Mortality from heart attack in Belgrade population during the period 1990-2004

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Ratkov Isidora

2008-01-01

Full Text Available INTRODUCTION In most countries, cardiovascular diseases are the leading disorders, with ischemic heart diseases being the leading cause of death. According to WHO data, every year about 17 million people die of cardiovascular diseases, which is 30% of all deaths. Ischemic heart diseases contribute from one-third to one-half of all deaths due to cardiovascular diseases. Three point eight million men and 3.4 million women in the world die every year from ischemic heart diseases, and in Europe about 2 million. The highest mortality rate from ischemic heart diseases occurs in India, China and Russia. OBJECTIVE The aim of this descriptive epidemiological study was to determine heart attack mortality in Belgrade population during the period 1990-2004. METHOD In the study, we conducted investigation of Belgrade population during the period 1990-2004. Mortality data were obtained from the city institution for statistics. The mortality rates were calculated based on the total Belgrade population obtained from the mean values for the last two register years (1991 and 2002. The mortality rates were standardized using the direct method of standardization according to the world (Segi standard population. RESULTS In the Belgrade population during the period 1990-2004, the participation of mortality rate due to heart attack among deaths from cardiovascular diseases was 17% in males and 10% in females. In Belgrade male population, mean standardized mortality rates (per 100,000 habitants were 50.5 for heart attack, 8.3 for chronic ischemic heart diseases and 4.6 for angina pectoris, while in females the rates were 30.8, 6.7 and 4.2, respectively. Mortality from ischemic heart diseases and from heart attack was higher in males than in females. During the studied 15-year period, on average 755 males and 483 females died due to heart attack every year. Mean standardized mortality rates per 100,000 habitants were 50.0 in male and 31.1 in female population. Males

Summary of 2017 ESC guidelines on valvular heart disease, peripheral artery disease, STEMI and on dual antiplatelet therapy.

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Van Camp, Guy; De Backer, Tine; Beauloye, Christophe; Desmet, Walter; Claeys, Marc J

2017-12-11

During the ESC congress in September 2017 in Barcelona, the new ESC guidelines were presented and are now available on the ESC website. The new guidelines cover management recommendations on following cardiovascular items: valvular heart disease, peripheral artery disease, ST elevation myocardial infarction (STEMI) and on dual antiplatelet therapy. The present document gives a summary of these guidelines and highlights the most important recommendations and changes in the management of these diseases. It will help to increase awareness about the new guidelines and may stimulate to consult the full document for specific items. Ultimately, the authors hope that this document will enhance implementation of new ESC guidelines in daily clinical practice.

STEMI vs NSTEACS management trends in non-invasive hospital

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Abdulhalim Jamal Kinsara

2016-07-01

Conclusion: NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors.

Knowledge of Signs and Symptoms of Heart Attack and Stroke among Singapore Residents

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Joy Li Juan Quah

2014-01-01

Full Text Available Aim. To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. Methods. A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. Results. The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4 out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9 out of 10 for stroke. Respondents who were ≥50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. Conclusion. We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.

Improvement in Care and Outcomes for Emergency Medical Service-Transported Patients With ST-Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline STEMI Accelerator Study.

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Kragholm, Kristian; Lu, Di; Chiswell, Karen; Al-Khalidi, Hussein R; Roettig, Mayme L; Roe, Matthew; Jollis, James; Granger, Christopher B

2017-10-11

Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non-PCI hospitals to go to a PCI center. We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI-capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service-transported patients, 88.7% (N=11 703; 10.5% OHCA) were taken directly to PCI hospitals. Among 1486 transfer-in patients, 21.7% had OHCA. Direct transport to a PCI center for OHCA increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02-1.14), versus 89.0% to 91.0% for patients without OHCA (odds ratio, 1.03; 95% confidence interval, 0.99-1.07; interaction P =0.23). The proportion with prehospital ECGs increased for patients taken directly to PCI centers (53.9%-61.9% for those with OHCA versus 73.9%-81.9% for those without OHCA; interaction P =0.12). Of 997 patients with OHCA taken directly to PCI hospitals and treated with primary PCI, first medical contact-to-device times within the guideline-recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction P =0.72). Direct transport to PCI hospitals increased for patients with STEMI with and without OHCA during the 2012 to 2014 Mission: Lifeline STEMI Accelerator program. Proportions with prehospital ECGs and timely reperfusion increased for patients taken directly to PCI hospitals. © 2017 The Authors

An avatar based education application to improve patients' knowledge of and response to heart attack symptoms: a pragmatic randomized controlled trial protocol.

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Tongpeth, Jintana; Du, Huiyun; Clark, Robyn

2018-06-19

To evaluate the effectiveness of an interactive, avatar based education application to improve knowledge of and response to heart attack symptoms in people who are at risk of a heart attack. Poor knowledge of heart attack symptoms is recognised as a significant barrier to timely medical treatment. Numerous studies have demonstrated that technology can assist in patient education to improve knowledge and self-care. A single-center, non-blinded, two parallel groups, pragmatic randomized controlled trial. Seventy patients will be recruited from the coronary care unit of a public hospital. Eligible participants will be randomised to either the usual care or the intervention group (usual care plus avatar-based heart attack education app). The primary outcome of this study is knowledge. Secondary outcomes include response to heart attack symptoms, health service use and satisfaction. Study participants will be followed-up for six months. This study will evaluate the avatar based education app as a method to deliver vital information to patients. Participants' knowledge of and response to heart attack symptoms, as well as their health service use, will be assessed to evaluate the intervention effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study.

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Muhlestein, Joseph Boone; Le, Viet; Albert, David; Moreno, Fidela Ll; Anderson, Jeffrey L; Yanowitz, Frank; Vranian, Robert B; Barsness, Gregory W; Bethea, Charles F; Severance, Harry W; Ramo, Barry; Pierce, John; Barbagelata, Alejandro; Muhlestein, Joseph Brent

2015-01-01

12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care. To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG. 6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory. The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL. Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology. Copyright © 2015 Elsevier Inc. All rights reserved.

Dysfunction of Right Heart in Attack Period of Bronchial Asthma in Children

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V.А. Kondratiev

2015-11-01

Full Text Available There were performed Doppler echocardiography investigations of functional state of the right heart in 42 children aged 5–17 years old in attack period of bronchial asthma of moderate to severe degree. Changes of intra-cardiac hemodynamics of the right heart in children in attack period of bronchial asthma were characterized by disturbance of systolic and diastolic function of the right ventricle and right atrium. Combined systolic-diastolic variant of the right ventricle dysfunction was typical for attack period of bronchial asthma in children and developed in 95.5 % of cases. Elevation of pressure in pulmonary artery was typical and significantly more often occurred in severe asthma attack, herewith pulmonary hypertension of the second degree predominated.

27. The impact of introduction of code-stemi program on clinical outcomes of acute st-elevation myocardial infarction (stemi patients undergoing primary pci: Single center study in Saudi Arabia

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A. ALYAHYA

2016-07-01

Full Text Available This study was conducted to evaluate the effect of direct Emergency Department activation of the Catheterization Lab on door to balloon (D2B time and outcomes of acute ST-elevation myocardial infarction (STEMI patients in King Khalid University Hospital (KKUH. Establishing dedicated comprehensive STEMI programs aiming at reducing door to balloon time will impact favourably the outcomes of patients presenting with acute STEMI. This was a retrospective cohort study that involved 100 patients in KKUH who presented with acute STEMI and underwent primary percutaneous intervention (PPCI, between June 2010 and January 2015. The cohort was divided into two groups, the first group consisted of 50 patients who were treated before establishing the Code-STEMI protocol, whereas the second group were 50 patients who were treated according to the protocol, which was implemented in June 2013. Code-STEMI program is a comprehensive program that includes direct activation of the cath lab team using a single call system, data monitoring and feedback, and standardized order forms. The mean age in both groups was 54 ± 12 years and 86% (43 and 94% (47 of the patients in the two groups were males, respectively. 90% (90 of patients in both groups had one or more comorbidities.Code-STEMI group had a significantly lower D2BT with 70% of patients treated within the recommended 90 minutes (median = 76.5 min, IQR: 63–90 min compared to only 26% of pre code-STEMI patients (median = 107 min, IQR: 74–149 min In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction, (8% vs. 0%, p = 0.043. In addition, the number of patients with more than one in-hospital complications was also reduced by 20%.Implementation of direct ER-Catheterization lab activation protocol was associated with a significant reduction in D2B time, and an overall improvement of in-hospital outcomes.

US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings.

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Pabayo, Roman; Kawachi, Ichiro; Gilman, Stephen E

2015-07-01

To examine prospectively the association between US state income inequality and incidence of heart attack. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.

STEMI time delays: A clinical perspective

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M.J. de Boer (Menko Jan); F. Zijlstra (Felix)

2015-01-01

textabstractSTEMI time delays have been introduced as a performance indicator or marker of quality of care. As they are only one part of a very complex medical process, one should be aware of concomitant issues that may be overlooked or even be more important with regard to clinical outcome of STEMI

Framework for a National STEMI Program: Consensus document developed by STEMI INDIA, Cardiological Society of India and Association Physicians of India

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Thomas Alexander

2015-09-01

Full Text Available The health care burden of ST elevation myocardial infarction (STEMI in India is enormous. Yet, many patients with STEMI can seldom avail timely and evidence based reperfusion treatments. This gap in care is a result of financial barriers, limited healthcare infrastructure, poor knowledge and accessibility of acute medical services for a majority of the population. Addressing some of these issues, STEMI India, a not-for-profit organization, Cardiological Society of India (CSI and Association Physicians of India (API have developed a protocol of “systems of care” for efficient management of STEMI, with integrated networks of facilities. Leveraging newly-developed ambulance and emergency medical services, incorporating recent state insurance schemes for vulnerable populations to broaden access, and combining innovative, “state-of-the-art” information technology platforms with existing hospital infrastructure, are the crucial aspects of this system. A pilot program was successfully employed in the state of Tamilnadu. The purpose of this article is to describe the framework and methods associated with this programme with an aim to improve delivery of reperfusion therapy for STEMI in India. This programme can serve as model STEMI systems of care for other low-and-middle income countries.

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood.

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Hamil-Luker, Jenifer; O'Rand, Angela M

2007-02-01

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.

Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions.

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Hendryx, Michael; Zullig, Keith J

2009-11-01

This study analyzes the U.S. 2006 Behavioral Risk Factor Surveillance System survey data (N=235,783) to test whether self-reported cardiovascular disease rates are higher in Appalachian coal mining counties compared to other counties after control for other risks. Dependent variables include self-reported measures of ever (1) being diagnosed with cardiovascular disease (CVD) or with a specific form of CVD including (2) stroke, (3) heart attack, or (4) angina or coronary heart disease (CHD). Independent variables included coal mining, smoking, BMI, drinking, physician supply, diabetes co-morbidity, age, race/ethnicity, education, income, and others. SUDAAN Multilog models were estimated, and odds ratios tested for coal mining effects. After control for covariates, people in Appalachian coal mining areas reported significantly higher risk of CVD (OR=1.22, 95% CI=1.14-1.30), angina or CHD (OR=1.29, 95% CI=1.19-1.39) and heart attack (OR=1.19, 95% CI=1.10-1.30). Effects were present for both men and women. Cardiovascular diseases have been linked to both air and water contamination in ways consistent with toxicants found in coal and coal processing. Future research is indicated to assess air and water quality in coal mining communities in Appalachia, with corresponding environmental programs and standards established as indicated.

Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries.

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Kaifoszova, Zuzana; Kala, Petr; Alexander, Thomas; Zhang, Yan; Huo, Yong; Snyders, Adriaan; Delport, Rhena; Alcocer-Gamba, Marco Antonio; Gavidia, Leslie Marisol Lugo

2014-08-01

This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from

Ventilatory control of heart rate during inhalation of 5% CO2 and types of panic attacks.

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Ley, R

1991-09-01

Differences in the magnitude of increases in heart rate during prolonged inhalation of 5% CO2 range from a mean of 25 b/min for a group of eight panic-disorder patients who panicked (Woods, Charney, Goodman, & Heninger, 1988. Archives of General Psychiatry, 45, 43-52) to zero b/min for 16 patients, eight of whom panicked (Craske & Barlow, 1990. Journal of Abnormal Psychology, 99, 302-307). What accounts for this disparity? The present paper describes how heart rate can be increased by means of voluntary overbreathing during prolonged inhalation of 5% CO2 in air. This suggests that differences in the degree of overbreathing may explain differences in the magnitude of increases in heart rate during inhalation of 5% CO2. An explanation is also offered for the curious finding that some patients experience "panic attacks" with zero increase in heart rate. Evidence suggests that this is likely to happen in cognitively based panic attacks, in contrast to hyperventilatory attacks or anticipatory attacks.

Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions

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Hendryx, M.; Zullig, K.J. [West Virginia University, Morgantown, WV (United States). Dept. of Community Medicine

2009-11-15

This study analyzes the U.S. 2006 Behavioral Risk Factor Surveillance System survey data (N = 235,783) to test whether self-reported cardiovascular disease rates are higher in Appalachian coal mining counties compared to other counties after control for other risks. Dependent variables include self-reported measures of ever (1) being diagnosed with cardiovascular disease (CVD) or with a specific form of CVD including (2) stroke, (3) heart attack, or (4) angina or coronary heart disease (CHD). Independent variables included coal mining, smoking, BMI, drinking, physician supply, diabetes co-morbidity, age, race/ethnicity, education, income, and others. SUDAAN Multilog models were estimated, and odds ratios tested for coal mining effects. After control for covariates, people in Appalachian coal mining areas reported significantly higher risk of CVD (OR = 1.22, 95% CI = 1.14-1.30), angina or CHO (OR = 1.29, 95% C1 = 1.19-1.39) and heart attack (OR = 1.19, 95% C1 = 1.10-1.30). Effects were present for both men and women. Cardiovascular diseases have been linked to both air and water contamination in ways consistent with toxicants found in coal and coal processing. Future research is indicated to assess air and water quality in coal mining communities in Appalachia, with corresponding environmental programs and standards established as indicated.

Outcome of everolimus eluting bioabsorbable vascular scaffold (BVS) compared to non BVS drug eluting stent in the management of ST-segment elevation myocardial infarction (STEMI) — A comparative study

International Nuclear Information System (INIS)

Chakraborty, Rabin; Patra, Soumya; Banerjee, Suvro; Pande, Arindam; Khan, Aftab; Mandol, Prakash Chandra; Ghosh, Debashish; De, Swapan Kumar; Das, Sankha Subhro; Nag, Raja

2016-01-01

Background: The safety and efficacy of everolimus eluting bioabsorbable vascular scaffold (BVS) in the management of “ST” segment elevation myocardial infarction (STEMI) are yet to be established. Aims: To evaluate immediate and short term safety and efficacy of the everolimus-eluting ABSORB BVS compared with non BVS drug eluting stent (DES) in patients with STEMI. Methods: From December 2013 to December 2014, 220 patients with STEMI were included in this study. Among them, 35 patients treated with BVS were compared with a control group composed of 180 patients who underwent non BVS DES implantation in the same time period. The incidence of major adverse cardiac events (MACE: stent thrombosis: death, non-fatal myocardial infarction, or target vessel/lesion revascularization) before discharge and up to six months was evaluated. Results: 1 vessel disease was more frequent whereas, 2 and 3 vessel disease was less frequent in BVS group. Procedural characteristics were also similar between groups, except for the use of post dilation (p = 0.04). Procedural success, in-hospital, and up to six-month MACE rates were similar between both groups. Definite or probable stent thrombosis did not occur (according to the ARC criteria) in BVS patients, though two patients during the index admission and another two patients in the first month after DES implantation had stent thrombosis. Conclusion: The use of the ABSORB BVS for STEMI is feasible and associated with good procedural safety, and angiographic success rate.

Outcome of everolimus eluting bioabsorbable vascular scaffold (BVS) compared to non BVS drug eluting stent in the management of ST-segment elevation myocardial infarction (STEMI) — A comparative study

Energy Technology Data Exchange (ETDEWEB)

Chakraborty, Rabin; Patra, Soumya, E-mail: dr_soumyapatra@rediffmail.com; Banerjee, Suvro; Pande, Arindam; Khan, Aftab; Mandol, Prakash Chandra; Ghosh, Debashish; De, Swapan Kumar; Das, Sankha Subhro; Nag, Raja

2016-04-15

Background: The safety and efficacy of everolimus eluting bioabsorbable vascular scaffold (BVS) in the management of “ST” segment elevation myocardial infarction (STEMI) are yet to be established. Aims: To evaluate immediate and short term safety and efficacy of the everolimus-eluting ABSORB BVS compared with non BVS drug eluting stent (DES) in patients with STEMI. Methods: From December 2013 to December 2014, 220 patients with STEMI were included in this study. Among them, 35 patients treated with BVS were compared with a control group composed of 180 patients who underwent non BVS DES implantation in the same time period. The incidence of major adverse cardiac events (MACE: stent thrombosis: death, non-fatal myocardial infarction, or target vessel/lesion revascularization) before discharge and up to six months was evaluated. Results: 1 vessel disease was more frequent whereas, 2 and 3 vessel disease was less frequent in BVS group. Procedural characteristics were also similar between groups, except for the use of post dilation (p = 0.04). Procedural success, in-hospital, and up to six-month MACE rates were similar between both groups. Definite or probable stent thrombosis did not occur (according to the ARC criteria) in BVS patients, though two patients during the index admission and another two patients in the first month after DES implantation had stent thrombosis. Conclusion: The use of the ABSORB BVS for STEMI is feasible and associated with good procedural safety, and angiographic success rate.

Before Using Aspirin to Lower Your Risk of Heart Attack or Stroke, Here Is What You Should Know

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... Medicines Safe Daily Use of Aspirin Before Using Aspirin to Lower Your Risk of Heart Attack or ... care provider can determine whether regular use of aspirin will help to prevent a heart attack or ...

Panic Attack or Heart Attack?

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... When in doubt about symptoms, seek care without delay to rule out heart disease. Heart disease affects your heart's ... which cause you concern, see your doctor without delay and ask for testing to rule out heart disease. 1 Gadolinium side effects could ...

Comparing Asian American Women's Knowledge, Self-Efficacy, and Perceived Risk of Heart Attack to Other Racial and Ethnic Groups: The mPED Trial.

