The Effects of Subjective Cognitive Decline on APOE Genotype Disclosure in the Butler Hospital Alzheimer's Prevention Registry.

BACKGROUND: Subjective cognitive decline (SCD) and APOE genotyping are both instrumental in identifying high-risk individuals for Alzheimer's disease (AD) prevention trials. OBJECTIVE: This study examined the relationship between SCD and the impact of APOE disclosure on the psychological and behavioral health of cognitively unimpaired individuals. Design/Setting/Participant: We recruited 189 trial volunteers (mean age 66, 65% female, 96% White), from the Butler Hospital Alzheimer's Prevention Registry. Participants completed screening for cognitive impairment and a psychological readiness assessment before learning their APOE genotype, and were followed for 6 months after. RESULTS: SCD had a modest, temporary impact on mood and event-related distress following APOE disclosure, specifically on those who were ε4 carriers. The presence of SCD (SCD+) did not compound the AD genetic test-specific distress related to learning that one was an ε4 carrier. SCD also did not moderate changes in perceived AD risk, with all non-carriers showing a more rapid decrease in perceived risk over time than carriers. Counterintuitively, those without SCD (SCD-) reported taking more steps in future-directives than the SCD+ group at baseline and after disclosure, potentially suggesting that those with SCD may have subtle executive declines that limit future-oriented actions or fear-avoidance behaviors. Further, the SCD- group was more accurate in recalling their APOE status and the recall accuracy correlated with their broad knowledge about APOE as a risk gene for AD. CONCLUSION: Our findings support the safety and tolerability of APOE disclosure in research volunteers regardless of their SCD statuses, but further studies are warranted to include diverse individuals and those pursuing testing through direct-to-consumer services outside of traditional research settings.

Bilateral vertebral arteries entering the C4 foramen transversarium with the left vertebral artery originating from the aortic arch.

Vertebral arteries (VAs) serve as major blood vessels to the central nervous system. VAs typically arise from the subclavian arteries and ascend separately within the transverse foramina of the cervical vertebrae (C6-C1) before entering the skull at the foramen magnum and joining at the base of the pons to form the basilar artery of the vertebrobasilar circulation. Therefore, variations in the origin and anatomic course of the VAs have implications for invasive medical procedures involving the superior thoracic/cervical regions or the cervical vertebrae. The current case report describes variation in the entry point of both VAs and the site of origin of the left vertebral artery. The variation was revealed during routine dissection of a 72-year-old female cadaver. It was found that the left vertebral artery originated directly from the aortic arch to abnormally enter the transverse foramen of C4 instead of the transverse foramen of C6. The right vertebral artery arose as usual from the right subclavian artery. However, the right vertebral artery also directly entered the transverse foramen of C4 instead of the transverse foramen of C6.

Wireless phone use in childhood and adolescence and neuroepithelial brain tumours: Results from the international MOBI-Kids study.

In recent decades, the possibility that use of mobile communicating devices, particularly wireless (mobile and cordless) phones, may increase brain tumour risk, has been a concern, particularly given the considerable increase in their use by young people. MOBI-Kids, a 14-country (Australia, Austria, Canada, France, Germany, Greece, India, Israel, Italy, Japan, Korea, the Netherlands, New Zealand, Spain) case-control study, was conducted to evaluate whether wireless phone use (and particularly resulting exposure to radiofrequency (RF) and extremely low frequency (ELF) electromagnetic fields (EMF)) increases risk of brain tumours in young people. Between 2010 and 2015, the study recruited 899 people with brain tumours aged 10 to 24 years old and 1,910 controls (operated for appendicitis) matched to the cases on date of diagnosis, study region and age. Participation rates were 72% for cases and 54% for controls. The mean ages of cases and controls were 16.5 and 16.6 years, respectively; 57% were males. The vast majority of study participants were wireless phones users, even in the youngest age group, and the study included substantial numbers of long-term (over 10 years) users: 22% overall, 51% in the 20-24-year-olds. Most tumours were of the neuroepithelial type (NBT; n = 671), mainly glioma. The odds ratios (OR) of NBT appeared to decrease with increasing time since start of use of wireless phones, cumulative number of calls and cumulative call time, particularly in the 15-19 years old age group. A decreasing trend in ORs was also observed with increasing estimated cumulative RF specific energy and ELF induced current density at the location of the tumour. Further analyses suggest that the large number of ORs below 1 in this study is unlikely to represent an unknown causal preventive effect of mobile phone exposure: they can be at least partially explained by differential recall by proxies and prodromal symptoms affecting phone use before diagnosis of the cases. We cannot rule out, however, residual confounding from sources we did not measure. Overall, our study provides no evidence of a causal association between wireless phone use and brain tumours in young people. However, the sources of bias summarised above prevent us from ruling out a small increased risk.

Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore.

BACKGROUND: A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. METHODS: A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. RESULTS: Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education (p < 0.007), being employed (p < 0.046) and younger age group (p < 0.003) are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea (64.8%), Drowsiness (62.4%) and Surgical Wound Pain (58.8%). Patients ranked Heart Attack (59.3%), Death (53.8%) and Stroke (52.7%) as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist (52.2%), instead of letting the doctor decide (37.1%) or deciding for themselves (10.7%). Discussion with the anaesthetist (61.3%) is the preferred medium of communication compared to reading a pamphlet (23.4%) or watching a video (15.4%). CONCLUSION: Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.

Sugars and adiposity: the long-term effects of consuming added and naturally occurring sugars in foods and in beverages.

OBJECTIVE: The aim of this study was to determine if the association with adiposity varies by the type (added vs. naturally occurring) and form (liquid vs. solid) of dietary sugars consumed. METHODS: Data from the 10-year National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study (n = 2,021 girls aged 9-10 years at baseline; n = 5,156 paired observations) were used. Using mixed linear models, 1-year changes in sugar intake, body mass index z-score (BMIz) and waist circumference (WC) were assessed. RESULTS: The results showed mean daily added sugar (AS) intake: 10.3 tsp (41 g) liquid; 11.6 tsp (46 g) solid and naturally occurring sugar intake: 2.6 tsp (10 g) liquid; 2.2 tsp (9 g) solid. Before total energy adjustment, each additional teaspoon of liquid AS was associated with a 0.222-mm increase in WC (p = 0.0003) and a 0.002 increase in BMIz (p = 0.003). Each teaspoon of solid AS was associated with a 0.126-mm increase in WC (p = 0.03) and a 0.001 increase in BMIz (p = 0.03). Adjusting for total energy, this association was maintained only between liquid AS and WC among all and between solid AS and WC among those overweight/obese only. There was no significant association with naturally occurring sugar. CONCLUSIONS: These findings demonstrate to suggest a positive association between AS intake (liquid and solid) and BMI that is mediated by total energy intake and an association with WC that is independent of it.

Factors associated with improved biochemical response to neoadjuvant androgen deprivation therapy before definitive radiation therapy in prostate cancer patients.

BACKGROUND: In prostate cancer patients treated with androgen deprivation therapy (ADT) and radiation therapy (RT), a pre-RT PSA level 0.5 ng ml(-1), determined after neoadjuvant ADT and before RT, predicts for worse survival measures. The present study sought to identify patient, tumor and treatment characteristics associated with the pre-RT PSA in prostate cancer patients. METHODS: We reviewed the charts of all patients diagnosed with intermediate- and high-risk prostate cancer and treated with a combination of neoadjuvant (median, 2.2 and 2.5 months, respectively), concurrent, and adjuvant ADT and RT between 1990 and 2011. RESULTS: A total of 170 intermediate- and 283 high-risk patients met inclusion criteria. On multivariate analysis, both intermediate- and high-risk patients with higher pre-treatment PSA (iPSA) were significantly less likely to achieve a pre-RT PSA <0.5 ng ml(-1) (iPSA 10.1-20 ng ml(-1): P=0.005 for intermediate risk; iPSA 10.1-20 ng ml(-1): P=0.005, iPSA >20 ng ml(-1): P<0.001 for high risk). High-risk patients undergoing total androgen blockade were more likely to achieve a pre-RT PSA <0.5 ng ml(-1) (P=0.031). We observed an interaction between race and type of neoadjuvant ADT (P=0.074); whereas African-American men on total androgen blockade reached pre-RT PSA <0.5 ng ml(-1) as frequently as other men on total androgen blockade (P=0.999), African-American men on luteinizing hormone-releasing hormone (LH-RH) agonist monotherapy/orchiectomy were significantly less likely to reach pre-RT PSA <0.5 ng ml(-1) compared with other men on LH-RH monotherapy/orchiectomy (P=0.001). CONCLUSIONS: Our findings suggest that total androgen blockade in the neoadjuvant period may be beneficial compared with LH-RH monotherapy for achieving a pre-RT PSA <0.5 ng ml(-1) in African-American men with high-risk prostate cancer. In addition, men with higher iPSA are more likely to have a pre-RT PSA greater than 0.5 ng ml(-1) in response to neoadjuvant ADT and are therefore candidates for clinical trials testing newer, more aggressive hormone-ablative therapies.

