Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials

OBJECTIVE To investigate the long-term prognostic implications of coronary calcification in patients undergoing percutaneous coronary intervention for obstructive coronary artery disease. METHODS Patient-level data from 6296 patients enrolled in seven clinical drug-eluting stents trials were analysed to identify in angiographic images the presence of severe coronary calcification by an independent academic research organisation (Cardialysis, Rotterdam, The Netherlands). Clinical outcomes at 3-years follow-up including all-cause mortality, death-myocardial infarction (MI), and the composite end-point of all-cause death-MI-any revascularisation were compared between patients with and without severe calcification. RESULTS Severe calcification was detected in 20% of the studied population. Patients with severe lesion calcification were less likely to have undergone complete revascularisation (48% vs 55.6%, p<0.001) and had an increased mortality compared with those without severely calcified arteries (10.8% vs 4.4%, p<0.001). The event rate was also high in patients with severely calcified lesions for the combined end-point death-MI (22.9% vs 10.9%; p<0.001) and death-MI- any revascularisation (31.8% vs 22.4%; p<0.001). On multivariate Cox regression analysis, including the Syntax score, the presence of severe coronary calcification was an independent predictor of poor prognosis (HR: 1.33 95% CI 1.00 to 1.77, p=0.047 for death; 1.23, 95% CI 1.02 to 1.49, p=0.031 for death-MI, and 1.18, 95% CI 1.01 to 1.39, p=0.042 for death-MI- any revascularisation), but it was not associated with an increased risk of stent thrombosis. CONCLUSIONS Patients with severely calcified lesions have worse clinical outcomes compared to those without severe coronary calcification. Severe coronary calcification appears as an independent predictor of worse prognosis, and should be considered as a marker of advanced atherosclerosis.

Religion and Ethnicity in Mongolian Societies. Historical and Contemporary Perspectives

This volume about religion and ethnicity in Mongolian societies is the outcome of an international seminar organized in Switzerland in 2009. Ten contributions explore the interplay of religion and ethnicity in the Mongolian and Buryat-Mongolian regions, covering four hundred years of Mongolian and Buryat history. Drawing on methods of diverse scholarly disciplines, including religious studies, Tibetan and Mongolian studies, social anthropology and history, the issues addressed include Mongolian identity formations in the light of the Tibeto-Mongolian interface in the 17th century, Buryat religious survival in the colonial setting of 18th and 19th century Russia, the interplay of religion and politics in Buryatia, a case study of the famous “Imperishable Body” of Khambo Lama Itigelov, an analysis of the religious politics of the Buryat Traditional Sangha in today’s Republic of Buryatia, the role of Shamanism in the identity practices of Modern Buryatia, as well as the revival of “traditional” religions like Buddhism and Shamanism in Mongolia and the emergence of new religions, especially Christianity. Furthermore, two contributions provide in-depth analyses of the dominant theoretical approaches that inform Russian and Anglophone scholarship dealing with these questions.

An Undisclosed Story of Roses: Church, State and Nation in Contemporary Georgia

I will attempt to problematize the typologies of nationalism when applied to the Georgian context, particularly in relationship to nationalism of President Mikheil Saakashvili. I will argue that the state-driven nationalism of post-Rose Revolution government was a hybrid form of ethno-cultural and civic which had elements of ethnic particularism towards the Orthodox Church. By reflecting on the growing assistance of Western institutions to Georgia, I will problematize the extent to which the rise of American and European involvement in the region reinforced the perceptions of the “self” and the “other” among the religious elites since the Rose Revolution. By presenting field research data (interviews) gathered in 23 eparchies and perishes with religious clerics in 7 regions of Georgia, I will argue that religious nationalism in Georgia strengthened not in response to but as an outcome of President Saakashvili’s policies towards the church, and partially as a reaction to the growing dissatisfaction with Western institutions working in Georgia and Western governments’ response to the Russo-Georgian War of 2008. By reflecting on empirical material, the paper attempts to problematize an understanding of religious nationalism as a social movement, an instance of cultural autonomy and a source of identity (Friedland 2001). In response, I suggest viewing religious nationalism in post-communist Georgia as medium of material and political interests

Reciprocity as a trigger of social cooperation in contemporary immigration societies?

