Vorapaxar in the Secondary Prevention of Atherothrombotic Events

BACKGROUND Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)

Correlation between carotid bifurcation calcium burden on non-enhanced CT and percentage stenosis, as confirmed by digital subtraction angiography

Objectives: Previous evidence supports a direct relationship between the calcium burden (volume) on post-contrast CT with the percent internal carotid artery (ICA) stenosis at the carotid bifurcation. We sought to further investigate this relationship by comparing non-enhanced CT (NECT) and digital subtraction angiography (DSA). Methods: 50 patients (aged 41-82 years) were retrospectively identified who had undergone cervical NECT and DSA. A 64-multidetector array CT (MDCT) scanner was utilised and the images reviewed using preset window widths/levels (30/300) optimised to calcium, with the volumes measured via three-dimensional reconstructive software. Stenosis measurements were performed on DSA and luminal diameter stenoses >40% were considered "significant". Volume thresholds of 0.01, 0.03, 0.06, 0.09 and 0.12 cm(3) were utilised and Pearson's correlation coefficient (r) was calculated to correlate the calcium volume with percent stenosis. Results: Of 100 carotid bifurcations, 88 were available and of these 7 were significantly stenotic. The NECT calcium volume moderately correlated with percent stenosis on DSA r=0.53 (p<0.01). A moderate-strong correlation was found between the square root of calcium volume on NECT with percent stenosis on DSA (r=0.60, p<0.01). Via a receiver operating characteristic curve, 0.06 cm(3) was determined to be the best threshold (sensitivity 100%, specificity 90.1%, negative predictive value 100% and positive predictive value 46.7%) for detecting significant stenoses. Conclusion: This preliminary investigation confirms a correlation between carotid bifurcation calcium volume and percent ICA stenosis and is promising for the optimal threshold for stenosis detection. Future studies could utilise calcium volumes to create a "score" that could predict high grade stenosis.

Effect of sorbitan-based surfactants on glass transition temperature of cellulose esters

Thermal behavior of mixtures composed of cellulose acetate butyrate (CAB), carboxymethylcellulose acetate butyrate (CMCAB), or cellulose acetate phthalate (CAPh), and sorbitan-based surfactants was investigated as a function of mixture composition by means of differential scanning calorimetry (DSC). Surfactants with three different alkyl chain lengths, namely, polyoxyethylenesorbitan monolaurate (Tween 20), polyoxyethylenesorbitan monopalmitate (Tween 40), and polyoxyethylene sorbitan monostearate (Tween 60) were chosen. DSC measurements revealed that Tween 20, 40, and 60 act as plasticizers for CAB, CMCAB, and CAPh (except for Tween 60), leading to a dramatic reduction of glass transition temperature (T-g). The dependence of experimental T-g values on the mixture composition was compared with theoretical predictions using the Fox equation. Plasticization was strongly dependent on mixture composition, surfactant hydrophobic chain length, and type of cellulose ester functional group.

No evidence for an association between the -36A>C phospholamban gene polymorphism and a worse prognosis in heart failure

Abstract Background In Brazil, heart failure leads to approximately 25,000 deaths per year. Abnormal calcium handling is a hallmark of heart failure and changes in genes encoding for proteins involved in the re-uptake of calcium might harbor mutations leading to inherited cardiomyopathies. Phospholamban (PLN) plays a prime role in cardiac contractility and relaxation and mutations in the gene encoding PLN have been associated with dilated cardiomyopathy. In this study, our objective was to determine the presence of the -36A>C alteration in PLN gene in a Brazilian population of individuals with HF and to test whether this alteration is associated with heart failure or with a worse prognosis of patients with HF. Methods We genotyped a cohort of 881 patients with HF and 1259 individuals from a cohort of individuals from the general population for the alteration -36A>C in the PLN gene. Allele and genotype frequencies were compared between groups (patients and control). In addition, frequencies or mean values of different phenotypes associated with cardiovascular disease were compared between genotypic groups. Finally, patients were prospectively followed-up for death incidence and genotypes for the -36A>C were compared regarding mortality incidence in HF patients. Results No significant association was found between the study polymorphism and HF in our population. In addition, no association between PLN -36A>C polymorphism and demographic, clinical and functional characteristics and mortality incidence in this sample of HF patients was observed. Conclusion Our data do not support a role for the PLN -36A>C alteration in modulating the heart failure phenotype, including its clinical course, in humans.

Prevalence of apical periodontitis detected in cone beam CT images of a Brazilian subpopulation

Objectives The aim of this study was to determine the prevalence of apical periodontitis (AP) detected in cone beam CT (CBCT) images from a database. Methods CBCT images of 300 Brazilian patients were assessed. AP images were measured in three dimensions. Age, gender, number and location of total teeth in each patient were considered. AP location was considered according to tooth groups. The extent of AP was determined by the largest diameter in any of the three dimensions. Percentages and the X2 test were used for statistical analysis. Results AP was found in 51.4% of the patients and in 3.4% of the teeth. Higher prevalence of AP was found in 60- to 69-year-olds (73.1%) and in mandibular molars (5.9%) (p < 0.05). Inadequate endodontic treatment presented higher prevalence of AP (78.1%). Conclusions AP can be frequently found in CBCT examinations. The presence of AP has a significant association with patients' age, and tooth type and condition. CBCT databases are useful for cross-sectional studies about AP prevalence in a population.

