bluuebunny/crossref_metadata_2025 huggingface dataset:
Confidence in Brazilian Unions
Authors: Frangi Lorenzo , Memoli Vincenzo
Published: August 2014

Although unions in Brazil are marginally effective in defining the employer-employee relationship, confidence in unions is high and exhibits a positive trend over time. A logistic regression model based on the Latinobarometer data series (1996–2009) empirically verifies that unions’ state embeddedness really does matter in explaining confidence in unions in Brazil (i.e., confidence in government, especially during the Lula presidency, has a significant positive effect). Moreover, people who have a negative perception of their personal economic situations and are less trustful of others are more inclined to have confidence in unions.

Não obstante o efeito bem limitado e marginal dos sindicatos na determinação das relações entre o patrão e o empregado, se mantem alto a confiança nos sindiatos e essa confiança mostra uma tendência positiva no decorrer do tempo. Um modelo de regressão logística baseado no série de dados Latinobarómetro (1996–2009) verifica empiricalmente que a integração dos sindicatos no Estado importa para explicar essa confiança neles, dado que a confiança no governo, sobretudo durante a presidência do Lula, tem tido um efeito positivo. Além disso, as pessoas cuja percepção da sua situação econômica pessoal seja negativa e que tenha menos confiança nos outros inclinam mais para confiar nos sindicatos.
Military Ties between France and Brazil during the Cold War, 1959–1975
Authors: Martins Filho João Roberto
Published: August 2014

An aspect of analyses of the Latin American military dictatorships that has so far been little recognized is the influence of the French concept of the guerre révolutionnaire (revolutionary war) developed by that country’s colonial army when engaged in Algeria in the 1950s. Evidence of this influence contradicts the view that U.S. doctrine was the main ideological factor affecting the military leaders of Brazil, Chile, and Argentina in the 1960s and 1970s.

Há um aspeto, até agora pouco reconhecido, das análises das ditaduras militares do Cono Sul do século XX, é a influência do conceito francês da guerre révolutionnaire (guerra revolucionária), desenvolvido pelo exército colonial desse país na época da luta algeriana de independência. A evidência de tal influência contradiz a concepção da doutrina estadunidense ser o fator ideológico principal compartilhado pelos chefes militares brasileiros, chilenos e argentinos das décadas de 1960 e 1970.
A regularity criterion for the Cahn-Hilliard-Boussinesq system with zero viscosity
Authors: Ma Caochuan , Alzahrani Faris Saeed , Hayat Tasawar , Zhou Yong
Published: August 2014

This paper studies a coupled Cahn-Hilliard-Boussinesq system with zero viscosity. We prove a regularity criterion in terms of vorticity in the homogeneous Besov space

B
˙

∞
,
∞

0

.

MSC:35Q30, 76D03, 76D05, 76D07.
Treatment effects in multiple cognitive domains in Alzheimer’s disease: a two-year cohort study
Authors: Behl Pearl , Edwards Jodi D , Kiss Alexander , Lanctot Krista L , Streiner David L , Black Sandra E , Stuss Donald T
Published: August 2014

Introduction

Despite widespread use of second-generation cholinesterase inhibitors for the symptomatic treatment of Alzheimer’s disease (AD), little is known about the long term effects of cholinergic treatment on global cognitive function and potential specific effects in different cognitive domains. The objectives of this study were to determine the association between cholinergic treatment and global cognitive function over one and two years in a cohort of patients with mild or moderate AD and identify potential differences in domain-specific cognitive outcomes within this cohort.

Methods

A cohort of patients meeting the revised National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for mild or moderate AD, including patients both on treatment with a cholinesterase inhibitor and untreated controls (treated = 65, untreated = 65), were recruited from the Cognitive Neurology Clinic at Sunnybrook Health Sciences Centre, as part of the Sunnybrook Dementia Study. Patients were followed for one to two years and underwent standardized neuropsychological assessments to evaluate global and domain-specific cognitive function. Associations between cholinesterase inhibitor use and global and domain-specific cognitive outcome measures at one and two years of follow-up were estimated using mixed model linear regression, adjusting for age, education, and baseline mini mental state examination (MMSE).

Results

At one year, treated patients showed significantly less decline in global cognitive function, and treatment and time effects across tests of executive and visuospatial function. At two years, there was a significant trend towards less decline in global cognition for treated patients. Moreover, treated patients showed significant treatment and time effects across tests of executive functioning, memory, and visuospatial function.

