Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type.

AIM: To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). METHODS AND RESULTS: Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES  vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). CONCLUSION: A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957).

Cell viability and noninvasive in vivo MRI tracking of 3D cell encapsulating self-assembled microcontainers.

Several molecular therapies require the implantation of cells that secrete biotherapeutic molecules and imaging the location and microenvironment of the cellular implant to ascertain its function. We demonstrate noninvasive in vivo magnetic resonance imaging (MRI) of self-assembled microcontainers that are capable of cell encapsulation. Negative contrast was obtained to discern the microcontainer with MRI; positive contrast was obtained in the complete absence of background signal. MRI on a clinical scanner highlights the translational nature of this research. The microcontainers were loaded with cells that were dispersed in an extracellular matrix, and implanted both subcutaneously and in human tumor xenografts in SCID mice. MRI was performed on the implants, and microcontainers retrieved postimplantation showed cell viability both within and proximal to the implant. The microcontainers are characterized by their small size, three dimensionality, controlled porosity, ease of parallel fabrication, chemical and mechanical stability, and noninvasive traceability in vivo.

What determines the wavelength of self-organized shoreline sand waves?

Shoreline undulations extending into the bathymetric contours with a length scale larger than that of the rhythmic surf zone bars are referred to as shoreline sand waves. Many observed undulations along sandy coasts display a wavelength in the order 1-7 km. Several models that are based on the hypothesis that sand waves emerge from a morphodynamic instability in case of very oblique wave incidence predict this range of wavelengths. Here we investigate the physical reasons for the wavelength selection and the main parametric trends of the wavelength in case of sand waves arising from such instability. It is shown that the existence of a minimum wavelength depends on an interplay between three factors affecting littoral drift: (A) the angle of wave fronts relative to local shoreline, which tends to cause maximum transport at the downdrift flank of the sand wave, (B) the refractive energy spreading which tends to cause maximum transport at the updrift flank and (C) wave focusing (de-focusing) by the capes (bays), which tends to cause maximum transport at the crest or slightly downdrift of it. Processes A and C cause decay of the sand waves while process B causes their growth. For low incidence angles, B is very weak so that a rectilinear shoreline is stable. For large angles and long sand waves, B is dominant and causes the growth of sand waves. For large angles and short sand waves C is dominant and the sand waves decay. Thus, wavelength selection depends on process C, which essentially depends on shoreline curvature. The growth rate of very long sand waves is weak because the alongshore gradients in sediment transport decrease with the wavelength. This is why there is an optimum or dominant wavelength. It is found that sand wave wavelength scales with λ0/β where λ0 is the water wave wavelength in deep water and β is the mean bed slope from shore to the wave base.

The 10 Step Equal Pay Self-Audit for Employers

This publication is a 10-step audit for employers to see if they are paying their female employees as much as their male employees

Qualitative modeling identifies IL-11 as a novel regulator in maintaining self-renewal in human pluripotent stem cells.

Pluripotency in human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs) is regulated by three transcription factors-OCT3/4, SOX2, and NANOG. To fully exploit the therapeutic potential of these cells it is essential to have a good mechanistic understanding of the maintenance of self-renewal and pluripotency. In this study, we demonstrate a powerful systems biology approach in which we first expand literature-based network encompassing the core regulators of pluripotency by assessing the behavior of genes targeted by perturbation experiments. We focused our attention on highly regulated genes encoding cell surface and secreted proteins as these can be more easily manipulated by the use of inhibitors or recombinant proteins. Qualitative modeling based on combining boolean networks and in silico perturbation experiments were employed to identify novel pluripotency-regulating genes. We validated Interleukin-11 (IL-11) and demonstrate that this cytokine is a novel pluripotency-associated factor capable of supporting self-renewal in the absence of exogenously added bFGF in culture. To date, the various protocols for hESCs maintenance require supplementation with bFGF to activate the Activin/Nodal branch of the TGFβ signaling pathway. Additional evidence supporting our findings is that IL-11 belongs to the same protein family as LIF, which is known to be necessary for maintaining pluripotency in mouse but not in human ESCs. These cytokines operate through the same gp130 receptor which interacts with Janus kinases. Our finding might explain why mESCs are in a more naïve cell state compared to hESCs and how to convert primed hESCs back to the naïve state. Taken together, our integrative modeling approach has identified novel genes as putative candidates to be incorporated into the expansion of the current gene regulatory network responsible for inducing and maintaining pluripotency.

