Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial

OBJECTIVE: We examined the effects of aprotinin on graft patency, prevalence of myocardial infarction, and blood loss in patients undergoing primary coronary surgery with cardiopulmonary bypass. METHODS: Patients from 13 international sites were randomized to receive intraoperative aprotinin (n = 436) or placebo (n = 434). Graft angiography was obtained a mean of 10.8 days after the operation. Electrocardiograms, cardiac enzymes, and blood loss and replacement were evaluated. RESULTS: In 796 assessable patients, aprotinin reduced thoracic drainage volume by 43% (P < .0001) and requirement for red blood cell administration by 49% (P < .0001). Among 703 patients with assessable saphenous vein grafts, occlusions occurred in 15.4% of aprotinin-treated patients and 10.9% of patients receiving placebo (P = .03). After we had adjusted for risk factors associated with vein graft occlusion, the aprotinin versus placebo risk ratio decreased from 1.7 to 1.05 (90% confidence interval, 0.6 to 1.8). These factors included female gender, lack of prior aspirin therapy, small and poor distal vessel quality, and possibly use of aprotinin-treated blood as excised vein perfusate. At United States sites, patients had characteristics more favorable for graft patency, and occlusions occurred in 9.4% of the aprotinin group and 9.5% of the placebo group (P = .72). At Danish and Israeli sites, where patients had more adverse characteristics, occlusions occurred in 23.0% of aprotinin- and 12.4% of placebo-treated patients (P = .01). Aprotinin did not affect the occurrence of myocardial infarction (aprotinin: 2.9%; placebo: 3.8%) or mortality (aprotinin: 1.4%; placebo: 1.6%). CONCLUSIONS: In this study, the probability of early vein graft occlusion was increased by aprotinin, but this outcome was promoted by multiple risk factors for graft occlusion.     

Sensitivity analysis for simulation-based decision making: Application to a hospital emergency service design

An increasing concern of decision makers when dealing with system design is preparation for a wide range of potentially uncertain operating conditions. This paper provides a novel multiobjective approach for simulation-driven decision making that accounts for not only the conventional average system performance indices, but also (i) upper-tail, or extreme, values of these indices, and (ii) measures of their sensitivity to uncertainty in model parameters. The proposed approach is applied to a hospital emergency department service design case study wherein different design alternatives are compared using total time-in-system performance metric under multiple uncertain operating conditions.     

Electrocopolymerization kinetics of a binary mixture of 3‐chloroaniline 2‐amino‐4‐phenylthiazole and characterization of the obtained block copolymer films

Electrocopolymerization of a binary mixture of 3‐chloroaniline and 2‐amino‐4‐phenylthiazole on platinum electrode in acid medium was carried out under different reaction conditions such as temperature, current density, hydrochloric acid, and monomer concentrations with duration time. The initial rate of the electrocopolymerization reaction on platinum electrode is small and the rate law is R_p = K₂ [D]^1.29[HCl]^0.97[M]^1.94. The apparent activation energy is found to be 38.87 kJ/mol. The obtained copolymer film is characterized by ¹H‐NMR, elemental analysis, GPC IR, UV‐visible, and cyclic voltammetry and compared with those of the two homopolymers. The mechanism of the electrocopolymerization reaction is also discussed and the monomer reactivity ratio (r₁and r₂) is calculated. The thermogravimetric analysis (TGA) is used to confirm the proposed structure and determination of the number of water molecules in the polymeric chain unit. X‐ray and scanning electron microscopic analysis are used to investigate the surface morphology. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 97: 2076–2087, 2005     

Solvent-free oxidation of benzyl alcohol using titania-supported gold–palladium catalysts: Effect of Au–Pd ratio on catalytic performance

The oxidation of benzyl alcohol with molecular oxygen under solvent-free conditions has been investigated using a range of titania-supported Au–Pd alloy catalysts to examine the effect of the Au–Pd ratio on the conversion and selectivity. The catalysts have been compared at high reaction temperature (160 °C) as well as at 100 °C, to determine the effect on selectivity since at lower reaction temperature the range of by-products that are formed are limited. Under these conditions the 2.5 wt.% Au–2.5 wt.% Pd/TiO₂ was found to be the most active catalyst, whereas the Au/TiO₂ catalyst demonstrated the highest selectivity to benzaldehyde. Toluene, formed via either a hydrogen transfer process or an oxygen transfer process, was observed as a major by-product under these forcing conditions.     