Conclusions

The present study offers two important contributions to knowledge of the effectiveness of cholinesterase inhibitor treatment in patients with mild-moderate AD: 1) that second-generation cholinesterase inhibitors demonstrate long-term effectiveness for reducing global cognitive decline over one to two years of follow-up, and 2) that decline in function for cognitive domains, including executive function, memory, and visuospatial skill that are primarily mediated by frontal networks and by the cholinergic system, rather than memory, may be slowed by treatment targeting the cholinergic system.
Cuts, concerns and compromise: standards must not be jeopardized
Authors: Cook Rosemary
Published: August 2014

One month into the Right Nurse, Right Skills Campaign, Rosemary Cook summarizes the evidence gathered so far and urges managers and team members to share their views.
The women in my life
Authors: Cox John
Published: August 2014

In the first of a series of columns reflecting on his work in collaboration with health visitors over the years, Professor John Cox recalls his own experiences of becoming a parent and later working alongside an influential health professional in Uganda.
Collection Directions: The Evolution of Library Collections and Collecting
Authors: Dempsey Lorcan , Malpas Constance , Lavoie Brian
Published: August 2014

This article takes a broad view of the evolution of collecting behaviors in a network environment and suggests some future directions based on various simple models. The authors look at the changing dynamics of print collections, at the greater engagement with research and learning behaviors, and at trends in scholarly communication. The goal is to provide context within which libraries can discuss changing patterns of investment across collection categories. The authors argue that the network is reconfiguring not only individual academic libraries but also the whole library system, as reduced transaction costs facilitate the unbundling of functions and their consolidation in network platforms and with other external service providers.
Staying True to the Core: Designing the Future Academic Library Experience
Authors: Bell Steven J.
Published: August 2014

In 2014, the practice of user experience design in academic libraries continues to evolve. It is typically applied in the context of interactions with digital interfaces. Some academic librarians are applying user experience approaches more broadly to design both environments and services with human-centered strategies. As the competition for the time and attention of students and faculty increases, along with expanding options for acquiring scholarly content that more frequently circumvent traditional libraries, academic librarians will seek new methods to understand and engage with the members of their community. This article envisions a future where user experience design moves from the periphery to the core of academic library operations. While it is a future shaped by advanced technology that radically changes user expectations, the author imagines an experience that is futuristic but rooted in the core values of contemporary academic library practice.
Electrochemical Performance of LiNi0.5Mn1.5O4 by Sol-gel Self-combustion Reaction Method in Different Kinds of Electrolyte for High-voltage Rechargeable Lithium Cells
Authors: Liang Xinghua , Shi Lin , Liu Yusi , Zeng Shuaibo , Ye Chaochao
Published: August 2014

LiNi
Finite Element Simulations on Erosion and Crack Propagation in Thermal Barrier Coatings
Authors: Ma Z. S. , Fu L. H. , Yang L. , Zhou Y. C. , Lu C.
Published: August 2014

Erosion of thermal barrier coatings occurs when atmospheric or carbon particles from the combustion chamber are ingested into aviation turbine engines. To understand the influence of erosion on the service life of thermal barrier coatings, we introduce the erosion and crack propagation models, and then by using finite element simulations, determine the relationship between the penetrating depth, the maximum principle stress and impingement variables such as velocity and angle. It is shown that cracks nucleate and extend during the erosion process and the length of a crack increases with the increase of the particle velocity and impact angle.
Impact of layup rate on the quality of fiber steering/cut-restart in automated fiber placement processes
Authors: Chen Jihua , Chen-Keat Teresa , Hojjati Mehdi , Vallee AJ , Octeau Marc-Andre , Yousefpour Ali
Published: August 2014

Developing reliable processes is one of the key elements in producing high-quality composite components using an automated fiber placement (AFP) process. In this study, both simulation and experimental studies were carried out to investigate fiber steering and cut/restart under different processing parameters, such as layup rate and compaction pressure, during the AFP process. First, fiber paths were designed using curved fiber axes with different radii. Fiber placement trials were then conducted to investigate the quality of the steered fiber paths. Furthermore, a series of sinusoidal fiber paths were fiber placed and investigated. Moreover, a six-ply laminate with cut-outs in it was manufactured in the cut/restart trials. The accuracy of the fiber cut/restart was compared at different layup rates for both one- and bi-directional layups. Experimental results show that it was possible to layup steered fiber paths with small radii of curvature (minimum 114 mm) designed for this study when the proper process condition was used. It was observed from the cut/restart trials that the quality of tow cut was independent of layup speed; however, the accuracy of tow restart was related to the layup speed. The faster the layup speed, the less accurate was the tow restart.
Competing Risks of Cancer Mortality and Cardiovascular Events in Individuals with Multimorbidity
Authors: Bayliss Elizabeth A. , Reifler Liza M. , Zeng Chan , McQuillan Deanna B. , Ellis Jennifer L. , Steiner John F.
Published: August 2014

Background

Cancer patients with cardiovascular and other comorbidities are at concurrent risk of multiple adverse outcomes. However, most treatment decisions are guided by evidence from single-outcome models, which may be misleading for multimorbid patients.

