Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The full anticoagulation versus aspirin and ticlopidine (fantastic) study

BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be as effective as or more effective than conventional anticoagulation in patients with an optimal result after implantation of intracoronary metallic stents. However, the safety and efficacy of antiplatelet therapy alone in an unselected population has not been evaluated. METHODS: Patients were randomized to conventional anticoagulation or to treatment with antiplatelet therapy alone. Indications for stenting were classified as elective (decided before the procedure) or unplanned (to salvage failed angioplasty or to optimize the results of balloon angioplasty). After stenting, patients received aspirin and either ticlopidine or conventional anticoagulation (heparin or oral anticoagulant). The primary end point was the occurrence of bleeding or peripheral vascular complications; secondary end points were cardiac events (death, infarction, or stent occlusion) and duration of hospitalization. RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249 to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned in 42%. Stent implantation was successfully achieved in 99% of patients. A primary end point occurred in 33 patients (13.5%) in the antiplatelet group and 48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to 0.98], P=0.03). Major cardiac-related events in electively stented patients were less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%). Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6 versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after coronary stenting significantly reduced rates of bleeding and subacute stent occlusion compared with conventional anticoagulation.     

Psychosocial issues in breast cancer

Over the past year, increasing research attention has been devoted to the issue of women at increased risk of developing breast cancer. These articles focus on a range of issues from recruiting high-risk women into breast cancer trials to recommendations for assessment and counseling women with a family history of breast cancer. In addition, continuing research attention has focused on quality of life, symptom management, and articles related to physician-patient communication. This review summarizes and critiques publications in these areas, and it includes articles reviewing the status of research in psychosocial oncology.     

Sleep and breathing disorders in patients with brain stem lesions

Most information about the structures within the brain stem that modulate respiration and sleep are gathered from animal experiments. Therefore we examined 10 patients several weeks after an infarction of the brain stem by means of polysomnography and tested the chemosensitive drives of respiration. None of these patients complained about symptoms of sleep disordered breathing. In each case polysomnographic measurements and ventilatory response curves revealed pathologic findings. The respiratory response to CO2 was diminished or completely abolished in each patient. In some cases hypoventilation or disturbances of the respiratory rhythmicity could be seen. In several cases missing REM sleep, sleep fragmentation or the reduction of slow wave sleep were observed. The study indicates that on the base of results from animal research the comparison of morphological and pathophysiological data is helpful to gain a better understanding on the coupling of the respiratory system with sleep at the brain stem level as well as on the pathomechanism of sleep related breathing disorder.     

Electrochemical behaviour of 1024 mild steel in slightly alkaline bicarbonate solutions

The electrochemical behaviour of 1024 mild steel electrodes is investigated in the presence of 0.05–0.5 M sodium bicarbonate in aqueous solution at pH 8.9 and 25°C. Voltammograms are obtained with a rotating gold ring-mild steel electrode and the effect of the NaHCO3 concentration, the potential limits and the rotation speed of the disc electrode is considered. The voltammograms display an oxidation peak current at low potentials, a passivity region and a transpassive region at high potentials for the potential sweep in the anodic direction. The oxidation current in the passivity region is practically independent of the applied potential and the NaHCO3 concentration. The rate-determining step of the oxidation reaction in both the oxidation peak current region and the transpassive region is determined.     

块效应图像质量模糊评估标准

研究和讨论了图像质量评估方法,提出一种基于模糊推理的块效应评估标准。假设图像由平滑区域、边缘区域以及纹理区域等组成,而且不同的区域应采用不同的方法进行质量评估。在此基础上,给出了三个分别适用于不同区域的图像质量评估因子,并提出了一个灵活的模糊图像质量评估方法。此方法把块效应和图像本身具有的边缘分开,防止了边缘会被误认为是块效应。仿真结果表明,提出的标准对于不同的图像具有鲁棒性,有一般图像质量评价标准的性能。     

Long-range correlation properties of coding and noncoding DNA sequences: GenBank analysis

An open question in computational molecular biology is whether long-range correlations are present in both coding and noncoding DNA or only in the latter. To answer this question, we consider all 33301 coding and all 29453 noncoding eukaryotic sequences--each of length larger than 512 base pairs (bp)--in the present release of the GenBank to dtermine whether there is any statistically significant distinction in their long-range correlation properties. Standard fast Fourier transform (FFT) analysis indicates that coding sequences have practically no correlations in the range from 10 bp to 100 bp (spectral exponent beta=0.00 +/- 0.04, where the uncertainty is two standard deviations). In contrast, for noncoding sequences, the average value of the spectral exponent beta is positive (0.16 +/- 0.05) which unambiguously shows the presence of long-range correlations. We also separately analyze the 874 coding and the 1157 noncoding sequences that have more than 4096 bp and find a larger region of power-law behavior. We calculate the probability that these two data sets (coding and noncoding) were drawn from the same distribution and we find that it is less than 10(-10). We obtain independent confirmation of these findings using the method of detrended fluctuation analysis (DFA), which is designed to treat sequences with statistical heterogeneity, such as DNA's known mosaic structure ("patchiness") arising from the nonstationarity of nucleotide concentration. The near-perfect agreement between the two independent analysis methods, FFT and DFA, increases the confidence in the reliability of our conclusion.     

Enhanced mortar approach to characterize the effect of reclaimed asphalt pavement on virgin binder true grade

The asphalt community seeks a solvent-free method to determine the properties of RAP binder and those of its blends with virgin binders. A promising approach is to test mortars composed of fine fractions of RAP and a virgin binder, and to calculate grade change rate (GCR) to predict blended binder true grade at any binder replacement rate (BRR). However, the existing mortar approach underestimates the effect of RAP on binder grade, particularly at high temperatures. This study identified the use of a shift factor in the existing method as the source of underestimations. An alternative data analysis method was developed, which eliminates the shift factor by using the relationship between binder and mortar properties. Dynamic shear rheometer tests were conducted on a total of 12 mortar combinations, including 4 virgin binders and 3 RAP sources at a BRR of 15%, and then, RAP GCR values were determined by following both the existing and the alternative methods. Satisfactory comparisons were only observed between grades predicted with the alternative method and measured values of manual RAP binder blends: the average difference was lower than 1 °C for BRR of 15 and 30%, and < 4 °C for BRR of 100%. This not only validated the alternative method but also substantiated that RAP GCR is constant, i.e., the grade of RAP blends linearly increased with BRR. Further evaluation of the enhanced mortar approach is recommended at intermediate and low temperatures as well as with blends including recycled asphalt shingles.