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Background Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUS-TIMI 54 (Prevention of Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin). MI can occur in diverse settings and with varying severity; therefore, understanding the types and sizes of MI events prevented is of clinical importance. Methods and Results MIs were adjudicated by a blinded clinical events committee and categorized by subtype and fold elevation of peak cardiac troponin over the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21 162 randomized patients over a median follow-up of 33 months. The majority of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden death (Type 3), percutaneous coronary intervention-related (Type 4a) and coronary artery bypass graft-related (Type 5) each accounted for

A great deal has happened in the fi eld of lungfi sh phylogenetics over the two decades that have passed since the publication of Th e Biology and Evolution of Lungfi shes. Th ree major contributory factors can be discerned: the application of cladistic methodology to ever larger data sets, the advent of molecular phylogenetics, and the conceptual impact of the node-based terminology of crown group, stem group and total group introduced by Jeff eries. In this chapter we will review the eff ect of these factors on the development of the subject and present a brief overview of current opinion. We will not, however, be able to outline a neat set of consensus views; despite, or perhaps because of, the richness of the fossil data set, the deep phylogeny of the lungfi shes is still the subject of much debate. Keywords: lungfi shes, Dipnoi, phylogeny, evolution, SarcopterygiiTh e Biology and Evolution of Lungfi shes, published in 1987, provided the fi rst computer-generated phylogenetic analysis of the lungfi shes, presented by Charles Marshall (1987a). Later, Schultze and Marshall (1993) provided a more comprehensive analysis, including taxa from the Devonian to Recent, with 90 characters coded from the skull, dentition and postcranium. However, even before this, an attempt to apply phylogenetic principles to the question oflungfi sh relationships had been made by Roger Miles. Miles (1977) presented a revised phylogeny of the Dipnoi, which diff ered from earlier phylogenies in that characters were clearly assessed as being primitive or derived, and principles of parsimony used to evaluate relationships within the group (i.e., with a minimum number of character changes allowed). Although Miles’s resulting cladogram (Miles 1977: Fig. 157) left many taxa unresolved within the larger phylogeny, it was, as he noted, an advance over previous phylogenies because his hypotheses of character evolution and taxon relationships were explicit and could be tested by future researchers. In the years since Miles (1977) and Schultze and Marshall (1993), several new analyses have been performed, most involving computer-based parsimony programs. Interestingly, there has been disagreement among these trees, particularly with regard to the resolution of Devonian taxa. Nevertheless, there appears to be broad agreement regarding the identity of basal taxa as well as relationships among Carboniferous and younger taxa, but less agreement on the resolution of taxa between these nodes. Other researchers have examined relationships of the Dipnoi within the Sarcopterygii, most recently using EST sequences (express sequence tags; Hallstrom and Janke 2009). Th ere seems to be broad agreement now that lungfi sh represent the extant sister taxon to the Tetrapoda. Th ese agreements and disagreements are reviewed below, with a fi nal word on potential directions for future research.

Acute myocardial infarction is the single most common cause of death for both men and women in Sweden. Great efforts have over the years successfully been made to improve immediate treatment and care, and thereby prognosis. However, inadequacies in use of new knowledge and technology have been reported in this field. We have investigated our own adaptation over time, to new reports on a limited, but central part of immediate treatment. We have also examined bed-side accuracy in use of advanced technology, continuous ST-monitoring, suggested to yield early important information on patients with acute coronary syndromes. We have further investigated the value of dynamic ST-segment changes during the very early phase of acute myocardial infarction and reasoned on implications of these findings.Among 6058 admissions for acute myocardial infarction during 12 years we examined time-trends in use of fibrinolytics and related these to presentations of new knowledge.Among 99 patients included in the TEAHAT study we explored the prognostic value of early ST-segment variability and found an almost linear relationship between ST-variability and one-year mortality.Among 374 patients included in the ASSENT 2 trial we validated the prognostic value of early ST-variability. We also found that evaluation of ST-variability adds important information to evaluation of ST-recovery. Three groups with 0.8%, 4.5% and 9.9% 30-day mortality were identified.Among 177 patients included in the ASSENT PLUS trial we studied ST-variations during the first 24 hours in relation to late angiographic findings. We found that ST-variations independently of ST-recovery predict thrombi and low-grade coronary flow.Among 752 patients included in the ASSENT 2 and ASSENT PLUS trials we prospectively investigated several previously suggested cut-offs for ST-recovery and times for analyses of these. We found that the best predictor of mortality was 50% ST-recovery at 60 minutes, identifying 2 groups with 1.4% vs. 6.1% 30-day mortality. Eighty-eight percent of deaths were correctly predicted.Among 431 patients included in the ASSENT 2 trial we examined bed-side accuracy of continuous ST-monitoring and found that this technology truly yields important on-line information on prognosis.We have shown the dynamics of the ST-segment to yield very important early information on prognosis, probably because they accurately reflect how early, how complete and how sustained blood-flow is restored at the microvascular level, and how the individual is constituted in dealing with future vascular events. We have also shown that much of this information is truly available in real-time, in the clinical setting. The analysis of our own use of fibrinolytics, showed that we were reasonably updated to new knowledge.