Objective

We assessed the interacting effects of cancer, cardiovascular, and other morbidity burdens on the competing outcomes of cancer mortality, serious cardiovascular events, and other-cause mortality.

Design

We analyzed a cohort of 6,500 adults with initial cancer diagnosis between 2001 and 2008, SEER 5-year survival ≥26%, and a range of cardiovascular risk factors. We estimated the cumulative incidence of cancer mortality, a serious cardiovascular event (myocardial infarction, coronary revascularization, or cardiovascular mortality), and other-cause mortality over 5 years, and identified factors associated with the competing risks of each outcome using cause-specific Cox proportional hazard models.

Results

Following cancer diagnosis, there were 996 (15.3%) cancer deaths, 328 (5.1%) serious cardiovascular events, and 542 (8.3%) deaths from other causes. In all, 4,634 (71.3%) cohort members had none of these outcomes. Although cancer prognosis had the greatest effect, cardiovascular and other morbidity also independently increased the hazard of each outcome. The effect of cancer prognosis on outcome was greatest in year 1, and the effect of other morbidity was greater in individuals with better cancer prognoses.

Conclusion

In multimorbid oncology populations, comorbidities interact to affect the competing risk of different outcomes. Quantifying these risks may provide persons with cancer plus cardiovascular and other comorbidities more accurate information for shared decision-making than risks calculated from single-outcome models.
(Re)presentar as identidades: a construción discursiva do xénero na conversación
Authors: Basanta Noemi
Published: August 2014

Nas últimas décadas, xurdiron no ámbito académico inves­tigacións realizadas desde a psicoloxía, socioloxía, antro­poloxía, historia ou lingüística que comezaron a contem­plar a creación das identidades como o resultado dunha elaboración contextualmente dependente e lingüistica­mente mediada que pode ser levada a cabo de maneira máis ou menos consciente por parte dos individuos. No presente traballo centraremos a atención neste proceso de (re)construción das identidades de xénero, afastándonos do esencialismo e á luz das transformacións históricas da argumentación feminista no seu estado actual. Emprega­remos un corpus de dúas horas de gravación realizadas a tres matrimonios heterosexuais, primeiro distribuídos en dous grupos homoxenéricos e posteriormente nun mes­mo grupo mixto no que participaron as seis persoas. Os temas marco que lles propuxemos —falar de “cuestións importantes para vós” e de “mocear”— buscan promover as construcións de xénero e mostrar como a conformación das identidades pode realizarse a través da estruturación e o desenvolvemento temático durante as conversas colo­quiais. Tomando como punto de partida as teorías Queer e os estudos de lingua e xénero máis recentes, asumire­mos a necesidade de non aplicar categorías de xénero estábeis sobre as nocións de feminidade ou masculinida­de e por ese motivo prestaremos atención ás flutuacións e posicións intermedias que aparecen nas conversas que gravamos. Defenderemos que a lingua debe contemplarse non só como un medio para reflectir as identidades senón tamén para crealas. Este traballo mostra que as persoas constrúen identidades de xénero durante as conversa­cións a través das súas negociacións temáticas e non sem­pre se adaptan aos roles sociais estabelecidos.
Resolution of Genetic Map Expansion Caused by Excess Heterozygosity in Plant Recombinant Inbred Populations
Authors: Truong Sandra K , McCormick Ryan F , Morishige Daryl T , Mullet John E
Published: August 2014

Recombinant inbred populations of many plant species exhibit more heterozygosity than expected under the Mendelian model of segregation. This segregation distortion causes the overestimation of recombination frequencies and consequent genetic map expansion. Here we build upon existing genetic models of differential zygotic viability to model a heterozygote fitness term and calculate expected genotypic proportions in recombinant inbred populations propagated by selfing. We implement this model using the existing open-source genetic map construction code base for R/qtl to estimate recombination fractions. Finally, we show that accounting for excess heterozygosity in a sorghum recombinant inbred mapping population shrinks the genetic map by 213 cM (a 13% decrease corresponding to 4.26 fewer recombinations per meiosis). More accurate estimates of linkage benefit linkage-based analyses used in the identification and utilization of causal genetic variation.
Performance of the Cas9 Nickase System inDrosophila melanogaster
Authors: Ren Xingjie , Yang Zhihao , Mao Decai , Chang Zai , Qiao Huan-Huan , Wang Xia , Sun Jin , Hu Qun , Cui Yan , Liu Lu-Ping , Ji Jun-Yuan , Xu Jiang , Ni Jian-Quan
Published: August 2014