Reconstruction from image correspondences

A single picture provides a largely incomplete representation of the scene one is looking at. Usually it reproduces only a limited spatial portion of the scene according to the standpoint and the viewing angle, besides it contains only instantaneous information. Thus very little can be understood on the geometrical structure of the scene, the position and orientation of the observer with respect to it remaining also hard to guess. When multiple views, taken from different positions in space and time, observe the same scene, then a much deeper knowledge is potentially achievable. Understanding inter-views relations enables construction of a collective representation by fusing the information contained in every single image. Visual reconstruction methods confront with the formidable, and still unanswered, challenge of delivering a comprehensive representation of structure, motion and appearance of a scene from visual information. Multi-view visual reconstruction deals with the inference of relations among multiple views and the exploitation of revealed connections to attain the best possible representation. This thesis investigates novel methods and applications in the field of visual reconstruction from multiple views. Three main threads of research have been pursued: dense geometric reconstruction, camera pose reconstruction, sparse geometric reconstruction of deformable surfaces. Dense geometric reconstruction aims at delivering the appearance of a scene at every single point. The construction of a large panoramic image from a set of traditional pictures has been extensively studied in the context of image mosaicing techniques. An original algorithm for sequential registration suitable for real-time applications has been conceived. The integration of the algorithm into a visual surveillance system has lead to robust and efficient motion detection with Pan-Tilt-Zoom cameras. Moreover, an evaluation methodology for quantitatively assessing and comparing image mosaicing algorithms has been devised and made available to the community. Camera pose reconstruction deals with the recovery of the camera trajectory across an image sequence. A novel mosaic-based pose reconstruction algorithm has been conceived that exploit image-mosaics and traditional pose estimation algorithms to deliver more accurate estimates. An innovative markerless vision-based human-machine interface has also been proposed, so as to allow a user to interact with a gaming applications by moving a hand held consumer grade camera in unstructured environments. Finally, sparse geometric reconstruction refers to the computation of the coarse geometry of an object at few preset points. In this thesis, an innovative shape reconstruction algorithm for deformable objects has been designed. A cooperation with the Solar Impulse project allowed to deploy the algorithm in a very challenging real-world scenario, i.e. the accurate measurements of airplane wings deformations.

I dati metereologici per applicazioni energetiche e ambientali

Many energetic and environmental evaluations need appropriate meteorological data, as input to analysis and prevision softwares. In Italy there aren't adeguate meteorological data because, in many cases, they are incomplete, incorrect and also very expensive for a long-term analysis (that needs multi-year data sets). A possible solution to this problem is the use of a Typical Meteorological Year (TRY), generated for specific applications. Nowadays the TRYs have been created, using statistical criteria, just for the analysis of solar energy systems and for predicting the thermal performance of buildings, applying it also to the study of photovoltaic plants (PV), though not specifically created for this type of application. The present research has defined the methodology for the creation of TRYs for different applications. In particular TRYs for environmental and wind plant analysis have been created. This is the innovative aspect of this research, never explored before. In additions, the methodology of the generation for the PV TRYs has been improved. The results are very good and the TRYs generated for these applications are adeguate to characterize the climatic condition of the place over a long period and can be used for energetic and environmental studies.

Messung der B s-Oszillation mit dem semileptonischen Zerfall B 0 s D - s (phi pi -) my + ny my mit dem D0-Detektor