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Fukuoka, Yoshimi; Lisha, Nadra E; Vittinghoff, Eric

2017-09-01

The aim of the study was to compare knowledge and awareness of heart attacks/heart disease and perceived risk for future heart attack in Asian/Pacific Islander women, compared to other racial and ethnic groups. In this cross-sectional study, 318 women enrolled in a mobile phone-based physical activity education trial were analyzed. Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Analyses were conducted using logistic, proportional odds, and linear regression models, depending on the outcome and adjusting for age. Pairwise differences between Asian/Pacific Islanders and the other four groups were assessed using a Bonferroni correction (p Asian/Pacific Islander women had significantly lower total scores for knowledge of heart attack and self-efficacy for heart attack recognition and care seeking behavior compared to the Caucasian women (p = 0.001 and p = 0.002, respectively). However, perceived risk did not differ among the groups. Forty-six percent of the Asian American women, compared to 25% of Caucasian women, falsely believed "breast cancer is the number one cause of death for women (p = 0.002)." In addition, Asian/Pacific Islander women were less likely to report "arm pain, numbness, tingling, or radiating" as one of the heart attack symptoms compared to the Caucasian and the multiracial group (34%, 63% [p Asian/Pacific Islander women and Caucasian women.

Consciousness in Non-Epileptic Attack Disorder

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Reuber, M.; Kurthen, M.

2011-01-01

Non-epileptic attack disorder (NEAD) is one of the most important differential diagnoses of epilepsy. Impairment of\\ud consciousness is the key feature of non-epileptic attacks (NEAs). The first half of this review summarises the clinical research\\ud literature featuring observations relating to consciousness in NEAD. The second half places this evidence in the wider context\\ud of the recent discourse on consciousness in neuroscience and the philosophy of mind. We argue that studies of consci...

Can You Recognize a Heart Attack or Stroke? What To Do When Every Moment Counts

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... Special Issues Subscribe August 2014 Print this issue Can You Recognize a Heart Attack or Stroke? What ... could prevent many of these deaths. Fast action can also limit permanent damage to the body. Heart ...

Applying Magneto-rheology to Reduce Blood Viscosity and Suppress Turbulence to Prevent Heart Attacks

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Tao, R.

Heart attacks are the leading causes of death in USA. Research indicates one common thread, high blood viscosity, linking all cardiovascular diseases. Turbulence in blood circulation makes different regions of the vasculature vulnerable to development of atherosclerotic plaque. Turbulence is also responsible for systolic ejection murmurs and places heavier workload on heart, a possible trigger of heart attacks. Presently, neither medicine nor method is available to suppress turbulence. The only method to reduce the blood viscosity is to take medicine, such as aspirin. However, using medicine to reduce the blood viscosity does not help suppressing turbulence. In fact, the turbulence gets worse as the Reynolds number goes up with the viscosity reduction by the medicine. Here we report our new discovery: application of a strong magnetic field to blood along its flow direction, red blood cells are polarized in the magnetic field and aggregated into short chains along the flow direction. The blood viscosity becomes anisotropic: Along the flow direction the viscosity is significantly reduced, but in the directions perpendicular to the flow the viscosity is considerably increased. In this way, the blood flow becomes laminar, turbulence is suppressed, the blood circulation is greatly improved, and the risk for heart attacks is reduced. While these effects are not permanent, they last for about 24 hours after one magnetic therapy treatment.

Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

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Coyne, Christopher J.

2014-12-01

Full Text Available Introduction: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG times for patients with ST-segment elevation myocardial infarction (STEMI. Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. Methods: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. Results: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01, ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01, and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03. Conclusion: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. [West J Emerg Med. 2015;16(1:184–189.

Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

Science.gov (United States)

Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana

2018-03-01

The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts

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... the-Counter Medicines Safe Daily Use of Aspirin Aspirin for Reducing Your Risk of Heart Attack and ... any pharmacy, grocery or convenience store and buy aspirin without a prescription. The Drug Facts label on ...

Are patients with non-ST elevation myocardial infarction undertreated?

Directory of Open Access Journals (Sweden)

Gosselink AT Marcel

2007-03-01

Full Text Available Abstract Background The worse prognosis in patients without ST-elevation (non-STEMI as compared to ST-elevation myocardial infarction (STEMI, may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population. Methods Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI. Results A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation were independent and significant predictors of long-term mortality. Conclusion In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.

Advances in invasive evaluation and treatment of patients with ischemic heart disease

NARCIS (Netherlands)

Hoeven, Barend Leendert van der

2008-01-01

The aim of this thesis was to evaluate new developments in the treatment of patients with ischemic heart disease, with special focus to the invasive evaluation of plaque characteristics in patients with ST-segment elevation myocardial infarction (STEMI) and treatment of STEMI patients with

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial

NARCIS (Netherlands)

Henriques, J.P.; Hoebers, L.P.; Ramunddal, T.; Laanmets, P.; Eriksen, E.; Bax, M.; Ioanes, D.; Suttorp, M.J.; Strauss, B.H.; Barbato, E.; Nijveldt, R.; Rossum, A.C. van; Marques, K.M.; Elias, J.; Dongen, I.M. van; Claessen, B.E.; Tijssen, J.G.; Schaaf, R.J. van der; Boer, M.J. de; et al.,

2016-01-01

BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left

Cancer and heart attack survivors’ expectations of employment status: results from the English Longitudinal Study of Ageing

Directory of Open Access Journals (Sweden)

Saskia F. A. Duijts

2017-08-01

Full Text Available Abstract Background Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made. Methods Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed. Results In cancer survivors at work (N = 159, alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13–0.76; p = 0.010. In heart attack survivors at work (N = 78, gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00–0.57; p = 0.018 and high expectation of being at work (OR 10.68; 95% CI 1.23–93.92; p = 0.033 remained significant in the multivariate model. The influence of gender (p = 0.066 and general health (p = 0.020 regarding employment status was found to differ significantly between cancer and heart attack survivors. Conclusions When predicting future employment status in cancer

Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing.

Science.gov (United States)

Duijts, Saskia F A; van der Beek, Allard J; Bleiker, Eveline M A; Smith, Lee; Wardle, Jane

2017-08-07

Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made. Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed. In cancer survivors at work (N = 159), alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health) remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13-0.76; p = 0.010). In heart attack survivors at work (N = 78), gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00-0.57; p = 0.018) and high expectation of being at work (OR 10.68; 95% CI 1.23-93.92; p = 0.033) remained significant in the multivariate model. The influence of gender (p = 0.066) and general health (p = 0.020) regarding employment status was found to differ significantly between cancer and heart attack survivors. When predicting future employment status in cancer survivors in the UK, general health is the most relevant factor

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI.

Science.gov (United States)

Kaymaz, Cihangir; Keleş, Nurşen; Özdemir, Nihal; Tanboğa, İbrahim Halil; Demircan, Hacer C; Can, Mehmet M; Koca, Fatih; İzgi, İbrahim Akın; Özkan, Alper; Türkmen, Muhsin; Kırma, Cevat; Esen, Ali M

2015-11-01

The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation. A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 µg/kg) was followed by infusion (0.15 µg/kg/min) for a mean (SD) duration of 22.4±6.8 hours. The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p75% ST-segment resolution (78.1%; pPCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

Plasma glucose and not hemoglobin or renal function predicts mortality in patients with STEMI complicated with cardiogenic shock

NARCIS (Netherlands)

Vis, Marije M.; Engström, Annemarie E.; Sjauw, Krischan D.; Tjong, Fleur Vy; Baan, Jan; Koch, Karel T.; de Vries, Hans J.; Tijssen, Jan Gp; de Winter, Robbert J.; Piek, Jan J.; Henriques, José Ps

2010-01-01

Objective To assess the predictive value of three biomarkers for mortality in ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock. Background STEMI complicated by cardiogenic shock accounts for the majority of STEMI related deaths. Patients with STEMI and hyperglycemia, anemia

Gender, TIMI risk score and in-hospital mortality in STEMI patients undergoing primary PCI: results from the Belgian STEMI registry.

Science.gov (United States)

Gevaert, Sofie A; De Bacquer, Dirk; Evrard, Patrick; Convens, Carl; Dubois, Philippe; Boland, Jean; Renard, Marc; Beauloye, Christophe; Coussement, Patrick; De Raedt, Herbert; de Meester, Antoine; Vandecasteele, Els; Vranckx, Pascal; Sinnaeve, Peter R; Claeys, Marc J

2014-01-22

The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was 10.1% in women vs. 4.9% in men (OR 2.2; 95% CI: 1.82-2.66, pdiscrimination and calibration in women as well as in men (c-statistic=0.84 [95% CI: 0.809-0.866], goodness-of-fit p=0.53 and c-statistic=0.89 [95% CI: 0.873-0.907], goodness-of-fit p=0.13, respectively), but mortality prediction for TIMI scores was better in men (p=0.02 for TIMI score x gender interaction). In the Belgian STEMI registry, pPCI-treated women had a higher in-hospital mortality rate even after correcting for TIMI risk score variables. The TIMI risk score was effective in predicting in-hospital mortality but performed slightly better in men. The database was registered with clinicaltrials.gov (NCT00727623).

[Experience in the treatment of patients with STEMI in the frame of urgent PCI Project in Medimurje County].

Science.gov (United States)

Hranilović, Rudolf

2009-02-01

In 2004, the mortality rate of cardiovascular disease in Medimurje County was 53%, with coronary heart disease accounting for 18.2% of cases. The need of organizing a County team for health was recognized. Five health priorities were acknowledged with coronary heart disease on the top of the list. In 2005, Medimurje County was among the first regions outside Zagreb that had launched the Project of urgent percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. Internal medicine physicians from the County Hospital received thorough education and printed materials on the issue were distributed to primary care physicians. A media campaign for the general population of the Medimurje County was also prepared. During the first 2 years of the project, the average pain-to-needle time in our patients was less than 4 hours. From the beginning of the project till July 2007, more than 100 patients with STEMI were treated with emergency PCI. There still are issues that have remained unsolved (how to reduce the pain-to-door and door-to-needle time, managing patients in cardiogenic shock, NSTEMI-patients, and presentation of patients with multivessel disease to cardiac surgeons). It is important to carry on with the intensive media campaign as well as with further education of patients, physicians and other health personnel.

Robustness of non-interdependent and interdependent networks against dependent and adaptive attacks

Science.gov (United States)

Tyra, Adam; Li, Jingtao; Shang, Yilun; Jiang, Shuo; Zhao, Yanjun; Xu, Shouhuai

2017-09-01

Robustness of complex networks has been extensively studied via the notion of site percolation, which typically models independent and non-adaptive attacks (or disruptions). However, real-life attacks are often dependent and/or adaptive. This motivates us to characterize the robustness of complex networks, including non-interdependent and interdependent ones, against dependent and adaptive attacks. For this purpose, dependent attacks are accommodated by L-hop percolation where the nodes within some L-hop (L ≥ 0) distance of a chosen node are all deleted during one attack (with L = 0 degenerating to site percolation). Whereas, adaptive attacks are launched by attackers who can make node-selection decisions based on the network state in the beginning of each attack. The resulting characterization enriches the body of knowledge with new insights, such as: (i) the Achilles' Heel phenomenon is only valid for independent attacks, but not for dependent attacks; (ii) powerful attack strategies (e.g., targeted attacks and dependent attacks, dependent attacks and adaptive attacks) are not compatible and cannot help the attacker when used collectively. Our results shed some light on the design of robust complex networks.

EkSTEMiT Learning Module and Inculcation of Inventive Thinking

Directory of Open Access Journals (Sweden)

Norhaslinda Abdul Samad

2017-10-01

Full Text Available The young generation of today must be prepared with the knowledge and skills necessary to be able to compete globally thus boosting economic growth and prosperity. Therefore, students should not only be equipped with knowledge but they are in need of the “21st century skills”, which is the top priority and one of the main education agenda goals today. As one of the domains in the 21st century skills, inventive thinking includes elements of flexibility, self-regulation, curiosity, creativity, risk taking, higher order thinking and reasoning. In order to inculcate inventive thinking for students, the EkSTEMiT Learning Module was developed for the topic Electrochemistry; one of the most difficult topics to learn among students. EkSTEMiT Learning Module was developed based on the STEM (Science, Technology, Engineering and Mathematics integrated model. Thus, this paper will discuss the conceptual framework underlying the development of EkSTEMiT Learning Module with descriptions of learning activities designed for Electrochemistry.

Transient Ischemic Attack

Medline Plus

Full Text Available ... stroke symptoms. Popular Topics TIA Cardiac Catheter Cholesterol Heart Attack Stent © 2018, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. ...

Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial.

Science.gov (United States)

Scholz, Karl Heinrich; Maier, Sebastian K G; Maier, Lars S; Lengenfelder, Björn; Jacobshagen, Claudius; Jung, Jens; Fleischmann, Claus; Werner, Gerald S; Olbrich, Hans G; Ott, Rainer; Mudra, Harald; Seidl, Karlheinz; Schulze, P Christian; Weiss, Christian; Haimerl, Josef; Friede, Tim; Meyer, Thomas

2018-04-01

The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability. Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001). In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients. NCT00794001.

Subgroup differences and determinants of patient-reported mental and physical health at hospital discharge among patients with ischemic heart disease

DEFF Research Database (Denmark)

Rasmussen, T. B.; Herning, M.; Johansen, P. P.

2017-01-01

Purpose: (i) To describe patient-reported outcomes (PROs) at hospital-discharge across three diagnostic IHD sub-groups; chronic ischemic heart disease/stable angina (IHD/AP), non-ST-elevation myocardial infarction/unstable angina (NSTEMI/UAP) and ST-elevation myocardial infarction (STEMI), and (i......) to examine determinants among demographic-, clinical- and self-report health behavior characteristics for PROs at hospital discharge in patients with IHD....

Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger.

Science.gov (United States)

Astarcioglu, Mehmet Ali; Sen, Taner; Kilit, Celal; Durmus, Halil Ibrahim; Gozubuyuk, Gokhan; Kalcik, Macit; Karakoyun, Suleyman; Yesin, Mahmut; Zencirkiran Agus, Hicaz; Amasyali, Basri

2015-10-01

The objective of this study is to assess the efficacy of WhatsApp application as a communication method among the emergency physician (EP) in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional cardiologist at a tertiary PCI center. Current guidelines recommend that patients with ST-segment elevation myocardial infarction (STEMI) receive primary PCI within 90 minutes. This door-to-balloon (D2B) time has been difficult to achieve in rural STEMI. We evaluated 108 patients with STEMI in a rural hospital with emergency department but without PCI capability to determine the impact of WhatsApp triage and activation of the cardiac catheterization laboratory on D2B time. The images were obtained from cases of suspected STEMI using the smartphones by the EP and were sent to the interventional cardiologist via the WhatsApp application (group 1, n=53). The control group included concurrently treated patients with STEMI during the same period but not receiving triage (group 2, n=55). The D2B time was significantly shorter in the intervention group (109±31 vs 130±46 minutes, PWhatsApp triage with activation of the cardiac catheterization laboratory was associated with shorter D2B time and results in a greater proportion of patients achieving guideline recommendations. The method is cheap, quick, and easy to operate. Copyright © 2015 Elsevier Inc. All rights reserved.

Consciousness in non-epileptic attack disorder.

Science.gov (United States)

Reuber, Markus; Kurthen, M

2011-01-01

Non-epileptic attack disorder (NEAD) is one of the most important differential diagnoses of epilepsy. Impairment of consciousness is the key feature of non-epileptic attacks (NEAs). The first half of this review summarises the clinical research literature featuring observations relating to consciousness in NEAD. The second half places this evidence in the wider context of the recent discourse on consciousness in neuroscience and the philosophy of mind. We argue that studies of consciousness should not only distinguish between the 'level' and `content' of consciousness but also between 'phenomenal consciousness' (consciousness of states it somehow "feels to be like") and 'access consciousness' (having certain 'higher' cognitive processes at one's disposal). The existing evidence shows that there is a great intra- and interindividual variability of NEA experience. However, in most NEAs phenomenal experience - and, as a precondition for that experience, vigilance or wakefulness - is reduced to a lesser degree than in those epileptic seizures involving impairment of consciousness. In fact, complete loss of "consciousness" is the exception rather than the rule in NEAs. Patients, as well as external observers, may have a tendency to overestimate impairments of consciousness during the seizures.

Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California

NARCIS (Netherlands)

Meltem Daysal, N.

2012-01-01

Abstract: In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome - the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California

Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California

NARCIS (Netherlands)

Meltem Daysal, N.

2012-01-01

In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999–2006). My results indicate that uninsured patients have an economically

Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

Centers for Disease Control (CDC) Podcasts

In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.

Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans--DiLH Survey.

Science.gov (United States)

Fukuoka, Yoshimi; Choi, JiWon; S Bender, Melinda; Gonzalez, Prisila; Arai, Shoshana

2015-07-01

The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes. A cross-sectional survey was conducted with 904 urban adults (mean age 44.3±16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013. Perceived risk for developing diabetes was indicated by 46.5% (n=421), and 14.3% (n=129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR]=1.7; 95% CI: 1.04-2.86) and Korean (AOR=2.4; 1.33-4.48) ethnicity, family history of diabetes (AOR=1.4; 1.00-1.84), female gender (AOR=1.4; 1.04-1.96), high cholesterol (AOR= 1.6; 1.09-2.37) and higher body mass index (BMI) (AOR=1.1; 1.08-1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR=2.9; 1.69-5.02), high blood pressure (AOR=2.4; 1.45-3.84), and higher BMI (AOR=1.1; 1.04-1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions. Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual's risk perceptions and the presence of actual risk factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Prehospital thrombolysis: A national perspective. Pharmaco-invasive strategy for early reperfusion of STEMI in Mexico].

Science.gov (United States)

Arriaga-Nava, Roberto; Valencia-Sánchez, Jesús-Salvador; Rosas-Peralta, Martin; Garrido-Garduño, Martin; Calderón-Abbo, Moisés

2015-01-01

To review the existing evidence on the role of prehospital thrombolysis in patients with ST-segment elevation acute myocardial infarction (STEMI) as part of a strategy of cutting edge to reduce the time of coronary reperfusion and as a consequence improves both the survival and function. We used the technique of exploration-reduction-evaluation-analysis and synthesis of related studies, with an overview of current recommendations, data from controlled clinical trials and from the national and international registries about the different strategies for STEMI reperfusion. In total, we examined 186 references on prehospital thrombolysis, 130 references in times door-treatment, 139 references in STEMI management and national and international registries as well as 135 references on rescue and primary percutaneous coronary intervention for STEMI. Finally the 48 references that were more relevant and informative were retained. The «time» factor is crucial in the success of early reperfusion in STEMI especially if thrombolysis is applied correctly during the prehospital time. The primary percutaneous coronary intervention is contingent upon its feasibility before 120 min from the onset of symptoms. In our midst to internationally, thrombolysis continues to be a strategy with great impact on their expectations of life and function of patients. Telecommunication systems should be incorporate in real time to the priority needs of catastrophic diseases such as STEMI where life is depending on time. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Transient Ischemic Attack

Medline Plus

Full Text Available ... major stroke. It's important to call 9-1-1 immediately for any stroke symptoms. Popular Topics TIA Cardiac Catheter Cholesterol Heart Attack Stent © 2018, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The content in this ...