Subjects presented at ASHP Midyear Clinical Meetings, 1967-90

The subject matter and trends of presentations made at ASHP Midyear Clinical Meetings (MCMs) were studied. A computerized database of information from MCM and Annual Meeting (AM) program and abstract books was created. The data were analyzed to determine the distribution of MCM presentations by subject and by author for the period 1967 to 1990, determine if there were differences in subjects covered between MCMs and AMs, explore the proposition that there has been duplication of material in MCM presentations, and evaluate the frequency with which MCM presentations have been published in ASHP journals. The total number of presentations made at MCMs from 1967 through 1990 was 8180, while the total for the AMs was 1547 for the two periods (1962-71 and 1985-90) studied. The most common keywords in titles were "pharmacy," "drug," "patient," "hospital," and "service." All International Pharmaceutical Abstracts subject categories and two other categories were represented; presentations in the institutional pharmacy practice category were the most frequent, while pharmacognosy-related presentations were least frequent. The overwhelming number of authors made only one presentation and were listed as the first author. The subjects of presentations were similar between AMs and MCMs. A tendency toward duplication of material was found. Of the 8180 MCM presentations, at least 1005 were published in an ASHP journal. Between 1967 and 1990, presentations at MCMs covered a wide range of subjects but were sometimes duplicative or not on the cutting edge.     

Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis

BACKGROUND: To identify predictors of long-term outcome after balloon aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78 +/- 9 years; 56% were women) undergoing this procedure at 24 clinical centers who had a mean initial increase in aortic valve area of 0.3 cm2. METHODS AND RESULTS: Baseline data included clinical, echocardiographic, and catheterization variables. Follow-up data included mortality, cause of death, rehospitalization, 6-month echocardiography, and functional status. Kaplan-Meier curves and log-rank tests were used to evaluate survival in subgroups. Multivariate Cox regression models were used to identify independent predictors of survival. Overall survival was 55% at 1 year, 35% at 2 years, and 23% at 3 years, with the majority of deaths (70%) classified as cardiac by an independent review committee. Rehospitalization was common (64%), although 61% of survivors at 2 years reported improved symptoms. Echocardiography at 6 months (n = 115) showed restenosis from the postprocedural valve area of 0.78 +/- 0.31 cm2 to 0.65 +/- 0.25 cm2 (P < .0001). With stepwise multivariate analysis, sequentially adding clinical, echocardiographic, and catheterization variables, the overall model identified independent predictors of survival as baseline functional status, baseline cardiac output, renal function, cachexia, female gender, left ventricular systolic function, and mitral regurgitation. Baseline and postprocedural variables were examined to identify which subgroup of patients has the best outcome after aortic valvuloplasty. A "lower-risk" subgroup (28% of the study population), defined by normal left ventricular systolic function and mild clinical functional limitation, had a 3-year survival of 36% compared with 17% in the remainder of the study group. CONCLUSIONS: Long-term survival after balloon aortic valvuloplasty is poor with 1- and 3-year survival rates of 55% and 23%, respectively. Although survivors report fewer symptoms, early restenosis and recurrent hospitalization are common.     

A systematic study of thiophene Langmuir-Blodgett films including new conjugated donor-acceptor molecules

Hemicyanine dyes are an extensively investigated group of materials which show promise for second-order non-linear optical properties; they have also proved to be good materials for deposition by the Langmuir-Blodgett technique. This work concerns a closely related group of materials which contain a thiophene moiety in place of the nitrogen heterocycle of the hemicyanine material. The synthesis of several groups of novel amphiphiles containing the thiophene moiety, and their subsequent screening as materials for deposition by the Langmuir Blodgett technique is described. General trends in the behaviour of the simplest materials are noted, whilst the report of the characterization of the more complex D--A thiophenes is extended to include data relating to the production of heterogeneous monolayer and alternate layer structures.     

Morphology of single crystals of poly (hydroxybutyrate) and copolymers of hydroxybuty rate and hydroxyvalerate

Single crystals of poly(hydroxybutyrate), and copolymers of hydroxybutyrate and hydroxyvalerate, have been grown from a variety of solvents and their morphology studied. In all cases the crystals appear elongated, with the crystallographic a axis along the long axis of the crystals. Screw dislocations (which act as branch points and can lead to large crystal aggregates) have been observed, and solvents, e.g. octanol in which more of these dislocations occur, have been identified. Decoration of the crystals with polyethylene shows that the fold plane is the (0 1 0) plane, while crystallographic and crystallinity arguments require successive adjacent folds to be along 1 1 0 directions. It is argued that folding is along [1 1 0] on the top, and [1 ¯1 0] on the bottom surface of a crystal.