Recent studies of the Cas9/sgRNA system in Drosophila melanogaster genome editing have opened new opportunities to generate site-specific mutant collections in a high-throughput manner. However, off-target effects of the system are still a major concern when analyzing mutant phenotypes. Mutations converting Cas9 to a DNA nickase have great potential for reducing off-target effects in vitro. Here, we demonstrated that injection of two plasmids encoding neighboring offset sgRNAs into transgenic Cas9D10A nickase flies efficiently produces heritable indel mutants. We then determined the effective distance between the two sgRNA targets and their orientations that affected the ability of the sgRNA pairs to generate mutations when expressed in the transgenic nickase flies. Interestingly, Cas9 nickase greatly reduces the ability to generate mutants with one sgRNA, suggesting that the application of Cas9 nickase and sgRNA pairs can almost avoid off-target effects when generating indel mutants. Finally, a defined piwi mutant allele is generated with this system through homology-directed repair. However, Cas9D10A is not as effective as Cas9 in replacing the entire coding sequence of piwi with two sgRNAs.
The Evolution of Lead Extraction
Authors: Maytin Melanie , Epstein Laurence M ,   Clinical Electrophysiology Fellow,   Chief, Arrhythmia Service, and Director, Electrophysiology Laboratory, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02215, US. E: lmepstein@partners.org
Published: August 2014

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.
Drug Interactions in Pulmonary Arterial Hypertension and Their Implications
Authors: Hossein-Ardeschir Ghofrani , Schermuly Ralph , Weissmann Norbert , Voswinckel Robert , Gall Henning , Seeger Werner , Grimminger Friedrich ,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH, Klinikstrasse 36, 35385 Giessen, Germany. E: Ardeschir.Ghofrani@innere.med.uni-giessen.de,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH,   Medical Clinic II/V, University Hospital Giessen and Marburg GmbH
Published: August 2014

Medical intervention is necessary in the treatment of pulmonary arterial hypertension (PAH) in order to prevent chronic disease progression and clinical deterioration. Recent years have seen the development of new disease-specific drugs, such as endothelin receptor antagonists (ERAs). However, there remains the potential for drug–drug interactions (DDIs), which can adversely affect drug metabolism and therefore treatment efficacy, an especially significant factor to consider in light of the increasing use of combination therapy in PAH and the ageing patient population who may also suffer age-related diseases requiring concomitant drug therapy. The ERA ambrisentan has demonstrated lower liver toxicity and fewer DDIs than other ERAs. The lack of any significant drug interactions with commonly used adjunct therapies such as warfarin or sildenafil could potentially improve treatment efficacy as well as patient safety.
Blood Pressure Control – The Role of Single-pill Combination Therapies
Authors: Burnier Michel ,   Nephrology and Hypertension Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 17, 1011 Lausanne, Switzerland. E: michel.burnier@chuv.ch
Published: August 2014

It is well-documented that reducing blood pressure (BP) in hypertensive individuals reduces the risk of cardiovascular events. Despite this, many patients with hypertension remain untreated or inadequately treated and fail to reach the recommended BP goals. Suboptimal BP control, while arising from multiple causes, is often due to poor patient compliance and/or persistence, and results in a significant healthcare and socioeconomic burden. By reducing the pill burden, the use of single-pill combination therapies for the treatment of hypertension has the potential to increase patient compliance and persistence. Compared with antihypertensive monotherapies, single-pill combinations may offer equivalent or better efficacy and the same or improved tolerability. As a result, single-pill combinations have the potential to reduce both the cardiovascular event rates and the non-drug healthcare costs associated with hypertension.
Developments in Strategies for Treating High-risk Hypertension
Authors: Sierra Cristina , Coca Antonio ,   Hypertension Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clinic (IDIBAPS), University of Barcelona,   Hypertension Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clinic (IDIBAPS), University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain. E: acoca@clinic.ub.es
Published: August 2014

On the basis of current evidence provided by various studies, the most recent international guidelines recommend reducing blood pressure levels to below 140/90mmHg for all hypertensive patients over 18 years of age, including the elderly, when this is clinically tolerated, as a necessary measure to reduce the global cardiovascular risk, which is the fundamental objective of treatment. For high-risk hypertensives, such as patients with diabetes, patients with silent target organ damage or established clinical cardiovascular disease, levels below 130/80mmHg should be reached and maintained, with even lower levels for patients with established renal disease and proteinuria within the nephrotic range. Blood pressure control in high-risk patients should be achieved as rapidly as possible using initial strategies that include combinations of antihypertensive drugs, and also the best drugs and drug combinations with proven capacity to regress silent organ damage and to interrupt the progression of cardiovascular disease. This must be accompanied by the additional lifestyle measures and drugs necessary to control other associated cardiovascular risk factors. In clinical practice this means that, together with renin–angiotensin–aldosterone system (RAAS) blockade, often associated with calcium-channel blockade, statins and antiplatelet drugs should routinely be administered in most patients, particularly those over 55 years of age, as they provide the only possibility of global risk prevention leading to greater survival.
Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation
Authors: Buellesfeld Lutz , Mandinov Lazar , Grube Eberhard ,   Department of Cardiology/Angiology, HELIOS Heart Centre Siegburg, Ringstrasse 49, 53721 Siegburg, Germany. E: LuB@gmx.com,   Mitralign Inc,   Department of Cardiology, HELIOS Heart Centre, Siegburg
Published: August 2014