A Comparative Study of Stressful Life Events and Stress Coping Strategies in Coronary Heart Disease Patients and Non-Patients

Directory of Open Access Journals (Sweden)

A. Heidari Pahlavian

2010-10-01

Full Text Available Introduction & Objective: Etiological researches suggest that biopsychosocial dimensions are responsible for coronary heart disease (CHD. The main goal of the present research was to compare stressful life events and stress coping strategies in coronary heart patients (Acute Myocardial Infarction and non-patients. Materials & Methods: In this cross sectional research 102 patients (all males suffering from acute myocardial infarction and 162 non-patient individuals after matching were studied and compared with regard to psychosocial life events and stress coping strategies through coping response inventory (Moos, 1993 , scaling of life Events (paykel , 1971 and researcher made questionnaire. Results: The result established that myocardial infarction patients experienced more stress than the control group during one year before heart- attack and they used more inadequate stress coping strategies comparing with the control individuals. Conclusion: This study showed that stress and inadequate coping strategies are important variables for the development of coronary heart diseases. (Sci J Hamadan Univ Med Sci 2010;17(3:33-38

Heart Health - Brave Heart

Science.gov (United States)

... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis

Science.gov (United States)

Pandit, Anil; Aryal, Madan Raj; Aryal Pandit, Aashrayata; Hakim, Fayaz Ahmad; Giri, Smith; Mainali, Naba Raj; Sharma, Prashant; Lee, Howard R; Fortuin, F David; Mookadam, Farouk

2014-01-01

Aim The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations. Methods PubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I2 statistics. Results In three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I2=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I2=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I2=0%) compared with culprit-only revascularisation. Conclusions In patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials. PMID:25332779

Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI

DEFF Research Database (Denmark)

Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian

2017-01-01

BACKGROUND: QRS duration has previously shown association with mortality in patients with acute myocardial infarction treated with thrombolytics, less is known in patients with suspected ST segment elevation myocardial infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus......, the objective was to investigate the prognostic effect of QRS duration on prehospital ECG and presence of classic left and right bundle branch block (LBBB/RBBB) for all-cause mortality in patients with suspected STEMI. METHOD: In total 2105 consecutive patients (mean age 64±13years, 72% men) with suspected...... STEMI were prospectively included. QRS duration was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (111ms). Primary endpoint was all-cause 30-day mortality. Predictors of all-cause mortality were...

Heart Disease Risk Factors

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... About CDC.gov . Home About Heart Disease Coronary Artery Disease Heart Attack Heart Attack Signs and Symptoms ... Privacy FOIA No Fear Act OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO ( ...

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

Science.gov (United States)

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

The Role of Alcohol Consumption in the Aetiology of Different Cardiovascular Disease Phenotypes: a CALIBER Study

Science.gov (United States)

2013-05-28

Chronic Stable Angina; Unstable Angina; Coronary Heart Disease Not Otherwise Specified; Acute Myocardial Infarction; Heart Failure; Ventricular Arrhythmias; Cardiac Arrest; Abdominal Aortic Aneurysm; Peripheral Arterial Disease; Ischaemic Stroke; Subarachnoid Haemorrhagic Stroke; Intracerebral Haemorrhagic Stroke; Stroke Not Otherwise Specified; Sudden Cardiac Death; Unheralded Coronary Death; Mortality; Coronary Heart Disease (CHD); Cardiovascular Disease (CVD); Fatal Cardiovascular Disease (Fatal CVD); ST Elevation Myocardial Infarction (STEMI); Non-ST Elevation Myocardial Infarction (nSTEMI); Myocardial Infarction Not Otherwise Specified (MI NOS)

Controversies in the treatment of patients with STEMI and multivessel disease: is it time for PCI of all lesions?

Science.gov (United States)

Ong, Peter; Sechtem, Udo

2016-06-01

Several randomized trials have suggested a benefit for multivessel PCI in patients with STEMI and multivessel disease. However, none of the studies compared multivessel PCI with a staged PCI-approach which is the current guideline recommended approach. The results of the trials may overestimate the beneficial effect of the multivessel PCI approach because the control group did not receive any ischaemia testing for evaluation of the significance of remaining lesions. Thus, unfavourable aspects of the multivessel PCI approach such as overestimation of non-culprit lesions at the time of acute coronary angiography, complications associated with PCI of the non-culprit lesion (i.e. dissection, no-reflow, acute stent thrombosis) or increased risk for contrast induced nephropathy may have gone unnoticed as the comparative management pathway was unusual and likely inferior to the guideline recommended approach. We believe that culprit lesion only PCI and staged evaluation of remaining areas of myocardial ischaemia with subsequent PCI is still preferable in patients with STEMI and multivessel disease but a randomized study comparing this approach with multivessel PCI is needed.

Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

DEFF Research Database (Denmark)

Pedersen, Frants; Butrymovich, Vitalij; Kelbæk, Henning

2014-01-01

BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study was to des......BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study...... was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI. METHODS: A centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2......,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI. RESULTS: Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after...

Antiplatelet therapy in STEMI undergoing primary PCI, when, which one and how long.

Science.gov (United States)

Baralis, Giorgio; Rossini, Roberta; Musumeci, Giuseppe

2018-02-19

Reperfusion therapy for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PPCI) and concomitant dual antiplatelet therapy (DAPT) with combination of a P2Y12 inhibitor and acetylsalicylic acid (ASA). Decision regarding DAPT can be challenging clinically in the modern era with the evolution of newer stents, more potent antiplatelet agents and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. This review outlines the currently available antiplatelet treatments, and their place within the therapeutic timeline of a patient presenting with STEMI.

Preliminary data from γ-cardiography during the abatement of an asthmatic attack (1961)

International Nuclear Information System (INIS)

Georges, R.; Vernejoul, P. de; Raynaud, C.; Blanchon, P.; Kellershohn, C.; Turiaf, J.

1961-01-01

The authors used gamma cardiology during the abatement of 16 cases of asthma with a view to detecting heart attacks not otherwise visible with routine methods of examination: clinical, radiological and electro-cardio-graphical. In gamma cardiology, a radioactive indicator is used and its path followed in the cavities of the heart. The method makes it possible to study the circulation in the right heart, the pulmonary crossing, and the left heart, as well as evaluation of the heart-flow. As a result of their investigations the authors, after having discussed the significance of the data obtained with the method, suggest that it is possible by the use of gamma cardiography during the abatement of an asthma attack: 1- To confirm attacks of the right heart which have already been detected by ordinary methods. 2- To confirm the presence of modifications in the recorded curves which suggest, in the case of the left heart, possible attack; such on attack is also indicated, in a small number of cases, by electrocardiography curves. Some considerations are put forward by the authors concerning the physiopathology of attacks on the left heart. (authors) [fr

Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes--results from the BASKET PROVE trial.

Science.gov (United States)

Jensen, Magnus Thorsten; Kaiser, Christoph; Sandsten, Karl Erik; Alber, Hannes; Wanitschek, Maria; Iversen, Allan; Jensen, Jan Skov; Pedersen, Sune; Soerensen, Rikke; Rickli, Hans; Zurek, Marzena; Fahrni, Gregor; Bertel, Osmund; De Servi, Stefano; Erne, Paul; Pfisterer, Matthias; Galatius, Søren

2013-10-09

Elevated heart rate (HR) is associated with mortality in a number of heart diseases. We examined the long-term prognostic significance of HR at discharge in a contemporary population of patients with stable angina (SAP), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) revascularized with percutaneous coronary intervention (PCI). Patients from the BASKET-PROVE trial, an 11-center randomized all-comers trial comparing bare-metal and drug-eluting stenting in large coronary vessels, were included. Discharge HR was determined from a resting ECG. Long-term outcomes (7 days to 2 years) were evaluated for all-cause mortality and cardiovascular death and non-fatal myocardial infarction. A total of 2029 patients with sinus rhythm were included, 722 (35.6%) SAP, 647 (31.9%) NSTE-ACS, and 660 (32.5%) STEMI. Elevated discharge HR was associated significantly with all-cause mortality: when compared to a reference of 90 bpm. For cardiovascular death/myocardial infarction, a discharge HR >90 bpm was associated with a hazard ratio of 6.2 (2.5-15.5, pacute coronary syndromes an elevated discharge HR was independently associated with poor prognosis. Conversely, a HR <60 bpm at discharge was associated with a good long-term prognosis irrespective of indication for PCI. © 2013.

Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline.

Science.gov (United States)

Jollis, James G; Granger, Christopher B; Henry, Timothy D; Antman, Elliott M; Berger, Peter B; Moyer, Peter H; Pratt, Franklin D; Rokos, Ivan C; Acuña, Anna R; Roettig, Mayme Lou; Jacobs, Alice K

2012-07-01

National guidelines call for participation in systems to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States. A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association Mission: Lifeline website. Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%). This survey broadly describes the

The association of a heart attack or stroke with depressive symptoms stratified by the presence of a close social contact: findings from the National Health and Aging Trends Study Cohort.

Science.gov (United States)

Simning, Adam; Seplaki, Christopher L; Conwell, Yeates

2018-01-01

The objective of the study is to examine whether the risk of having clinically significant depressive symptoms following a heart attack or stroke varies by the presence of a close social contact. The National Health and Aging Trends Study is a nationally representative longitudinal survey of US Medicare beneficiaries aged 65 and older initiated in 2011. A total of 5643 older adults had information on social contacts at baseline and depressive symptoms at the 1-year follow-up interview. The two-item Patient Health Questionnaire identified clinically significant depressive symptoms. Interview questions examined social contacts and the presence of self-reported heart attack or stroke during the year of follow-up. A total of 297 older adults reported experiencing a heart attack and/or stroke between their baseline and follow-up interviews. In regression analyses accounting for sociodemographics, baseline depressive symptoms, medical comorbidity, and activities of daily living impairment, older adults with no close social contacts had increased odds of depressive symptoms at follow-up after experiencing a heart attack or stroke, while those with close social contacts had increased odds of depressive symptoms at follow-up after experiencing a stroke, but not a heart attack. Older adults have increased odds of having depressive symptoms following a self-reported stroke, but only those with no close social contacts had increased odds of depressive symptoms following a heart attack. Social networks may play a role in the mechanisms underlying depression among older adults experiencing certain acute health events. Future work exploring the potential causal relationships suggested here, if confirmed, could inform interventions to alleviate or prevent depression among at risk older adults. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Non-invasive ventilation in severe asthma attack, its possibilities and problems.

Science.gov (United States)

Murase, K; Tomii, K; Chin, K; Niimi, A; Ishihara, K; Mishima, M

2011-06-01

Asthma attack is characterized by episodic attacks of cough, dyspnea and wheeze occurring due to bronchoconstriction, airway hyperresponsiveness and mucous hypersecretion. Although nationwide clinical guidelines have been published to establish the standard care of asthma, choices in the treatment of fatal asthma attacks remain of clinical significance. Especially, in a severe asthma attack, despite the application of conventional medical treatment, respiratory management is critical. Even though non-invasive ventilation (NIV) has been shown to be effective in a wide variety of clinical settings, reports of NIV in asthmatic patients are scarce. According to a few prospective clinical trials reporting promising results in favour of the use of NIV in a severe asthma attack, a trial of NIV prior to invasive mechanical ventilation seems acceptable and may benefit patients by decreasing the need for intubation and by supporting pharmaceutical treatments. Although selecting the appropriate patients for NIV use is a key factor in successful NIV application, how to distinguish such patients is quite controversial. Larger high quality clinical trails are urgently required to confirm the benefits of NIV to patients with severe asthma attack. In this article, we focus on the body of evidence supporting the use of NIV in asthma attacks and discuss its advantages as well its problems.

Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment

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... Bar Home Current Issue Past Issues Cover Story Heart Health Heart Disease: Symptoms, Diagnosis, Treatment Past Issues / Winter 2009 ... of this page please turn Javascript on. Most heart attacks happen when a clot in the coronary ...

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI).

Science.gov (United States)

Chacón-Diaz, Manuel; Araoz-Tarco, Ofelia; Alarco-León, Walter; Aguirre-Zurita, Oscar; Rosales-Vidal, Maritza; Rebaza-Miyasato, Patricia

2018-05-01

The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction 75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age>75 years, and the absence of electrocardiographic signs of reperfusion. Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality. Copyright © 2018 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.

Science.gov (United States)

Peerbhai, Shareez; Masha, Luke; DaSilva-DeAbreu, Adrian; Dhoble, Abhijeet

2017-12-01

Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia. We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease. Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.

Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program.

Science.gov (United States)

Shavadia, Jay S; French, William; Hellkamp, Anne S; Thomas, Laine; Bates, Eric R; Manoukian, Steven V; Kontos, Michael C; Suter, Robert; Henry, Timothy D; Dauerman, Harold L; Roe, Matthew T

2018-03-01

Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3). Patient-specific time-to-treatment categories were converted to minutes ahead of or behind their group-specific mean; average time-to-treatment difference for all patients at a given hospital was termed comprehensive ECG-to-device time. Hospitals were then stratified into tertiles based on their comprehensive ECG-to-device times with negative values below the mean representing shorter (faster) time intervals. Of 117,857 patients, the proportion in Groups 1, 2, and 3 were 42%, 33%, and 25%, respectively. Lower rates of heart failure and cardiac arrest at presentation are noted within patients presenting to high-performing hospitals. Median comprehensive ECG-to-device time was shortest at -9 minutes (25th, 75th percentiles: -13, -6) for the high-performing hospital tertile, 1 minute (-1, 3) for middle-performing, and 11 minutes (7, 16) for low-performing. Unadjusted rates of in-hospital mortality were 2.3%, 2.6%, and 2.7%, respectively, but the adjusted risk of in-hospital mortality was similar across tertiles. Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

[Evidence-based management of ST-segment elevation myocardial infarction (STEMI). Latest guidelines of the European Society of Cardiology (ESC) 2010].

Science.gov (United States)

Silber, S

2010-12-01

Acute myocardial infarction and its consequences (death, chronic ischemic coronary artery disease, heart failure) are still the number 1 causes of death and of cardiovascular diseases in Germany. In this context, patients with STEMI are at the highest risk. The first-line management of STEMI patients often determines if the outcome is life or death. This overview presents the current optimal evidence-based management of STEMI patients as a practice-oriented extract according to the latest ESC guidelines, fully published some weeks ago (http://www.escardio.org).All efforts must be made to keep the respective time intervals between the onset of symptoms and the beginning of reperfusion therapy as short as possible, i.e. best within a dedicated STEMI network. Two of the time intervals are particularly essential: the time delay between the onset of symptoms and the first medical contact (FMC) and the time delay between FMC and the beginning of reperfusion. The time delay between the onset of symptoms and FMC depends on the patient as well as on the organization of the emergency medical service (EMS). Unfortunately, too many patients/bystanders still hesitate to immediately call the EMS. More intense measures must therefore be taken to educate the public. The optimal FMC by medical doctors or paramedics reacts quickly and ideally arrives with ECG equipment for immediate diagnosis of STEMI (persistent ST-segment elevation or presumably new left bundle branch block) before hospital admission. Unfortunately in many cases, the FMC is the emergency room of a hospital. Further decisions can be made without laboratory findings. In Germany, the average time delay between onset of symptoms and FMC is 100 min and therefore longer than in some other European countries.The next critical time interval is that between FMC and the beginning of reperfusion: this interval depends solely on the EMS organization and the distance to the next catheter laboratory with 24 h PCI (percutaneous

[Quality indicators for the assessment of ST-segment elevation acute myocardial infarction (STEMI) networks. How hospital discharge records could be integrated with Emergency medical services data: the Emilia-Romagna STEMI network experience].

Science.gov (United States)

Pavesi, Pier Camillo; Guastaroba, Paolo; Casella, Gianni; Berti, Elena; De Palma, Rossana; Di Bartolomeo, Stefano; Di Pasquale, Giuseppe

2015-09-01

The assessment of the regional network for ST-segment elevation acute myocardial infarction (STEMI) is fundamental for quality assurance. Since 2011 all Italian Health Authorities, in addition to hospital discharge records (HDR), must provide a standardized information flow (ERD) about emergency department (ED) and emergency medical system (EMS) activities. The aim of this study was to evaluate whether data integration of ERD with HDR may allow the development of appropriate quality indicators. Patients admitted to coronary care units (CCU) for STEMI between January 1 to December 31, 2013, were identified from the regional HDR database. All data were linked to those of the regional ERD database. Four quality indicators were defined: 1) rates of EMS activation, 2) rates of EMS direct transfer to the catheterization laboratory (Cath-lab), 3) transfer rates from a Spoke to a Hub hospital with angioplasty facilities, and 4) median time spent in ED. In 2013, 2793 patients with STEMI were admitted to the CCU. Of these, 1684 patients (60%) activated EMS and were transported to Spoke or Hub hospitals; 955 (57%) entered directly in CCU/Cath-lab; 677 were transferred directly to a Hub hospital ED without being admitted to a Spoke hospital. The median ED time in Hub hospital was 47 min (IQR 24-136) and in Spoke hospital 53 min (IQR 30-131). The integration among administrative data banks (i.e., HDR with ERD) allowed the assessment of the regional STEMI network and the identification of potentially useful quality indicators. Their easy availability should enable comparisons with local, national and international standards, and may favor quality improvement.

Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

Centers for Disease Control (CDC) Podcasts

2011-09-01

In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.  Created: 9/1/2011 by National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch.   Date Released: 9/1/2011.

Adults with Congenital Heart Defects

Science.gov (United States)

... Ebstein's Anomaly l-Transposition of the Great Arteries Patent Ductus Arteriosus (PDA) Pulmonary Valve Stenosis and Regurgitation ... Sodium and Salt 3 Heart Attack Symptoms in Women 4 Warning Signs of a Heart Attack 5 ...

Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report.

Science.gov (United States)

Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O

2016-05-01

To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P IOM report. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

Are the rules for the right to self-defense outdated to address current conflicts like attacks from non-state actors and cyber-attacks?

Directory of Open Access Journals (Sweden)

Gonzalo J. Arias

2017-06-01

Full Text Available The latest US-led coalition’s attacks against ISIS in Syria raised the question whether states can use defensive force against non-state actors. Two critical incidents had previously triggered the discussion on the importance and consequences of cyber-attacks as a new form armed attacks. The first one occurred in Estonia in 2007, when the country experienced extensive computer hacking attacks that lasted several weeks. The second incident happened in 2008, during the Georgia–Russia conflict over South Ossetia, when Georgia experienced cyber-attacks similar to those suffered by Estonia in the previous year. Furthermore, on June 21, 2016, the central banks of Indonesia and South Korea were hit by cyber-attacks on their public websites since activist hacking group Anonymous pledged last month to target banks across the world. The previous incidents have created, once again, public questioning if the rules on the use of force and the right of self-defense established in the United Nations Charter are sufficient and efficient to address these new forms of attacks.

Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

DEFF Research Database (Denmark)

Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik

2010-01-01

Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid...... management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients....

Understand Your Risk of Heart Attack

Science.gov (United States)

... not as great as men's. Heredity (Including Race) Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart ...

