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Janus kinase inhibitors (JAKis) are the most recent new drug class to arrive to the market for rheumatoid arthritis (RA) treatment. While they have proven to be a very effective treatment option, there remains significant concern regarding the risk of cardiovascular events, thrombosis and malignancy, particularly given the findings of the post-marketing ORAL Surveillance study and FDA black box warnings. This article reviews the key findings of the most impactful cohort of studies and registry data since ORAL Surveillance. It also evaluates the role of JAKis in practice and offers guidance on risk stratifying patients and determining their suitability for a JAKi. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based guidance on how to best treat RA-ILD. This review article aims to evaluate the evidence from cohort studies and best real word data from registries. Extensive discussion of the relative merits and drawbacks of glucocorticoids, various biologics, small molecules and anti-fibrotics is presented. The limited available guidelines in RA-ILD are also discussed and a rational treatment algorithm is offered. [ABSTRACT FROM AUTHOR]

Keywords: Editorials; atherosclerosis; clinical trials; prevention; triglycerides EN Editorials atherosclerosis clinical trials prevention triglycerides 380 382 3 08/02/22 20220802 NES 220802 Appropriately designed and conducted randomized clinical trials (RCTs) are foundational for the practice of evidence-based medicine, including the regulatory approval of therapeutics and the inclusion of those therapies in clinical practice guidelines. There are 3 classes of drugs that lower low-density lipoprotein (LDL) that are proven to also reduce the cardiovascular complications associated with coronary atherosclerosis. Editorials, atherosclerosis, clinical trials, prevention, triglycerides. [Extracted from the article]

This commitment to public education, health literacy, and health promotion is likely to provide advances across a range of illnesses and population subgroups. Keywords: COVID-19; epidemiology; health literacy EN COVID-19 epidemiology health literacy e893 e897 5 05/06/21 20210504 NES 210504 Now that we have turned the page on the I annus horribilis i of 2020, and vaccines are being rolled out across the United States, Americans have begun to contemplate a return to normal prepandemic life, while people in other parts of the world continue to suffer. Essential to this call is the notion of health equity - that all those living in the United States should have the same access to care, which is the cornerstone of the AHA's 2024 impact goal: I Every person deserves the opportunity for a full, healthy life. Even before the pandemic, the AHA had shifted its focus from concentrating solely on the reduction of cardiovascular and stroke mortality to a more positive goal: improvement of cardiovascular health across the life course. [Extracted from the article]

The article offers information on the management of antithrombotic therapy after acute coronary syndromes. It discusses about rapidly changing guidelines in response to multiple clinical trials of new therapies, the management of antithrombotic agents for patients after an acute coronary syndrome is becoming increasingly complex.

Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health. [ABSTRACT FROM AUTHOR]

Several attempts have been made to assess the efficacy of healthy menu labeling with mixed findings. Recent studies have focused mainly on traditional survey techniques; the present study focused on the effects and relationships of disclosure of calories and color-coding as well as the role of gender, hunger level, quick service restaurant (QSR) dining frequency and calorie consciousness using eye-tracking technology, surveys and qualitative results. Based on these techniques, results indicated relatively equal effects for calorie disclosure and color-coding treatments, but when calorie information was provided QSR menu selections changed to less caloric choices when participants had higher hunger levels, were less frequent QSR diners and when calorie information in menus was deemed as higher importance by participants. [ABSTRACT FROM AUTHOR]

The Infantile Haemangioma Referral Score (IHReS) is a validated, decision-making tool designed to aid physicians in appropriate and timely referral of patients with infantile haemangiomas (IH) to specialist centres. Previous studies have assessed its usefulness in identifying patients who require referral; however, none have analysed its utility in identifying those who do not. We sought to assess the use of the IHReS score by GPs and paediatricians and to correlate the patients' score with outcomes through retrospective, cross-sectional analysis of all new IH referrals to a dedicated IH clinic over 6 months. The IHReS was retrospectively applied using information from referral letters and dermatology clinic letters. Data on demographics, wait time and outcomes were analysed. Forty-four patients were identified (females, n = 23; males, n = 21). The mean age at referral was 30 (SD 48) weeks. Only three (7%) referrals had recorded the patient's IHReS. Overall, 17 (39%) patients did not satisfy criteria for referral when the IHReS was applied retrospectively. Of these, 10 (59%) were discharged on the first visit, 6 (35%) were offered follow-up and one did not attend. No patients in this group received propranolol. Of the 27 (61%) patients who met the IHReS criteria 12 (44%) required propranolol, 11 (41%) were monitored for potential treatment, and 4 (15%) were discharged. The IHReS is a useful tool for identifying patients with IH who do not require referral to a specialist centre. It is underutilized by GPs and paediatricians and its use could reduce the number of inappropriate referrals to dermatology. [ABSTRACT FROM AUTHOR]