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.
Closing the Patent Foramen Ovale with Amplatzer Devices
Authors: Meier Bernhard ,   Professor and Chairman of Cardiology, Cardiovascular Department, University Hospital, 3010 Bern, Switzerland. E: bernhard.meier@insel.ch
Published: August 2014

The relative risk of a thromboembolic event is four-fold higher in the 25–35% of adults with a patent foramen ovale (PFO) and 33-fold higher in patients who also have an atrial septal aneurysm. The American PICSS trial showed a yearly incidence of stroke or death after an initial event of 5% with warfarin and 9% with acetylsalicylic acid. The presence of a PFO more than doubles the mortality rate in patients with clinically relevant pulmonary embolism. The risk of a PFO increases with age. Proof of effectiveness in migraine alleviation is likely to be achievable in a couple of years – much quicker than in prevention of paradoxical embolism. Percutaneous closure of PFO has been performed with various devices at the University Hospital Bern in Switzerland since April 1994, with over 1,000 patients treated. At the last available transoesophageal echocardiogram, a significant residual shunt persisted in 4% with Amplatzer devices and 17% with other devices. During follow-up, a recurrent embolic event was observed in 1.6% of patients per year – less than would be expected under medical treatment. Several randomised multicentre trials comparing catheter closure with medical treatment have been started. The PC and CLOSURE trials are in the follow-up phase; results cannot be expected before 2010, and they may well be ‘falsely’ neutral because the follow-up is rather short for the low-risk patients randomised. In a matched control study on patients with cryptogenic stroke and a PFO, 158 patients were treated medically and 150 concomitant patients underwent percutaneous PFO closure. At four years, PFO closure resulted in a trend towards risk reduction of death, stroke or transient ischaemic attack (TIA) (9 versus 24%; p=0.08) compared with medical treatment. The calculated occurrence of patients with cryptogenic strokes associated with a PFO amounts to somewhere between 100 and 300 per year and per million population, corresponding to more than 10% of yearly coronary angioplasty cases. Coronary and peripheral paradoxical emboli without prior exclusion of competing causes plus the presumed associations between PFO and migraine or decompression illness in divers open additional vast fields of potential indications for catheter closure. Finally, the linearly decreasing prevalence of a PFO with age suggests a weeding out of PFO carriers (unless spontaneous closure is assumed). A PFO represents a lethal threat that increases with age. It can be closed percutaneously in 15 minutes virtually free of complications. The patient can resume unrestricted physical activities a few hours after the intervention.
Risk Stratification in Acute Coronary Syndromes and Pulmonary Embolism
Authors: Chan WY Wandy , Troughton Richard W ,   University of Otago, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. E: wandyc@cdhb.govt.nz,   University of Otago, Christchurch
Published: August 2014

Acute coronary syndromes and acute pulmonary embolism are common diagnoses that are associated with high rates of mortality and adverse clinical outcome. Early risk stratification is recommended for both conditions. Careful assessment of clinical and haemodynamic status in combination with cardiac imaging and quantitation of biomarkers, such as the cardiac troponins and the B-type natriuretic peptides, can allow more accurate status risk stratification and guide more optimal therapy.
Routine Invasive Strategy Compared with a Selective Invasive Strategy in Women with Non-ST-elevation Acute Coronary Syndromes
Authors: Alfredsson Joakim , Swahn Eva ,   Department of Medical and Health Sciences, Division of Cardiology, Linköping University Hospital, SE 581 85 Linköping, Sweden. E: joakim.alfredsson@liu.se,   Department of Medical and Health Sciences, Division of Cardiology, University Hospital, Linköping
Published: August 2014

