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- Christiansen, Evald H, et al.
(författare)
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Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI.
- 2017
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Ingår i: The New England journal of medicine. - : Massachussetts Medical Society. - 1533-4406 .- 0028-4793. ; 376:19, s. 1813-1823
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Tidskriftsartikel (refereegranskat)abstract
- The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events.We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure.A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P=0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P=0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure.Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736 .).
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| 2. |
- Escaned, Javier, et al.
(författare)
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Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
- 2018
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Ingår i: JACC. - : Elsevier. - 1936-8798 .- 1876-7605. ; 11:15, s. 1437-1449
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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| 3. |
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| 4. |
- Ahlberg, Erik, et al.
(författare)
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"Vi klimatforskare stödjer Greta och skolungdomarna"
- 2019
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Ingår i: Dagens nyheter (DN debatt). - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- DN DEBATT 15/3. Sedan industrialiseringens början har vi använt omkring fyra femtedelar av den mängd fossilt kol som får förbrännas för att vi ska klara Parisavtalet. Vi har bara en femtedel kvar och det är bråttom att kraftigt reducera utsläppen. Det har Greta Thunberg och de strejkande ungdomarna förstått. Därför stödjer vi deras krav, skriver 270 klimatforskare.
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| 5. |
- Asad Ayoubi, Mehran, et al.
(författare)
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Self-assembly of block copolymer-based ionic supramolecules based upon multi-tail amphiphiles
- 2015
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Ingår i: RSC Advances. - : Royal Society of Chemistry (RSC). - 2046-2069. ; 5:39, s. 31091-31103
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Tidskriftsartikel (refereegranskat)abstract
- Utilising simple acid-base titration chemistry, a new family of Linear-b-Amphiphilic Comb (L-b-AC) ionic supramolecules [Soft Matter 2013, 9, 1540-1555] featuring multi-tail side-chains have been synthesized and examined by synchrotron SAXS. To three different parent diblock copolymers of poly(styrene)-b-poly( methacrylic acid) PS-b-PMAA multi-tail ammonium side-chains of (C8)(2)-, (C8)(4) -or (C12)(2)-type were attached at various side-chain grafting densities (X), making it possible to separate effects of the details of the AC-block architecture from effects of the overall volume fraction of the AC block. The micro-segregated morphologies of these systems include AC-block filled spherical microdomains in a liquid-like state (SPHLL), AC-block filled hexagonally-packed cylinders (CYL), alternating lamellar microlayers of AC- and L-blocks (LAM) and L-block filled hexagonally-packed cylinders (CYL*). For systems with the same parent diblock copolymer that also carry a constant volume fraction of AC-blocks, an increase in the side-chain length (l(sc)) and/or in the number of alkyl tails at a side-chain branch point (m) result in a microdomain morphology that is either unchanged or changed into one with a less curved interface. For lamellae-forming L-b-AC ionic supramolecules made up of the same parent diblock copolymer, a body of experimental data showing small variations in the repeat distance of the LAM micro-segregated structure (d(LAM)) could be obtained by making appropriate combinations of X, lsc and m. For such lamellae-forming L-b-AC ionic supramolecules, the average of d(LAM) values decreases when l(sc) and/or m increase. For systems with (C12)(2)-type side-chains, the effective Flory-Huggins interaction parameter between L-and AC-blocks chi'(C12)(2)/X was determined at various side-chain grafting densities and it was observed that chi'(C12)(2)/X increases when X is increased.
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| 6. |
- Biermann, F., et al.
(författare)
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The Earth System Governance Project as a network organization : a critical assessment after ten years
- 2019
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Ingår i: Current Opinion in Environmental Sustainability. - : Elsevier BV. - 1877-3435 .- 1877-3443. ; 39, s. 17-23
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Forskningsöversikt (refereegranskat)abstract
- The social sciences have engaged since the late 1980s in international collaborative programmes to study questions of sustainability and global change. This article offers an in-depth analysis of the largest long-standing social-science network in this field: the Earth System Governance Project. Originating as a core project of the former International Human Dimensions Programme on Global Environmental Change, the Earth System Governance Project has matured into a global, self-sustaining research network, with annual conferences, numerous taskforces, research centers, regional research fellow meetings, three book series, an open access flagship journal, and a lively presence in social media. The article critically reviews the experiences of the Earth System Governance network and its integration and interactions with other programmes over the last decade.
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| 7. |
- Bråbäck, Lennart, et al.
(författare)
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Childhood asthma and smoking exposures before conception - a three-generational cohort study.
- 2018
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 29:4, s. 361-368
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Some human and animal studies have recently shown that maternal grandmother's smoking during pregnancy increases the risk of asthma in the grandchildren. We have investigated whether sex of the exposed parent and/or grandchild modifies the association between grandmaternal smoking and grandchild asthma.METHODS: We formed a cohort study based on linkage of national registries with prospectively collected data over three generations. Smoking habits in early pregnancy were registered since 1982 and purchases of prescribed medication since 2005. In all, 10329 children born since 2005 had information on maternal and grandmaternal smoking on both sides and were followed from birth up to 6 years of age. Ages when medication was purchased were used to classify the cohort into never, early transient (0-3 years), early persistent (0-3 and 4-6 years) and late-onset (4-6 years) phenotypes of childhood asthma.RESULTS: Maternal grandmother's smoking was associated with an increased odds of early persistent asthma after adjustment for maternal smoking and other confounders (odds ratio 1.29, 95% confidence interval 1.10-1.51). Grandchild sex did not modify the association. Paternal grandmother's smoking was not associated with any of the asthma phenotypes.CONCLUSION: Maternal but not paternal exposure to nicotine before conception was related to an increased risk of early persistent childhood asthma, but not other asthma phenotypes. Our findings are possibly consistent with a sex specific mode of epigenetic transfer.
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| 10. |
- Crews, Timothy E., et al.
(författare)
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Is the future of agriculture perennial? Imperatives and opportunities to reinvent agriculture by shifting from annual monocultures to perennial polycultures
- 2018
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Ingår i: Global Sustainability. - : Cambridge University Press (CUP). - 2059-4798. ; 1, s. 1-18
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Tidskriftsartikel (refereegranskat)abstract
- Modern agriculture is associated with numerous environmental predicaments, such as land degradation, water pollution, and greenhouse gas emission. Socio-economically, it is characterized by a treadmill of technological change, increased mechanization, and economic consolidation, while depressing economic returns to farmers. A root cause is the dominance of annual plants cultivated in monocultures. Annual crops require the yearly clearing of vegetation resulting in soil erosion and other forms of ecosystem degradation. Monocultures are susceptible to agricultural pests and weeds. By contrast, perennial polycultures informed by natural ecosystems, promise more sustainable agroecosystems with the potential to also revitalize the economic foundation of farming and hence rural societies.
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