Heart disease and diet

Science.gov (United States)

Diet - heart disease; CAD - diet; Coronary artery disease - diet; Coronary heart disease - diet ... diet and lifestyle can reduce your risk of: Heart disease, heart attacks, and stroke Conditions that lead ...

Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015.

Science.gov (United States)

Puymirat, Etienne; Simon, Tabassome; Cayla, Guillaume; Cottin, Yves; Elbaz, Meyer; Coste, Pierre; Lemesle, Gilles; Motreff, Pascal; Popovic, Batric; Khalife, Khalife; Labèque, Jean-Noel; Perret, Thibaut; Le Ray, Christophe; Orion, Laurent; Jouve, Bernard; Blanchard, Didier; Peycher, Patrick; Silvain, Johanne; Steg, Philippe Gabriel; Goldstein, Patrick; Guéret, Pascal; Belle, Loic; Aissaoui, Nadia; Ferrières, Jean; Schiele, François; Danchin, Nicolas

2017-11-14

ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010. © 2017 American Heart Association, Inc.

Long-term mortality after primary PCI for STEMI in patients with insulin-dependent diabetes mellitus

Directory of Open Access Journals (Sweden)

Zlatanović Petar

2015-01-01

Full Text Available Introduction: Primary PCI (pPCI is the gold standard in the treatment of patients with acute myocardial infarction (AMI with ST elevation (STEMI. Aim: The purpose of this study is to evaluate the influence of diabetic status upon arrival at five year survival in patients with STEMI that were treated with pPCI. Material and methods: Consecutive data for 2087 patients admitted in the period from 1st of January 2009. to 31st of December 2010. with diagnosis of acute STEMI were collected from catheterisation laboratory cardiology clinic CCS electronic database. Patients were divided into 3 groups: those without diabetes mellitus (DM, IDDM (insulin dependent diabetes mellitus, NIDDM (non-insulin dependent diabetes mellitus. Results: 1664 patients (79.7% did not have DM, 98 (4.7% had IDDM and 325 (15.6% had NIDDM. There was a statistically significant difference in mortality rate among three groups after 30 days, one year and five years after intervention, and the highest rates were recorded at the IDDM patients, then at the NIDDM and the lowest in patients without DM (15.3% vs 8.3% vs 5.9 %, p < 0.001 after 30 days; 21.4% vs 15.4% vs 10.9%, p < 0.001 after one year and 32.7% vs 24.3% vs 18%, p < 0.001 after 5 years. Also, there was a highly statistically significant difference in five-year mortality rate between patients with and without DM (26.2 % vs 17.6%, p < 0.001. IDDM was a independent factor when it comes to predicting five-year mortality (HR = 1.58, 95% CI 1.07-2.32, p = 0.02 whereas NIDDM was not (HR = 1.24, 95% CI 0.95-1.63, p = 0.12. Conclusion: Diabetic patients had an increased risk of mortality in the short and long-term follow-up after pPCI. Insulin-dependent was a single predicting factor after five year follow-up.

Securing ad hoc wireless sensor networks under Byzantine attacks by implementing non-cryptographic method

Directory of Open Access Journals (Sweden)

Shabir Ahmad Sofi

2017-05-01

Full Text Available Ad Hoc wireless sensor network (WSN is a collection of nodes that do not need to rely on predefined infrastructure to keep the network connected. The level of security and performance are always somehow related to each other, therefore due to limited resources in WSN, cryptographic methods for securing the network against attacks is not feasible. Byzantine attacks disrupt the communication between nodes in the network without regard to its own resource consumption. This paper discusses the performance of cluster based WSN comparing LEACH with Advanced node based clusters under byzantine attacks. This paper also proposes an algorithm for detection and isolation of the compromised nodes to mitigate the attacks by non-cryptographic means. The throughput increases after using the algorithm for isolation of the malicious nodes, 33% in case of Gray Hole attack and 62% in case of Black Hole attack.

Elderly patients with STEMI are suboptimally treated with reperfusion therapy

Czech Academy of Sciences Publication Activity Database

Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

2008-01-01

Roč. 117, č. 19 (2008), s. 79-79 ISSN 0009-7322. [The 2008 World Congress on Cardiology . 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * primary reprefusion therapy * STEMI Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

Clinical presentation, Quality of care, Risk factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries.

Science.gov (United States)

Shehab, Abdulla; AlHabib, Khalid F; Bhagavathula, Akshaya Srikanth; Hersi, Ahmad; Alfaleh, Hussam; Alshamiri, Mostafa Q; Ullah, Anhar; Sulaiman, Khadim; Almahmeed, Wael; Al Suwaidi, Jassim; Alsheikh-Ali, Alwai A; Amin, Haitham; Al Jarallah, Mohammed; Salam, Amar M

2018-03-14

Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher in-hospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce

Heart-Health Screenings

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... Tools For Your Heart Health • Watch, Learn & Live Animations Library Subscribe to Heart Insight magazine and monthly ... in Spanish . Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

Science.gov (United States)

Bejiqi, Ramush A.; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

2015-01-01

Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. Aims: In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. Methods: To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. Conclusion: In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded. PMID:25870479

Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.

Directory of Open Access Journals (Sweden)

Jie Gong

Full Text Available To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2 in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP.Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention.Community-based and patient-centered self-care for behavioral intervention in urban settings of China.A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients or the standard care only (6 centers and 218 patients.KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke.Heart attack and stroke (clinically diagnosed, primary outcome, blood pressure (measured, secondary outcome, and physical activity (self-report, tertiary outcome were assessed at the individual level during the baseline, 3- and 6-month post-intervention.Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05 and stroke (5.11% vs. 9.90%, p<0.05, and moderate reduction in blood pressure (-3.72 mmHg in DBP and -2.92 mmHg in DBP at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85 and 6-month (d = 0.45, 95% CI: 0.04, 0.85 post-intervention, respectively.The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti

Coronary Artery Dissection: Not Just a Heart Attack

Science.gov (United States)

... for Heart.org CPR & ECC for Heart.org Shop for Heart.org Causes for Heart.org Advocate ... chest pain or pressure, shortness of breath, profuse sweating and dizziness. “Around 80 percent of the time, ...

Heart disease and depression

Science.gov (United States)

... gov/ency/patientinstructions/000790.htm Heart disease and depression To use the sharing features on this page, ... a heart attack or heart surgery Signs of Depression It is pretty common to feel down or ...

Optimal pharmacological therapy in ST-elevation myocardial infarction-a review : A review of antithrombotic therapies in STEMI.

Science.gov (United States)

Hermanides, R S; Kilic, S; van 't Hof, A W J

2018-04-23

Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications. Compared with clopidogrel, prasugrel and ticagrelor are more potent and predictable, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in primary percutaneous coronary intervention. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. In this review, we provide a critical and updated review of currently available antithrombotic therapies used in patients with STEMI undergoing primary PCI. Finding a balance that minimises both thrombotic and bleeding risk is difficult, but crucial. Further randomised trials for this optimal balance are needed.

Risks for Heart Disease & Stroke

Science.gov (United States)

... Prevent Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and ... can’t change some of your risks for heart disease and stroke, but you can manage many of ...

Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment-Elevation Myocardial Infarction.

Science.gov (United States)

Nishiguchi, Tsuyoshi; Tanaka, Atsushi; Taruya, Akira; Emori, Hiroki; Ozaki, Yuichi; Orii, Makoto; Shiono, Yasutsugu; Shimamura, Kunihiro; Kameyama, Takeyoshi; Yamano, Takashi; Yamaguchi, Tomoyuki; Matsuo, Yoshiki; Ino, Yasushi; Kubo, Takashi; Hozumi, Takeshi; Hayashi, Yasushi; Akasaka, Takashi

2016-12-01

Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9-73.2] ng/mL versus prestent local, 69.1 [32.2-152.3] ng/mL versus poststent local, 68.0 [35.6-133.3] ng/mL; Pclinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention. © 2016 American Heart Association, Inc.

Complement activation, endothelial dysfunction, insulin resistance and chronic heart failure

DEFF Research Database (Denmark)

Bjerre, M.; Kistorp, C.; Hansen, T.K.

2010-01-01

Objectives. Patients with chronic heart failure (CHF) have an exaggerated immune response, endothelial damage/dysfunction, and increased risk of diabetes mellitus (DM). The inter-relationship(s) between indices of complement activation (soluble membrane attack complex, sMAC), inflammation (hs...... to ischemic heart disease (IHD) as compared with CHF patients with non-ischemic ethiology (p = 0.02), but were not predictive of survival or progression of CHF. A moderate strong relation between sMAC and sEsel levels was found beta = 0.33 (p ... damaging of the heart tissue...

Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

DEFF Research Database (Denmark)

Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

2014-01-01

diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

Options for Heart Valve Replacement

Science.gov (United States)

... Guide: Understanding Your Heart Valve Problem | Spanish Symptom Tracker | Spanish Pre-surgery Checklist | Spanish What Is Heart ... Cardiac Arrest: How Are They Different? 7 Warning Signs of a Heart Attack 8 Low Blood Pressure - ...

Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

Directory of Open Access Journals (Sweden)

Xiao-Gang Zhu

2016-10-01

Full Text Available Objective: To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI. Methods: A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared. Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05; 99mTc-MIBI and 18F-FDG intake of observation group after PCI were more than those of control group (P<0.05; serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05. Conclusions: Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocardial infarction, single-vessel disease, and complete revascularization: follow-up study.

LENUS (Irish Health Repository)

Manola, Sime

2012-01-31

AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg\\/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg\\/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.

Outcome of Stable Patients With Acute Myocardial Infarction and Coronary Artery Bypass Surgery Within 48 Hours: A Single-Center, Retrospective Experience.

Science.gov (United States)

Grothusen, Christina; Friedrich, Christine; Loehr, Johannes; Meinert, Jette; Ohnewald, Eva; Ulbricht, Ulysses; Attmann, Tim; Haneya, Assad; Huenges, Katharina; Freitag-Wolf, Sandra; Schoettler, Jan; Cremer, Jochen

2017-10-03

The optimal timing of coronary artery bypass grafting (CABG) in clinically stable patients with acute myocardial infarction who are unsuitable for percutaneous coronary intervention is unclear. We report our experience with early CABG in these patients. Between January 2001 and May 2015, 766 patients with ST-segment-elevation myocardial infarction (STEMI, n=305) or non-STEMI (NSTEMI, n=461) not including cardiogenic shock underwent CABG within 48 hours at our department. STEMI patients were younger than non-STEMI patients (age 65 years [range: 58-72] versus 70 years [range: 62-75], P <0.001) with a lower EuroSCORE II (4.12 [range: 2.75-5.81] versus 4.58 [range: 2.80-7.74], P =0.009). STEMI patients had undergone preoperative percutaneous coronary intervention more often (20.3% versus 7.8%, P <0.001). Time to surgery was shorter in STEMI compared with non-STEMI patients (5.0 hours [range: 3.2-8.8] versus 11.7 hours [range: 6.4-22.0], P <0.001). No significant differences concerning arterial graft use (93.8% versus 94.8%, P =0.540) or complete revascularization (87.5% versus 83.4%, P =0.121) were observed. The rate of strokes did not differ between the groups (2.0% versus 3.9%, P =0.134). Thirty-day mortality was lower in STEMI patients (2.7% versus 6.6% P =0.018), especially when CABG was performed within 6 hours (1.8% versus 7.1%, P =0.041). Survival of STEMI and non-STEMI patients was 94% versus 88% after 1 year ( P <0.001), 87% versus 73% after 5 years ( P <0.001), and 74% versus 57% after 10 years ( P <0.001). Independent predictors of 30-day and long-term mortality included preoperatively increased lactate values, age, atrial fibrillation, and reduced left ventricular function. Stable STEMI patients showed a lower rate of perioperative complications and better survival compared with non-STEMI patients when CABG was performed within 48 hours. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Research on the technology of detecting the SQL injection attack and non-intrusive prevention in WEB system

Science.gov (United States)

Hu, Haibin

2017-05-01

Among numerous WEB security issues, SQL injection is the most notable and dangerous. In this study, characteristics and procedures of SQL injection are analyzed, and the method for detecting the SQL injection attack is illustrated. The defense resistance and remedy model of SQL injection attack is established from the perspective of non-intrusive SQL injection attack and defense. Moreover, the ability of resisting the SQL injection attack of the server has been comprehensively improved through the security strategies on operation system, IIS and database, etc.. Corresponding codes are realized. The method is well applied in the actual projects.

A qualitative study of younger men's experience of heart attack (myocardial infarction).

Science.gov (United States)

Merritt, Christopher J; de Zoysa, Nicole; Hutton, Jane M

2017-09-01

The effects of heart attack, or myocardial infarction (MI), across psychosocial domains may be particularly acute in younger adults, for whom serious health events are non-normative. MI morbidity is declining in Western countries, but in England MI numbers have plateaued for the under-45 cohort, where approximately 90% of patients are male. Qualitative research on younger adults' experience of MI is limited, and no study has sampled exclusively under-45s. This study aimed to understand how a sample of men under 45 adjusted to and made sense of MI. Qualitative research design based on semi-structured in-depth interviews. Ten men aged under 45 who had experienced MI in the past 3-6 months were purposively recruited and interviewed. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Seven superordinate themes were identified. This article focuses in depth on the three most original themes: (1) 'I'm less of a man', which described experiences of losing 'maleness' (strength, independence, ability to provide) post-MI; (2) 'Shortened horizons', which covered participants' sense of foreshortened future and consequent reprioritization; and (3) 'Life loses its colour', describing the loss of pleasure from lifestyle-related changes. Themes broadly overlapped with the qualitative literature on younger adult MI. However, some themes (e.g., loss of 'maleness' post-MI, and ambivalence towards MI risk factors) appeared unique to this study. Themes were also discussed in relation to risk factors for anxiety and depression and how this might inform clinical care for a younger, male population. Statement of contribution What is already known on this subject? Myocardial infarction (MI) morbidity is not declining in England for under-45s. Adjustment to MI is particularly challenging for younger adults, perhaps because it is non-normative. However, little is known about the experience of MI in younger adults. What does this study add? This

CARDIAC EMERGENCY: LIFT UP YOUR HEARTS

CERN Multimedia

2000-01-01

50 000 deaths every year in France following heart problems. You or someone close to you, a friend, a relative, a colleague at work. You all probably know someone who has had a heart attack. Noting that 80% of all deaths occur outside hospital, the Fédération Française de Cardiologie, working in collaboration with first aid groups (rescue associations, etc.), are launching a nationwide campaign to train as many people as possible in what to do for cardiac first aid. According to specialists, more than half of all heart attack victims could have survived if someone nearby had been quick at doing what was needed. The CERN Fire Brigade is helping in this campaign by offering two free training sessions, each lasting three hours and mainly based on recognizing a heart attack, the proper way of calling for help, and practice in mouth-to-mouth resuscitation and heart massage. The courses will be held on 20 November and 6 December from4 to 7 p.m. at Building 65. So don’t wait, stop b...

Attacks on quantum key distribution protocols that employ non-ITS authentication

Science.gov (United States)

Pacher, C.; Abidin, A.; Lorünser, T.; Peev, M.; Ursin, R.; Zeilinger, A.; Larsson, J.-Å.

2016-01-01

We demonstrate how adversaries with large computing resources can break quantum key distribution (QKD) protocols which employ a particular message authentication code suggested previously. This authentication code, featuring low key consumption, is not information-theoretically secure (ITS) since for each message the eavesdropper has intercepted she is able to send a different message from a set of messages that she can calculate by finding collisions of a cryptographic hash function. However, when this authentication code was introduced, it was shown to prevent straightforward man-in-the-middle (MITM) attacks against QKD protocols. In this paper, we prove that the set of messages that collide with any given message under this authentication code contains with high probability a message that has small Hamming distance to any other given message. Based on this fact, we present extended MITM attacks against different versions of BB84 QKD protocols using the addressed authentication code; for three protocols, we describe every single action taken by the adversary. For all protocols, the adversary can obtain complete knowledge of the key, and for most protocols her success probability in doing so approaches unity. Since the attacks work against all authentication methods which allow to calculate colliding messages, the underlying building blocks of the presented attacks expose the potential pitfalls arising as a consequence of non-ITS authentication in QKD post-processing. We propose countermeasures, increasing the eavesdroppers demand for computational power, and also prove necessary and sufficient conditions for upgrading the discussed authentication code to the ITS level.

Heart Disease Affects Women of All Ages

Science.gov (United States)

Skip Navigation Bar Home Current Issue Past Issues Heart Disease Affects Women of All Ages Past Issues / Winter ... weeks of a heart attack. For Women with Heart Disease: About 6 million American women have coronary heart ...

Heart Age PSA (:60)

Centers for Disease Control (CDC) Podcasts

This 60 second public service announcement is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.

Total Dietary Fiber, and Selected Vegetable, Fruit, Legume and Cereal Fiber Intake and Risk of Heart Attack in Periodontitis Subjects

Directory of Open Access Journals (Sweden)

Nelson Wood

2011-10-01

Full Text Available Background: Epidemiological studies have found an association between periodontal disease and coronary artery disease(Arbes, Slade et al. 1999; Beck, Elter et al. 2001; Genco, Offenbacher et al. 2002, and have even implicated periodontal disease as a risk factor(Arbes, Slade et al. 1999; Beck, Elter et al. 2001, however have not proven causality(Hujoel, Drangholt et al. 2000. Although dietary amounts, sources, and types (soluble versus insoluble of fiber have been shown to reduce the risk of heart attack (Liu, Buring et al. 2002; Negri, Vecchia et al. 2003, this author is unaware of studies that have examined the association between food sources of dietary fiber and heart attack risk in subjects with periodontitis.This study was designed to determine whether total dietary fiber and fiber from different plant sources (vegetables, fruits, legumes, or cereals modified self-reported HA risk, as well as acute-phase inflammatory responses in subjects with periodontitis using NHANES III data.Objectives: The objective of this study was to investigate the association between total dietary fiber intake levels, and selected vegetables, fruits, legumes, and cereal fiber intake and the risk of self-reported history of heart attack (HA in periodontitis subjects using data available in the Third National Health and Nutrition Examination Survey (NHANES III.Materials and Methods: Adult participants in NHANES III were used in this study. Zero to thirty three (0-33 percent of sites with periodontal attachment loss > 3 mm was considered a healthy periodontium, while greater than thirty three percent (>33 of sites with periodontal attachment loss of > 3 mm as periodontitis. The outcome variable was the self-reported history of HA. Total dietary fiber, and monthly selected vegetable, fruit, legume and cereal consumption were divided into low and adequate levels. Data was analyzed by Kruskal-Wallis, ANOVA and multivariate analyses using SPSS ®. P<0.05 was used to

Relationship between early administration of abciximab and TIMI flow in STEMI patients undergoing primary angioplasty: findings from a large regional STEMI network.

