Aspiration Thrombectomy for Treatment of ST-segment Elevation Myocardial Infarction: a Meta-analysis of 26 Randomized Trials in 11 943 Patients.

INTRODUCTION AND OBJECTIVES There is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. METHODS We performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. RESULTS We observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. CONCLUSIONS Among unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion. Full English text available from:www.revespcardiol.org/en.

Diet and mobility of an Iron Age population in Switzerland; Stable carbon, nitrogen and sulphur isotope analysis of the human remains from Münsingen

The 220 abundantly equipped burials from the Late Iron Age cemetery of Münsingen (420 – 240 BC) marked a milestone for Iron Age research. The evident horizontal spread throughout the time of occupancy laid the foundation for the chronology system of the Late Iron Age. Today the skulls of 77 individuals and some postcranial bones are still preserved. The aim was to obtain information about nutrition, social stratification and migration of the individuals from Münsingen. Stable isotope ratios of carbon, nitrogen and sulphur were analysed. The results of 63 individuals show that all consumed C3 plants as staple food with significant differences between males and females in δ13C and δ15N values. The results indicate a gender restriction in access to animal protein. Stable isotope values of one male buried with weapons and meat as grave goods suggest a diet with more animal proteins than the other individuals. It is possible that he was privileged due to high status. Furthermore, the δ34S values indicate minor mobility. Assuming that the subadults represent the local signal of δ34S it is very likely that adults with enriched δ34S could have migrated to Münsingen at some point during their lives. This study presents stable isotope values of one of the most important Late Iron Age burial sites in Central Europe. The presented data provide new insight into diet, migration and social stratification of the population from Münsingen.

Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population.

BackgroundIn Switzerland assisted suicide is legal if no self-interest is involved.AimsTo compare the strength and direction of associations with sociodemographic factors between assisted and unassisted suicides.MethodWe calculated rates and used Cox and logistic regression models in a longitudinal study of the Swiss population.ResultsAnalyses were based on 5 004 403 people, 1301 assisted and 5708 unassisted suicides from 2003 to 2008. The rate of unassisted suicides was higher in men than in women, rates of assisted suicides were similar in men and women. Higher education was positively associated with assisted suicide, but negatively with unassisted. Living alone, having no children and no religious affiliation were associated with higher rates of both.ConclusionsSome situations that indicate greater vulnerability such as living alone were associated with both assisted and unassisted suicide. Among the terminally ill, women were more likely to choose assisted suicide, whereas men died more often by unassisted suicide.

Identfying predictors of St. Louis encephalitis activity in Houston Texas

Generalized linear Poisson and logistic regression models were utilized to examine the relationship between temperature and precipitation and cases of Saint Louis encephalitis virus spread in the Houston metropolitan area. The models were investigated with and without repeated measures, with a first order autoregressive (AR1) correlation structure used for the repeated measures model. The two types of Poisson regression models, with and without correlation structure, showed that a unit increase in temperature measured in degrees Fahrenheit increases the occurrence of the virus 1.7 times and a unit increase in precipitation measured in inches increases the occurrence of the virus 1.5 times. Logistic regression did not show these covariates to be significant as predictors for encephalitis activity in Houston for either correlation structure. This discrepancy for the logistic model could be attributed to the small data set.^ Keywords: Saint Louis Encephalitis; Generalized Linear Model; Poisson; Logistic; First Order Autoregressive; Temperature; Precipitation. ^

Clay mineral and heavy metal composition of sea-bed surface sediments and pre-Holocene sediment samples taken during POLARSTERN cruise ANT-XXIII/9

Surface mineralogical compositions and their association to modern processes are well known from the east Atlantic and south-west Indian sectors of the Southern Ocean, but data from the interface of these areas - the Prydz Bay-Kerguelen region - is still missing. The objective of our study was to provide mineralogical data of reference samples from this region and to relate these mineralogical assemblages to hinterland geology, weathering, transport and depositional processes. Clay mineral assemblages were analysed by means of X-ray diffraction technique. Heavy mineral assemblages were determined by counting of gravity-separated grains under a polarizing microscope. Results show that by use of clay mineral assemblages four mineralogical provinces can be subdivided: i) continental shelf, ii) continental slope, iii) deep sea, iv) Kerguelen Plateau. Heavy mineral assemblages in the fine sand fraction are relatively uniform except for samples taken from the East Antarctic shelf. Our findings show that mineralogical studies on sediment cores from the study area have the potential to provide insights into past shifts in ice-supported transport and activity and provenance of different water masses (e.g. Antarctic slope current and deep western boundary current) in the Prydz Bay-Kerguelen region.

Heat flow in the Central Basin of the Indian Ocean and the northern part of the Afanasy Nikitin Rise

Heat flux data obtained during Cruise 20 of R/V Akademik Mstislav Keldysh in the Central Basin of the Indian Ocean and northern part of the Afanasy Nikitin Rise are presented. Thermal conditions on the rise are not associated with an anomalous zone of the large tectonic deformation block north of it. Geothermal data indicate that the Afanasy Nikitin Rise has formed near an ancient spreading axis. Distribution of measured heat flux values indicates an additional source of heat in the Central Basin resulting from dissipative heating of the crust in the two-stage plate tectonics model.

