Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry.

BACKGROUND: Thrombolysis is still used when primary angioplasty is delayed for a long time, but 25%-30% of patients require rescue angioplasty (RA). There are no established recommendations for antithrombotic management in RA. This registry analyzes regimens for antithrombotic management. METHODS: A retrospective, multicenter, observational registry of consecutive patients treated with RA at 8 hospitals. All variables were collected and follow-up took place at 6 months. RESULTS: The study included 417 patients. Antithrombotic therapy in RA was: no additional drugs 22.3%, unfractionated heparin (UFH) 36.6%, abciximab 15.5%, abciximab plus UFH 10.5%, bivalirudin 5.7%, enoxaparin 4.3%, and others 4.7%. Outcomes at 6 months were: mortality 9.1%, infarction 3.3%, definite or probable stent thrombosis 4.3%, revascularization 1.9%, and stroke 0.5%. Mortality was related to cardiogenic shock, age > 75 years, and anterior location. The stent thrombosis rate was highest with bivalirudin (12.5% at 6 months). The incidence of bleeding at admission was high (14.8%), but most cases were not severe (82% BARC ≤2). Variables independently associated with bleeding were: femoral access (OR 3.30; 95% CI 1.3-8.3: p = 0.004) and post-RA abciximab infusion (OR 2.26; 95% CI 1.02-5: p = 0.04). CONCLUSIONS: Antithrombotic treatment regimens in RA vary greatly, predominant strategies consisting of no additional drugs or UFH 70 U/kg. No regimen proved predictive of mortality, but bivalirudin was related to more stent thrombosis. There was a high incidence of bleeding, associated with post-RA abciximab infusion and femoral access.

Discrete classification technique applied to TV advertisements liking recognition system based on low-cost EEG headsets.

BACKGROUND: In this paper a new approach is applied to the area of marketing research. The aim of this paper is to recognize how brain activity responds during the visualization of short video advertisements using discrete classification techniques. By means of low cost electroencephalography devices (EEG), the activation level of some brain regions have been studied while the ads are shown to users. We may wonder about how useful is the use of neuroscience knowledge in marketing, or what could provide neuroscience to marketing sector, or why this approach can improve the accuracy and the final user acceptance compared to other works. METHODS: By using discrete techniques over EEG frequency bands of a generated dataset, C4.5, ANN and the new recognition system based on Ameva, a discretization algorithm, is applied to obtain the score given by subjects to each TV ad. RESULTS: The proposed technique allows to reach more than 75 % of accuracy, which is an excellent result taking into account the typology of EEG sensors used in this work. Furthermore, the time consumption of the algorithm proposed is reduced up to 30 % compared to other techniques presented in this paper. CONCLUSIONS: This bring about a battery lifetime improvement on the devices where the algorithm is running, extending the experience in the ubiquitous context where the new approach has been tested.

Diffusion behavior of humic acid during desalination with air gap and water gap membrane distillation.

Desalination and water reuse are important means to resolve local water scarcity and security issues worldwide where membrane distillation (MD) may be part of a solution. Natural organic matter and in particular, humic acids (HA), are widely present in water supplies to be treated but exhibit little understood behavior to diffuse through MD membranes into permeate. In this work, air gap (AGMD) and water gap (WGMD) were utilized to study HA behavior in MD using seawater and synthetic water over a range of typical MD temperatures, flow rates and membrane types. HA diffusion was first shown with seawater feed then on synthetic solutions at all process conditions. While electrical conductivity rejection was always above than 99%, HA rejection showed values of 33% and 90% for AGMD and 68% and 93% for WGMD with seawater and synthetic water, respectively. Analytical techniques were used to perform a preliminary organic matter characterization in permeate, obtaining clear differences between the feed and permeate HA property. Compared to hydrophobic membranes, uniquely oleophobic membranes inhibit HA diffusion suggesting hydrophobic surface diffusion of HA through the membrane. HA flux as well as potential undesirable effects of the organic matter in permeate should be considered for MD applications.

Impact of Percutaneous Coronary Revascularization of Severe Coronary Lesions on Secondary Branches.

INTRODUCTION AND OBJECTIVES: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS: This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS: We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. CONCLUSIONS: The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.

[Extreme thrombocytopenia following abciximab therapy]. / Trombocitopenia extrema secundaria a abcixamab.

Antagonists of the glycoprotein IIb/IIIa receptor block the binding of fibrinogen and Von Willebrand factor to the platelet receptor. This effect can lead to bleeding and thrombocytopenia. We analyzed the incidence and clinical repercussions of severe thrombocytopenia (< 20 000 /microl) secondary to abciximab treatment in a prospective study of 375 patients (74% men) who underwent percutaneous coronary revascularization and received abciximab at our hospital. We recorded clinical and demographic characteristics, angiographic findings, laboratory results and platelet counts (before, 4 hours after and 12 hours after the procedure) and hematocrit. The incidence of severe acute thrombocytopenia was 1.1%. All patients were men, and none had relevant bleeding complications. Management consisted of monitoring the bleeding, discontinuing the drug and transfusing platelets. Clinicians should be alert to this complication during the initial hours after the administration of abciximab.