Burial effects of organic coatings on the heterogeneous reactivity of particle-borne benzo[a]pyrene (BaP) toward ozone.

With an aerosol flow tube coupled to an Aerodyne aerosol mass spectrometer (AMS), room temperature (296 ± 3 K) kinetics studies have been performed on the reaction of gas-phase ozone with benzo[a]pyrene (BaP) adsorbed in submonolayer amounts to dry ammonium sulfate (AS) particles. Three organic substances, i.e., bis(2-ethylhexyl)sebacate (BES, liquid), phenylsiloxane oil (PSO, liquid), and eicosane (EC, solid), were used to coat BaP-AS particles to investigate the effects of such organic coatings on the heterogeneous reactivity of PAHs toward ozone. All the reactions of particle-borne BaP with excess ozone exhibit pseudo-first-order kinetics in terms of BaP loss, and reactions with a liquid organic coating proceed by the Langmuir-Hinshelwood (L-H) mechanism. Liquid organic coatings did not significantly affect the kinetics, consistent with the ability of reactants to rapidly diffuse through the organic coating. In contrast, the heterogeneous reactivity of BaP was reduced substantially by a thin (4-8 nm), solid EC coating and entirely suppressed by thick (10-80 nm) coatings, presumably because of slow diffusion through the organic layer. Although the heterogeneous reactivity of surface-bound PAHs is extremely rapid in the atmosphere, this work is the first to experimentally demonstrate a mechanism by which the lifetime of PAHs may be significantly prolonged, permitting them to undergo long-range transport to remote locations.

Optimized noninvasive procedures to measure DNA damage in comet assay.

The comet assay is a well-established, simple and sensitive method to measure DNA damage in single cell and is commonly used in human trials to investigate the effects of pollution, occupational hazards and potential genoprotective agents. Peripheral blood lymphocytes are most commonly used in human biomonitoring studies, but lymphocytes collected from the mouth offer a potentially attractive, noninvasive alternative. The aim of the current study was to develop a buccal cell lymphocyte comet assay procedure. Cells were collected from mouthwash of three healthy volunteers and tested individually. The comet assay was performed under different pH and times of alkaline treatment, electrophoresis run times and hydrogen peroxide concentrations. Optimal conditions for buccal lymphocytes in comet assay were found to be pH >13 for unwinding and electrophoresis buffers, 10-min alkaline unwinding treatment and 20-min electrophoresis run time. We successfully utilized our optimized assay conditions to demonstrate the genoprotective activity of quercetin. This newly established procedure offers an alternative noninvasive sampling method for the investigation of DNA protection and/or damaging effect.

Quantifying trace gas uptake to tropospheric aerosol: recent advances and remaining challenges.

