medical stability mainly for nursing and organizational reasons. Within 30 days of enrollment, 7 (9.3%) patients were rehospitalized, 3 of them for persisting or relapsing heart failure. Conclusions: There appears to be potential to shorten inhospital stay in patients with ADHF mainly by providing post discharge ambulatory nursing care in order to improve resource utilization and to diminish “hospitalization-associated disability”. doi: http://dx.doi.org/10.4021/jocmr1154w

Arrays of electromechanically operated optical microshutters have been designed, fabricated with polysilicon micromachining and tested. An innovative operation principle is described, which combines high switching speed, large lateral displacement while keeping low operating voltage. The main results obtained are switching speed of 50 /spl mu/s for a lateral displacement of 30 /spl mu/m, at a switching voltage of typically 70 V.

This paper describes an optical MEMS based on an array of electrostatically actuated polysilicon microshutters. Developed in the framework of an industrial project, they are integrated in a matrix of 602 elements that can be individually addressed and that constitute the core of an assembly for light switching. Despite severe specifications on the long-term functionality of this system, samples devices with several tens of millions of cycles have been demonstrated. The paper will focus on the technology, the design and the characteristics of these arrays. A large experimental work has allowed us to identify the main failure modes and the long-term behavior such as out of plane movement or in-use stiction. These phenomena will be discussed hereafter. We also report on possible improvements of the design that should solve the remaining limitations of the system.

Aneurysms of the left main coronary artery are very rare. 1 We report on a patient with critical stenosis and large aneurysm of the ]eft main coronary artery, critical three-vessel disease, and an aberrant conus artery without significant atherosclerotic changes rising from the right coronary ostium. A 59-year-old man with a 2-year history of stable angina pectoris was hospitalized with signs of anterolateral ischemia in the electrocardiogram and retrosternal pain that was unresponsive to nitroglycerin. There was no patient or family history of connective-tissue or infectious disease (endocarditis or mucocutaneous syndrome). Under standard therapy the pain was relieved, the electrocardiographic changes regressed, and creatine kinase (including MB fraction), aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels remained normal. Total cholesterol was 5 mmol/L (

To determine the benefit of atrial contribution on work capacity in relation to left ventricular ejection fraction, we studied 17 patients (68 +/- 13 years) with dual chamber pacemakers (DDD) implanted for high degree atrioventricular (AV) block. In random order they were assigned to rate responsive ventricular (VVIR) and to atrial triggered ventricular (VDD) stimulation. Maximum oxygen uptake (max VO2), that correlates best with work capacity, was measured by spiroergometry at a respiratory quotient of 1.1 during treadmill exercise test. Left ventricular ejection fraction at rest was determined by radionuclide ventriculography during VDD-stimulation and an AV delay of 150 ms. There were no differences between these two pacing modes relating heart rate, blood pressure, minute ventilation, exercise duration and maximal work load. In eight patients with an ejection fraction50% (60 +/- 10%), but not in nine patients with an ejection fraction50% (41 +/- 10%), maximum oxygen uptake was significantly higher (P0.01) during atrial triggered ventricular pacing (1440 +/- 533 ml/min) compared with rate responsive ventricular pacing (1328 +/- 536 ml/min). Thus, rate responsive single chamber pacemakers largely enable the same work capacity as dual chamber pacemakers in patients with high degree AV block. Patients with normal left ventricular function may profit most from preserved AV synchrony as shown by the higher maximum oxygen uptake on exercise.

Background In the BAsel Stent Kosten Effektivitats Trial PROspective Validation Examination (BASKET-PROVE), drug-eluting stents (DESs) had similar 2-year rates of death and myocardial infarction but lower rates of target vessel revascularization and major adverse cardiac events compared with bare-metal stents (BMSs). However, comparative clinical effects of newest-generation DES with biodegradable polymers vs second-generation DES or newest-generation BMS with biocompatible coatings, all combined with a prasugrel-based antiplatelet therapy, on 2-year outcomes are not known. Methods In BASKET-PROVE II, 2,400 patients with de novo lesions in native vessels ≥3 mm in diameter are randomized 1:1:1 to receive a conventional DES, a DES with a biodegradable polymer, or a BMS with biocompatible coating. In addition to aspirin, stable patients with BMS will receive prasugrel for 1 month, whereas all others will receive prasugrel for 12 months. The primary end point will be combined cardiac death, nonfatal myocardial infarction, and target vessel revascularization up to 2 years. Secondary end points include stent thrombosis and major bleeding. The primary aim is to test (1) the noninferiority of a biodegradable-polymer DES to a conventional DES and (2) the superiority of both DESs to BMS. A secondary aim is to compare the outcomes with those of BASKET-PROVE regarding the effects of prasugrel-based vs clopidogrel-based antiplatelet therapy. Results By the end of 2010, 878 patients (37% of those planned) were enrolled. Conclusions This study will test the comparative long-term safety and efficacy of newest-generation stents on the background of contemporary antiplatelet therapy in a large all-comer population undergoing large native coronary artery stenting.