Similar to pandemic influenza in the past century, COVID-19 may also lead to lingering aftereffects, the so-called long-haul COVID syndrome, which remains poorly understood. SARS-CoV-2 is only one of a family of coronaviruses, including Middle East Respiratory Syndrome (MERS) virus found in camels, that causes seasonal outbreaks of even more COVID-19 at 1 Year American Heart Association Presidents Reflect on the Pandemic AHA UPDATE Elkind et al COVID-19 at 1 Year Circulation. Racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19: findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry [published online November 17, 2020]. [Extracted from the article]

Crowdfunding in restaurants is a relatively new and underresearched area. This study assessed the relationship among theoretical preparation considerations with success factors for reward-based concepts in Germany using platform content and interviews. The findings support and contradict earlier propositions. Specifically, the study found support for the following preparation considerations in the German restaurant context: professional video pitch, brief textual description, team composition considerations, appropriate funding targets, shorter funding duration, rewards that are tailored to fit, and the importance of getting the word out. Little support for social capital needs and funding target restrictions was found. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; health care; medical students; personal protective equipment EN COVID-19 health care medical students personal protective equipment e775 e777 3 05/07/20 20200505 NES 200505 Many fourth-year medical students who have met requirements and normally would be enjoying time off until graduation in May and June are being called to the frontlines to fight the coronavirus disease 2019 (COVID-19) pandemic. Accessed April 3, 2020 3 The United States Conference of Mayors Shortages of COVID-19 emergency equipment in U.S. cities: a survey of the nation's mayors. https://www.usmayors.org/issues/covid-19/equipment-survey/. [Extracted from the article]

Keywords: coronavirus infections; epidemiology; heart failure; hypertension; life expectancy; pandemics; social determinants of disease EN coronavirus infections epidemiology heart failure hypertension life expectancy pandemics social determinants of disease e743 e745 3 04/20/20 20200414 NES 200414 As the United States and the world confront the novel coronavirus (COVID-19) pandemic, the American Heart Association (AHA) and its thousands of science volunteers have an important role to play to help stop the spread. That may seem counterintuitive to some, considering that COVID-19 is an infectious disease and the AHA has spent the last nearly 100 years focused on noncommunicable diseases such as cardiovascular diseases (CVDs), stroke, and other vascular disorders. Coronavirus infections, epidemiology, heart failure, hypertension, life expectancy, pandemics, social determinants of disease. [Extracted from the article]

As we enter the information age of health care, digital health technologies offer significant opportunities to optimize both clinical care delivery and clinical research. Despite their potential, the use of such information technologies in clinical care and research faces major data quality, privacy, and regulatory concerns. In hopes of addressing both the promise and challenges facing digital health technologies in the transformation of health care, we convened a think tank meeting with academic, industry, and regulatory representatives in December 2016 in Washington, DC. In this paper, we summarize the proceedings of the think tank meeting and aim to delineate a framework for appropriately using digital health technologies in healthcare delivery and research. [ABSTRACT FROM AUTHOR]

