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BACKGROUND: The index of microvascular resistance (IMR) is an established tool to assess the status of coronary microcirculation. However, the need for a pressure wire and hyperemic agents have limited its routine use and have led to the development of angiography-derived pressure-wire-free methods (angiography-derived IMR [IMRAngio]). In this review and meta-analysis, we aim to assess the global diagnosis accuracy of IMRAngio versus IMR. METHODS: A systematic review of the literature was performed. Studies directly evaluating IMRAngio versus IMR were considered eligible. Pooled values of diagnostic test and summary receiver operator curve were calculated. RESULTS: Seven studies directly comparing IMRAngio versus IMR were included (687 patients; 807 vessels). Pooled sensitivity, specificity, +likelihood ratio (LR), and -LR were 82%, 83%, 4.5, and 0.26 respectively. Pooled accuracy was 83% while pooled positive predictive value and negative predictive value were 76% and 85%, respectively. Comparable results were obtained when analyzing by clinical scenario (acute and nonacute coronary syndromes). CONCLUSION: IMRAngio shows a good diagnostic performance for the prediction of abnormal IMR.

We provide quantitative guidance on whether and to what extent different elements of Heterogeneous Agent New Keynesian (HANK) models amplify or dampen the response of aggregate consumption to a monetary policy shock. We emphasize four findings. First, the introduction of capital adjustment costs does not affect the aggregate response, but does change the transmission mechanism so that a larger share of indirect effects originates from equity prices rather than from labor income. Second, incorporating estimated unequal incidence functions for aggregate labor income fluctuations leads to either amplification or dampening, depending on the data and estimation methods. Third, distribution rules for monopoly profits that allocate a larger share to liquid assets lead to greater amplification. Fourth, assumptions about the fiscal reaction to a monetary policy shock have a stronger effect on the aggregate consumption response than any of the other three elements.

AIMS Intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS) in women with bladder pain syndrome/interstitial cystitis (BPS/IC) has shown promising results. This study compared the efficacy, safety, and costs of intravesical HA/CS (Ialuril®, IBSA) to dimethyl sulfoxide (DMSO). METHODS Randomized, open-label, multicenter study involving 110 women with BPS/IC. The allocation ratio (HA/CS:DMSO) was 2:1. Thirteen weekly instillations of HA (1.6%)/CS (2.0%) or 50% DMSO were given. Patients were evaluated at 3 (end-of-treatment) and 6 months. Primary endpoint was reduction in pain intensity at 6 months by visual analogue scale (VAS) versus baseline. Secondary efficacy measurements were quality of life and economic analyses. RESULTS A significant reduction in pain intensity was observed at 6 months in both treatment groups versus baseline (P

Objective The European Acquired Haemophilia registry (EACH2) collected data on the demographics, diagnosis, underlying disorders, bleeding characteristics, treatment, and outcome of women with acquired haemophilia A (AHA), a rare and often severe bleeding disorder caused by autoantibodies directed against coagulation factor VIII. Design Prospective, multi-centre, large-scale, pan-European registry. Setting A total of 117 haemophilia centres in 13 European countries. Population Pregnancy-associated AHA. Methods Data were reported using a web-based electronic case report form. Diagnosis was based on the presence of a prolonged activated partial thromboplastin time, reduced coagulation Factor VIII level and positive inhibitor assay. Main outcome measures Presenting characteristics, time to diagnosis, haemostatic treatment and outcome, immunosuppressive treatment and outcome. Results The EACH2 registry (n = 501) documented 42 (8.4%) cases of AHA associated with the peripartum period, a median Factor VIII level at diagnosis of 2.5 (range 0–25) IU/dl and inhibitor titre of 7.8 (range 0.7–348) BU/ml. Antepartum inhibitors were evident in eight women. Time to diagnosis of AHA after delivery was 89 (range 21–120) days. First-line haemostatic treatment was successful in 20/23 (87%) women treated. Bleeding episodes resolved in 17/18 (94%) women treated with a bypassing agent and 29/39 (74%) women achieved complete remission with first-line immunosuppressive treatment. Two babies experienced postnatal bleeding, suggesting transplacental transfer of the antibody. All women were alive at last follow-up. Conclusions Although rare, pregnancy-associated AHA may cause severe bleeding-related morbidity. Once diagnosed, women respond well to haemostatic treatment with bypassing agents and immunosuppression. Awareness of peripartum AHA requires improvement to facilitate rapid and appropriate management.

AF and the Risk of Thromboembolic Events. Introduction: Asymptomatic atrial fibrillation (AF) can expose patients to the risk of stroke. The primary objective of this study was to assess the incidence of thromboembolic events in relationship with CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke, or transient ischemic attack) score and AF presence/duration. The secondary objective was to compare intermittent versus continuous monitoring strategies. Methods and Results: Data from patients with an implanted pacemaker and a history of AF were analyzed. Thromboembolic risk was quantified through CHADS2 score. Three AF groups were considered: patients with 5-minutes AF on 1 day but 24 hours (AF-24 hours). Monitoring strategies involving 24-hour Holter, 1-week Holter, and 30-day Holter were simulated. Data from 568 patients continuously monitored for 1 year were analyzed: 171 (30%) had CHADS2 score = 0; 269 (47%) had CHADS2 score = 1; 111 (20%) had CHADS2 score = 2; and 17 (3%) had CHADS2 score ≥ 3. During follow-up, 14 patients (2.5%) had an ischemic thromboembolic event. AF-24 hours patients numbered 223 (39.2%); AF-5 minutes, 179 (31.5%); and AF-free, 29.2%. By combining AF presence/duration with CHADS2 score, two subpopulations with markedly different risks of events (0.8% vs 5%, P = 0.035) were identified, the former corresponding to AF-free with CHADS2≤2, or AF-5 minutes with CHADS2≤1, or AF-24 hours with CHADS2= 0. The mean sensitivity in detecting an AF episode lasting >5 minutes was 44.4%, 50.4%, and 65.1% for 24-hour Holter, 1-week Holter, and 1-month Holter monitoring, respectively. Conclusion: In patients with recurrent AF episodes, risk stratification for thromboembolic events can be improved by combining CHADS2 score with AF presence/duration. (J Cardiovasc Electrophysiol, Vol. 20, pp. 241-248, March 2009)