The interactions of trace gases with tropospheric aerosol can have significant effects on both gas phase and aerosol composition. In turn, this may affect the atmospheric oxidizing capacity, aerosol hygroscopicity and optical properties, and the lifetimes of trace aerosol species. Through the detailed description of specific reaction systems, this review article illustrates how detailed experimental studies of gas-particle interactions lead to both a comprehensive understanding of the underlying physical chemistry as well as accurate parameterizations for atmospheric modeling. The reaction systems studied illustrate the complexity in the field: (i) N(2)O(5) uptake, presented as a benchmark multiphase system, can lead to both NO(x) loss and halogen activation, (ii) loss of HO(2) on aqueous particles is surprisingly poorly studied given its potential importance for HO(x) loss, (iii) uptake of HNO(3) by marine aerosol and heterogeneous oxidation of organic-bearing particles are examples of how gas-particle interactions can lead to substantial alteration of aerosol composition, and (iv) the uptake of glyoxal to ammonium sulfate aerosol leads to highly complex particle-phase chemistry. In addition, for the first time, this article presents the challenges that must be addressed in the design and interpretation of atmospheric gas-to-particle uptake experiments.

Addition of short-term androgen deprivation therapy to dose-escalated radiation therapy improves failure-free survival for select men with intermediate-risk prostate cancer.

BACKGROUND: Dose-escalated (DE) radiation therapy (RT) and androgen deprivation therapy (ADT) improve prostate cancer outcomes over standard-dose RT. The benefit of adding ADT to DE-RT for men with intermediate-risk prostate cancer (IR-PrCa) is uncertain. PATIENTS AND METHODS: We identified 636 men treated for IR-PrCa with DE-RT (>75Gy). The adult comorbidity evaluation-27 index classifed comorbidity. Kaplan-Meier and log-rank tests compared failure-free survival (FFS) with and without ADT. RESULTS: Forty-five percent received DE-RT and 55% DE-RT with ADT (median 6 months). On Cox proportional hazard regression that adjusted for comorbidity and tumor characteristics, ADT improved FFS (adjusted hazard ratio 0.36; P = 0.004). Recursive partitioning analysis of men without ADT classified Gleason 4 + 3 = 7 or ≥50% positive cores as unfavorable disease. The addition of ADT to DE-RT improved 5-year FFS for men with unfavorable disease (81.6% versus 92.9%; P = 0.009) but did not improve FFS for men with favorable disease (96.3% versus 97.4%; P = 0.874). When stratified by comorbidity, ADT improved FFS for men with unfavorable disease and no or mild comorbidity (P = 0.006) but did not improve FFS for men with unfavorable disease and moderate or severe comorbidity (P = 0.380). CONCLUSION: The addition of ADT to DE-RT improves FFS for men with unfavorable IR-PrCa, especially those with no or minimal comorbidity.

Investigation of aqueous-phase photooxidation of glyoxal and methylglyoxal by aerosol chemical ionization mass spectrometry: observation of hydroxyhydroperoxide formation.

Aqueous-phase processing of glyoxal (GLY) and methylglyoxal (MG) produces highly oxygenated, less volatile organic acids that can contribute to SOA formation and aging. In this study, aerosol chemical ionization mass spectrometry (aerosol CIMS) is employed to monitor aqueous-phase photooxidation of GLY and MG. Using iodide (I(-)) as the reagent ion, aerosol CIMS can simultaneously detect important species involved in the reactions: organic acids, peroxides, and aldehydes, so that the reconstructed total organic carbon (TOC) concentrations from aerosol CIMS data agree well with offline TOC analysis. This study also reports the first direct detection of hydroxyhydroperoxide (HHP) formation from the reaction of H(2)O(2) with GLY or MG. The formation of HHPs is observed to be reversible and an estimate of their equilibrium constants is made to be between 40 and 200 M(-1). Results of this study suggest that HHPs can form additional formic acid and acetic acid via photooxidation and regenerate GLY or MG during photooxidation, compensating their loss. HHP formation needs to be further studied for inclusion in aqueous-phase chemical models given that it may affect the aqueous partitioning of carbonyls in the atmosphere.

Intensity modulated proton therapy treatment planning using single-field optimization: the impact of monitor unit constraints on plan quality.

