1,884 research outputs found
Does the routine availability of CT–Derived FFR influence management of patients with stable chest pain compared to CT angiography alone? The FFRCT RIPCORD Study.
No full textOBJECTIVES: This study sought to determine the effect of adding computed tomography–derived fractional flow reserve (FFRCT) data to computed tomography angiographic (CTA) data alone for assessment of lesion severity and patient management in 200 patients with chest pain.BACKGROUND: Invasive and noninvasive tests used in the assessment of patients with angina all have disadvantages. The ideal screening test for patients presenting for the first time with chest pain would describe both coronary anatomy and the presence of ischemia and would be readily accessible, low cost, and noninvasive.METHODS: Two hundred patients with stable chest pain underwent CTA for clinical reasons, and FFRCT was calculated. Three experienced interventional cardiologists assessed the CTA result for each patient and by consensus developed a management plan (optimal medical therapy, percutaneous coronary intervention, coronary artery bypass graft surgery, or more information required). FFRCT data for each vessel were then revealed, and the interventional cardiologists made a second plan by consensus, using the same 4 options. The primary endpoint for the study was the difference between the 2 strategies.RESULTS: Overall, after disclosure of FFRCT data there was a change in the allocated management category on the basis of CTA alone in 72 cases (36%). This difference is explained by a discordance between the CTA- and FFRCT-derived assessments of lesion severity. For example, FFRCT was >0.80 in 13 of 44 vessels (29.5%) graded as having a stenosis>90%. In contrast, FFRCT was #0.80 in 17 of 366 vessels (4.6%) graded as having stenosis #50%.CONCLUSIONS: This study demonstrates proof of concept that the availability of FFRCT results has a substantial effect on the labeling of significant coronary artery disease and therefore on the management of patients compared to CTA alone. Further studies are needed to determine whether FFRCT has potential as a noninvasive diagnostic and management screening tool for patients with stable chest pain
Combination thrombolytic therapy and percutaneous coronary intervention: the future for revascularisation for acute myocardial infarction?
No full textIt seems theoretically sound to consider rescue percutaneous coronary intervention (PCI) in patients with failed thrombolysis. However, randomised controlled data in this setting are limited. In this brief review we will present those trials analysing the role of rescue PCI in patients with acute myocardial infarction and failed thrombolysis, and consider appropriate management strategies in this setting.Stephen G. Worthley, H. M. Omar Farouque, Azfar G. Zaman, and Ian T. Meredit
Malignancy: an unrecognized risk factor for coronary stent thrombosis?
No full textStent thrombosis is a potentially catastrophic complication of coronary artery stenting. There have been particular concerns about the incidence of stent thrombosis following insertion of drug-eluting stents. We report a series of cases in which stent thrombosis occurred in association with malignancy and describe the potential mechanisms behind such an association. We speculate that this association merits further investigation as it raises the possibility that known malignancy may be a risk factor for stent thrombosis and that unexplained stent thrombosis, particularly if recurrent, should stimulate a search for occult malignanc
Organizational change: the role of organizational culture and employees' trust in their managers
No full textThis study was conducted in a third world economy to find the role of organizational cultural traits of involvement and adaptability on employees’ readiness for change and consequently successful implementation of change at the organizational unit level. Employees’ trust in their managers was considered as the moderating variable. The study was conducted in a large public sector organization and a banking company that remained in the public sector for more than three decades. The overall results revealed similar patterns of outcomes in terms of readiness for change, trust effect, and change outcome. Although the relationship between the cultural traits of involvement and adaptability and the success of change was not supported for lack of adequate outcome performance measures, these traits were significantly responsible for creating readiness for change in employees. Also, against the expectations, the positive relationship between adaptability culture and readiness was stronger when trust in managers was low rather than when it was high.M.S.Includes bibliographical referencesby Shahid Zaman Kha