Cardiovascular disease is the leading cause of death in both men and women in the developed world. Non-ST-elevation acute coronary syndromes (NSTE-ACS) are the most prevalent acute manifestations of coronary heart disease. Revascularisation is performed in the NSTEACS setting to relieve symptoms and prevent progression to myocardial ischaemia and death. Today, early invasive treatment with coronary angiography and revascularisation if feasible has become the strategy of choice in patients with NSTE-ACS, and is a class 1 recommendation in both American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines on NSTE-ACS, at least for patients with medium- or high-risk indications. However, gender differences in terms of benefit from an early invasive strategy have been intensively debated and the data are conflicting. In this article, we will discuss possible gender differences in randomised trials addressing this matter.
Cardiac Computed Tomography – Cardiologists and Radiologists – Together Is Better for Patients
Authors: Cuéllar-Calàbria Hug , Aguilar-Torres Río ,   Institute for Diagnostic Imaging, Hospital Universitari Vall d’Hebron, Barcelona,   Cardiac Imaging Unit, Servicio de Cardiología, Hospital Universitario de Bellvitge, c/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain. E: rioaguilar@pulso.com
Published: August 2014

A rapid transformation has occurred in cardiac imaging since the introduction of cardiac computed tomography (CT) at the beginning of the 21st century. The initial necessity for radiologists to learn how to use a new technology has been replaced by the need to apply it more efficiently, obtaining the best from the technique in more appropriate indications and in a safer manner. Interaction with cardiologists has grown even faster than the evolution of equipment and imaging protocols, allowing for more efficient sharing of knowledge and information. Cardiac CT is a recently introduced technology, so basic debates about indications, diagnostic performance and training are still ongoing. Cardiac CT is commonly performed following a multidisciplinary approach, with suboptimal results. Despite this, studies conducted to evaluate diagnostic performance and prediction of clinical events in populations examined with non-invasive coronary angiography indicate that cardiologists and radiologists are working more closely than before.
Anticoagulant Therapy in Atrial Fibrillation – Time for a Change?
Authors: De Caterina Raffaele , Renda Giulia ,   Institute of Cardiology and Centre of Excellence on Ageing, ‘G d’Annunzio’ University, Institute of Cardiology and University Cardiology Division, Ospedale SS Annunziata, Via dei Vestini, 66013 Chieti, Italy. E: rdecater@unich.it,   Institute of Cardiology and Centre of Excellence on Ageing, ‘G d’Annunzio’ University, Chieti
Published: August 2014

Although to date warfarin and other vitamin K antagonists have clearly had the greatest efficacy among commonly available treatments in preventing stroke in atrial fibrillation, their use is associated with a substantial risk of major bleeding and is impractical because of their narrow therapeutic window, their interaction with drugs and foods and the need for frequent coagulation monitoring. Several new anticoagulants are undergoing phase III clinical trials in atrial fibrillation with the aim of demonstrating non-inferiority compared with vitamin K antagonists or superiority compared with aspirin in patients in whom vitamin K antagonists are contraindicated or not tolerated. In the recently released Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, the first such drug, dabigatran etexilate, was proved substantially equivalent to 2–3 international normalised ratio (INR)-adjusted warfarin at the dosage of 110mg twice a day (BID), with superior efficacy at a dosage of 150mg BID. With these new drugs, cardiologists and internists are witnessing a real revolution in the thromboprophylaxis in atrial fibrillation.
A Comparison of Drug-eluting Stents for Percutaneous Coronary Intervention – Background, Rationale and Design of the COMPARE Trial
Authors: Smits Pieter C ,   Department of Cardiology, Thorax Centre, Erasmus Medical Centre, Maasstad Ziekenhuis, Groene Hilledijk 315, 3075 EA Rotterdam, The Netherlands. E: SmitsP@maasstadziekenhuis.nl
Published: August 2014

Drug-eluting stents (DES) can reduce the risk of restenosis associated with percutaneous intervention procedures. However, the first-generation sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) are associated with a higher rate of stent thrombosis compared with bare-metal stents (BMS). Recently, an everolimus-eluting stent (EES) has been developed and data from randomised, controlled trials have demonstrated the safety and efficacy of the EES in the treatment of coronary artery disease. The randomised, all-comer, real-world COMPARE trial has compared the clinical outcomes achieved with two DES (EES and PES) in a real-world setting. It was a physician-initiated, single-centre, openlabel, randomised, all-comer, real-world study. The study was designed to allow an evaluation of stent efficacy and safety in a real-world setting with a diverse and complex population. Accordingly, the results are intended to provide more patient-orientated rather than device-orientated data. Preliminary results from the COMPARE trial suggest that the EES is safe and efficacious in the diverse patient population of the study.
Treatment of In-stent Restenosis – Past, Present and Future
Authors: Alfonso Fernando ,   Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico ‘San Carlos’, Ciudad Universitaria, Plaza de Cristo Rey, Madrid 28040, Spain. E: falf@hotmail.com
Published: August 2014