PURPOSE: To investigate the effect of monitor unit (MU) constraints on the dose distribution created by intensity modulated proton therapy (IMPT) treatment planning using single-field optimization (SFO). METHODS: Ninety-four energies between 72.5 and 221.8 MeV are available for scanning beam IMPT delivery at our institution. The minimum and maximum MUs for delivering each pencil beam (spot) are 0.005 and 0.04, respectively. These MU constraints are not considered during optimization by the treatment planning system; spots are converted to deliverable MUs during postprocessing. Treatment plans for delivering uniform doses to rectangular volumes with and without MU constraints were generated for different target doses, spot spacings, spread-out Bragg peak (SOBP) widths, and ranges in a homogeneous phantom. Four prostate cancer patients were planned with and without MU constraints using different spot spacings. Rounding errors were analyzed using an in-house software tool. RESULTS: From the phantom study, the authors have found that both the number of spots that have rounding errors and the magnitude of the distortion of the dose distribution from the ideally optimized distribution increases as the field dose, spot spacing, and range decrease and as the SOBP width increases. From our study of patient plans, it is clear that as the spot spacing decreases the rounding error increases, and the dose coverage of the target volume becomes unacceptable for very small spot spacings. CONCLUSIONS: Constraints on deliverable MU for each spot could create a significant distortion from the ideally optimized dose distributions for IMPT fields using SFO. To eliminate this problem, the treatment planning system should incorporate the MU constraints in the optimization process and the delivery system should reliably delivery smaller minimum MUs.

Medication use is associated with fatigue in a sample of community-living individuals who have a spinal cord injury: a chart review.

OBJECTIVES: To investigate the relationship between medications known to cause fatigue in spinal cord injury (SCI) and fatigue severity and to describe the pattern of prescription of these medications. STUDY DESIGN: Retrospective chart review. SETTING: GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. METHODS: Medical charts of 136 individuals admitted to the GF Strong Outpatient SCI Program between December 2004 and May 2007 were reviewed. Data collected included information on medications, clinical and demographic characteristics and Fatigue Severity Scale (FSS) scores. Multiple linear regression techniques were used to analyse the data. RESULTS: Fifty-two percent of the subjects had clinically relevant fatigue. As a group, the subjects were taking 147 different medications; 41/147 medications were identified as causing fatigue. The two most commonly prescribed categories of medications were antispasticity medications (75 subjects) and analgesic medications (61 subjects). Although several variables were found to contribute to the FSS scores including the use of fatigue-causing medications, the presence of pain (7.6% of variance) and the use of fatigue-causing analgesics (4.2% of variance) explained the most variance in the scores. CONCLUSION: Fatigue is prevalent in outpatients with SCI. Fatigue-causing medications contribute to a higher FSS score. Clinicians treating persons with SCI should be aware that fatigue is a common and significant problem. Clinicians should be aware that fatigue may be exacerbated by the use of medication and should enquire about the effects of medication on fatigue when assessing and prescribing new medications.

Comparison of the single-use LMA supreme with the reusable ProSeal LMA for anaesthesia in gynaecological laparoscopic surgery.

The Laryngeal Mask Airway Supreme (LMAS) is a new, single-use laryngeal mask airway with gastric access. We conducted a randomised controlled study comparing the LMAS with the reusable ProSeal Laryngeal Mask Airway (PLMA) in 70 patients undergoing general anaesthesia with paralysis for gynaecological laparoscopic surgery. Our primary outcome measure was the oropharynegal leak pressure. We also compared the two devices for ease of insertion, adequacy of ventilation and incidence of complications. Both devices had similar rates of successful insertion at the first attempt (LMAS 94% vs PLMA 91%). There was no difference in the time to establish an effective airway (LMAS 25 +/- 22 vs PLMA 24 +/- 9 seconds), although gastric tube insertion was faster for the LMAS (5 +/- 1 vs 7 +/- 3 seconds, P < 0.001). The mean oropharyngeal leak pressure in the LMAS was significantly lower than in the PLMA (27.9 +/- 4.7 vs 31.7 +/- 6.3 cmH2O, P = 0.007). This was consistent with a lower maximum tidal volume achieved with the LMAS (481 +/- 76 vs 515 +/- 63 ml, P = 0.044). We found that after 60 minutes the cuff pressure was significantly higher in the PLMA (110 +/- 21 vs 57 +/- 8 cmH2O, P < 0.001). There was no difference in the ability to provide adequate ventilation and oxygenation during anaesthesia. Complication rates were similar We conclude that the oropharyngeal leak pressure and the maximum achievable tidal volume are lower with the LMAS than with the PLMA.