Thyroid Hormones and Cardiovascular Function and Diseases
No full textThyroid hormone (TH) receptors are present in the myocardium and vascular tissue, and minor alterations in TH
concentration can affect cardiovascular (CV) physiology. The potential mechanisms that link CV disease with thyroid
dysfunction are endothelial dysfunction, changes in blood pressure, myocardial systolic and diastolic dysfunction,
and dyslipidemia. In addition, cardiac disease itself may lead to alterations in TH concentrations (notably, low
triiodothyronine syndrome) that are associated with higher morbidity and mortality. Experimental data and small
clinical trials have suggested a beneficial role of TH in ameliorating CV disease. The aim of this review is to provide
clinicians dealing with CV conditions with an overview of the current knowledge of TH perturbations in CV disease
Evlenmeyin: Nasıl, Ne Zaman Ve Kiminle Evlenilebileceği Üzerine Tavsiyeler
No full textJames W. Donovan's "Don't Marry" ( Evlenmeyin Nasıl, Ne Zaman Ve Kiminle Evlenilebileceği Üzerine Tavsiyeler) is an advice book written in the late 19th century that deals with the institution of marriage and partner selection. Translated into Turkish by Umut Yarım, this work starts from the premise that marriage is a serious partnership rather than a romantic dream. The author warns young people against making hasty decisions and lists the points to be considered to achieve happiness in marriage. The book covers topics such as the characteristics of the ideal spouse, character compatibility, the importance of financial status, and the difficulties that may be encountered in marriage in detail. While seeking answers to fundamental questions such as "Who to marry?" and "When to marry?", Donovan also examines the causes of unhappy marriages. Although the work reflects the social norms of the period, it encourages the reader to make conscious and prudent choices by offering universal observations on human relationships. The author's aim is not to reject marriage completely, but to protect against the regrets of marriages made with the wrong person or at the wrong time.James W. Donovan'ın "Evlenmeyin" (Don't Marry) adlı eseri, evlilik kurumunu ve eş seçimini ele alan, 19. yüzyıl sonlarında yazılmış bir tavsiye kitabıdır. Umut Yarım tarafından Türkçeye çevrilen bu çalışma, evliliğin romantik bir hayalden ziyade ciddi bir ortaklık olduğu gerçeğinden yola çıkar. Yazar, gençleri aceleci kararlar vermemeleri konusunda uyarır ve evlilikte mutluluğu yakalamak için dikkat edilmesi gereken hususları sıralar. Kitapta, ideal eşin özellikleri, karakter uyumu, maddi durumun önemi ve evlilikte karşılaşılabilecek zorluklar gibi konular detaylı bir şekilde işlenir. Donovan, "Kiminle evlenmeli?" ve "Ne zaman evlenmeli?" gibi temel sorulara yanıt ararken, mutsuz evliliklerin nedenlerini de irdeler. Eser, dönemin toplumsal normlarını yansıtmakla birlikte, insan ilişkilerine dair evrensel gözlemler sunarak okuyucuyu bilinçli ve sağduyulu seçimler yapmaya teşvik eder. Yazarın amacı evliliği tamamen reddetmek değil, yanlış kişiyle veya yanlış zamanda yapılan evliliklerin getireceği pişmanlıklardan korumaktır
Ghayat al-amani and the life and times of al-Hadi Yahya b. al-Husayn: an introduction, newly edited text and translation with detailed annotation
No full textThe thesis is anchored upon a text extracted from an important 11th / 17th century Yemeni historical work. This text deals primarily with al-Hādī ilā 'I-Haqq, the founder of the Zaydī Imamate in the Yemen that lasted well over a thousand years. AI-Hādīs imamate, of considerable significance in itself, also coincides with one of the most turbulent periods of early Yemeni mediaeval history. The- edited Arabic text, with its accompanying apparatus criticus. Is to be found at the opposite end of this volume. The Introduction considers various aspects of Imam al-Hadī’s life, religious ideas and aspirations and matters directly connected with the edited text and the work of which it forms a part. Among the most important subjects discussed are the MSS used in the production of the edited text, the problem concerning the authorship of Ghāyat al-amānī and the relationship of the latter work to Anbā' al-zaman. A short biography of al-Hādī is provided, together with a treatment of the historical background to ai-Hādīs imamate. The introduction also describes the editorial method followed with regard to the text, and certain key personal names and toponyms are dealt with there. The method employed by the author of the Ghāyat is to record the events of any one year by Itself. I have translated one year at a time and then followed it by the annotations appertaining to it. It is hoped that by means of these annotations. (some of which through necessity are quite detailed ), the text will be better understood. The numerous personages, tribal names and toponyms are considered, as well as problems concerning points of chronology and various matters of historical and religious significance. Specific comment is made upon certain interesting terms or any unusual or striking vocabulary. The thesis concludes with maps, genealogical tables and a comprehensive bibliography