Self Instructional Math, HR-324, 1995

The Self Instructional Math course book is designed to provide a basic math knowledge for those involved in the planning, design, and construction of highways. It was developed in a manner to allow the student to take the course with minimal supervision and at times that the work schedule allows. The first version of the course was developed in the early 1970's and due to its popularity was revised in the early 1990's to reflect changes in the highway construction math needs. The anticipated move to metric (System International) measurements by the highway industry has necessitated the need to change the math course problem values to metric units. The course includes the latest in Iowa DOT policy information relative to the selection and use of metric values for highway design, and construction. Each unit of the book contains instructional information, section quizzes and a comprehensive examination. All problem values are expressed in metric rather than dual (english and SI) units. The appendix contains useful conversion factors to assist the reader in making the change to metric.

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 912 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. PassingBablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis

Besoins, prescriptions et sécurité des produits sanguins labiles ; autosuffisance en produits sanguins labiles [Roundtables of SFTS Congress 2013: Needs, indications and safety of blood products; self-sufficiency in blood products].

The current issues debate brings together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products are confronted.

On-pump fibrillating heart mitral valve replacement with the SAPIEN? XT transcatheter heart valve.

In some high-risk patients, standard mitral valve replacement can represent a challenging procedure, requiring a risky extensive decalcification of the annulus. In particular, high-risk redo patients and patients with a previously implanted transcatheter aortic valve, who develop calcific mitral disease, would benefit from the development of new, minimally invasive, transcatheter or hybrid techniques for mitral valve replacement. In particular, mixing transcatheter valve therapies and well-established minimally invasive techniques for mitral replacement or repair can help in decreasing the surgical risk and the technical complexity. Thus, placing transcatheter, balloon-expandable Sapien? XT stent-valves in calcified, degenerated mitral valves through a right thoracotomy, a left atriotomy and on an on-pump fibrillating heart, represents an attractive alternative to standard surgery in redo patients, in patients with concomitant transcatheter aortic stent-valves in place and in patients with a high-risk profile. We describe this hybrid technique in detail.

Development of Self-Cleaning Box Culvert Designs, TR-545, 2009

The main function of a roadway culvert is to effectively convey drainage flow during normal and extreme hydrologic conditions. This function is often impaired due to the sedimentation blockage of the culvert. This research sought to understand the mechanics of sedimentation process at multi-box culverts, and develop self-cleaning systems that flush out sediment deposits using the power of drainage flows. The research entailed field observations, laboratory experiments, and numerical simulations. The specific role of each of these investigative tools is summarized below: a) The field observations were aimed at understanding typical sedimentation patterns and their dependence on culvert geometry and hydrodynamic conditions during normal and extreme hydrologic events. b) The laboratory experiments were used for modeling sedimentation process observed insitu and for testing alternative self-cleaning concepts applied to culverts. The major tasks for the initial laboratory model study were to accurately replicate the culvert performance curves and the dynamics of sedimentation process, and to provide benchmark data for numerical simulation validation. c) The numerical simulations enhanced the understanding of the sedimentation processes and aided in testing flow cases complementary to those conducted in the model reducing the number of (more expensive) tests to be conducted in the laboratory. Using the findings acquired from the laboratory and simulation works, self-cleaning culvert concepts were developed and tested for a range of flow conditions. The screening of the alternative concepts was made through experimental studies in a 1:20 scale model guided by numerical simulations. To ensure the designs are effective, performance studies were finally conducted in a 1:20 hydraulic model using the most promising design alternatives to make sure that the proposed systems operate satisfactory under closer to natural scale conditions.

