Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Stress-induced birefringence in the isotropic phases of lyotropic mixtures.

In this work, the frequency dependence of the known mechano-optical effect which occurs in the micellar isotropic phases (I) of mixtures of potassium laurate (KL), decanol (DeOH), and water is investigated in the range from 200mHz to 200Hz. In order to fit the experimental data, a model of superimposed damped harmonic oscillators is proposed. In this phenomenological approach, the micelles (microscopic oscillators) interact very weakly with their neighbors. Due to shape anisotropy of the basic structures, each oscillator i (i=1,2,3,...,N) remains in its natural oscillatory rotational movement around its axes of symmetry with a frequency ω_{0i}. The system will be in the resonance state when the frequency of the driving force ω reaches a value near ω_{0i}. This phenomenological approach shows excellent agreement with the experimental data. One can find f∼2.5, 9.0, and 4.0Hz as fundamental frequencies of the micellar isotropic phases I, I_{1}, and I_{2}, respectively. The different micellar isotropic phases I, I_{1}, and I_{2} that we find in the phase diagram of the KL-DeOH-water mixture are a consequence of possible differences in the intermicellar correlation lengths. This work reinforces the possibilities of technological applications of these phases in devices such as mechanical vibration sensors.