Conventional chromium mask transfer can be used for the photolithographic transfer of high spatial frequency gratings at nonnormal incidence. A systematic study brings the tolerance on the transfer parameters such as proximity, angle of incidence, and line/space ratio.

Despite higher costs, expenditure, and the necessity of repeatedly reprogramming of dual chamber pacemakers, they are increasingly implanted to achieve an optimal work capacity. The influence of an individually programmed atrioventricular (AV) delay between 100-250 msec on physical work capacity in 12 patients (68 +/- 16 years) with dual chamber pacemakers implanted for high degree AV block was studied. During radionuclide ventriculography at rest the "optimal AV delay" with the maximal achieved left ventricular ejection fraction and the "most unfavorable AV delay" with the least achieved ejection fraction were determined. The ejection fraction at rest with the "optimal AV delay" was 51 +/- 14% and with the "most unfavorable AV delay" 45 +/- 15% (P < 0.001). In random order each patient was assigned to either AV delay and a spiroergometry was performed to determine maximum oxygen uptake (max VO2), which correlates best with work capacity, at a respiratory quotient of 1.1. The results show neither a difference in maximum oxygen uptake (1,262 +/- 446 mL/min with the optimal AV delay, 1,248 +/- 400 mL/min with the most unfavorable AV delay, respectively) nor in heart rate, blood pressure, exercise duration, maximal workload, and minute ventilation. Thus, an individually programmed AV delay affects left ventricular ejection fraction at rest. In contrast, an individually programmed AV delay has no influence on physical work capacity in patients with a dual chamber pacemaker.

Causes of decompensation of treated chronic congestive heart failure in patients referred for emergency hospitalization were examined prospectively. 111 consecutive patients (76 +/- 11 years) were interviewed and their records examined on admission. The diagnosed underlying diseases were coronary artery disease (80%), hypertensive heart disease (40%), valvular heart disease (11%), and idiopathic dilated (7%) and alcoholic (5%) cardiomyopathy. The grounds for decompensation of chronic congestive heart failure were: insufficient compliance 47% (n = 52, irregular or not intake of medication [25%], salt [9%] or fluid [7%] excess, stopping medication because of side effects [6%]), uncontrolled hypertension (27%), insufficient diuretic therapy in spite of progressive symptoms (23%), treatment with negative inotropic drugs (21%), acute rhythm disturbances (14%), acute myocardial infarction or unstable angina pectoris (14%), infections (6%). 80% of the patients were treated with diuretics, 34% with digoxin, 31% with ACE-inhibitors. Insufficient basic knowledge about the disease (regular weighing, diet, behavior if symptoms worsen) was found in 78% of patients, complete lack of knowledge concerning the prescribed drugs in 29%. Only 44% were regularly followed by their physicians, 53% had either no regular follow-ups or they were set at too long intervals.In the majority of patients, one or more avoidable causes leading to decompensation of chronic congestive heart failure can be identified. The main potential for intervention aiming at a reduction of the hospitalization frequency lies in improving patient compliance and state of the art medication by the primary care physician. Equally unsatisfactory is the low frequency of follow-up checks to reassess and renew drug therapy.

After blunt chest trauma, myocardial contusion is frequently suspected, but diagnostic criteria are difficult to define and commonly accepted recommendations for duration and form of patient monitoring are lacking. We therefore conducted a retrospective review of the hospital records of 50 consecutively hospitalized patients with the diagnosis of myocardial contusion after blunt chest trauma, and analyzed the pathological laboratory, ECG and echocardiography findings as well as the associated injuries and cardiac-related complications. The average injury severity score was 25 +/- 8. Initially 98% of the patients were hemodynamically stable. In 90% there were abnormal enzyme levels consistent with myocardial injury. Typically, the maximum level of CPK-MB, LDH and CPK-MB/CPK (MB-fraction) was found initially and these values declined rapidly. The MB fraction normalized within 8 hours. In 32% of the patients there were the following ECG changes consistent with myocardial contusion transient: ventricular tachycardia (12%), ST/T changes (12%), complete right bundle branch block (10%), atrial fibrillation (4%), first degree AV block (2%). The episodes of ventricular tachycardia were registered within the first 24 hours; in 5 of these 6 patients the admission ECG was normal. An echocardiography was done in 64% of the patients and in 37% showed either a pericardial effusion, regional wall motion abnormalities, a pneumopericardium or an intramyocardial hematoma in the free wall of the right ventricle. One patient died of multiorgan failure during this hospitalization. There were no sudden cardiac deaths. The diagnosis of myocardial contusion is vital in unstable patients but also very important in hemodynamically stable patients, despite its low morbidity. The minimum program we recommend for diagnosis and monitoring should include enzyme levels (CPK, CPK-MB) and ECG controls. Echocardiography may be necessary as well. If during the initial compulsory 24 hour monitoring of ECG and hemodynamics no complications occur, further monitoring is not necessary.

