Combined Evaluation of ST-segment Elevation in lead AVR and ST-segment Depression in other Leads Enhances Prediction of in-hospital Cardiovascular Death in Patients with Non ST-segment Elevation Acute Coronary Syndrome

Objective: To investigate the prognostic significance of ST-segment elevation (STE) in aVR associated with ST-segment depression (STD) in other leads in patients with non-STE acute coronary syndrome (NSTE-ACS). Background: In NSTE-ACS patients, STD has been extensively associated with severe coronary lesions and poor outcomes. The prognostic role of STE in aVR is uncertain. Methods: We enrolled 888 consecutive patients with NSTE-ACS. They were divided into two groups according to the presence or not on admission ECG of aVR STE≥ 1mm and STD (defined as high risk ECG pattern). The primary and secondary endpoints were: in-hospital cardiovascular (CV) death and the rate of culprit left main disease (LMD). Results: Patients with high risk ECG pattern (n=121) disclosed a worse clinical profile compared to patients (n=575) without [median GRACE (Global-Registry-of-Acute-Coronary-Events) risk score =142 vs. 182, respectively]. A total of 75% of patients underwent coronary angiography. The rate of in-hospital CV death was 3.9%. On multivariable analysis patients who had the high risk ECG pattern showed an increased risk of CV death (OR=2.88, 95%CI 1.05-7.88) and culprit LMD (OR=4.67,95%CI 1.86-11.74) compared to patients who had not. The prognostic significance of the high risk ECG pattern was maintained even after adjustment for the GRACE risk score (OR = 2.28, 95%CI:1.06-4.93 and OR = 4.13, 95%CI:2.13-8.01, for primary and secondary endpoint, respectively). Conclusions: STE in aVR associated with STD in other leads predicts in-hospital CV death and culprit LMD. This pattern may add prognostic information in patients with NSTE-ACS on top of recommended scoring system.

The book of Qohelet. A digital scholarly edition of the hebrew text

The objective of the present dissertation is a born-digital critical edition of the Hebrew Old Testament book of Qohelet. The edition is based on an extensive collation of variant readings from indirect sources – the Septuagint, the Peshitta, the works of St. Jerome (the Vulgate and the Commentary), and the Targum – as well as from direct sources such as the Qumran fragments and Hebrew medieval manuscripts. The ultimate goal of the edition is (a) to reproduce the earliest textual form, the Archetype, that can be reconstructed on the basis of the available evidence; and (b) to propose a rehabilitation of the Original of the Author by resorting, when necessary, to conjectural emendation. We date the Archetype to the II century BCE, corresponding to the date of Hebrew fragments from Qumran, while we place the Original between the V and III centuries BCE. Unlike previous critical editions of Qohelet, ours follows the so-called eclectic model, which involves the reconstitution of a critical text and the preparation of an apparatus of secondary variants. Our edition includes, moreover, new data, taken both from primary literature, such as the recently published Göttingen Septuagint, and from up-to-date studies and critical commentaries on the text of Qohelet. The work is made up of five main parts: an introduction, which sets forth the rationale of the edition and the methodology adopted; the collation, where the variants are listed in their original language; the commentary, where they are extensively discussed; the critical text accompanied by the apparatus, which presents a selection of authentic Hebrew variants taken from the collation; and finally, a translation of the critical text. The edition uses the mark-up language of the Text Encoding Initiative (TEI). It is realized in pdf, via LaTeX, and will be available in digital form, via the TEI-Publisher editor.