Macleod/Swyer-James syndrome is an uncommon and complex disease characterized by roentgenographic hyperlucency of one lung or lobe due to loss of the pulmonary vascular structure and to alveolar overdistension. This syndrome seems to be an acquired disease that follows viral bronchiolitis and pneumonitis in childhood. It must be differentiated from many other causes of unilateral lung "transradiancy" on the chest roentgenogram, such as those related to congenital bronchial and/or vascular abnormalities. We here describe an 11-year-old patient with Macleod/Swyer-James syndrome and bronchiectasis resulting in severe recurrent bronchopulmonary infections. Despite the severe impairment of pulmonary function, the patient underwent resection of the right lung with progressive improvement of clinical and physiologic parameters.

This paper studies the joint dynamics of U.S. output and unemployment rate in a nonlinear VAR model. The nonlinearity is introduced through a feedback variable that endogenously augments the output lags of the VAR in recessionary phases. Sufficient conditions for the ergodicity of the model, potentially applying to a larger class of threshold models, are provided. The linear specification is severely rejected in favor of our threshold VAR. However, in the estimation the feedback is found to be statistically significant only on unemployment, while it transmits to output through its cross-correlation. This feedback effect from recessions generates important asymmetries in the propagation of shocks, a possible key to interpret the divergence in the measures of persistence existing in the literature. The regime-dependent persistence also explains the finding that the feedback from recession exerts a positive effect on the long-run growth rate of the economy, an empirical validation for the Schumpeterian macroeconomic theories.

Zusammenfassung Effekte der Futterung von Rapsextraktionsschrot auf die Funktion und Histomorphologie von Leber und Schilddruse beim wachsenden Schwein Es wurden die Effekte der Futterung unterschiedlicher Mengen an 0- und 00-Rapsextraktions-schrot (RES) wahrend 5 und 12 Wo und die Futterung von siliertem 0-RES wahrend 10 Wo auf Gewichtszunahmen, Schilddrusenfunktion und Leberfunktion, -histomorphologie und -des-oxyribonukleinsauregehalt bei wachsenden Schweinen untersucht. Futterverwertung und Gewichtszunahmen wurden selbst bei 20% 0- und 00-RSM in der Ration nicht signifikant beeinflust. Die Leberfunktion (erfast durch Messung der Aktivitat leberspezifischer Enzyme im Blutplasma und die Metabolisierung von 14C-Aminopyrin) wurde ebenfalls nicht signifikant verandert. Die Futterung von 0-RES, nicht jedoch von 00-RES, erhohte das Lebergewicht dosisabhangig, bedingt durch zellulare Hypertrophie und verbunden mit einer Reduktion der Hepatocytenzahl/Lobulus. Der Desoxyribonukleinsauregehalt/g Leber, nicht aber in der Gesamtleber, wurde durch die Futterung von 0-RES reduziert. Die Hypertrophie wurde primar durch eine Zunahme der Cytoplasmafraktion beeinflust, ohne feststellbare ultrastrukturelle Veranderungen. Die Aufnahme von 0-RES, nicht jedoch von 00-RES, verursachte eine Zunahme des Schilddrusengewichts und eine Reduktion des thyroidalen Gehalts von T4, T3 und Thyroglobulin und der Jodierung von Thyroglobulin. Die goitrogenen Effekte, sich ausernd in leicht reduzierten Konzentrationen von zirkulierendem (freiem) T4, waren kompensiert durch eine relative Zunahme von T3 und damit des T3/T4-Verhaltnisses. Das aufgenommene Goitrin wurde uber den Urin hauptsachlich in hydroxylierter Form ausgeschieden und die Effizienz der Ausscheidung nahm mit zunehmender Zufuhr ab. Die morphologischen Veranderungen der Schilddruse und Leber erfolgten deshalb teilweise als Folge einer Anreicherung von Goitrin und dessen hydroxylierter Form im Organismus. Im Vergleich zu 0-RES verursachte die Futterung von siliertem 0-RES eine deutliche Hypothyreose und eine Reduktion der Konzentration an freiem T4 und T3 im Blutplasma, das Lebergewicht wurde aber reduziert als Folge einer Reduktion der Hepatocytengrose, begleitet von einer Reduktion des Desoxyribonukleinsauregehalts in der Gesamtleber. Deshalb waren unterschiedliche Substanzen in siliertem und nicht-siliertem 0-RES fur goitrogene oder hepatotoxische Effekte verantwortlich.