Background Patients who have had a prior myocardial infarction (MI) are at increased risk for adverse outcomes after subsequent percutaneous coronary intervention (PCI). Objective The objective of this study is to examine the efficacy and safety of cangrelor, a potent intravenous P2Y 12 inhibitor, in patients with prior MI. Methods Pooled data from the CHAMPION trials were examined. Prior MI was defined as a history of MI, excluding MI events at baseline. The primary endpoint was a composite of death, MI, ischemia-driven revascularization, or stent thrombosis at 48-h post-randomization. The primary safety endpoint was GUSTO-defined severe bleeding at 48 h. Results Out of 24,691 patients, 5699 (23%) had a prior MI. The primary endpoint was higher in patients with vs. without prior MI (4.9% vs. 4.0%, p = 0.002). The primary endpoint was 4.2% with cangrelor vs. 5.7% with clopidogrel (absolute risk reduction = 1.5%; OR 0.72 [95%CI 0.57–0.92]) in patients with prior MI and 3.7% with cangrelor vs. 4.3% with clopidogrel (absolute risk reduction = 0.6%; OR 0.85 [95%CI 0.74–0.99]) in patients without prior MI ( P -interaction = 0.25). The rate of GUSTO-defined severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR 1.39 [95%CI 0.31–6.24]) in patients with prior MI, and 0.2% with cangrelor vs. 0.2% with clopidogrel (OR 1.18 [95%CI 0.65–2.14]) in patients without prior MI ( P -interaction = 0.84). Conclusion In the CHAMPION trials, patients with prior MI had higher rates of ischemic outcomes within 48 h after PCI. Cangrelor reduced ischemic events with no significant increase in GUSTO-defined severe bleeding in patients with or without prior MI. [ABSTRACT FROM AUTHOR]

Earlier research considered ethnic congruent versus incongruent music; this study extended earlier research by comparing the impacts of ethnic congruent music, ethnic incongruent music and restaurant background sounds on the dining experience. Additionally, it extends earlier research considering the impact on menu item selection and price expectations based on the impact of music/sound. Findings indicated music congruence effects along with baseline sounds should be considered by practitioners and researchers. Italian folk music increased Italian item selections compared to restaurant background sounds. Thai folk music was equal to background sounds for Thai items. Higher expected prices were apparent when listening to both Italian music and background sounds. [ABSTRACT FROM AUTHOR]

Background: Cangrelor, an intravenous, reversible P2Y12 antagonist, is approved for use in patients undergoing percutaneous coronary intervention (PCI).Objectives: This study sought to evaluate the efficacy and safety of cangrelor compared with clopidogrel in subgroups that did and did not receive glycoprotein IIb/IIIa inhibitors (GPIs).Methods: This pooled, patient-level analysis of the 3 CHAMPION (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials analyzed all randomized patients who underwent PCI and received the study drug (n = 24,902). Only bailout/rescue GPI use was permitted, except in CHAMPION PCI, in which routine or bailout/rescue GPI use was at the site investigator's discretion. The primary efficacy endpoint was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h after randomization.Results: Overall, 3,173 patients (12.7%) received a GPI, most commonly eptifibatide (69.4%). Despite variation in indications for GPIs, baseline characteristics were well balanced between the cangrelor and clopidogrel arms in subsets receiving and not receiving GPIs. Rates of the primary composite endpoint were lower with cangrelor compared with clopidogrel in patients who did (4.9% vs. 6.5%; odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55 to 1.01) or did not receive a GPI (3.6% vs. 4.4%; OR: 0.82; 95% CI: 0.72 to 0.94; Pint = 0.55). Cangrelor did not increase the primary safety endpoint, GUSTO-defined severe/life-threatening bleeding, in patients who did (0.4% vs. 0.5%; OR: 0.71; 95% CI: 0.25 to 1.99) or did not receive GPIs (0.2% vs. 0.1%; OR: 1.56; 95% CI: 0.80 to 3.04; Pint = 0.21). GPI use was associated with increased risk of bleeding in both treatment arms.Conclusions: Cangrelor's efficacy in reducing ischemic complications in patients undergoing PCI was maintained irrespective of GPI administration. GPI use was associated with substantially higher bleeding rates, regardless of the randomization to cangrelor or clopidogrel. (A Clinical Trial to Demonstrate the Efficacy of Cangrelor [PCI]: NCT00305162; Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [PLATFORM]: NCT00385138; A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]: NCT01156571). [ABSTRACT FROM AUTHOR]

The study investigates the importance of culinary attributes and hospitality services attributes as tourism drivers. Specifically, it considers the relationship between pre-visit expectations and post-visit expectation fulfillment using an expectancy-fulfillment grid approach. Using this grid approach, five tertiary attributes, two secondary attributes, and seven primary attributes were identified. The seven primary tourism attribute drivers included nature and landscape, traditional dishes of the region, regional wines, friendliness of staff in the hotels and restaurants, friendliness of staff in wineries, competencies of staff in hotels and restaurants, and competencies of staff in wineries. Research implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

Background: Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown.Methods: Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding.Results: A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55).Conclusions: Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218.). [ABSTRACT FROM AUTHOR]

The article presents a research which offers information on an association of female corresponding authors and female co-authors in top contemporary cardiovascular medicine journal. The topics addressed include details on an analysis which used a bibliometric approach to analyse the authorships of manuscripts from the 20 top impact cardiology journals of 2017.