Left atrial spontaneous contrasts (LASC) are found almost exclusively with transesophageal echocardiography (TEE), usually in patients with mitral stenosis or mitral prosthetic valves. The prevalence of LASC was examined in 143 consecutive patients undergoing TEE and transthoracic echocardiography (TEE). LASC of variable intensity were observed in 31 patients (22%) with TEE, in contrast to none with TTE. There was a significant correlation between the presence of LASC and atrial fibrillation (p less than 0.001), left atrial dilatation (p less than 0.005) and presence of mitral valve prosthesis or mitral stenosis (p less than 0.02). In 48% of patients with LASC the mitral valve was entirely normal. Multivariance analysis showed atrial fibrillation and left atrial dilatation to be independent predictors for the presence of LASC. There were significantly more ischemic strokes in patients with LASC (35% vs 12% in patients without LASC). LASC are a frequent observation with TEE. As sensitivity of the echocardiography instruments steadily improves, LASC are also found in increasing numbers of patients with minimal structural change of the heart. LASC may indicate the presence of microthrombi and thus be involved in the pathogenesis of thromboembolic complications; their clinical relevance and prognostic significance needs to be further investigated.

Acute infections with group A beta-hemolytic streptococcus normally take a favourable course under therapy with penicillin. Only in a few cases has a completely different manifestation been described with multisystem failure similar to toxic shock syndrome induced by Staphylococcus aureus. We report on 4 patients (1990/91) who showed this manifestation in spite of immediate antibiotic therapy. In 3 patients the suspected portal of entry was the skin, in 1 patient it was unknown. Group A streptococci were grown from blood cultures from all 4 patients. Without an underlying immune deficiency all 4 patients (age 22, 24, 38 and 51) went into septic shock with high fever, hepatic and renal impairment, diarrhea, DIC and cerebral confusion. 2 patients died within a few days after developing acute respiratory distress syndrome and cerebral edema. All strains isolated from the patients were penicillin-sensitive, group A streptococci. 3 of them were M-type 1, which are known to be more invasive. The bacteremia by itself is not sufficient to explain all complications and the high mortality rate. It is probable that streptococcal toxins, such as pyrogenic exotoxin A, streptolysin O, or a new unknown one, play a decisive role.

By patterning the iron oxide film of a conventional iron oxide mask it is possible to obtain a binary phase grating of high diffraction efficiency and high transmission that can be used in high-resolution displacement sensors.

Preliminary data of inquiry on illness behavior are presented. 94% of the subjects (N =472 people working in administrative and industrial firms) reported at least one symptom within 1 month. Their consecutive activities are described.

A large gap is existing between the system of medical services and the "consumer". It is necessary to reinforce preventive attitudes and behavior should prepare the fundamental concepts. A research design is presented.

To control the quality of our care and to define the potential for lifesaving early intervention in patients with acute myocardial infarction, we analyzed the course of 709 patients (66.4 +/- 10.8 yrs) admitted to the coronary care unit for acute myocardial infarction over a period of 36 months. 77 patients (70.2 +/- 9.3 yrs) died in the coronary care unit, and thus early mortality was 10.9%. Only 8% died from disturbances of cardiac rhythm and 19% from rupture of a ventricle. 73% died in cardiogenic shock, of whom 21 were below 70 years old and represent a potential group for early intervention. In 13 patients of this subgroup possibilities of better management in the pre-hospital phase were found retrospectively. In 5/77 patients the optimal treatment was not achieved during clinical course. Cardiogenic shock is the major cause of death in the early phase of acute myocardial infarction. A further substantial reduction of mortality will be achieved only by reaching more risk patients in the pre-infarction phase and by shortening the pre-hospital phase.