Impacto de la revascularización coronaria percutánea de lesiones coronarias graves en ramas secundarias / Impact of percutaneous coronary revascularization of severe coronary lesions on secondary branches

Introducción y objetivos: Comparar la estrategia de revascularización percutánea de lesiones graves en ramas coronarias secundarias (RS) (diámetro ≥ 2 mm) de arterias epicárdicas mayores frente al tratamiento conservador. Métodos: Estudio de cohortes retrospectivo en el que se compara a pacientes con lesiones graves en RS de arterias epicárdicas principales tratados con revascularización percutánea o con un tratamiento farmacológico a criterio del operador. Se analizó el porcentaje de eventos relacionados con la rama (muerte cardiovascular, infarto de miocardio atribuible a RS o necesidad de revascularización de la RS). Resultados: Se analizaron 679 lesiones en RS (662 pacientes). Tras un seguimiento medio de 22,2+/-10,5 meses, no hubo diferencias significativas entre ambos grupos de tratamiento en mortalidad de causa cardiovascular (el 1,7 frente al 0,4%; p=0,14), infarto agudo de miocardio (IAM) no fatal (el 1,7 frente al 1,7%; p=0,96) o necesidad de revascularización de la RS (el 4,1 frente al 5,4%; p=0,45) ni en el porcentaje total de eventos (el 5,1 frente al 6,3%; p=0,54). Las variables que mostraron asociación con la ocurrencia de eventos en el análisis multivariable fueron la diabetes (sHR=2,87; IC95%, 1,37-5,47; p=0,004), IAM previo (sHR=3,54; IC95%, 1,77-7,30; p < 0,0001), el diámetro de referencia de la RS (sHR=0,16; IC95%, 0,03-0,97; p=0,047) y la longitud de la lesión (sHR=3,77; IC95%, 1,03-1,13; p < 0,0001). Estos resultados se mantuvieron tras realizar análisis por puntuación de propensión. Conclusiones: En el seguimiento, el porcentaje de eventos relacionados con la RS fue bajo respecto al total de pacientes, sin diferencias significativas entre una y otra estrategia de tratamiento. Las variables que se asociaron con la ocurrencia de eventos en el análisis multivariable fueron la diabetes mellitus, el antecedente de IAM y la mayor longitud de la lesión

Introduction and objectives: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. Methods: This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). Results: We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2+/-10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. Conclusions: The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length

Caffeine-containing energy drink improves physical performance of elite rugby players during a simulated match.

The purpose of this study was to investigate the effectiveness of a caffeine-containing energy drink in enhancing rugby players' physical performance during a simulated match. A second purpose was to determine the urinary caffeine excretion derived from the energy drink intake. In a randomized and counterbalanced order, 26 elite rugby players (mean ± SD for age and body mass, 25 ± 2 y and 93 ± 15 kg) played 2 simulated rugby games (2 × 30 min) 60 min after ingesting (i) 3 mg of caffeine per kilogram of body mass in the form of an energy drink (Fure, ProEnergetics) or (ii) the same drink without caffeine (placebo). During the matches, the individual running distance and the instantaneous speed were measured, and the number of running actions above 20 km·h(-1) (i.e., sprints) were determined, using global positioning system devices. The number of impacts above 5 g during the matches was determined by accelerometry. The ingestion of the energy drink, compared with the placebo, increased the total distance covered during the match (4749 ± 589 vs 5139 ± 475 m, p < 0.05), the running distance covered at more than 20 km·h(-1) (184 ± 38 vs 208 ± 38 m, p < 0.05), and the number of sprints (10 ± 7 vs 12 ± 7, p < 0.05). The ingestion of the energy drink also resulted in a greater overall number of impacts (481 ± 352 vs 641 ± 366, p < 0.05) and a higher postexercise urine caffeine concentration (0.1 ± 0.1 vs 2.4 ± 0.9 µg·mL(-1), p < 0.05). The use of an energy drink with a caffeine dose equivalent to 3 mg·kg(-1) considerably enhanced the movement patterns of rugby players during a simulated match.

Sellar paraganglioma: a unique route to a rare destination case report and literature review.

OBJECTIVE: Paragangliomas of the sella are rare; 14 cases have been reported in the literature. We describe here the unique case of a sellar paraganglioma that extended into the orbit through the superior orbital fissure. We have also reviewed all reported cases of sellar paragangliomas to better define best management strategies. CLINICAL PRESENTATION: A 63-year-old male presented with left eye proptosis and conjunctival vessel dilatation. INTERVENTION: Resection of the intraorbital component of the tumor was accomplished using a transcranial-transorbital approach. CONCLUSION: This is the first report of a sellar/parasellar paraganglioma extending into the orbit through the superior orbital fissure. While an appropriate treatment paradigm has not been established, a review of all previously reported cases suggests that radiotherapy is an important consideration.