The article offers ways in conducting and planning the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial in the U.S. The topics discussed include the primary goal of holding ISCHEMIA trial, the grant proposed to the organization the National Heart, Lung, and Blood Institute (NHLBI), and the estimated number of patients suffering from myocardial infarction.

The article addresses the question of whether coronary artery bypass graft surgery (CABG) is underutilized in contemporary clinical practice. Topics discussed include the indications for CABG, a review of evidence on the role of CABG versus medical therapy and CABG versus percutaneous coronary intervention (PCI), and why CABG utilization will continue to decline.

The ability to continue combination antiretroviral therapy (cART) in human immunodeficiency virus (HIV)–infected patients undergoing hematopoietic cell transplantation (HCT) for treatment of hematologic malignancies is likely a critical factor in preventing the establishment of an HIV reservoir in transplanted stem cells. Thus, we studied the feasibility of continued antiretroviral therapy in our HIV-infected patients undergoing autologous or allogeneic transplantation. All HIV-infected adults undergoing HCT for hematologic malignancy at Fred Hutchinson Cancer Research Center between 2006 and 2014 were included; most were enrolled in a prospective clinical study to monitor HIV reservoirs after transplantation ( NCT00968630 and NCT00112593 ). Non-nucleotide reverse transcriptase inhibitor or integrase-strand inhibitor–anchored antiretroviral therapy regimens were continued or selected before HCT by infectious disease physicians. Plasma HIV RNA was measured every other day for the first 2 weeks after transplantation and then every 2 weeks. Missed doses of cART and reasons for changing the cART regimen during the post-transplantation hospitalization were documented through review of inpatient pharmacy records. Seven autologous and 8 allogeneic transplantations were performed. In 9 transplantations, the cART regimen was not altered after HCT and no doses were missed. In 2 patients who required alterations in their cART regimen because of development of acute renal failure (n = 1) and small bowel obstruction (n = 1) after HCT, enfuvirtide was used as a bridging component of the regimen. Plasma HIV RNA remained suppressed during the first 28 days in 12 of 15 transplantations, and no patients had a plasma HIV RNA >1000 copies/mL during long-term follow up. Non-nucleotide reverse transcriptase inhibitor– and integrase-strand inhibitor–based cART are safe and effective in HIV-infected persons during the peri-HCT period. Most patients undergoing HCT were able to continue cART without missed doses. Sustained HIV viremia and emergence of resistance were not detected. [ABSTRACT FROM AUTHOR]

This study assesses the impact of the liking level of specific wines and foods on wine–food match perceptions. The findings assist in understanding the complex relationship between wine–food combinations and perceptions of liking when consumed together. Generally, the significant differences in match level in this 2 × 2 design followed traditional perceptions matches and mismatches. This provides empirical support for these relationships across a diverse group of respondents in terms of objective wine–food knowledge and involvement. Three of the four wine–food combinations had positive direct relationships among wine liking, food liking, or both on the liking level of the wine–food combination when tasted together. [ABSTRACT FROM PUBLISHER]

Few studies have utilized casual restaurant field settings to test relationships among music treatments, the impact on the perceived atmosphere, and, ultimately, the impact on the intent to return and total amount spent. This study tested direct, moderating, and mediating relationships shown in the Oakes (2000) musicscape model in a casual restaurant setting. The tests supported direct and moderating effects of age and music treatments on atmosphere perception and consumer’s intention to return and total amount spent. Results supported the partial mediation effect of perceived atmosphere as an intervening variable between age with intent to return and total spending behaviors. Implications of findings are discussed along with suggestions for future research. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether there is an interaction between “small” (i.e., table setting) and “large” (i.e., eating location) scales of the eating environments in affecting food acceptance and consumption. An identical roast chicken was presented at three table-setting conditions: plastic tray (PT), home-style table (HT), and gourmet table (GT) settings both in sensory testing booths and realistic contexts (e.g., classroom for PT, home-style dining room for HT, and restaurant for GT). Participants favored the appearance of food served at a gourmet table setting located in a restaurant setting significantly more than in a sensory testing booth. The participants were more willing to eat the food served using a gourmet table setting in the restaurant setting than in the sensory testing booth, leading to a significant increase in their food consumption. In addition, participants consumed food more slowly and perceived themselves to be less hungry when they ate in realistic contexts rather than in sensory testing booths. In conclusion, our findings demonstrated that food acceptance and intake can vary according to whether the small (table setting) and large (eating location) scales of the eating environments are well-matched or not. [ABSTRACT FROM AUTHOR]