While the system stabilizing function of reciprocity is widely acknowledged, much less attention has been paid to the argument that reciprocity might initiate social cooperation in the first place. This paper tests Gouldner’s early assumption that reciprocity may act as a ‘starting mechanism’ of social cooperation in consolidating societies. The empirical test scenario builds on unequal civic engagement between immigrants and nationals, as this engagement gap can be read as a lack of social cooperation in consolidating immigration societies. Empirical analyses using survey data on reciprocal norms and based on Bayesian hierarchical modelling lend support for Gouldner’s thesis, underlining thereby the relevance of reciprocity in today’s increasingly diverse societies: individual norms of altruistic reciprocity elevate immigrants’ propensity to volunteer, reducing thereby the engagement gap between immigrants and natives in the area of informal volunteering. In other words, compliance with altruistic reciprocity may trigger cooperation in social strata, where it is less likely to occur. The positive moderation of the informal engagement gap through altruistic reciprocity turns out to be most pronounced for immigrants who are least likely to engage in informal volunteering, meaning low, but also high educated immigrants.

Contemporary ecotypic divergence during a recent range expansion was facilitated by adaptive introgression

Although rapid phenotypic evolution during range expansion associated with colonization of contrasting habitats has been documented in several taxa, the evolutionary mechanisms that underlie such phenotypic divergence have less often been investigated. A strong candidate for rapid ecotype formation within an invaded range is the three-spine stickleback in the Lake Geneva region of central Europe. Since its introduction only about 140 years ago, it has undergone a significant expansion of its range and its niche, now forming phenotypically differentiated parapatric ecotypes that occupy either the pelagic zone of the large lake or small inlet streams, respectively. By comparing museum collections from different times with contemporary population samples, we here reconstruct the evolution of parapatric phenotypic divergence through time. Using genetic data from modern samples, we infer the underlying invasion history. We find that parapatric habitat-dependent phenotypic divergence between the lake and stream was already present in the first half of the twentieth century, but the magnitude of differentiation increased through time, particularly in antipredator defence traits. This suggests that divergent selection between the habitats occurred and was stable through much of the time since colonization. Recently, increased phenotypic differentiation in antipredator defence traits likely results from habitat-dependent selection on alleles that arrived through introgression from a distantly related lineage from outside the Lake Geneva region. This illustrates how hybridization can quickly promote phenotypic divergence in a system where adaptation from standing genetic variation was constrained.

Disentangling the role of phenotypic plasticity and genetic divergence in contemporary ecotype formation during a biological invasion

The occurrence of contemporary ecotype formation through adaptive divergence of populations within the range of an invasive species typically requires standing genetic variation but can be facilitated by phenotypic plasticity. The relative contributions of both of these to adaptive trait differentiation have rarely been simultaneously quantified in recently diverging vertebrate populations. Here we study a case of intraspecific divergence into distinct lake and stream ecotypes of threespine stickleback that evolved in the past 140 years within the invasive range in Switzerland. Using a controlled laboratory experiment with full-sib crosses and treatments mimicking a key feature of ecotypic niche divergence, we test if the phenotypic divergence that we observe in the wild results from phenotypic plasticity or divergent genetic predisposition. Our experimental groups show qualitatively similar phenotypic divergence as those observed among wild adults. The relative contribution of plasticity and divergent genetic predisposition differs among the traits studied, with traits related to the biomechanics of feeding showing a stronger genetic predisposition, whereas traits related to locomotion are mainly plastic. These results implicate that phenotypic plasticity and standing genetic variation interacted during contemporary ecotype formation in this case.

Anke von Kügelgen on Contemporary Islamic Thought

Anke von Kügelgen joins Peter to discuss developments over the last century or so, including attitudes towards past thinkers like Avicenna, Averroes and Ibn Taymiyya. This interview is based on research conducted to write a forthcoming book on Philosophy in the Islamic world in the 19th and 20th centuries, to be co-edited by Prof von Kügelgen together Professor Ulrich Rudolph, and Michael Frey as redactor. It will be the fourth volume of a German Overview of the whole history of philosophy in the Islamic world (Grundriss der Geschichte der Philosophie in der islamischen Welt, published by Schwabe Verlag in Basel). Prof von Kügelgen would like to recognize the contribution of her collaborators: her main partner for the philosophy in the Arab speaking countries is Sarhan Dhouib, originally from Tunesia, now at the University of Kassel. For Muslim Southasia, she is working with Jan Peter Hartung from the SOAS in London, and for Iran, Reza Hajatpour, Katajun Amirpur and Roman Seidel who are all at present at German Universities. The part on Philosophy in the Ottoman Empire is written by Sait Özervarlı from the Yildiz Teknik Universitesi in Istanbul and for Turkey by Christoph Herzog from the University of Bamberg.

Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†.

Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014.