Das Standardmodell (SM) der Teilchenphysik beschreibt sehr präzise die fundamentalen Bausteine und deren Wechselwirkungen (WW). Trotz des Erfolges gibt es noch offene Fragen, die vom SM nicht beantwortet werden können. Ein noch noch nicht abgeschlossener Test besteht aus der Messung der Stärke der schwachen Kopplung zwischen Quarks. Neutrale B- bzw. $bar{B}$-Mesonen können sich innerhalb ihrer Lebensdauer über einen Prozeß der schwachen WW in ihr Antiteilchen transformieren. Durch die Messung der Bs-Oszillation kann die Kopplung Vtd zwischen den Quarksorten Top (t) und Down (d) bestimmt werden. Alle bis Ende 2005 durchgeführten Experimente lieferten lediglich eine untere Grenze für die Oszillationsfrequenz von ms>14,4ps-1. Die vorliegenden Arbeit beschreibt die Messung der Bs-Oszillationsfrequenz ms mit dem semileptonischen Kanal BsD(-)+. Die verwendeten Daten stammen aus Proton-Antiproton-Kollisionen, die im Zeitraum von April 2002 bis März 2006 mit dem DØ-Detektor am Tevatron-Beschleuniger des Fermi National Accelerator Laboratory bei einer Schwerpunktsenergie von $sqrt{s}$=1,96TeV aufgezeichnet wurden. Die verwendeten Datensätze entsprechen einer integrierten Luminosität von 1,3fb-1 (620 millionen Ereignisse). Für diese Oszillationsmessung wurde der Quarkinhalt des Bs-Mesons zur Zeit der Produktion sowie des Zerfalls bestimmt und die Zerfallszeit wurde gemessen. Nach der Rekonstruktion und Selektion der Signalereignisse legt die Ladung des Myons den Quarkinhalt des Bs-Mesons zur Zeit des Zerfalls fest. Zusätzlich wurde der Quarkinhalt des Bs-Mesons zur Zeit der Produktion markiert. b-Quarks werden in $pbar{p}$-Kollisionen paarweise produziert. Die Zerfallsprodukte des zweiten b-Hadrons legen den Quarkinhalt des Bs-Mesons zur Zeit der Produktion fest. Bei einer Sensitivität von msenss=14,5ps-1 wurde eine untere Grenze für die Oszillationsfrequenz ms>15,5ps-1 bestimmt. Die Maximum-Likelihood-Methode lieferte eine Oszillationsfrequenz ms>(20+2,5-3,0(stat+syst)0,8(syst,k))ps-1 bei einem Vertrauensniveau von 90%. Der nicht nachgewiesene Neutrinoimpuls führt zu dem systematischen Fehler (sys,k). Dieses Resultat ergibt zusammen mit der entsprechenden Oszillation des Bd-Mesons eine signifikante Messung der Kopplung Vtd, in Übereinstimmung mit weiteren Experimenten über die schwachen Quarkkopplungen.

Caratterizzazione morfologica e neurochimica dei neuroni sensitivi e motori del trigono vescicale e del muscolo uretrale di maiale

Il trigono della vescica urinaria (UBT) è un'area limitata attraverso la quale penetrano nella vescica la maggior parte dei vasi e fibre e in cui le fibre nervose e neuroni intramurali sono più concentrati. Mediante l’utilizzo combinato di un tracciante retrogrado(FB) e dell’immunoistochimica sono stati valutati il fenotipo e l’area del soma dei neuroni dei gangli spinali (DRG), dei neuroni post-gangliari, il fenotipo dei gangli della catena simpatica (STG) e i gangli mesenterici caudali (CMG) innervanti l’UBT. - Caratterizzazione dei neuroni dei DRG con: peptide correlato al gene della calcitonina (CGRP)(30±3%, 29±3%, rispettivamente), sostanza P(SP)(26±8%, 27±12%), ossido nitrico sintasi neuronale (nNOS)(21±4%; 26±7%), neurofilamento 200kDa (NF200)(75±14%, 81±7% ) , transient receptor potential vanilloid1 (TRPV1)(48±13%, 43±6%) e isolectina-B4-positivi (IB4) (56±6%;43±10%). I neuroni sensoriali, distribuiti da L2 a Ca1 (DRG), hanno presentato una localizzazione segmentale, mostrando maggior densità nei DRG L4-L5 e S2-S4. I neuroni sensoriali lombari sono risultati significativamente più grandi di quelle sacrali (1.112±624μm2 vs716±421μm2). Complessivamente, questi dati indicano che le vie lombari e sacrali probabilmente svolgono ruoli diversi nella trasmissione sensitiva del trigono della vescica urinaria. -I neuroni FB+ della STG e dei CMG sono risultati immunoreattivi per la tirosina idrossilasi (TH)(66±10,1%, 53±8,2%, rispettivamente), la dopamina beta-idrossilasi (DβH)(62±6,2%, 52±6,2%), neuropeptideY (NPY)(59±8%; 66±7%), CGRP(24±3%, 22±3%), SP(22±2%; 38±8%), polipeptide intestinale vasoattivo (VIP)(19±2%; 35±4%), nNOS(15±2%; 33±8%), trasportatore vescicolare dell'acetilcolina (VAChT)(15±2%; 35±5%), leu-encefalina (LENK)(14±7%; 26±9%), e somatostatina (SOM)(12±3%;32±7%).Il numero medio di neuroni FB+ (1845,1±259,3) era nella STG in L1-S3, con i pirenofori più piccoli (465,6±82.7μm2). Un gran numero (4287,5±1450,6) di neuroni FB+ di piccole dimensioni (476,1±103,9μm2) sono stati localizzati lungo il margine dei CMG. Il maggior numero (4793,3±1990,8) di neuroni FB + è stato osservato nel plesso pelvico, dove i neuroni marcati erano raggruppati in micro-gangli e con pirenoforo ancora più piccolo (374,9±85,4 μm2).