The purposes of this study were to (1) explore significant differences in perception of match for a variety of food and wine styles; (2) evaluate the impacts of wine sweetness level, wine acidity level, and wine tannin level on perception of match; and (3) investigate the impact of food and wine expertise on perceived level of match. The highest perceived wine matches for each food item were: Sauvignon Blanc and chêvre, Chardonnay and brie, Cabernet Sauvignon and spicy Italian salami, and Port and milk chocolate. Wine sweetness, acidity, and tannin levels all significantly impacted the level of match with certain food items. Food and wine expertise also significantly impacted the level of match, indicating differences between the more expert and novice participants in the role wine sweetness, acidity, and tannin had on level of match. [ABSTRACT FROM AUTHOR]

Randomized controlled trials have traditionally been the gold standard against which all other sources of clinical evidence are measured. However, the cost of conducting these trials can be prohibitive. In addition, evidence from the trials frequently rests on narrow patient-inclusion criteria and thus may not generalize well to real clinical situations. Given the increasing availability of comprehensive clinical data in electronic health records (EHRs), some health system leaders are now advocating for a shift away from traditional trials and toward large-scale retrospective studies, which can use practice-based evidence that is generated as a by-product of clinical processes. Other thought leaders in clinical research suggest that EHRs should be used to lower the cost of trials by integrating point-of-care randomization and data capture into clinical processes. We believe that a successful learning health care system will require both approaches, and we suggest a model that resolves this escalating tension: a “green button” function within EHRs to help clinicians leverage aggregate patient data for decision making at the point of care. Giving clinicians such a tool would support patient care decisions in the absence of gold-standard evidence and would help prioritize clinical questions for which EHR-enabled randomization should be carried out. The privacy rule in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may require revision to support this novel use of patient data. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial. METHODS AND RESULTS: Of 18 624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary stent. Ticagrelor reduced stent thrombosis compared with clopidogrel across all definitions: definite, 1.37% (n=71) versus 1.93% (n=105; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.50-0.90; P=0.0091); definite or probable, 2.21% (n=118) versus 2.87% (n=157; HR, 0.75; 95% CI, 0.59-0.95; P=0.017); and definite, probable, and possible, 2.94% (n=154) versus 3.77 (n=201; HR, 0.77; 95% CI, 0.62-0.95). The reduction in definite stent thrombosis was consistent regardless of acute coronary syndrome type, presence of diabetes mellitus, stent type (drug-eluting or bare metal stent), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel before randomization, and use of glycoprotein IIb/IIIa inhibitors at randomization. The reduction in stent thrombosis with ticagrelor was numerically greater for late (>30 days; HR, 0.48; 95% CI, 0.24-0.96) and subacute (4 hours-30 days; HR, 0.60; 95% CI, 0.39-0.93) compared with acute (<24 hours; HR, 0.94; 95% CI, 0.43-2.05) stent thrombosis or for patients compliant to therapy (ie, taking blinded study treatment >=80% of the time) compared with less compliant patients. Randomization to ticagrelor was a strong independent inverse predictor of definite stent thrombosis (HR, 0.65; 95% CI, 0.48-0.88). CONCLUSION: Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes, with consistent benefit across a broad range of patient, stent, and treatment characteristics. [ABSTRACT FROM AUTHOR]