Stable carbon and nitrogen isotopic ratios of cores from the Bering Sea

Stable carbon and nitrogen isotopic ratios (d13C and d15N) of organic matter were measured in three sediment cores from deep basins of the Bering Sea to investigate past changes in surface nutrient conditions. For surface water reconstructions, hemipelagic layers in the cores were distinguished from turbidite layers (on the basis of their sedimentary structures and 14C ages) and analyzed for isotopic studies. Although d13C profiles may have been affected by diagenesis, both d15N and d13C values showed common positive anomalies during the last deglaciation. We explain these anomalies as reflecting suppressed vertical mixing and low nutrient concentrations in surface waters caused by injection of meltwater from alpine glaciers around the Bering Sea.

Element concentrations, and Sr and Os isotope ratios of DSDP Leg 92 metalliferous carbonates

The Os concentration and isotopic composition of metalliferous carbonates deposited on the East Pacific Rise over the past 28 Ma are reported with complimentary Sr isotope data. Variations in the Os isotopic composition of these samples are interpreted as a record of past changes in the Os isotopic composition of seawater. These results are consistent with isotopic analyses of leachable Os in pelagic clays which have also been interpreted as a record of the 187Os/186Os ratio of seawater through time (Pegram et al., 1992, doi:10.1016/0012-821X(92)90132-F). The metalliferous carbonate record clearly shows that seawater Os and Sr isotope systems are partially decoupled from one another over the past 28 Ma. Accelerated weathering of ancient organic-rich sediments is suggested as a possible mechanism to account for this decoupling and the rapid increase in the 187Os//186Os ratio of seawater over the past 15 Ma. This rapid increase suggests that the seawater Os record can potentially be used as a stratigraphic tool in some Neogene marine deposits.

Coarse-sand ice-rafted debris components and mass accumulation rates of ODP Site 152-918

To understand the late Cenozoic glacial history of the Northern Hemisphere, continuous long-term proxy records from climatically sensitive regions must be examined. Ice-rafted debris (IRD) from Ocean Drilling Program (ODP) Site 918, located in the Irminger Basin, is one such record. IRD in marine sediments is a direct indicator of the presence of glacial ice extending to sea level on adjacent landmasses, and, therefore, is an important paleoclimatic signal from the mid- to high latitudes. The IRD record at Site 918 is the first long-term ice-rafting record available for southeast Greenland, a region that may have been a key nucleation area for widespread glaciation during the late Cenozoic (Larsen et al, 1994, doi:10.2973/odp.proc.ir.152.1994). This data report presents the results of coarse sand-size IRD mass accumulation rate (MAR) analyses for Site 918 from the late Miocene through the Pleistocene. In addition, a preliminary analysis of IRD compositions is included. Detailed discussions of the local, regional, and global paleoclimatic implications of this data, and of the companion Site 919 Pleistocene IRD MAR data (Krissek, 1999, doi:10.2973/odp.proc.sr.163.118.1999), are in preparation. Such future work will include comparisons of these IRD MAR data sets to the Site 919 oxygen isotope stratigraphy developed by Flower (1998, doi:10.2973/odp.proc.sr.152.219.1998).

Chemical composition of basalts and minerals from basalts of the Bouvet triple junction

This study focuses on mafic volcanic rocks from the Bouvet triple junction, which fall into six geochemically distinct groups: (1) N-MORB, the most widespread type, encountered throughout the study area. (2) Subalkaline volcanics, hawaiites and mugearites strongly enriched in lithophile elements and radiogenic isotopes and composing the Bouvet volcanic rise, and compositionally similar basalts and basaltic andesites from the Spiess Ridge, generated in a deeper, fertile mantle region. (3) Relatively weakly enriched basalts, T-MORB derived by the mixing of Type 1 and 2 melts and exposed near the axes of the Mid-Atlantic, Southwest Indian, and America-Antarctic Ridges. (4) Basalts with a degree of trace lithophile element enrichment similar to the Spiess Ridge and Bouvet Island rocks, but higher in K, P, Ti, and Cr. These occur within extensional structures: the rift valley of the Southwest Indian Ridge, grabens of the East Dislocation Zone, and the linear rise between the Spiess Ridge and Bouvet volcano. Their parental melts presumably separated from plume material that spread from the main channels and underwent fluid-involving differentiation in the mantle. (5) A volcanic suite ranging from basalt to rhyolite, characterized by low concentrations of lithophile elements, particularly TiO2, and occurring on the Shona Seamount and other compressional features within the Antarctic and South American plates near the Bouvet triple junction. Unlike Types 1 to 4, which display tholeiitic differentiation trends, this suite is calc-alkaline. Its parental melts were presumably related to the plume material as well but, subsequently, they underwent a profound differentiation involving fluids and assimilated surrounding rocks in closed magma chambers in the upper mantle. Alternatively, the Shona Seamount might be a fragment of an ancient oceanic island arc. (6) Enriched basalts, distinguished from the other enriched rock types in very high P and radiogenic isotope abundances and composing a tectonic uplift near the junction of the three rifts. It thus follows that the main factors responsible for the compositional diversity of volcanic rocks in this region include (i) mantle source heterogeneity, (ii) plume activity, (iii) an intricate geodynamic setup at the triple junction giving rise to stresses in adjacent plate areas, and (iv) the geological prehistory. The slow spreading rate and ensuing inefficient mixing of the heterogeneous mantle material result in strong spatial variations in basaltic compositions.