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- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 2. |
- Coelho, Ana Maria Mendonça, et al.
(författare)
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MECHANISMS OF THE BENEFICIAL EFFECT OF HYPERTONIC SALINE SOLUTION IN ACUTE PANCREATITIS.
- 2010
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Ingår i: Shock. - 1540-0514. ; 34, s. 502-507
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS:: Administration of hypertonic saline (HS) solution to rats with acute pancreatitis (AP) decreases mortality and systemic inflammation. We hypothesized that these effects are relates not only to systemic inflammatory reduction but also to reduction of the pancreatic lesion. METHODS:: AP was induced in Wistar rats by injection of 2.5% sodium taurocholate. Animals were divided in groups: C (without AP), NT (not treated AP), NS (AP treated with NaCl 0.9%), and HS (AP treated with NaCl 7.5%). RESULTS:: Trypsinogen activation peptides (TAP) and amylase activity were increased in ascitic fluid and serum and were not affected by treatment with HS. Pancreas inflammation was evaluated by increased myeloperoxidase (MPO) activity, malonyldialdehyde (MDA) formation and histopathology for severity of pancreatic lesions. HS did not affect these parameters. Expression of cyclooxygenase (COX)-2 and inducible nitric oxide synthase (iNOS) was markedly increased in the pancreas of the AP group and was reduced by treatment with HS. This treatment also reduced the levels of TNF-alpha and IL-6 but not of IL-10 in the pancreatic tissue. CONCLUSIONS:: These results show that HS modulates cytokines production and expression of enzymes responsible for inflammatory mediators production in the pancreas without affecting the severity of the pancreatic lesions.
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| 3. |
- Vasile, Massimiliano, et al.
(författare)
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The Suaineadh Project : a Stepping Stone Towards the Deployment of Large Flexible Structures in Space
- 2010
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Ingår i: Proceedings of the 61<sup>st</sup> International Astronautical Congress. - : the International Astronautical Federation. ; , s. IAC-10-C3.4-
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Konferensbidrag (refereegranskat)abstract
- The Suaineadh project aims at testing the controlled deployment and stabilization of space web. The deployment system is based on a simple yet ingenious control of the centrifugal force that will pull each of the four daughters sections apart. The four daughters are attached onto the four corners of a square web, and will be released from their initial stowed configuration attached to a central hub. Enclosed in the central hub is a specifically designed spinning reaction wheel that controls the rotational speed with a closed loop control fed by measurements from an onboard inertial measurement sensor. Five other such sensors located within the web and central hub provide information on the surface curvature of the web, and progression of the deployment. Suaineadh is currently at an advanced stage of development: all the components are manufactured with the subsystems integrated and are presently awaiting full integration and testing. This paper will present the current status of the Suaineadh project and the results of the most recent set of tests. In particular, the paper will cover the overall mechanical design of the system, the electrical and sensor assemblies, the communication and power systems and the spinning wheel with its control system.
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