In-stent restenosis (ISR) remains a significant clinical problem. The penetration of drug-eluting stents (DES) is quite variable and patients with DES may also suffer from ISR. Treatment of ISR remains a technical challenge and the long-term clinical outcome of these patients may be complicated by recurrences. Different strategies have been used for the treatment of patients with bare-metal ISR. Currently, DES constitute the intervention of choice in this setting. However, the best intervention for patients suffering from ISR after DES implantation remains to be elucidated. This report summarises our clinical and research efforts in this adverse anatomical scenario over the last decade. We will address the treatment of patients with ISR, revisiting the historical background, emphasising the currently available alternatives and disclosing future perspectives.
New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?
Authors: van Geldorp Martijn WA , Takkenberg Johanna JM , Bogers Ad JJC , Kappetein A Pieter ,   Department of Cardiothoracic Surgery, Erasmus Medical Centre, 3000 CA, Rotterdam, The Netherlands. E: m.vangeldorp@erasmus.nl,   Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,   Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,   Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam
Published: August 2014

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.
Atherosclerosis – The Future Challenge for Europe’s Health Economies
Authors: Carson Andrew ,   Associate Dean, School of Post-graduate General Practice, NHS West Midlands, and General Practitioner, Bellevue Medical Centre, 6 Bellevue, Edgbaston, Birmingham, B5 7LX, UK. E: andy@andrewcarson.demon.co.uk
Published: August 2014

Atherosclerotic disease has been a feature of more affluent societies since ancient times. Currently, cardiovascular disease accounts for almost half of all mortality across Europe, causing over two million deaths within the EU and costing EU health economies €192 billion per year. The pathogenesis of atherosclerosis is complex, and our understanding of it has come a long way over the last 50 years. The public and many health professionals have an image of cholesterol that is probably over-simplistic. The oxidation of lowdensity lipoprotein (LDL) cholesterol to form oxLDL is the first molecular step in atherosclerosis pathogenesis, and it appears that oxLDL levels may act as a useful biomarker in identifying individuals at greatest risk of cardiovascular events. Inhibition of oxLDL or its active removal may represent a useful new therapeutic strategy. Antioxidants such as lycopene may offer another approach to prevention or treatment, and emerging evidence around the role of anti-Chlamydia pneumoniae antibodies in LDL oxidation could open up another avenue of preventative and therapeutic options.
Myocardial Perfusion Imaging from Echocardiography to SPECT, PET, CT and MRI – Recent Advances and Applications
Authors: Tsai W Kevin , Holohan Kathleen M , Williams Kim Allan ,   Fellow in Cardiology,   Nuclear Cardiology Research Specialist,   Professor of Medicine and Radiology, and Director of Nuclear Cardiology, University of Chicago Pritzker School of Medicine, Department of Medicine (Cardiology) and Radiology (Nuclear Medicine), University of Chicago, 5758 S Maryland Avenue MC9025, Chicago, IL 60637, US. E: kwilliam@medicine.bsd.uchicago.edu
Published: August 2014

This article highlights recent advances in myocardial perfusion imaging in echocardiography, single-photon-emission computed tomography, positron-emission tomography, cardiac computed tomography and cardiac magnetic resonance imaging. The future of non-invasive cardiac imaging is trending towards comprehensive studies combining different modalities to evaluate both cardiac anatomy and its functional status.
Assessment of Cardiovascular Risk – The Impact and Future of Non-traditional Cardiovascular Risk Markers
Authors: Olsen Michael Hecht ,   Associate Professor of Medicine, University of Copenhagen, and Chief Physician in Cardiology, Department of Internal Medicine, Glostrup University Hospital, Unit of Cardiovascular Research, Division of Cardiology, Department of Internal Medicine, Glostrup University Hospital, Nordre Ringvej, 2600 Glostrup, Denmark. E: mho@dadlnet.dk
Published: August 2014

In relatively young patients (men <55 and women >65 years of age), first-time hospitalisation for cardiovascular disease (CVD) strikes without warning since the traditional cardiovascular risk factors are often normal or only slightly elevated. Therefore, we need non-traditional cardiovascular risk markers more closely related to CVD that can reliably predict future CVD in individuals, making better targeted prevention and more individualised treatment possible. However, it has been difficult to find non-traditional cardiovascular risk markers suitable for risk assessment, underlining the importance of future research into the complex mechanisms that lead to CVD. Better understanding of these complex mechanisms might enable us to find better risk markers and improve future cardiovascular risk assessment and treatment.
The Expanding Role of Echocardiography in Interventional Cardiology
Authors: Smith Lindsay A , Bhan Amit , Monaghan Mark J ,   Department of Non-Invasive Cardiology, King’s College Hospital, London,   Department of Non-Invasive Cardiology, King’s College Hospital, London,   Department of Non-Invasive Cardiology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK. E: mark.monaghan@nhs.net
Published: August 2014