Science.gov (United States)

Izzo, Antonio; Rosiello, Renato; Lucchini, Giuseppe; Tomasi, Luca; Mantovani, Paola; Lettieri, Corrado; Baccaglioni, Nicola; Romano, Michele; Buffoli, Francesca; Izzo, Beatrice; Zanini, Roberto

2017-06-01

The aim of this study is to assess whether in S-T Elevation Myocardial Infarction (STEMI) a relationship between early administration of abciximab and Thrombolysis In Myocardial Infarction (TIMI) flow before and after primary percutaneous coronary intervention (PCI) in 960 consecutive patients exists. From 1 February 2001 onward, in the Province of Mantua it has been operating a 'Cardiology Network for the Acute Infarction Care' having its Hub in the Central Coronary ICU/Cath Lab of Mantua Hospital and being its Spokes centers represented by the emergency rooms and Central Coronary ICUs of the four territorial hospitals. T1 (time from symptoms onset to first medical contact) and T2 (time from first medical contact to angioplasty) are shorter for patients rescued by first aid units rather than for those presented in emergency rooms as well as Ta (time from symptoms onset to abciximab administration). Furthermore, the patients that received abciximab before hospital arrival had less frequently a coronary occlusion [odds ratio = 0.74, 95% confidence interval (0.57-0.96), P = 0.013]. The patients with T1 less than 4 h are 753/960 (78.4%). For this type of patients, there was a significant Ta difference between the pre-PCI TIMI-flow classes (F = 4.467, df = 3, P = 0.04). Planned contrasts revealed that mean time of TIMI flow 0 (M = 104.2) is statistically different from mean time of TIMI flow 3 (M = 85.7), P = 0.013. Our results suggest that the use of abciximab, free from pharmacokinetic limits of oral P2Y12 inhibitors, should be considered in STEMI patients with early presentation before primary PCI.

Long-term clinical outcome in STEMI patients treated with primary PCI and drug-eluting or bare-metal stents: insights from a high-volume single-center registry

DEFF Research Database (Denmark)

Pedersen, Sune; Galatius, Soren; Mogelvang, Rasmus

2011-01-01

Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial.......Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial....

Effects of Implementing STEM-I Project-Based Learning Activities for Female High School Students

Science.gov (United States)

Lou, Shi-Jer; Tsai, Huei-Yin; Tseng, Kuo-Hung; Shih, Ru-Chu

2014-01-01

This study aims to explore the application of STEM-I (STEM-Imagination) project-based learning activities and its effects on the effectiveness, processes, and characteristics of STEM integrative knowledge learning and imagination development for female high school students. A total of 72 female high school students were divided into 18 teams.…

B-type Natriuretic Peptide and RISK-PCI Score in the Risk Assessment in Patients with STEMI Treated by Primary Percutaneous Coronary Intervention.

Science.gov (United States)

Asanin, Milika; Mrdovic, Igor; Savic, Lidija; Matic, Dragan; Krljanac, Gordana; Vukcevic, Vladan; Orlic, Dejan; Stankovic, Goran; Marinkovic, Jelena; Stankovic, Sanja

2016-01-01

RISK-PCI score is a novel score for risk stratification of patients with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). The aim of this study was to evaluate the role of B-type natriuretic peptide (BNP) and the RISK-PCI score for early risk assessment in patients with STEMI treated by pPCI. In 120 patients with STEMI treated by pPCI, BNP was measured on admission before pPCI. The primary end point was 30-day mortality. The ROC curve analysis revealed that the most powerful predictive factors of 30-day mortality were the plasma level of BNP ≥ 206.6 pg/mL with the sensitivity of 75% and specificity of 87.5% and the RISK-PCI score ≥ 5.25 with the sensitivity of 75% and specificity of 85.7%. Thirty-day mortality was 6.7%. After multivariate adjustment, admission BNP (≥ 206.6 pg/mL) (OR 2.952, 95% CI 1.072 - 8.133, p = 0.036) and the RISK-PCI score (≥ 5.25) (OR 2.284, 95% CI 1.140-4.578, p = 0.020) were independent predictors of 30-day mortality. The area under the ROC curve using the RISK-PCI score and BNP to detect mortality was 0.828 (p = 0.002) and 0.903 (p PCI score increased the area under the ROC to 0.949 (p PCI score for 30-day mortality. BNP on admission and the RISK-PCI score were the independent predictors of 30-day mortality in patients with the STEMI treated by pPCI. BNP in combination with the RISK-PCI score showed the way to more accurate risk assessment in patients with STEMI treated by pPCI.

Warning Signs of Heart Failure

Science.gov (United States)

... the two terms are used interchangeably. View an animation of heart failure . If you have been diagnosed ... resources here Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time

DEFF Research Database (Denmark)

Terkelsen, C J; Christiansen, E H; Sørensen, J T

2009-01-01

There is a continuing controversy about the acceptable time-window for primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Recent American and European guidelines recommend PPCI if the delay in performing PPCI instead of administering...... directly to catheterisation laboratories running 24/7....

Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.

Science.gov (United States)

Miedema, Michael D; Garberich, Ross F; Schnaidt, Lucas J; Peterson, Erin; Strauss, Craig; Sharkey, Scott; Knickelbine, Thomas; Newell, Marc C; Henry, Timothy D

2017-04-12

The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138]  mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Rehab for the Heart (A Minute of Health with CDC)

Centers for Disease Control (CDC) Podcasts

2017-08-24

Each year, nearly 790,000 adults in the U.S. suffer a heart attack. This podcast discusses the importance of getting cardiac rehab after a heart attack.  Created: 8/24/2017 by MMWR.   Date Released: 8/24/2017.

Determination of Relations between Systolic Blood Pressure and Heart Attack in Patients with Type 2 Diabetes with Association Rules

Directory of Open Access Journals (Sweden)

Seyyed Payam Shariatpanahi

2018-03-01

Full Text Available Abstract Background: Today, the high prevalence of diabetes and its complications are one of the most important public health issues worldwide. For this reason, finding relations between diabetes risk factors is very effective in preventing and reducing complications. For discovering these relations, the data mining methods can be used. By extracting association rules, which is one of the data mining techniques, we can discover the relations between a large numbers of variables in a disease. Materials and Methods: The population of this study was 1046 patients with type 2 diabetes, whose data had recorded between 2011 and 2014 at the Special Clinic for Diabetes in Tehran's Imam Khomeini Hospital. After pre-processing step with SPSS19 software, 573 people entered the analysis phase. The FP-Growth algorithm was applied to the data set to discover the relations between heart attack and other risk factors using Rapid miner5 software. Relations, after extraction, were given to the doctor to confirm clinical validation. Results: The obtained results of studying these 573 people (Including 292 (51% women and 281 (49% men, with age range 27 to 82 years showed that the lack of blood pressure, creatinine and diastolic blood pressure at its normal level, despite higher systolic blood pressure level than normal, doesn't increase the probability of heart attack. Conclusion: Using association rules is a good way of identifying relations between the risk factors of a disease. Also, it can provide new hypotheses to do epidemiological studies for researchers.

CDC Vital Signs-Heart Age

Centers for Disease Control (CDC) Podcasts

This podcast is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.

Osteoprotegerin Levels Change During STEMI and Reflect Cardiac Function

DEFF Research Database (Denmark)

Lindberg, Søren; Jensen, Jan S; Hoffmann, Søren

2014-01-01

% confidence interval) before PCI, after PCI, and on day 1 and day 2 of 2650 ng/L (2315-3036 ng/L), 2778 ng/L (2442-3363 ng/L), 2024 ng/L (1775-230 6 ng/L), and 1808 ng/L (1551-2106 ng/L), respectively (P ...-reactive protein. Patients with reduced LVEF (P = 0.009). Adjustment for age, sex, body mass index, and cardiovascular risk factors did not significantly affect...... the association between reduced LVEF and increased OPG response (mean increase 33% (4%-70%; F = 5.784; P = 0.023). CONCLUSIONS: Circulating OPG levels are altered during STEMI treated with primary PCI. A high OPG level is independently associated with impaired LVEF....

Short- and long-term variations in non-linear dynamics of heart rate variability

DEFF Research Database (Denmark)

Kanters, J K; Højgaard, M V; Agner, E

1996-01-01

OBJECTIVES: The purpose of the study was to investigate the short- and long-term variations in the non-linear dynamics of heart rate variability, and to determine the relationships between conventional time and frequency domain methods and the newer non-linear methods of characterizing heart rate...... rate and describes mainly linear correlations. Non-linear predictability is correlated with heart rate variability measured as the standard deviation of the R-R intervals and the respiratory activity expressed as power of the high-frequency band. The dynamics of heart rate variability changes suddenly...

New Trends in Heart Regeneration: A Review

Directory of Open Access Journals (Sweden)

Kochegarov A

2016-11-01

Full Text Available In this review, we focus on new approaches that could lead to the regeneration of heart muscle and the restoration of cardiac muscle function derived from newly-formed cardiomyocytes. Various strategies for the production of cardiomyocytes from embryonic stem cells, induced pluripotent stem cells, adult bone marrow stem cells and cardiac spheres from human heart biopsies are described. Pathological conditions which lead to atherosclerosis and coronary artery disease often are followed by myocardial infarction causing myocardial cell death. After cell death, there is very little self-regeneration of the cardiac muscle tissue, which is replaced by non-contractile connective tissue, thus weakening the ability of the heart muscle to contract fully and leading to heart failure. A number of experimental research approaches to stimulate heart muscle regeneration with the hope of regaining normal or near normal heart function in the damaged heart muscle have been attempted. Some of these very interesting studies have used a variety of stem cell types in combination with potential cardiogenic differentiation factors in an attempt to promote differentiation of new cardiac muscle for possible future use in the clinical treatment of patients who have suffered heart muscle damage from acute myocardial infarctions or related cardiovascular diseases. Although progress has been made in recent years relative to promoting the differentiation of cardiac muscle tissue from non-muscle cells, much work remains to be done for this technology to be used routinely in translational clinical medicine to treat patients with damaged heart muscle tissue and return such individuals to pre-heart-attack activity levels.

Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data

DEFF Research Database (Denmark)

Terkelsen, Christian Juhl; Jensen, Lisette Okkels; Hansen, Hans-Henrik Tilsted

2011-01-01

In patients with ST-segment elevation myocardial infarction (STEMI), delay between contact with the health care system and initiation of reperfusion therapy (system delay) is associated with mortality, but data on the associated risk for congestive heart failure (CHF) among survivors are limited....

Rehab for the Heart (A Cup of Health with CDC)

Centers for Disease Control (CDC) Podcasts

Each year, nearly 790,000 adults in the U.S. suffer a heart attack. For a third of these, it's not their first. Cardiac rehabilitation could have prevented many of these. In this podcast, Dr. Fleetwood Loustalot discusses the importance of getting cardiac rehab after a heart attack.

Risks for Heart Valve Problems

Science.gov (United States)

... and Live Our Interactive Cardiovascular Library has detailed animations and illustrations to help you learn about conditions, treatments and procedures related to heart disease and stroke. Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Healthy Heart Collaboration and Developed Toolkit

Science.gov (United States)

Impact: EPA is raising awareness of heart disease and its link to air pollution and other environmental factors as a partner in Million Hearts, a national initiative to prevent heart attacks and strokes. The talk will provide an up to date review of the evidence linking air poll...

Heart Failure in Children and Adolescents

Science.gov (United States)

... the lungs where oxygen is added. Watch an animation of blood flow in the heart All the ... resources here Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Capacitive Sensing for Non-Invasive Breathing and Heart Monitoring in Non-Restrained, Non-Sedated Laboratory Mice.

Science.gov (United States)

González-Sánchez, Carlos; Fraile, Juan-Carlos; Pérez-Turiel, Javier; Damm, Ellen; Schneider, Jochen G; Zimmermann, Heiko; Schmitt, Daniel; Ihmig, Frank R

2016-07-07

Animal testing plays a vital role in biomedical research. Stress reduction is important for improving research results and increasing the welfare and the quality of life of laboratory animals. To estimate stress we believe it is of great importance to develop non-invasive techniques for monitoring physiological signals during the transport of laboratory animals, thereby allowing the gathering of information on the transport conditions, and, eventually, the improvement of these conditions. Here, we study the suitability of commercially available electric potential integrated circuit (EPIC) sensors, using both contact and contactless techniques, for monitoring the heart rate and breathing rate of non-restrained, non-sedated laboratory mice. The design has been tested under different scenarios with the aim of checking the plausibility of performing contactless capture of mouse heart activity (ideally with an electrocardiogram). First experimental results are shown.

Capacitive Sensing for Non-Invasive Breathing and Heart Monitoring in Non-Restrained, Non-Sedated Laboratory Mice

Directory of Open Access Journals (Sweden)

Carlos González-Sánchez

2016-07-01

Full Text Available Animal testing plays a vital role in biomedical research. Stress reduction is important for improving research results and increasing the welfare and the quality of life of laboratory animals. To estimate stress we believe it is of great importance to develop non-invasive techniques for monitoring physiological signals during the transport of laboratory animals, thereby allowing the gathering of information on the transport conditions, and, eventually, the improvement of these conditions. Here, we study the suitability of commercially available electric potential integrated circuit (EPIC sensors, using both contact and contactless techniques, for monitoring the heart rate and breathing rate of non-restrained, non-sedated laboratory mice. The design has been tested under different scenarios with the aim of checking the plausibility of performing contactless capture of mouse heart activity (ideally with an electrocardiogram. First experimental results are shown.

Reduced ischemia-reperfusion injury with isoproterenol in non-heart-beating donor lungs.

Science.gov (United States)

Jones, D R; Hoffmann, S C; Sellars, M; Egan, T M

1997-05-01

Transplantation of lungs retrieved from non-heart-beating donors could expand the donor pool. Recent studies suggest that the ischemia-reperfusion injury (IRI) to the lung can be attenuated by increasing intracellular cAMP concentrations. The purpose of this study was to determine the effect of IRI on capillary permeability, as measured by Kfc, in lungs retrieved from non-heart-beating donors and reperfused with or without isoproterenol (iso). Using an in situ isolated perfused lung model, lungs were retrieved from non-heart-beating donor rats ventilated with O2 or not at varying intervals after death. The lungs were reperfused with or without iso (10 microM). Kfc, lung viability, and pulmonary hemodynamics were measured, and tissue levels of adenine nucleotides and cAMP were measured by HPLC. Iso-reperfusion decreased Kfc significantly (P Kfc in non-iso-reperfused (r = 0.65) and iso-perfused (r = 0.84) lungs. cAMP levels increased significantly with iso-reperfusion. cAMP levels correlated with Kfc (r = 0.87) in iso-reperfused lungs. Iso-reperfusion of lungs retrieved from non-heart-beating donor rats results in decreased capillary permeability and increased lung tissue cAMP levels. Pharmacologic augmentation of tissue TAN and cAMP levels may further ameliorate the increased capillary permeability seen in lungs retrieved from non-heart-beating donors.

Valsartan in the treatment of heart attack survivors

Directory of Open Access Journals (Sweden)

Bodh I Jugdutt

2006-06-01

Full Text Available Bodh I JugduttDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaAbstract: Survivors of myocardial infarction (MI are at high risk of disability and death. This is due to infarct-related complications such as heart failure, cardiac remodeling with progressive ventricular dilation, dysfunction, and hypertrophy, and arrhythmias including ventricular and atrial fibrillation. Angiotensin (Ang II, the major effector molecule of the renin–angiotensin–aldosterone system (RAAS is a major contributor to these complications. RAAS inhibition, with angiotensin-converting enzyme (ACE inhibitors were first shown to reduce mortality and morbidity after MI. Subsequently, angiotensin receptor blockers (ARBs, that produce more complete blockade of the effects of Ang II at the Ang II type 1 (AT1 receptor, were introduced and the ARB valsartan was shown to be as effective as an ACE inhibitor in reducing mortality and morbidity in high-risk post-MI suvivors with left ventricular (LV systolic dysfunction and and/or heart failure and in heart failure patients, respectively, in two major trials (VALIANT and Val-HeFT. Both these trials used an ACE inhibitor as comparator on top of background therapy. Evidence favoring the use of valsartan for secondary prevention in post-MI survivors is reviewed.Keywords: valsartan, myocardial infarction, infarct survivors, remodeling, heart failure

An approach to Identify the Risk Induced by Cyber-Attack on the Non-safety NPP I and C System

Energy Technology Data Exchange (ETDEWEB)

Kim, Hee Eun; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of); Kim, Jong Hyun [Chosun University, Gwangju (Korea, Republic of); Son, Han Sung [Joonbu University, Geumsan (Korea, Republic of)

2016-05-15

In this study, influence of the attack on the non-safety system will be investigated, because the cyber-attack on the safety system cannot be accomplished easily. To identify the risk from cyber-attack, the result of PSA will be applied. Cyber-attack may cause other risks except for the core damage. Those risks also can be identified by applying this method. This study could be reinforced in a more realistic way if the information on the maintenance is considered, because certain type of cyber-attack could be detected during the maintenance. Also, possible set of wrong actions need to be selected, based on the knowledge of I and C system and its vulnerabilities because the hacker might not attack every information. To obtain the realistic result information that can be manipulated need to be listed, because the hacker may not attack certain information, not to be detected during the maintenance. In addition, by using the result of this study, the test plan for the cyber-attack can be suggested. If the scenario is given, the criteria for the test target selection can be obtained. It includes the target component and information.

An approach to Identify the Risk Induced by Cyber-Attack on the Non-safety NPP I and C System

International Nuclear Information System (INIS)

Kim, Hee Eun; Kang, Hyun Gook; Kim, Jong Hyun; Son, Han Sung

2016-01-01

In this study, influence of the attack on the non-safety system will be investigated, because the cyber-attack on the safety system cannot be accomplished easily. To identify the risk from cyber-attack, the result of PSA will be applied. Cyber-attack may cause other risks except for the core damage. Those risks also can be identified by applying this method. This study could be reinforced in a more realistic way if the information on the maintenance is considered, because certain type of cyber-attack could be detected during the maintenance. Also, possible set of wrong actions need to be selected, based on the knowledge of I and C system and its vulnerabilities because the hacker might not attack every information. To obtain the realistic result information that can be manipulated need to be listed, because the hacker may not attack certain information, not to be detected during the maintenance. In addition, by using the result of this study, the test plan for the cyber-attack can be suggested. If the scenario is given, the criteria for the test target selection can be obtained. It includes the target component and information

Ventricular arrhythmia burst is an independent indicator of larger infarct size even in optimal reperfusion in STEMI

NARCIS (Netherlands)

van der Weg, Kirian; Majidi, Mohamed; Haeck, Joost D. E.; Tijssen, Jan G. P.; Green, Cynthia L.; Koch, Karel T.; Kuijt, Wichert J.; Krucoff, Mitchell W.; Gorgels, Anton P. M.; de Winter, Robbert J.