Redes sociales online, género y construcción del self

Las Redes Sociales Online (RSO) son cada día más populares. Las últimas investigaciones destacan su relevancia en el proceso de construcción de la identidad de género, ya que se encuentran los estereotipos de género clásicos y modulan el bienestar psicológico de los usuarios. Debido a la carencia de estudios españoles, el objetivo de la presente investigación fue conocer los perfiles de los jóvenes en la red social Facebook en términos de estereotipos de género, de personalidad y para comprender qué relación tiene una determinada presentación con el bienestar psicológico. Participaron en el estudio 112 jóvenes con una media de 23 años. Los instrumentos utilizados fueron la adaptación española del test TIPI (Oberst, Renau, Gosling & Rusiñol, manuscrito no publicado), la escala Redsocs y la Escala de Bienestar Psicológico de Ryff (Díaz & et al., 2006). Los resultados indicaron que las chicas estaban más implicadas en las RSO que los chicos, y que en ellas quieren generar un perfil andrógino, ya que para su bienestar psicológico valoran positivamente poseer tanto características femeninas como masculinas. Se concluye que la lucha para combatir los estereotipos de género se libra en un entorno offline o face to face, ya que las RSO ayudan a controlar estas diferencias.

Viral self-assembly as a thermodynamic process

The protein shells, or capsids, of nearly all spherelike viruses adopt icosahedral symmetry. In the present Letter, we propose a statistical thermodynamic model for viral self-assembly. We find that icosahedral symmetry is not expected for viral capsids constructed from structurally identical protein subunits and that this symmetry requires (at least) two internal switching configurations of the protein. Our results indicate that icosahedral symmetry is not a generic consequence of free energy minimization but requires optimization of internal structural parameters of the capsid proteins

Long-term clinical outcome after sirolimus-stent implantation for in sirolimus-eluting stent restenosis

Rapport de synthèse : But: la resténose intra-stent au sirolimus (SAS) reste un problème clinique. Parmi tes diverses approches thérapeutiques disponibles aujourd'hui aucune n'a la primauté car tes résultats à moyen terme restent relativement médiocres. Méthodologie: les patients souffrant d'une resténose intra-SAS chez lesquels un second SAS a été implanté comme traitement de cette resténose ont été inclus dans ce registre. Lors d'ischémie clinique ou électrique après implantation d'un SAS les malades chez lesquels l'angioplastie au ballon seul ne donnait pas un résultat satisfaisant ont bénéficié de l'implantation d'un stent actif dans un stent actif. Résultats: vingt-sept patients sont inclus dans ce registre. La resténose était de type focale dans 34% des cas, diffuse dans 59% des cas et proliférative dans 7% des cas. La procédure a été un succès chez tous les patients sans complications aiguës durant l'hospitalisation. A 14±7 mois, on dénombre 8 (30%) événements cardiaques majeurs (1 mort, 1 infarctus du myocarde, 4 revascularisations additionnelles de la lésion, 1 revascularisation additionnelle du vaisseau cible). Un patient a subi un pontage aorto-coronarien. Dix-neuf patients (70%) ont évolué sans aucun problème. Conclusion: en conclusion, l'implantation d'un SAS pour traiter une resténose intra-SAS est réalisable avec un très bon résultat immédiat. Cependant, l'incidence d'un événement cardiaque majeur reste élevée à long terme.

Subjective mental time: the functional architecture of projecting the self to past and future.

Abstract Human experience takes place in the line of mental time (MT) created through 'self-projection' of oneself to different time-points in the past or future. Here we manipulated self-projection in MT not only with respect to one's life events but also with respect to one's faces from different past and future time-points. Behavioural and event-related functional magnetic resonance imaging activity showed three independent effects characterized by (i) similarity between past recollection and future imagination, (ii) facilitation of judgements related to the future as compared with the past, and (iii) facilitation of judgements related to time-points distant from the present. These effects were found with respect to faces and events, and also suggest that brain mechanisms of MT are independent of whether actual life episodes have to be re-experienced or pre-experienced, recruiting a common cerebral network including the anteromedial temporal, posterior parietal, inferior frontal, temporo-parietal and insular cortices. These behavioural and neural data suggest that self-projection in time is a fundamental aspect of MT, relying on neural structures encoding memory, mental imagery and self.