Echocardiography provides excellent realtime imaging of the heart, making it the imaging modality of choice immediately before, during and after cardiac interventional procedures. It helps to guide case selection and execution of the intervention, evaluates the effects of the intervention and enables early detection of complications. Advances in the design and technology of medical devices and delivery systems, coupled with demand for alternative non-surgical therapies for common medical problems, have led to an increase in the volume, variety and complexity of non-coronary cardiac interventional procedures performed. Many of these procedures require a multidisciplinary team approach and demand optimal imaging to ensure successful outcomes. The aim of this article is to review the expanding role of echocardiography in non-coronary interventional cardiology in adults.
Detection of Complications After Aortic Stent Grafting
Authors: Tsoumakidou Georgia , Brountzos Elias ,   Second Department of Radiology, Athens University Medical School, Attikon University Hospital, 1 Rimini St, 12462 Chaidari, Greece. E: gtsoumakidou@yahoo.com,   Second Department of Radiology, Attikon University Hospital, Athens University Medical School
Published: August 2014

Today, endovascular aortic aneurysm repair (EVAR) is used as an alternative to open surgery. Although the peri-procedural mortality rate is lower with EVAR, there is a high rate of re-intervention that makes long-term surveillance necessary; therefore, we reviewed the possible complications that can occur after EVAR and focused on the different imaging strategies used for follow-up. So far, multidetector computed tomography angiography (MDCTA) is the most widely accepted surveillance method, but carries the risk of radiation and contrast nephrotoxicity. Radiography, MRA, duplex and contrast-enhanced ultrasonography can also provide high-quality imaging, each with its own advantages and limitations. The ideal follow-up protocol (time intervals and type of imaging modality) needs to be further defined in order to ensure proper endograft function and prevent complications.
Atrial Fibrillation in the Setting of Heart Failure
Authors: Prystowsky Eric , Jean-Yves Le Heuzey ,   Clinical Electrophysiology Laboratory, St Vincent Hospital, The Care Group, 8333 Naab Road, Suite 400, Indianapolis, IN 46260, US. E: eprymd@aol.com, jean-yves.le-heuzey@egp.aphp.fr,   Hôpital Européen Georges Pompidou, Paris, jean-yves.le-heuzey@egp.aphp.fr
Published: August 2014

In the treatment and management of atrial fibrillation (AF), the debate over ‘rate versus rhythm’ has largely been answered by several large randomised prospective clinical trials that have shown no distinct advantage for one strategy over the other in terms of clinical outcomes. Prior to the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial, these studies were largely conducted on patients without heart failure (HF) and included patients with paroxysmal AF. Notably, only 23% of patients enrolled in the largest rate versus rhythm AF trial to date, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), had HF. However, the treatment of patients with both AF and HF remains a specific challenge. While anticoagulation treatment is necessary in all cases, the definition of the optimal therapy prescribed to control arrhythmia itself is much more difficult. There appear to be specific advantages of sinus rhythm in patients who have AF and HF. These might include a salutary effect of sinus rhythm due to at least three factors: regularisation of the rhythm, physiological rate control and restoration of atrial contribution to cardiac output. It would be prudent to assess carefully whether patients presenting with both AF and HF will benefit from improved outcomes following restoration and maintenance of sinus rhythm, whether achieved by drug therapy or catheter ablation.
Considerations for the Development of New Antiarrhythmic Drugs
Authors: Camm John , Pratt Craig , Priori Silvia ,   BHF Professor of Clinical Cardiology, Division of Cardiac and Vascular Sciences, St George’s University of London, Cranmer Terrace, London, SW17 0RE, UK. E: jcamm@sgul.ac.uk,   Department of Cardiology, Methodist DeBakey Heart Center, Houston,   Department of Molecular Cardiology, Fondazione Salvatore Maugeri, IRCCS, Pavia
Published: August 2014

Several studies over the past few years have investigated the benefits of antiarrhythmic drugs (AADs) for the treatment of atrial fibrillation (AF). Data from key studies comparing rate versus rhythm control show no evidence of superiority in terms of survival benefits with either therapeutic strategy. In terms of AADs, many of the currently available drugs are associated with safety issues, thus the relative risk–benefit ratios of each drug is a major consideration when selecting an AAD in therapy. The safety issues and complications associated with current therapeutic drug options clearly indicate the need for novel drug development in the field of AF. New approaches that have been evaluated include AADs with greater atrial selectivity and novel non-selective multichannelblocking AADs. Trials evaluating new AADs will likely need to demonstrate superior safety profiles over existing drugs. However, in light of the inconclusive results in terms of survival benefits of the major rate versus rhythm studies and the increasing use of nonpharmacological techniques, including direct-current cardioversion and ablative techniques, cardiologists are faced with questions concerning the specific direction of new AAD development to be undertaken in future.