Safety and performance of the ultrathin sirolimus-eluting Coronary Stent in an All-comers Patient Population: The S-FLEX UK-II Registry
No full textOBJECTIVE: We evaluated the clinical safety and performance of the ultrathin strut biodegradable polymer-coated Supraflex Cruz (Sahajanand Medical TechnologiesLtd., Surat, India) sirolimus-eluting stent (SES) in an all-comer patient population requiring coronary stent implantation. STUDY DESIGN: The study was a prospective, observational, multicentre, single-arm registry. STUDY SETTINGS: The study was conducted at 19 NHS Hospitals across the UK, from March 2020 to September 2021. STUDY PARTICIPANTS: A total of 1904 patients with symptomatic coronary artery disease (age ≥18 years) who underwent percutaneous coronary intervention with at least one Supraflex Cruz SES were enrolled. PRIMARY AND SECONDARY OUTCOMES MEASURE: The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI) and clinically indicated target lesion revascularisation (CI-TLR), at 12 months. Safety endpoints were stent thrombosis, all-cause death and any MI. Prespecified subgroups analysis included patients with diabetes mellitus, bifurcation lesion, type B2/C lesion defined as per ACC/AHA (American College of Cardiology/American Heart Association) lesion classification and long coronary lesions (>20 mm). RESULTS: A total of 2973 Supraflex Cruz SES were implanted in 1835 patients (mean age: 65.20±11.03 years). Of these, 404 patients had diabetes mellitus (491 lesions), 271 had bifurcation lesions (293 lesions), 1541 had type B2/C lesions (1832 lesions) and 985 had long coronary lesions (>20 mm, 1139 lesions). Among the overall population, device success was achieved in 98.2% of lesions. TLF occurred in 12 (0.7%) patients (0.3% cardiac death, 0.2% TV-MI, 0.2% CI-TLR) at 30 days and in 43 (2.3%) patients (0.8% cardiac death, 0.8% TV-MI, 0.8% CI-TLR) at 12 months follow-up. The rate of definite stent thrombosis was 0.3% in the overall population at 12 months. The incidence of TLF and stent thrombosis was 6.2% and 1% in the diabetic, 1.8% and none in bifurcation lesion, 2.5% and 0.3% in type B2/C lesion, and 2.7% and 0.3% in long coronary lesions (>20 mm) subgroups, respectively. at 12 months follow-up. CONCLUSION: The S-FLEX UK-II registry confirms the clinical safety and performance of the ultrathin Supraflex Cruz SES in an all-comer population with complex coronary artery disease, demonstrating low rates of TLF and stent thrombosis. TRIAL REGISTRATION NUMBER: ISRCTN39751665 (https://doi.org/10.1186/ISRCTN39751665).</p
Progression and regression of atherosclerotic lesions: monitoring with serial noninvasive magnetic resonance imaging
No full text© 2002 American Heart Association, Inc.BackgroundModification or stabilization of atherosclerotic plaques has been proposed as the mechanism responsible for the beneficial clinical effect of lipid-lowering therapies. An imaging modality able to quantify atherosclerotic plaque composition could potentially allow not only the identification of these vulnerable atherosclerotic lesions, but also monitoring of the effects of therapeutic interventions on plaque composition. Our aim was to monitor changes in burden and composition of atherosclerotic plaques in a rabbit model of complex atherosclerosis using serial noninvasive magnetic resonance imaging (MRI).Methods and resultsAortic atherosclerotic lesions were induced in rabbits and the animals randomized to continue an atherogenic diet (atherosclerosis progression) or resume normal chow (atherosclerosis regression) for 6 months. MRI of the aorta was performed at 3 time points in each rabbit, as follows: baseline, after atherosclerosis induction (9 months old), and after atherosclerosis regression or progression (15 months old). Histopathologic correlation with MRI was performed. There was a significant (PConclusionsThese findings indicate that serial noninvasive MRI can monitor changes in atherosclerotic plaque composition under conditions of atherosclerotic progression and regression.Gérard Helft, Stephen G. Worthley, Valentin Fuster, Zahi A. Fayad, Azfar G. Zaman, Roberto Corti, John T. Fallon, and Juan J. Badimo
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