Background--We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial. Methods and Results--Of 18624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary stent. Ticagrelor reduced stent thrombosis compared with clopidogrel across all definitions: definite, 1.37% (n=71) versus 1.93% (n=105; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.50-0.90; P=0.0091); definite or probable, 2.21% (n=118) versus 2.87% (n=157; HR, 0.75; 95% CI, 0.59-0.95; P=0.017); and definite, probable, and possible, 2.94% (n=154) versus 3.77 (n=201; HR, 0.77; 95% CI, 0.62-0.95). The reduction in definite stent thrombosis was consistent regardless of acute coronary syndrome type, presence of diabetes mellitus, stent type (drug-eluting or bare metal stent), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel before randomization, and use of glycoprotein IIb/IIIa inhibitors at randomization. The reduction in stent thrombosis with ticagrelor was numerically greater for late (>30 days; HR, 0.48; 95% CI, 0.24-0.96) and subacute (4 hours-30 days; HR, 0.60; 95% CI, 0.39-0.93) compared with acute (<24 hours; HR, 0.94; 95% CI, 0.43-2.05) stent thrombosis or for patients compliant to therapy (ie, taking blinded study treatment >80% of the time) compared with less compliant patients. Randomization to ticagrelor was a strong independent inverse predictor of definite stent thrombosis (HR, 0.65; 95% CI, 0.48-0.88). Conclusion--Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes, with consistent benefit across a broad range of patient, stent, and treatment characteristics. Clinical Trial Registration--URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872. [ABSTRACT FROM AUTHOR]

Background. The incidence of immune reconstitution inflammatory syndrome (IRIS) when antiretroviral therapy (ART) is initiated after an AIDS-defining opportunistic infection (OI) is uncertain and understudied for the most common OIs. Methods. We examined patients in the University of Washington Human Immunodeficiency Virus Cohort initiating potent ART subsequent to an AIDS-defining OI. IRIS was determined through retrospective medical record review and adjudication using a standardized data collection process and clinical case definition. We compared demographic and clinical characteristics, and immunologic changes in patients with and without IRIS. Results. Among 196 patients with 260 OIs, 21 (11%; 95% confidence interval, 7%-16%) developed paradoxical IRIS in the first year on ART. The 3 most common OIs among study patients were Pneumocystis pneumonia (PCP, 28%), Candida esophagitis (23%), and Kaposi sarcoma (KS, 16%). Cumulative 1-year incidence of IRIS was 29% (12/41) for KS, 16% (4/25) for tuberculosis, 14% (1/7) for Cryptococcus, 10% (1/10) for Mycobacterium avium complex, and 4% (3/72) for PCP. Morbidity and mortality were highest in those with visceral KS-IRIS compared with other types of IRIS (100% [6/6] vs 7% [1/15], P < .01). Patients with mucocutaneous KS and tuberculosis-IRIS experienced greater median increase in CD4+ cell count during the first 6 months of ART compared with those without IRIS (+158 vs +53 cells/µL, P = .04, mucocutaneous KS; +261 vs +113, P = .04, tuberculosis). Conclusions. Cumulative incidence and features of IRIS varied depending on the OI. IRIS occurred in .10% of patients with KS, tuberculosis, or Cryptococcus. Visceral KS-IRIS led to considerable morbidity and mortality. [ABSTRACT FROM AUTHOR]

The article discusses a study regarding the pandemic H1N1 2009 influenza and HIV infection in the U.S. A total of 23 cases of laboratory-confirmed pandemic H1N1 2009 in HIV-infected persons were identified in Seattle, Washington. Among the 23 patients, only two were not given treatment for influenza. The findings suggest that HIV infection alone does not seem to be a risk factor for severe H1N1 pandemic, provided that patients do not have other risk factors associated with poor outcomes, not severely immunocompromised, and are treated for influenza.

A letter to the editor is presented related to HIV prevention in previous issues of the journal.

The article focuses on a randomised double-blind study which compared the efficacy of P2Y12 inhibitor ticagrelor with clopidogrel in patients with planned invasive strategy for coronary acute syndromes (PLATO). Several patients who were hospitalised for acute coronary syndromes were assigned randomly to ticagrelor and placebo and clopidogrel and placebo for 6-12 months. The study showed the occurrence of primary composite endpoint in fewer patients in the ticagrelor group compared with those in the clopidogrel. It also revealed that there was no difference between both groups in the rates of major bleeding or severe bleeding.

