Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey

AIMS Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.

Prospective analysis of adrenal function in patients with acute exacerbations of COPD: the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial

OBJECTIVE To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD). DESIGN Prospective observational study. SUBJECTS AND METHODS Patients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 μg corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment. RESULTS A total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496±398 and 816±413 nmol/l respectively) and lowest on day 6 (235±174 and 453±178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis. CONCLUSION Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.

Case-control study of association of maternal recall of diarrhea or use of antimicrobials in the periconceptional period and neural tube defects

In June 1995 a case-control study was initiated by the Texas Department of Health among Mexican American women residing in the fourteen counties of the Texas-Mexico border. Case-women had carried infants with neural tube defect. Control-women had given birth to infants without neural tube defects. The case-control protocol included a general questionnaire which elicited information regarding illnesses experienced and antibiotics taken from three months prior to conception to three months after conception. An assessment of the associations between periconceptional diarrhea and the risk of neural tube defects indicated that the unadjusted association of diarrhea and risk of neural tube defect was significant (OR = 3.3, CI = 1.4–7.6). The unadjusted association of use of oral antimicrobials and risk of neural tube defect was also significant (OR = 3.4, CI = 1.6–7.3). These associations persisted among women who had no fever during the periconceptional period and were present irrespective of folate intake. Diarrhea was associated with an increased risk of NTD independent of use of antimicrobials. The converse was also true; antimicrobials were associated with an increased risk of NTD independent of diarrhea. Further research regarding these potentially modifiable risk factors is warranted. Replication of these findings could result in interventions in addition to folate supplementation. ^

Intensive use of aluminium in car body construction

The developments in materials over the last decade have been considerable within the automotive industry, being one of the leaders in innovative product applications. Sustainable product development of an automotive structure requires a balanced approach towards technological, economical and ecological aspects. The introduction of new materials and processes is dependent on satisfying different factors. Competitive and legislative pressures, creating the need for change, affect these factors considerably. The process, direction and speed of change are often reactive. Current paper shows the application of aluminium alloys, for the use in the bottom structure of a car to face the problem for the weight of the entire bottom structure under static load conditions, including stiffness, strength and buckling constraints. In addition to minimized mass and materials' price, the assessment of an environmental impact of materials-candidates during the entire life cycle of the structure is considered.

Use of STATCOM in wind farms with fixed-speed generators for grid code compliance

The increasing penetration of wind energy into power systems has pushed grid operators to set new requirements for this kind of generating plants in order to keep acceptable and reliable operation of the system. In addition to the low voltage ride through capability, wind farms are required to participate in voltage support, stability enhancement and power quality improvement. This paper presents a solution for wind farms with fixed-speed generators based on the use of STATCOM with braking resistor and additional series impedances, with an adequate control strategy. The focus is put on guaranteeing the grid code compliance when the wind farm faces an extensive series of grid disturbances.

Modeling the Real-Time Use of Reserves in the Joint Energy and Reserve Hourly Scheduling of a Pumped Storage Plant

This paper studies the impact that different approaches of modeling the real-time use of the secondary regulation reserves have in the joint energy and reserve hourly scheduling of a price-taker pumped-storage hydropower plant. The unexpected imbalance costs due to the error between the forecasted real-time use of the reserves and the actual value are also studied and evaluated for the different approaches. The proposed methodology is applied to a daily-cycle and closed-loop pumped-storage hydropower plant. Preliminary results show that the deviations in the water volume at the end of the day are important when the percentage of the real-time use of reserves is unknown in advance, and also that the total income in all approaches after correcting these deviations is significantly lower than the maximum theoretical income.