2016-01-01

We hypothesized that ventricular arrhythmia (VA) bursts during reperfusion phase are a marker of larger infarct size despite optimal epicardial and microvascular perfusion. 126 STEMI patients were studied with 24h continuous, 12-lead Holter monitoring. Myocardial blush grade (MBG) was determined and

Automated Generation of Attack Trees

DEFF Research Database (Denmark)

Vigo, Roberto; Nielson, Flemming; Nielson, Hanne Riis

2014-01-01

Attack trees are widely used to represent threat scenarios in a succinct and intuitive manner, suitable for conveying security information to non-experts. The manual construction of such objects relies on the creativity and experience of specialists, and therefore it is error-prone and impractica......Attack trees are widely used to represent threat scenarios in a succinct and intuitive manner, suitable for conveying security information to non-experts. The manual construction of such objects relies on the creativity and experience of specialists, and therefore it is error......-prone and impracticable for large systems. Nonetheless, the automated generation of attack trees has only been explored in connection to computer networks and levering rich models, whose analysis typically leads to an exponential blow-up of the state space. We propose a static analysis approach where attack trees...... are automatically inferred from a process algebraic specification in a syntax-directed fashion, encompassing a great many application domains and avoiding incurring systematically an exponential explosion. Moreover, we show how the standard propositional denotation of an attack tree can be used to phrase...

Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.

Science.gov (United States)

Tran, Dat T; Welsh, Robert C; Ohinmaa, Arto; Thanh, Nguyen X; Kaul, Padma

2017-04-01

The aim of this study was to examine temporal trends and provincial variations in reperfusion strategies and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI) at hospitals in Canada capable of performing percutaneous coronary intervention (PCI). We included patients aged ≥ 20 years who were hospitalized between fiscal years 2009 and 2013 in all provinces except Quebec. We categorized patients as receiving fibrinolysis (lysis), primary PCI (pPCI), or no reperfusion. Patients undergoing lysis were further categorized as (1) lysis + PCI ≤ 90 minutes, (2) lysis + PCI > 90 minutes, and (3) lysis only. Patients undergoing pPCI were further categorized as (1) pPCI ≤ 90 minutes and (2) pPCI > 90 minutes. We used logistic regression to examine the baseline-adjusted association between reperfusion strategy and in-hospital mortality. Among 44,650 STEMI episodes in 44,373 patients, 66.3% received pPCI (annual increase of 7.8%; P 90 minutes (adjusted odds ratio of 0.42; 95% confidence interval, 0.32-0.55 compared with pPCI ≤ 90 minutes). The use of pPCI in STEMI has increased significantly in Canada; however, significant interprovincial variation remains. Changes in reperfusion strategies do not appear to have had an impact on in-hospital mortality rates. Patients who underwent lysis followed by PCI in a systematic fashion had the lowest mortality. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Determination of 2D equivalent angles of attack for a non-rotating wind turbine rotor blade

Energy Technology Data Exchange (ETDEWEB)

Maassen, W.H.

1993-11-01

For the investigation into models to compute the title subject use has been made of the Lanchester-Prandtl lifting line model. The inflow conditions are given by a uniform inflow velocity and the geometrical angles of attack at every spanwise position. A model using pressure measurements at the instrumented sections and a model using 2-dimensional C{sub L}-{alpha} data at certain spanwise positions were investigated. In section two the experimental setups of the experiments at ECN (Netherlands Energy Research Foundation) and FFA (the Aeronautical Research Institute of Sweden) are presented. In section three the theoretical background and the different methods to compute the 2D equivalent angles of attack are outlined. In section four the results of the computations of the downwash and the 2D equivalent angles of attack for the considered FFA wind tunnel experiment is presented. Finally, in section five the most important conclusions are summarized and a recommendation for the computation of the 2D equivalent angles of attack for the non-rotating blade experiments at ECN is formulated. 59 figs., 2 tabs., 3 appendices, 30 refs.

Transient complete atrioventricular block with Morgagni—Adams—Stokes attacks in a child after aortic valve replacement

Directory of Open Access Journals (Sweden)

D. R. Sabirova

2014-01-01

Full Text Available The diagnosis and treatment of life-threatening arrhythmias after surgical correction of congenital heart diseases is one the urgent problems in pediatrlc cardiology. The paper describes the clinical picture, diagnosis, and therapy in a patent with transient complete atrioventricular block after open heart surgery. A protracted Morgagni—Adams—Stokes attack is one of the causes of sudden cardiac death. The occurrence of even single syncopes in patients after surgery for congenital heart disease requires that the arrhythmogenic nature of the attack should be ruled out for the timely and adequate therapy including the implantation of antiarrhythmic devices.

Heart Age PSA (:60)

Centers for Disease Control (CDC) Podcasts

2015-09-01

This 60 second public service announcement is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.  Created: 9/1/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/1/2015.

Medications Used to Treat Heart Failure

Science.gov (United States)

... and Live Our Interactive Cardiovascular Library has detailed animations and illustrations to help you learn about conditions, treatments and procedures related to heart disease and stroke. Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Multi-constituent cardiovascular pills (MCCP)--challenges and promises of population-based prophylactic drug therapy for prevention of heart attack.

Science.gov (United States)

Jamieson, Michael J; Naghavi, Morteza

2007-01-01

Risk factors for atherosclerotic cardiovascular disease (CVD) are highly co-prevalent but poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Association for Eradication of Heart Attack (AEHA) has recently proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of "vulnerable patients". The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The "Polypill" concept, introduced by Wald and Law suggests a combination of statin, low-dose antihypertensives, aspirin and folic acid, in a single pill, taken prophylactically by high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. "Polypill" is but one of an astronomical number of possible multiconstituent pills (MCCP). Attractive as the MCCP concept is, it lacks evidence from randomized controlled trials, and begs numerous questions about the credibility of the concept, the design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, "class" vs. unique properties, interactions, evidence of clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the-counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, commercial viability, etc. If these issues are favorably addressed, MCCP stand to dramatically change the manner in which CVD is prevented particularly in developing societies. Notwithstanding, assuming low commercial interests, realizing the promises of MCCP will demand serious attention from national public health policymakers. The clinical and regulatory implications of population-based secondary prevention (which rely on a different evidence base

Improved early risk stratification of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention using a combination of serum soluble ST2 and NT-proBNP.

Directory of Open Access Journals (Sweden)

Jongwook Yu

Full Text Available Although soluble suppression of tumorigenicity 2 (sST2 in serum is known to be associated with ischemic heart disease and heart failure, data regarding its prognostic impact in ST-segment elevation myocardial infarction (STEMI is limited. We evaluated the prognostic impacts of serum sST2 and other serum biomarkers in STEMI patients undergoing primary percutaneous coronary intervention (PCI.Consecutive all 323 patients with STEMI that underwent primary PCI were enrolled. Blood tests and samples were obtained in an emergency room. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCEs, defined as a composite of cardiovascular death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization.Mean age was 59.1±13.1 years (men 84%. MACCE (20 cardiovascular deaths, 7 non-fatal MI, 4 non-fatal stroke, 7 ischemia-driven revascularizations occurred in 38 patients (12%. After adjusting for confounding factors, Cox regression analysis revealed that high serum sST2 (>75.8 ng/mL mean value, adjusted hazard ratio 2.098, 95% CI 1.008-4.367, p = 0.048 and high serum NT-proBNP level (>400 pg/mL, adjusted hazard ratio 2.606, 95% CI 1.086-6.257, p = 0.032 at the time of presentation independently predicted MACCE within a year of primary PCI. Furthermore, when high serum sST2 level was combined with high serum NT-proBNP level, the hazard ratio of MACCE was highest (adjusted hazard ratio 7.93, 95% CI 2.97-20.38, p<0.001.Elevated serum levels of sST2 or NT-proBNP at the time of presentation were found to predict 1-year MACCE independently and elevated serum levels of sST2 plus NT-proBNP were associated with even poorer prognosis in patients with STEMI undergoing primary PCI.

CDC Vital Signs-Heart Age

Centers for Disease Control (CDC) Podcasts

2015-09-01

This podcast is based on the September 2015 CDC Vital Signs report. Your heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. Learn what you can do to lower your heart age and keep it low.  Created: 9/1/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/1/2015.

WILD PIG ATTACKS ON HUMANS

Energy Technology Data Exchange (ETDEWEB)

Mayer, J.

2013-04-12

Attacks on humans by wild pigs (Sus scrofa) have been documented since ancient times. However, studies characterizing these incidents are lacking. In an effort to better understand this phenomenon, information was collected from 412 wild pig attacks on humans. Similar to studies of large predator attacks on humans, data came from a variety of sources. The various attacks compiled occurred in seven zoogeographic realms. Most attacks occurred within the species native range, and specifically in rural areas. The occurrence was highest during the winter months and daylight hours. Most happened under non-hunting circumstances and appeared to be unprovoked. Wounded animals were the chief cause of these attacks in hunting situations. The animals involved were typically solitary, male and large in size. The fate of the wild pigs involved in these attacks varied depending upon the circumstances, however, most escaped uninjured. Most human victims were adult males traveling on foot and alone. The most frequent outcome for these victims was physical contact/mauling. The severity of resulting injuries ranged from minor to fatal. Most of the mauled victims had injuries to only one part of their bodies, with legs/feet being the most frequent body part injured. Injuries were primarily in the form of lacerations and punctures. Fatalities were typically due to blood loss. In some cases, serious infections or toxemia resulted from the injuries. Other species (i.e., pets and livestock) were also accompanying some of the humans during these attacks. The fates of these animals varied from escaping uninjured to being killed. Frequency data on both non-hunting and hunting incidents of wild pig attacks on humans at the Savannah River Site, South Carolina, showed quantitatively that such incidents are rare.

Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest.

Science.gov (United States)

Deakin, Charles D; Fothergill, Rachael; Moore, Fionna; Watson, Lynne; Whitbread, Mark

2014-07-01

The relationship between the neurological status at the time of handover from the ambulance crew to a Heart Attack Centre (HAC) in patients who have achieved return of spontaneous circulation (ROSC) and subsequent outcome, in the context of current treatment standards, is unknown. A retrospective review of all patients treated by London Ambulance Service (LAS) from 1(st) April 2011 to 31(st) March 2013 admitted to a HAC in Greater London was undertaken. Neurological status (A - alert; V - responding to voice; P - responding to pain; U - unresponsive) recorded by the ambulance crew on handover was compared with length of hospital stay and survival to hospital discharge. A total of 475 sequential adult cardiac arrests of presumed cardiac origin, achieving ROSC on admission to a HAC were identified. Outcome data was available for 452 patients, of whom 253 (56.0%) survived to discharge. Level of consciousness on admission to the HAC was a predictor of duration of hospital stay (Pa shockable rhythm, 32.3% (120/371) were 'A' or 'V', compared with 9.1% (9/99) of those with non-shockable rhythms (PA or V) compared with those with non-shockable rhythms. Most patients who are conscious on admission to the HAC will survive, compared with approximately half of those who are unconscious (P or U), suggesting that critical care is generally appropriate at all levels of consciousness if ROSC has been achieved. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Protecting Cryptographic Memory against Tampering Attack

DEFF Research Database (Denmark)

Mukherjee, Pratyay

In this dissertation we investigate the question of protecting cryptographic devices from tampering attacks. Traditional theoretical analysis of cryptographic devices is based on black-box models which do not take into account the attacks on the implementations, known as physical attacks. In prac......In this dissertation we investigate the question of protecting cryptographic devices from tampering attacks. Traditional theoretical analysis of cryptographic devices is based on black-box models which do not take into account the attacks on the implementations, known as physical attacks....... In practice such attacks can be executed easily, e.g. by heating the device, as substantiated by numerous works in the past decade. Tampering attacks are a class of such physical attacks where the attacker can change the memory/computation, gains additional (non-black-box) knowledge by interacting...... with the faulty device and then tries to break the security. Prior works show that generically approaching such problem is notoriously difficult. So, in this dissertation we attempt to solve an easier question, known as memory-tampering, where the attacker is allowed tamper only with the memory of the device...

Modeling attacker-defender interactions in information networks.

Energy Technology Data Exchange (ETDEWEB)

Collins, Michael Joseph

2010-09-01

The simplest conceptual model of cybersecurity implicitly views attackers and defenders as acting in isolation from one another: an attacker seeks to penetrate or disrupt a system that has been protected to a given level, while a defender attempts to thwart particular attacks. Such a model also views all non-malicious parties as having the same goal of preventing all attacks. But in fact, attackers and defenders are interacting parts of the same system, and different defenders have their own individual interests: defenders may be willing to accept some risk of successful attack if the cost of defense is too high. We have used game theory to develop models of how non-cooperative but non-malicious players in a network interact when there is a substantial cost associated with effective defensive measures. Although game theory has been applied in this area before, we have introduced some novel aspects of player behavior in our work, including: (1) A model of how players attempt to avoid the costs of defense and force others to assume these costs; (2) A model of how players interact when the cost of defending one node can be shared by other nodes; and (3) A model of the incentives for a defender to choose less expensive, but less effective, defensive actions.

Rehab for the Heart (A Cup of Health with CDC)

Centers for Disease Control (CDC) Podcasts

2017-08-24

Each year, nearly 790,000 adults in the U.S. suffer a heart attack. For a third of these, it’s not their first. Cardiac rehabilitation could have prevented many of these. In this podcast, Dr. Fleetwood Loustalot discusses the importance of getting cardiac rehab after a heart attack.  Created: 8/24/2017 by MMWR.   Date Released: 8/24/2017.

Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery

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Jagdish Menghraj Shahani

2012-01-01

Full Text Available The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease

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Malik, Archana [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); St. Christopher' s Hospital for Children, Department of Radiology, Philadelphia, PA (United States); Hellinger, Jeffrey C. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); New York Cardiovascular Institute at Lenox Hill Radiology, New York, NY (United States); Servaes, Sabah; Keller, Marc S. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Schwartz, Mathew C. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Levine Children' s Hospital, Sanger Heart and Vascular Institute, Charlotte, NC (United States); Epelman, Monica [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Nemours Children' s Health System/Nemours Children' s Hospital, Department of Medical Imaging/Radiology, Orlando, FL (United States)

2017-03-15

CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. Non-cardiovascular findings are common in children with

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease

International Nuclear Information System (INIS)

Malik, Archana; Hellinger, Jeffrey C.; Servaes, Sabah; Keller, Marc S.; Schwartz, Mathew C.; Epelman, Monica

2017-01-01

CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. Non-cardiovascular findings are common in children with

Disorders of cardiac hemodynamic in attack period of bronchial asthma in children

Directory of Open Access Journals (Sweden)

Kondratiev V.А.

2016-05-01

Full Text Available By dopplerechocardiography method there was studied functional state of cardiac ventricles and character of hemodynamic disorders in 48 patients aged 5-17 years in attack period of moderately-severe and severe bronchial asthma. Group of comparison included 40 healthy peers. Disorders of central and peripheral hemodynamic in attack period of bronchial asthma in children were accompanied both by systolic and diastolic dysfunction of the left and right heart ventricles, herewith right ventricle was functioning in the mode of hyperdynamic, and left one – in the mode of hypodynamic. Combined systolic-diastolic variant of dysfunction both of right and left ventricles was developing in 58,3% of patients with moderately-severe and in 91,6% of patients with severe bronchial asthma. In the attack period of bronchial asthma in children equal directionality of systolic and diastolic dysfunction of heart ventricles was developing; this was characterized by synchronization of their function. Assessment of functional interaction of the ventricles under conditions of severe asthma attack showed direct and high (r=0,67 correlative interaction between finding of Tei index of the left and right ventricles, which characterize their systolic function; this, under conditions of increased hemodynamic pre-loading testified to compensatory increase of systolic interaction of ventricles. Direct and high (r=0,69 correlative interaction between time indices of isovolumic relaxation of the left and right ventricles, characterizing their diastolic function, testified to compensatory increase of diastolic interaction of ventricles under conditions of increase of hemodynamic post-loading. Imbalance of central and peripheral link of hemodynamic in attack period of bronchial asthma in children testified to development of cardiac insufficiency, which was compensated predominantly at the expense of increase of heart contractions rate.

Clinical profile and 30-day outcome of women with acute coronary syndrome as a first manifestation of ischemic heart disease: A single-center observational study.

Science.gov (United States)

Nanjappa, Veena; Aniyathodiyil, Gopi; Keshava, R

2016-01-01

Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days. 133 successive cases of women presenting with ACS, who met the inclusion criteria between 2012 and 2014, were included. Cases were grouped into ST elevation myocardial infarction (STEMI), non ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). The mean age was 64.4±11 years. The mean BMI was 23.64±3.23kg/m(2). Diabetes was present in 58.3% in NSTEMI, 65.1% in STEMI, and 57.1% in UA group. Hypertension was found in 75% of NSTEMI, 60.2% of STEMI, and 71.4% of UA group. Severe MR was found in 11.1% of NSTEMI and 3.6% of STEMI patients. 8.3% of NSTEMI and 15.7% of STEMI patients presented in Killips class IV. Single vessel disease was most commonly found across the spectrum of ACS. 68.7% patients in STEMI group underwent primary angioplasty. 5.6% of NSTEMI and 7.2% in STEMI group had contrast-induced nephropathy (CIN). All deaths were noted in STEMI group with eight in-hospital deaths and three during 30-day follow-up period. Killips class III and IV and higher grace score (>150) were predictors of in-hospital mortality. Chronic kidney disease, ischemic mitral regurgitation, LV clot, and in-hospital cardiac arrest were associated with higher risk. Copyright © 2016. Published by Elsevier B.V.

ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.

Science.gov (United States)

Fernández Fernández, Juan; Deliz-Guzmán, Claudia; Andino-Colón, César; Claudio-Hernández, Héctor; Lugo-Amador, Nannette

2016-01-01

Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

Problem: Heart Valve Regurgitation

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... should be completely closed For example: Watch an animation of mitral valve regurgitation A leaking mitral valve ... Not Alone Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Non-O blood groups can be a prognostic marker of in-hospital and long-term major adverse cardiovascular events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Aras, Dursun; Topaloglu, Serkan; Temizhan, Ahmet; Kisacik, Halil Lutfi; Aydogdu, Sinan

2015-09-01

Recent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) METHODS: 1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months. The prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 pblood group compared with O blood group (pblood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population. Copyright © 2015 Elsevier Ltd. All rights reserved.

Depression and coronary artery disease -real heart attack

International Nuclear Information System (INIS)

Farooqi, S.; Ahmed, B.

2001-01-01

Both depression and ischaemic heart disease are said to become the leading causes of morbidity and mortality in developing countries during the next two decades. The relationship between these two disorders has long been speculated but only recently addressed scientifically. A Medline search was conducted to obtain the articles that address the association between depressive disorders and coronary artery disease (CAD). Most studies following large cohorts over a period ranging from 4.5 to 27 years have shown that depression is associated with a significantly high risk of developing CAD. These studies also show that patients who have depression following myocardial infarction hat poorer prognosis on major cardiac end points like reoccurrence of myocardial infarction and death as compared to the non-depressed group. The psychosocial variables associated with depression like social isolation, acute and chronic stressful life events are also associated with increased risk of developing CAD. The mechanisms underlying this association between depression and CAD are unknown at present. The effectiveness of psychosocial interventions in reducing this increased risks have been demonstrated while the trials assessing the efficacy and safety of anti depressed drugs are underway. The implications of these finding are discussed in the context of developing countries. (author)

Infectious and non-infectious neurologic complications in heart transplant recipients.