Background: Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y12. This agent might have a role in the treatment of patients who require rapid, predictable, and profound but reversible platelet inhibition. Methods: We performed a large-scale international trial comparing cangrelor with 600 mg of oral clopidogrel administered before percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. The primary efficacy end point was a composite of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours. Results: We enrolled 8877 patients, and 8716 underwent PCI. At 48 hours, cangrelor was not superior to clopidogrel with respect to the primary composite end point, which occurred in 7.5% of patients in the cangrelor group and 7.1% of patients in the clopidogrel group (odds ratio, 1.05; 95% confidence interval [CI], 0.88 to 1.24; P=0.59). Likewise, cangrelor was not superior at 30 days. The rate of major bleeding (according to Acute Catheterization and Urgent Intervention Triage Strategy criteria) was higher with cangrelor, a difference that approached statistical significance (3.6% vs. 2.9%; odds ratio, 1.26; 95% CI, 0.99 to 1.60; P=0.06), but this was not the case with major bleeding (according to the Thrombolysis in Myocardial Infarction criteria) or severe or life-threatening bleeding (according to Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries criteria). A secondary exploratory end point of death from any cause, Q-wave myocardial infarction, or ischemia-driven revascularization showed a trend toward a reduction with cangrelor, but it was not significant (0.6% vs. 0.9%; odds ratio, 0.67; 95% CI, 0.39 to 1.14; P=0.14). Conclusions: Cangrelor, when administered intravenously 30 minutes before PCI and continued for 2 hours after PCI, was not superior to an oral loading dose of 600 mg of clopidogrel, administered 30 minutes before PCI, in reducing the composite end point of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours. (ClinicalTrials.gov number, NCT00305162.) N Engl J Med 2009;361:2318-29. [ABSTRACT FROM AUTHOR]

The article discusses issues related to the premature release of data from the clinical trials on the use of the cholesterol-lowering drug ezetimibe. The authors believe that four particular elements must be implemented right away in clinical trials, which will be used to measure outcomes efficiently. According to them, these include the maintenance and enhancement of the requirement for independent data and safety monitoring committees. The need for the regulations of the U.S. Securities and Exchange Commission (SEC) to be reformed is also noted.

The author discusses the need for the proper use of the criteria for coronary revascularization and for the learning health system. It mentions the principle promoted by the Institute of Medicine on the health care system and the promotion of natural outgrowth of patient care. It discusses the programs initiated by the American Heart Association (AHA) and the American College of Cardiology on the care for patients with coronary revascularization.

The article focuses on the acute management of patients presenting with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS), as well as patients with percutaneous coronary intervention (PCI). Different recommendations for patients with NSTE ACS such as immediate aspirin, clopidogrel and upstream treatment, as well as suggestions for antiplatelet and anticoagulant therapies were also discussed.

The article relates the authors' perspective on the comparative effectiveness study of angiotensin-converting-enzyme (ACE) inhibitors in the treatment of congestive heart failure, published within the issue. They assert that the results of the study suggests that there maybe critical differences in outcomes among the groups of ACE inhibitors commonly used to treat heart failure. However, they argue that further studies are needed to compare ACE's efficacy and validate the study's findings.

This article presents the second of three physician responses to a hypothetical case in this issue of a 65-year-old diabetic, overweight man who has been diagnosed with coronary heart disease. This physician believes the patient would get a greater benefit from revascularization than he would from medical therapy. The author believes the disease of the left anterior descending coronary artery is most likely responsible for the onset of symptoms and suggests a percutaneous coronary intervention (PCI) be performed with the placement of a drug-eluting stent.

We describe repeated episodes of hepatitis C (HCV) activation associated with initiation of highly active antiretroviral therapy (HAART) in two HIV/HCV coinfected individuals with undetectable serum HCV RNA. Both patients developed high HCV viremia (>1 million IU/mL) and elevations in aminotransferases >10 times upper limit of normal) within 4 months of starting HAART. This is the first report of clinically significant HCV activation in HCV-seropositive patients with initially undetectable HCV viremia. These observations suggest that flares of hepatitis C in the setting of the immune reconstitution inflammatory syndrome can occur even in those patients who have undetectable serum HCV levels prior to HAART initiation. [ABSTRACT FROM AUTHOR]

Using a restaurant industry sample, this study examines the importance of managers' and organizational members' involvement in the implementation of strategy. The study assesses the impact of managers' perception of environmental uncertainty, firm size, and unit type on strategy implementation tactics and level of involvement. Findings indicate that firms operating in an environment of greater uncertainty bring more organizational members into the implementation process. Unit type and size were significant predictors of involvement and success. Larger firms utilized implementation processes that involved more organizational members across the hierarchy. Greater involvement in the implementation process had a consistent positive relationship with implementation success regardless of firm size or perceived environmental uncertainty. The interaction between firm size and dynamism in the environment appears to cause small firm managers to utilize higher involvement methods. [ABSTRACT FROM AUTHOR]