FDTD calculations of SAR for child voxel models in different postures between 10 MHz and 3 GHz.

Calculations of specific energy absorption rate (SAR) have been performed on the rescaled NORMAN 7-y-old voxel model and the Electronics and Telecommunications Research Institute (ETRI) child 7-y-old voxel model in the standing arms down, arms up and sitting postures. These calculations were for plane-wave exposure under isolated and grounded conditions between 10 MHz and 3 GHz. It was found that there was little difference at each resonant frequency between the whole-body averaged SAR values calculated for the NORMAN and ETRI 7-y-old models for each of the postures studied. However, when compared with the arms down posture, raising the arms increased the SAR by up to 25%. Electric field values required to produce the International Commission on Non-Ionizing Radiation Protection and Institute of Electrical and Electronic Engineers public basic restriction were calculated, and compared with reference levels for the different child models and postures. These showed that, under certain worst-case exposure conditions, the reference levels may not be conservative.

Smoking, alcohol and gastric cancer risk in Korean men: the National Health Insurance Corporation Study.

We investigated the risk of gastric cancer by subsite in relation to cigarette smoking and alcohol in a large population-based cohort of 669 570 Korean men in an insurance plan followed for an average 6.5 years, yielding 3452 new cases of gastric cancer, of which 127 were cardia and upper-third gastric cancer, 2409 were distal gastric cancer and 1007 were unclassified. A moderate association was found between smoking, cardia and upper-third (adjusted relative risk (aRR) 2.2; 95% confidence interval (CI) 1.4-3.5) and distal cancers (aRR=1.4; 95% CI=1.3-1.6). We also found a positive association between alcohol consumption and distal (aRR=1.3; 95% CI=1.2-1.5) and total (aRR=1.2; 95% CI=1.1-1.4) gastric cancer. Combined exposure to high levels of tobacco and alcohol increased the risk estimates further; cardia and upper-third gastric cancers were more strongly related to smoking status than distal gastric cancer.British Journal of Cancer (2007) 97, 700-704. doi:10.1038/sj.bjc.6603893 www.bjcancer.com Published online 17 July 2007.

Prognostic implication of ST-segment resolution following primary percutaneous transluminal coronary angioplasty for ST-elevation acute myocardial infarction.

BACKGROUND: ST-segment changes have been shown to correlate with myocardial tissue perfusion. Complete ST-segment resolution after thrombolysis in acute myocardial infarction is associated with lower mortality and better left ventricular function. Primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction restores better epicardial coronary flow to the infarct-related artery than thrombolysis. However, ST changes may persist and flow can remain poor despite a patent vessel. AIM: To examine the prognostic implication of ST-segment resolution immediately following primary and rescue PTCA for ST-elevation acute myocardial infarction (STEMI). METHODS: Records of 201 consecutive primary and rescue PTCA performed at Westmead Hospital for STEMI from January 2000 to December 2001 were reviewed. ST-segment elevation (taken 20 ms after the end of the QRS complex) was measured immediately before and after the procedure. ST-segment resolution of greater than 70% after the procedure was considered as -'complete' ST-segment resolution, whereas ST-segment resolution of less than 70% was considered as 'incomplete' ST-segment resolution. RESULTS: Of the 201 patients, 117 (58%) had complete ST-elevation resolution and 84 (42%) did not. There was a significant difference in survival free of major adverse cardiovascular events; 60% of those with complete ST-segment resolution were event-free at 2 years compared with 35% of those patients without complete ST-segment resolution. CONCLUSION: ST-segment resolution after primary and rescue PTCA for STEMI is associated with significantly higher event-free survival. The goal of primary angio-plasty should be the restoration of normal epicardial flow with normalization of ST-segments.