Science.gov (United States)

Muñoz, Patricia; Valerio, Maricela; Palomo, Jesús; Fernández-Yáñez, Juan; Fernández-Cruz, Ana; Guinea, Jesús; Bouza, Emilio

2010-05-01

Neurologic complications are important causes of morbidity and mortality in heart transplant (HT) recipients. New immunomodulating agents have improved survival rates, although some have been associated with a high rate of neurologic complications (infectious and non-infectious). We conducted this study to analyze the frequency of these complications, before and after the use of daclizumab induction therapy. We reviewed all neurologic complications in our HT cohort, comparing infectious with non-infectious complications over 2 periods of time in which different induction therapies were used (316 patients with OKT3 or antithymocyte globulin from 1988 to 2002, and 68 patients with daclizumab from 2003 to 2006). Neurologic complications were found in 75/384 patients (19.5%) with a total of 78 episodes. Non-infectious complications accounted for 68% of the 78 episodes of neurologic complications. A total of 51 patients and 53 episodes were detailed as follows: 25 episodes of stroke (25 of 78 total episodes, 32%; 19 ischemic, 6 hemorrhagic); 7 neuropathies; 6 seizures; 4 episodes of transient ischemic attack (TIA); 3 anoxic encephalopathy; 2 each brachial plexus palsy and metabolic encephalopathy; and 1 each myoclonia, central nervous system (CNS) lymphoma, subdural hematoma, and Cotard syndrome. Mean time to presentation of stroke, TIA, and encephalopathy was 1 day (range, 1-19 d) posttransplant. Mortality rate among non-infectious complications was 12/53 (22.6%). Infectious complications accounted for 32% of the 78 total episodes. We found 25 episodes in 24 patients: 17 herpes zoster (median, 268 d after HT), 3 CNS aspergillosis (median, 90 d after HT), 1 CNS toxoplasmosis and tuberculosis (51 d after HT), 1 pneumococcal meningitis (402 d after HT), and 2 Listeria meningitis (median, 108 d after HT). The 3 patients with CNS aspergillosis died. The mortality rate among patients with infectious neurologic complications was 12% (42.8% if the CNS was involved). When we

Pulse pressure as a haemodynamic variable in systolic heart failure

NARCIS (Netherlands)

Petrie, Colin James

2016-01-01

In patients with heart failure, the heart is unable to pump enough blood to satisfy the requirements of the body. Explanations for this include heart muscle damage after a heart attack. This could be very recently, or in the past, sometimes dating back many years. In other cases the explanation for

Recognizing Advanced Heart Failure and Knowing Your Options

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... and Live Our Interactive Cardiovascular Library has detailed animations and illustrations to help you learn about conditions, treatments and procedures related to heart disease and stroke. Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Osteoprotegerin predicts long-term outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Pedersen, Sune Folke; Bjerre, Mette; Mogelvang, Rasmus

2012-01-01

: 1.03-1.59; p = 0.03), repeat myocardial infarction (HR: 1.30; CI: 1.00-1.68; p = 0.05) and admission with heart failure (HR: 1.50; CI: 1.18-1.90; p = 0.001). Conclusion: This study shows that OPG independently predicts long-term outcome in STEMI patients treated with pPCI. Eventually, this knowledge...... in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods: We included 716 consecutive STEMI patients admitted to a single high-volume invasive heart center from September 2006 to December 2008. Endpoints were all...

Investigating Effect of Olfactory Stimulation by Vanilla on the Rate of Apnea Attacks in Neonates with Apnea of Prematurity: A Randomized Clinical Trial

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Sakineh Yaghoubi

2017-12-01

Full Text Available Background Apnea of prematurity (AOP is a developmental disorder that affects the premature newborns frequently. One of the new non-drug methods for controlling apnea attacks is olfactory stimulation. The aim of this study was to determine the effect of olfactory stimulation by vanilla on the rate of apnea attacks in neonates with AOP. Materials and Methods: This study is a single-blind randomized clinical trial study. The study samples included a total of 40 premature neonates with AOP who were admitted to the neonatal Intensive care unit (NICU of Shahid Sadoughi hospital in Yazd, Iran, in 2016 and were assigned randomly in experimental (n=20, and control (n=20 groups. The experimental group was exposed to cotton impregnated with 2ml of vanillin extractfor 24 hours. The number of apnea attacks, heart rate, and arterial oxygen saturation (SaO2 level were measured before, during and after intervention for three consecutive days. Data analysis was performed using statistical analysis in SPSS version 22.0 software. Results: The results showed that there was no significant difference between the two groups in terms of mean number of apnea attacks (p>0.05. However, there was a significant difference between in the experimental group on the first day (2.84 ± 1.25, and second day (1.63 ± 1.01 in terms of the mean number of attacks. Also, there was a significant difference between the mean heart rate and SaO2 level in both the experimental and control groups (p

MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction-DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy

DEFF Research Database (Denmark)

Falkentoft, Alexander C; Rørth, Rasmus; Iversen, Kasper

2018-01-01

BACKGROUND: Midregional proadrenomedullin (MR-proADM) has demonstrated prognostic potential after myocardial infarction (MI). Yet, the prognostic value of MR-proADM at admission has not been examined in patients with ST-segment-elevation MI (STEMI). METHODS AND RESULTS: The aim of this substudy......, DANAMI-3 (The Danish Study of Optimal Acute Treatment of Patients with ST-segment-elevation myocardial infarction), was to examine the associations of admission concentrations of MR-proADM with short- and long-term mortality and hospital admission for heart failure in patients with ST......-segment-elevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of MR-proADM was 0.64 nmol/L (25th-75th percentiles, 0.53-0.79). Within 30 days 23 patients (2...

Blind Data Attack on BGP Routers

Science.gov (United States)

2017-03-01

Second Reader Dr. Cynthia Irvine Chair, Cyber Academic Group iii THIS PAGE INTENTIONALLY LEFT BLANK iv ABSTRACT Transport Communication Protocol (TCP...Postgraduate School. The experience of higher learning at this institution was incredible, and I would whole-heartedly recommend it to any of my peers and...data attack packets to the victim device. Scapy is a Python library that is used to craft and send packets [28]. BGP is supported in Python through

Approach to chest pain and acute myocardial infarction.

Science.gov (United States)

Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

2016-03-01

Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

Heart Rate and Initial Presentation of Cardiovascular Diseases (Caliber)

Science.gov (United States)

2013-09-17

Abdominal Aortic Aneurysm; Coronary Heart Disease NOS; Unheralded Coronary Death; Intracerebral Haemorrhage; Heart Failure; Ischemic Stroke; Myocardial Infarction; Stroke; Peripheral Arterial Disease; Stable Angina Pectoris; Subarachnoid Haemorrhage; Transient Ischemic Attack; Unstable Angina; Cardiac Arrest, Sudden Cardiac Death

Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases

International Nuclear Information System (INIS)

Sultana, R.; Sultana, N.; Rasheed, A.; Rasheed, Z.; Ahmed, M.; Ishaq, M.; Samad, A.

2010-01-01

Background: Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI). Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction (AMI). Methods: The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase (SK) were enrolled in the study. Result: Of the total 1023, 689 (67.3%) patients were males and 334 (32.6%) were females. Six hundred and twenty-nine (61.5%) were successfully resolved after thrombolytic therapy while in 395 (38.5%) patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve (30%) and 444 (43.4%) with complete resolution, 344 (33.62%) and 325 (31.76%) with partial resolution, 367 (35.8%) and 491 (19.29%) were with no resolution at 60 and 90 minutes respectively. Conclusion: Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution. (author)

Empowered to gain a new foothold in life—A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

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Charlotte P. Simonÿ

2015-12-01

Full Text Available This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR. CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients’ particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1 receiving a helpful but limited caring hand, (2 being supported to find new values in life, and (3 developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients’ total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting

Truthfulness in transplantation: non-heart-beating organ donation

Directory of Open Access Journals (Sweden)

Potts Michael

2007-08-01

Full Text Available Abstract The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit. Verheijde, Rady, and McGregor attack the deception involved in NHBD, arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent. Such honesty about NHBD should be welcomed. However, NHBD violates a fundamental end of medicine, nonmaleficience, "do no harm." Physicians should not be harming or killing patients, even if it is for the benefit of others. Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

Influence of Diabetes Mellitus on Clinical Outcomes Following Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

DEFF Research Database (Denmark)

Jensen, Lisette Okkels; Maeng, Michael; Thayssen, Per

2012-01-01

and nondiabetic patients treated with primary PCI for ST-segment elevation MI (STEMI) in Western Denmark. From January 2002 through June 2005, 3,655 consecutive patients with STEMI treated with primary PCI and stent implantation (316 patients with DM, 8.6%; 3,339 patients without DM, 91.4%) were recorded...... in the Western Denmark Heart Registry. All patients were followed for 3 years. Cox regression analysis was used to compute hazard ratios (HRs), controlling for potential confounding. Three-year rates of definite stent thrombosis were 1.6% in the DM group and 1.5% in the non-DM group (adjusted HR 1.15, 95...

Heart Rate Variability and Wavelet-based Studies on ECG Signals from Smokers and Non-smokers

Science.gov (United States)

Pal, K.; Goel, R.; Champaty, B.; Samantray, S.; Tibarewala, D. N.

2013-12-01

The current study deals with the heart rate variability (HRV) and wavelet-based ECG signal analysis of smokers and non-smokers. The results of HRV indicated dominance towards the sympathetic nervous system activity in smokers. The heart rate was found to be higher in case of smokers as compared to non-smokers ( p smokers from the non-smokers. The results indicated that when RMSSD, SD1 and RR-mean features were used concurrently a classification efficiency of > 90 % was achieved. The wavelet decomposition of the ECG signal was done using the Daubechies (db 6) wavelet family. No difference was observed between the smokers and non-smokers which apparently suggested that smoking does not affect the conduction pathway of heart.

Quantum chemical study of halophilic interactions. Communication 3. Non-empirical study of the ways of tetrachloromethane attack by halide ions

International Nuclear Information System (INIS)

Kobychev, V.B.; Vitkovskaya, N.M.; Abramov, A.V.; Timokhin, B.V.

1999-01-01

It has been shown by means of non-empirical calculations of model reactions between tetrachloromethane and chlorine/iodine anions that in case of attack via carbon atom according to mechanism S N 2 formation of weakly-bound CCl 4 complexes with halide ions is observed at initial state. Further transformation of the complexes is restricted by considerable potential barriers. Attack of nucleophil via chlorine atom with formation of stable complexes CCl 3 -Cl-Hlg - is preferable [ru

Dynamic changes in sRAGE levels and relationship with cardiac function in STEMI patients

DEFF Research Database (Denmark)

Jensen, Louise J N; Lindberg, Søren; Hoffmann, Søren

2015-01-01

the dynamic changes in sRAGE levels during AMI and relationship with cardiac dysfunction. DESIGN AND METHODS: We prospectively included 80 patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). sRAGE concentrations were measured before p...... in the early phase of AMI; sRAGE levels significantly increased after pPCI compared with sRAGE before pPCI (median ratio: 1.25, 95% CI: 1.15-1.35, P...phase rather than in the days after AMI and pPCI. The increase...

System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Terkelsen, Christian Juhl; Sørensen, Jacob Thorsted; Maeng, Michael

2010-01-01

Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first...... contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients...

Assessing the risk of attack in the management of asthma: a review and proposal for revision of the current control-centred paradigm.

Science.gov (United States)

Blakey, John D; Woolnough, Kerry; Fellows, Jodie; Walker, Samantha; Thomas, Mike; Pavord, Ian D

2013-09-01

Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks.

A Non-blind Color Image Watermarking Scheme Resistent Against Geometric Attacks

Directory of Open Access Journals (Sweden)

A. Ghafoor

2012-12-01

Full Text Available A non-blind color image watermarking scheme using principle component analysis, discrete wavelet transform and singular value decomposition is proposed. The color components are uncorrelated using principle component analysis. The watermark is embedded into the singular values of discrete wavelet transformed sub-band associated with principle component containing most of the color information. The scheme was tested against various attacks (including histogram equalization, rotation, Gaussian noise, scaling, cropping, Y-shearing, X-shearing, median filtering, affine transformation, translation, salt & pepper, sharpening, to check robustness. The results of proposed scheme are compared with state-of-the-art existing color watermarking schemes using normalized correlation coefficient and peak signal to noise ratio. The simulation results show that proposed scheme is robust and imperceptible.

Migraine and risk of stroke and acute coronary syndrome in two case-control studies in the Danish population

DEFF Research Database (Denmark)

Osler, Merete; Wium-Andersen, Ida Kim; Jørgensen, Martin Balslev

2017-01-01

INTRODUCTION: Migraine has consistently been associated with increased risk of ischemic stroke, while the evidence for a relation with other types of stroke or coronary outcomes is limited. We examined the association between migraine and stroke and acute coronary syndrome (ACS) subtypes and the ......INTRODUCTION: Migraine has consistently been associated with increased risk of ischemic stroke, while the evidence for a relation with other types of stroke or coronary outcomes is limited. We examined the association between migraine and stroke and acute coronary syndrome (ACS) subtypes...... medication had increased ORs of all stroke subtypes (ischemic, hemorrhagic stroke and transient ischemic attacks). The diagnosis of migraine was also associated with both angina and myocardial infarction (ST-elevation Myocardial Infarction [STEMI], non-STEMI and unspecified) with the highest OR for angina...

'Cryptogenic Drop Attacks' revisited: evidence of overlap with functional neurological disorder.

Science.gov (United States)

Hoeritzauer, Ingrid; Carson, Alan J; Stone, Jon

2018-02-07

In their 1973 BMJ paper 'Cryptogenic Drop Attacks', Stevens and Matthews described 40, mostly middle-aged, female patients with drop attacks of unknown cause. Although clinically common, there has been little on this topic since. We aimed to determine clinical features, comorbidity and outcome of patients with drop attacks. We carried out a retrospective review of patients with cryptogenic drop attacks seen consecutively by one clinician (JS) between 2006 and 2016. Demographics, phenomenology, duration and frequency of attacks, attack description and comorbid diagnoses were recorded. Patients were followed up with a notes review. 83 patients with cryptogenic drop attacks were predominantly female (89%, n=79), mean age 44  years. The majority (93%, n=77) could not remember the fall itself and almost half (43%, n=36) experienced prodromal dissociative symptoms. Mechanical trips or syncope preceded drop attacks, historically, in 24% (n=20) of cases. Persistent fatigue (73%, n=61), chronic pain (40%, n=33), functional limb weakness (31%,n=26) and dissociative (non-epileptic) attacks 28% (n=23) were common, with the latter usually preceding or emerging from drop attacks. At follow-up (88%, mean 38 months), 28% (n=23) had resolution of their drop attacks. Predisposing (but non-causative) disease comorbidity was found at baseline (n=12) and follow-up (n=5). Cryptogenic drop attacks are associated with high frequency of comorbid functional somatic and functional neurological disorders. Patients commonly have prodromal dissociative symptoms and in some there was a clear relationship with prior or subsequent dissociative (non-epileptic) attacks. Some cryptogenic drop attacks may be best understood as phenomena on the spectrum of dissociative attacks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Emotional stimuli-provoked seizures potentially misdiagnosed as psychogenic non-epileptic attacks: A case of temporal lobe epilepsy with amygdala enlargement

Directory of Open Access Journals (Sweden)

Hidetaka Tamune

Full Text Available The association between emotional stimuli and temporal lobe epilepsy (TLE is largely unknown. Here, we report the case of a depressed, 50-year-old female complaining of episodes of a “spaced out” experience precipitated by emotional stimuli. Psychogenic non-epileptic attacks were suspected. However, video-EEG coupled with emotional stimuli-provoked procedures and MRI findings of amygdala enlargement, led to the diagnosis of left TLE. Accurate diagnosis and explanation improved her subjective depression and seizure frequency. This case demonstrated that emotional stimuli can provoke seizures in TLE and suggested the involvement of the enlarged amygdala and the modulation of emotion-related neural circuits. Keywords: Video-EEG, Psychogenic non-epileptic attacks, Temporal lobe epilepsy, Amygdala enlargement, Reflex seizure, Provoked seizure

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience

International Nuclear Information System (INIS)

Akhtar, R.P.; Khan, J.S.; Abid, A.R.; Gardezi, S.J.R.

2007-01-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of noncardiac surgical operation with minimal risk. (author)

Adaptive cyber-attack modeling system

Science.gov (United States)

Gonsalves, Paul G.; Dougherty, Edward T.

2006-05-01

The pervasiveness of software and networked information systems is evident across a broad spectrum of business and government sectors. Such reliance provides an ample opportunity not only for the nefarious exploits of lone wolf computer hackers, but for more systematic software attacks from organized entities. Much effort and focus has been placed on preventing and ameliorating network and OS attacks, a concomitant emphasis is required to address protection of mission critical software. Typical software protection technique and methodology evaluation and verification and validation (V&V) involves the use of a team of subject matter experts (SMEs) to mimic potential attackers or hackers. This manpower intensive, time-consuming, and potentially cost-prohibitive approach is not amenable to performing the necessary multiple non-subjective analyses required to support quantifying software protection levels. To facilitate the evaluation and V&V of software protection solutions, we have designed and developed a prototype adaptive cyber attack modeling system. Our approach integrates an off-line mechanism for rapid construction of Bayesian belief network (BN) attack models with an on-line model instantiation, adaptation and knowledge acquisition scheme. Off-line model construction is supported via a knowledge elicitation approach for identifying key domain requirements and a process for translating these requirements into a library of BN-based cyber-attack models. On-line attack modeling and knowledge acquisition is supported via BN evidence propagation and model parameter learning.

Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI.

Science.gov (United States)

Dehghani, Payam; Lavoie, Andrea; Lavi, Shahar; Crawford, Jennifer J; Harenberg, Sebastian; Zimmermann, Rodney H; Booker, Jeff; Kelly, Sheila; Cantor, Warren J; Mehta, Shamir R; Bagai, Akshay; Goodman, Shaun G; Cheema, Asim N

2017-10-01

Patients undergoing PCI early after fibrinolytic therapy are at high risk for both thrombotic and bleeding complications. We sought to assess the pharmacodynamic effects of ticagrelor versus clopidogrel in the fibrinolytic-treated STEMI patients undergoing early PCI. Patients undergoing PCI within 24 hours of tenecteplase (TNK), aspirin, and clopidogrel for STEMI were randomized to receive additional clopidogrel 300 mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline) at 4 and 24 hours post-PCI. The primary end point was PRU ≤208 at 4 hours. A total of 140 patients (74 in ticagrelor and 66 in clopidogrel group) were enrolled. The mean PRU values at baseline were similar for the 2 groups (257.8±52.9 vs 259.5±56.7, P=.85, respectively). Post-PCI, patients on ticagrelor, compared to those on clopidogrel, had significantly lower PRU at 4 hours (78.7±88 vs 193.6±86.5, respectively, PPCI frequently had PRU >208. In this high-risk population, ticagrelor provides more prompt and potent platelet inhibition compared with clopidogrel (Funded by Astra Zeneca; NCT01930591, https://clinicaltrials.gov/ct2/show/NCT01930591). Copyright © 2017 Elsevier Inc. All rights reserved.

