Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience

BACKGROUND: Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size. However, the safety and feasibility of such an approach has not been adequately established. METHODS: In this single-center prospective study we examined 73 consecutive patients who had an acute STEMI and at least one or more lesions > or = 70% in a major epicardial vessel other than the infarct-related artery. In the first 28 patients, forming the multi-vessel (MV) PCI group, all lesions were treated during the primary procedure. In the following 45 patients, forming the culprit-only (CO) PCI group, only the culprit lesion was treated during the initial procedure, followed by either planned-staged or ischemia-driven revascularization of the non-culprit lesions. Fluoroscopy time and contrast dye amount were compared between both groups, and patients were followed up for one year for major adverse cardiac events (MACE) and other significant clinical events. RESULTS: The two groups were well balanced in terms of clinical characteristics, number of diseased vessels and angiographic characteristics of the culprit lesion. In the MV-PCI group, 2.51 lesions per patient were treated using 2.96 +/- 1.34 stents (1.00 lesions and 1.76 +/- 1.17 stents in the CO-PCI group, both p < 0.001). The fluoroscopy time increased from 10.3 (7.2-16.9) min in the CO-PCI group to 12.5 (8.5-19.3) min in the MV-PCI group (p = 0.22), and the amount of contrast used from 200 (180-250) ml to 250 (200-300) ml, respectively (p = 0.16). Peak CK and CK-MB were significantly lower in patients of the MV-PCI group (843 +/- 845 and 135 +/- 125 vs 1652 +/- 1550 and 207 +/- 155 U/l, p < 0.001 and 0.01, respectively). Similar rates of major adverse cardiac events at one year were observed in the two groups (24% and 28% in multi-vessel and culprit treatment groups, p = 0.73). The incidence of new revascularization in both infarct- and non-infarct-related arteries was also similar (24% and 28%, respectively, p = 0.73). CONCLUSION: We may state from this limited experience that a multi-vessel stenting approach for patients with acute STEMI and multi-vessel disease is feasible and probably safe during routine clinical practice. Our data suggest that this approach may help to limit the infarct size. However, larger studies, perhaps using drug-eluting stents, are still needed to further evaluate the safety and efficiency of this procedure, and whether it is associated with a lower need of subsequent revascularization and lower costs.

[Stem-cell-based approaches for treating inner ear diseases]

The capacity of stem cells to regenerate lost tissue cells has gained recognition among physicians. Despite the successful use of blood stem cells for treating blood cancers, other stem cell types have not yet been widely introduced into clinical practice. Therapy options involving stem cells for inner ear diseases consequently have not been implemented. Nonetheless, several reports have recently been published describing the generation of morphologically and immunologically distinctive inner ear cell types-such as hair cells, supporting cells, and spiral ganglion neurons-from stem cells. Although promising, all of these studies still lack functional results regarding hearing restoration or vestibular function.

Insider Trading in Germany - Do Corporate Insiders Exploit Inside Information?

Our study focuses on the question whether corporate insiders in Germany exploit inside information while trading in their company’s stock. In contrast to prior international studies, which are not able to link insider transactions to a formal definition of inside information, we relate insider transactions to subsequent releases of inside information via ad-hoc news disclosures. We find evidence that corporate insiders as a group seem to trade on inside information. Moreover, members of the supervisory board seem to be most active in exploiting inside information, since they realize exceptionally high profits with their frequent front-running transactions.

Johannis Buxtorfi Epitome grammaticae Hebraeae, breviter et methodicè : ... adjecta succincta de mutatione punctorum vocalium instructio...

Auf d. hinteren Vorsatz viele Anmerkungen von alter Hand, Signatur: "Johannes Bernhardus Waldschmidt, Fr. Anno 1666" Dabei handelt es sich wahrscheinl. um einen Frankfurter Bibliothekar dieser Zeit. - Auf dem Titelblatt weitere Signatur: Philippus Jacobus Waldschmidt, Ff 1652. Überklebte Schnittstelle.

Theoretische und praktische Überlegungen für die Evaluation komplexer Interventionen zur Verbesserung der Behandlungsqualität

Komplexe Interventionen wie z.B. klinische Behandlungspfade leisten einen Beitrag zu verbesserten Patientenergebnissen – falls sie denn gut implementiert sind. Sie stellen hohe Anforderungen an die Evaluation: Im Vorfeld müssen Überlegungen zu Kontext und zu angenommenen Ursache-Wirkungs-Zusammenhängen stattfinden und wichtige Stakeholder sollten dabei einbezogen sein. Bevor nach der Wirkung einer Maßnahme gefragt werden kann, muss zuerst deren Implementierung überprüft werden. Andernfalls können Ergebnisse der Wirkungsanalyse nur teilweise mit der Intervention in Verbindung gebracht, und Evaluationsergebnisse können nur schwer für die Verbesserung der Maßnahme genutzt werden.

Understanding E-Bike Users' Behaviour, Motives, and Barriers to the Use - An Empirical Study with high Potential for Mobility Management

A representative study among e-bike owners and tenants in Switzerland (n = 1652) provides a deeper understanding of e-bike users characteristics, motives, values, usage behavior, and barriers to the use. In a micro simulation the implications of the findings for the energy demand and CO2 emissions are estimated.

Belägerung der Vestung Poroto[!] Longone in der Insul Elba, 1650

[Stecher: Caspar Merian]

Grundtriß der Prager Stätte

Betreffend die Belagerung 1648

Bestürmbung der Prager Stätte : 1648

Aus: Theatrum Europaeum ; 6

Sefer Nishmat ḥayim : kolel derushim yeḳarim ṿe-niśgavim ʿal ʿinyan ha-neshamah ...

ha-kol bi-khtav ʿalav ... Menasheh ben Yiśraʾel