Heart Health Tests for Diabetes Patients

Science.gov (United States)

... or fluids in the body. They include: Electrocardiogram ("EKG" or "ECG") This test measures the electrical activity ... Tools & Resources Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Study of Serum Uric Acid Levels in Myocardial Infarction and Its Association With Killip Class

Directory of Open Access Journals (Sweden)

Maryam Mehrpooya

2017-02-01

Full Text Available The present study aimed to compare the serum level of uric acid in patients with and without heart failure and also to determine the association between uric acid level and clinical status by Killip class in patients with STEMI. This case-control study was conducted on 50 consecutives as control group and 50 patients with acute heart failure, (20 patients had acute STEMI, who documented by both clinical conditions and echocardiography assessment. The mean plasma level of uric acid in the case group was 7.6±1.6 milligrams/deciliter (mg/dL and in the control group was 4.5±1.5 respectively (P<0.001. These values in patients with STEMI was about 9.2±0.86, but in patients with acute heart failure in absence of STEMI was 6.5±1.04 (P<0.001. Moreover, there was significant difference among the level of uric acid and Killip classes (P<0.001. Also there was significant difference for uric acid level between HFrEF (HF with reduced EF and severe LV systolic dysfunction (0.049. In STEMI patients with culprit LAD, mean uric acid was significantly higher than cases with culprit LCX [(9.7±0.98 versus 8.6±0.52 respectively P=0.012]. Regarding  treatment plan in patients with STEMI, mean level of uric acid in those considered for CABG was significantly higher than who were considered for PCI, 9.9±0.82 versus 8.9±0.76 respectively, P=0.029. In STEMI patients with higher killip class, higher level of uric acid was seen. Also, the severity of LV systolic dysfunction was associated with higher level of uric acid.

Excess mortality in women compared to men after PCI in STEMI: an analysis of 11,931 patients during 2000-2009.

Science.gov (United States)

de Boer, Sanneke P M; Roos-Hesselink, Jolien W; van Leeuwen, Maarten A H; Lenzen, Mattie J; van Geuns, Robert-Jan; Regar, Evelyn; van Mieghem, Nicolas M; van Domburg, Ron; Zijlstra, Felix; Serruys, Patrick W; Boersma, Eric

2014-09-20

Ambiguity exists whether gender affects outcome in patients undergoing percutaneous coronary intervention (PCI). To evaluate the relationship between gender and outcome in a large cohort of PCI patients, 11,931 consecutive patients who underwent PCI for various indications during 2000-2009 were studied using survival analyses and Cox regression models. Most patients (n=8588; 72%) were men. Women were older and more often had a history of hypertension and diabetes mellitus. Men smoked more frequently, had a more extensive cardiovascular history (previous MI, PCI and CABG), a higher prevalence of renal impairment and multi-vessel disease. In STEMI patients, women had higher 31-day mortality rates than men (11.6% vs. 6.5%, respectively, pPCI for STEMI had higher mortality than men. The excess mortality in women appeared in the first month after PCI and could only partially be explained by a difference in baseline characteristics. No gender differences in outcome in patients undergoing PCI for NSTE-ACS and stable angina were observed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Research Note on the Energy Infrastructure Attack Database (EIAD

Directory of Open Access Journals (Sweden)

Jennifer Giroux

2013-12-01

Full Text Available The January 2013 attack on the In Amenas natural gas facility drew international attention. However this attack is part of a portrait of energy infrastructure targeting by non-state actors that spans the globe. Data drawn from the Energy Infrastructure Attack Database (EIAD shows that in the last decade there were, on average, nearly 400 annual attacks carried out by armed non-state actors on energy infrastructure worldwide, a figure that was well under 200 prior to 1999. This data reveals a global picture whereby violent non-state actors target energy infrastructures to air grievances, communicate to governments, impact state economic interests, or capture revenue in the form of hijacking, kidnapping ransoms, theft. And, for politically motivated groups, such as those engaged in insurgencies, attacking industry assets garners media coverage serving as a facilitator for international attention. This research note will introduce EIAD and position its utility within various research areas where the targeting of energy infrastructure, or more broadly energy infrastructure vulnerability, has been addressed, either directly or indirectly. We also provide a snapshot of the initial analysis of the data between 1980-2011, noting specific temporal and spatial trends, and then conclude with a brief discussion on the contribution of EIAD, highlighting future research trajectories. 

Heart scanner - who's between a rock and a hard place?

African Journals Online (AJOL)

evidence of coronary heart disease succumbs to a fatal heart attack. Cardiac symptoms, positive stress test results and angiographically visible narrowings are all dependent on significant lumenal stenosis. Considerable atherosclerosis can be present in an asymptomatic patient in whom physical examination, stress testing ...

Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population

Directory of Open Access Journals (Sweden)

Rajni Sharma

2014-01-01

Full Text Available Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5% and rest were females. Most patients had ST elevation myocardial infarction (STEMI 995 (63.7% followed by unstable angina (UA 390 (25% and non-STEMI (NSTEMI 177 (11.3%. Risk factors; smoking was present in 770 (49.3%, hypertension in 628 (40.2%, diabetes in 578 (37%, and obesity in (29.64% patients. Angiography was done in 1443 (92.38% patients. left anterior descending was most commonly involved, left main (LM coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28% UA, 94 (56.29% NSTEMI and 468 (51.71% STEMI patients. Double-vessel disease was present in 67 (18.08% UA, 25 (14.97% NSTEMI and 172 (19.01% STEMI patients. Triple vessel disease was present in 28 (7.55% UA, 16 (9.58% NSTEMI, 72 (7.95% STEMI patients. LM disease was present in 12 (3.23% UA, 2 (1.19% NSTEMI and 9 (0.99% STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%, free wall rupture in 2 (0.1%, cardiogenic shock in 45 (2.9%, severe mitral regurgitation in 3 (0.2%, complete heart block in 11 (0.7% patients. Total 124 (7.9% patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent

Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial.

Science.gov (United States)

Ardehali, Abbas; Esmailian, Fardad; Deng, Mario; Soltesz, Edward; Hsich, Eileen; Naka, Yoshifumi; Mancini, Donna; Camacho, Margarita; Zucker, Mark; Leprince, Pascal; Padera, Robert; Kobashigawa, Jon

2015-06-27

The Organ Care System is the only clinical platform for ex-vivo perfusion of human donor hearts. The system preserves the donor heart in a warm beating state during transport from the donor hospital to the recipient hospital. We aimed to assess the clinical outcomes of the Organ Care System compared with standard cold storage of human donor hearts for transplantation. We did this prospective, open-label, multicentre, randomised non-inferiority trial at ten heart-transplant centres in the USA and Europe. Eligible heart-transplant candidates (aged >18 years) were randomly assigned (1:1) to receive donor hearts preserved with either the Organ Care System or standard cold storage. Participants, investigators, and medical staff were not masked to group assignment. The primary endpoint was 30 day patient and graft survival, with a 10% non-inferiority margin. We did analyses in the intention-to-treat, as-treated, and per-protocol populations. This trial is registered with ClinicalTrials.gov, number NCT00855712. Between June 29, 2010, and Sept 16, 2013, we randomly assigned 130 patients to the Organ Care System group (n=67) or the standard cold storage group (n=63). 30 day patient and graft survival rates were 94% (n=63) in the Organ Care System group and 97% (n=61) in the standard cold storage group (difference 2·8%, one-sided 95% upper confidence bound 8·8; p=0·45). Eight (13%) patients in the Organ Care System group and nine (14%) patients in the standard cold storage group had cardiac-related serious adverse events. Heart transplantation using donor hearts adequately preserved with the Organ Care System or with standard cold storage yield similar short-term clinical outcomes. The metabolic assessment capability of the Organ Care System needs further study. TransMedics. Copyright © 2015 Elsevier Ltd. All rights reserved.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

Science.gov (United States)

Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

2007-10-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

Metabolic syndrome in patients with ischemic heart disease

International Nuclear Information System (INIS)

Yasmin, S.; Naveed, T.; Shakoor, T.

2008-01-01

To determine the frequency of metabolic syndrome in patients with Ischemic Heart Disease (IHD). Cross-sectional, descriptive study. A total of 100 subjects with ischemic heart disease, fulfilling the inclusion criteria, were enrolled in the study. Demographic data (age and gender) and the 5 component conditions of the metabolic syndrome were noted. Subjects were physically assessed for the abdominal obesity, based on waist circumference. Fasting blood samples for glucose and lipid profile in first 24 hours after acute coronary insult were drawn and tested in central laboratory. Variables were processed for descriptive statistics. In this study population, 68% were male and 32% were female with mean age of 52 +-13.6 years in men and 56 +- 12.5 years in women. Frequency of metabolic syndrome was 32% in men and 28% in women. It increased with age. The highest rate of metabolic syndrome was in men diagnosed as STEMI (odds ratio: 3.39, 95% CI=1.36-8.41). Frequency of metabolic syndrome was high among the patients with IHD. It supports the potential for preventive efforts in persons with high-risk of IHD. (author)

Non-compaction cardiomyopathy – an unusual cause of heart failure

Directory of Open Access Journals (Sweden)

Jure Dolenc

2011-03-01

Full Text Available Introduction: Non-compaction cardiomyopathy is a rare inborn anomaly caused by disorder of endomyocardial morphogenesis. The diagnosis is based on echocardiographic criteria. The prevalence in the adult population is not known. The symptoms are atypical. Three main groups of clinical signs exist: heart failure, thromobembolic events and arrhythmias. In the group of patients with reduced left ventricular function the prognosis is poor and the treatment options are limited. Patients and methods: In the recent 10 years, 7 patients with non-compaction cardiomyopathy were diagnosed at the Department of Cardiology of the University Medical Centre Ljubljana. Results: All seven patients were males, their mean age at the last follow-up being 39 ± 20.3 years (range 20 to 70 years. Five patients were diagnosed in adulthood. All of them fulfilled the echocardiographic diagnostic criteria of noncompaction cardiomyopathy. Five patients had depressed function of both ventricles, two patients had isolated left ventricular dysfunction. Three patients had decreased left ventricular ejection fraction, six patients showed left ventricular diastolic dysfunction. Only three patients had normal physical capacity. Two patients presented with clinical signs of overt heart failure. During follow-up, one patient died from heart failure. We observed thromboembolic events in one patient. Three patients suffered from nonsustained ventricular tachycardias and two patients had rhythm conduction abnormalities. Conclusions: Non-compaction cardiomyopathy is a rare disorder. We observed all common complications in our group of patients. The majority of patients displayed dysfunction of the affected ventricle and the dysfunction was more pronounced in older patients. Treatment of complications is an important factor in long-term survival of these patients.

Pregnancy and non-valvular heart disease - Anesthetic considerations

Directory of Open Access Journals (Sweden)

Maitra Gaurab

2010-01-01

Full Text Available Non-valvular heart disease is an important cause of cardiac disease in pregnancy and presents a unique challenge to the anesthesiologist during labor and delivery. A keen understanding of the underlying pathophysiology, in addition to the altered physiology of pregnancy, is the key to managing such patients. Disease-specific goals of management may help preserve the hemodynamic and ventilatory parameters within an acceptable limit and a successful conduct of labor and postpartum period

Structured telephone support or non-invasive telemonitoring for patients with heart failure.

Science.gov (United States)

Inglis, Sally C; Clark, Robyn A; Dierckx, Riet; Prieto-Merino, David; Cleland, John G F

2015-10-31

Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the

Preliminary data from {gamma}-cardiography during the abatement of an asthmatic attack (1961); Premieres donnees de la {gamma}-cardiographie au decours de l'etat de mal asthmatique (1961)

Energy Technology Data Exchange (ETDEWEB)

Georges, R; Vernejoul, P de; Raynaud, C; Blanchon, P; Kellershohn, C; Turiaf, J [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1961-07-01

The authors used gamma cardiology during the abatement of 16 cases of asthma with a view to detecting heart attacks not otherwise visible with routine methods of examination: clinical, radiological and electro-cardio-graphical. In gamma cardiology, a radioactive indicator is used and its path followed in the cavities of the heart. The method makes it possible to study the circulation in the right heart, the pulmonary crossing, and the left heart, as well as evaluation of the heart-flow. As a result of their investigations the authors, after having discussed the significance of the data obtained with the method, suggest that it is possible by the use of gamma cardiography during the abatement of an asthma attack: 1- To confirm attacks of the right heart which have already been detected by ordinary methods. 2- To confirm the presence of modifications in the recorded curves which suggest, in the case of the left heart, possible attack; such on attack is also indicated, in a small number of cases, by electrocardiography curves. Some considerations are put forward by the authors concerning the physiopathology of attacks on the left heart. (authors) [French] Les auteurs ont fait appel a la gammacardiographie au decours de 16 cas d'etat de mal asthmatique, dans le but d'objectiver des atteintes cardiaques incapables d'etre revelees par les moyens d'exploration de routine: cliniques, radiologiques et electrocardiographiques. La gammacardiographie est un procede qui enregistre a l'aide d'un indicateur radioactif, le trajet de celui-ci dans les cavites cardiaques. Elle permet l'etude de la circulation dans le coeur droit, de la traversee pulmonaire, et le coeur gauche, de meme que le calcul du debit cardiaque. Au terme de leurs investigations, les auteurs apres avoir discute la signification des donnees fournies par la methode admettent que la gammacardiographie objective au secours de l'etat de mal asthmatique: 1- La confirmation de l'atteinte du coeur droit deja etablie

Non-heart-beating lung donation : How big is the pool?

NARCIS (Netherlands)

Nijkamp, Danielle M.; van der Bij, Wim; Verschuuren, Erik A. M.; Heemskerk, Martin B. A.; de Buijzer, Erwin; Erasmus, Michiel E.

Lungs from non-heart-beating (NHB) donors are seldom used in The Netherlands despite the good quality of these organs. Based on a retrospective analysis of 162 NHB donor procedures we found that only 5% of the lungs were actually utilized, but that 30% of the lungs were suitable for transplantation.

Computer Network Attack and Its Effectiveness against Non-State Actors

National Research Council Canada - National Science Library

Presby, Timothy D

2006-01-01

.... With the United States engaged in counter-insurgency operations against terrorist groups, synchronizing the effects of CNA with more traditional forms of kinetic attacks, as well as other instruments...

Participation in Heart-Healthy Behaviors: A Secondary Analysis of the American Heart Association Go Red Heart Match Data.

Science.gov (United States)

Arslanian-Engoren, Cynthia; Eastwood, Jo-Ann; De Jong, Marla J; Berra, Kathy

2015-01-01

The American Heart Association created Go Red Heart Match, a free and secure online program that enables women to connect with each other to fight heart disease either personally or as a caregiver for someone with heart disease. Through these connections, participants have an opportunity to develop a personal, private, and supportive relationship with other women; share common experiences; and motivate and encourage each other to follow a heart-healthy lifestyle. The aims of this study were to describe the demographic characteristics of the Go Red Heart Match responders and to determine whether participation in the program prompted participants to engage in heart-healthy behaviors. A secondary analysis of data collected as part of a needs assessment survey from the American Heart Association Go Red Heart Match was conducted. A total of 117 (35%) of the 334 invited women completed the survey. Most responders were female, married, and college educated. A total of 105 (90%) responders were diagnosed with a type of heart disease or stroke and 77 (73%) responders had undergone treatment. As a result of participating in the program, 75% of the responders reported the following improvements in heart-healthy behaviors: eating a more heart-healthy diet (54%), exercising more frequently (53%), losing weight (47%), and quitting smoking (10%). Responders who had a diagnosis of heart attack (n = 48) were more likely (P = .003) to quit smoking than were those with other diagnoses (n = 69). Notably, 48% of responders reported encouraging someone else in their life to speak to their doctor about their risk for heart disease. Most women who participated in Heart Match reported engaging in new heart-healthy behaviors. The findings support expanding the existing program in a more diverse population as a potentially important way to reach women and encourage cardiovascular disease risk reduction for those with heart disease and stroke.

Cyber Attacks, Information Attacks, and Postmodern Warfare

Directory of Open Access Journals (Sweden)

Valuch Jozef

2017-06-01

Full Text Available The aim of this paper is to evaluate and differentiate between the phenomena of cyberwarfare and information warfare, as manifestations of what we perceive as postmodern warfare. We describe and analyse the current examples of the use the postmodern warfare and the reactions of states and international bodies to these phenomena. The subject matter of this paper is the relationship between new types of postmodern conflicts and the law of armed conflicts (law of war. Based on ICJ case law, it is clear that under current legal rules of international law of war, cyber attacks as well as information attacks (often performed in the cyberspace as well can only be perceived as “war” if executed in addition to classical kinetic warfare, which is often not the case. In most cases perceived “only” as a non-linear warfare (postmodern conflict, this practice nevertheless must be condemned as conduct contrary to the principles of international law and (possibly a crime under national laws, unless this type of conduct will be recognized by the international community as a “war” proper, in its new, postmodern sense.

Non-contrast MR angiography for diagnosis of congenital heart disease

International Nuclear Information System (INIS)

Matsuo, Mikaru; Yoshioka, Kunihiro; Takahashi, Shin; Oyama, Kotaro

2006-01-01

Fast imaging employing steady state acquisition (FIESTA) has been reported to be suitable for cardiac imaging in adolescents and adults. The purpose of this study was to establish the applicability and limitation of MR Angiography using FIESTA in the diagnosis of congenital heart disease. Thirty-five patients with congenital heart disease underwent MR Angiography using FIESTA and the 3D Gd-enhanced fast spoiled gradient recalled acquisition in the steady state (SPGR) technique. The measurements of the vascular diameters and diagnostic quality of the two techniques were compared. Correlations between FIESTA and the 3D Gd-fast SPGR technique were excellent in vascular diameter (aAo 0.90, arch 0.78, dAo 0.92, SCA 0.70, RPA 0.90, LPA 0.95). The agreement of the vascular diameters in the Bland-Altman method was good (aAo 0.22 mm, arch 0.07 mm, dAo 0.14 mm, SCA 0.31 mm, RPA 0.45 mm, LPA 0.12 mm). However, MR angiography (MRA) by 3D Gd-enhanced SPGR had a higher resolution than that by FIESTA. Due to signal loss caused at the regions of vascular stenosis or Blalock-Taussig shunt on FIESTA, we could not evaluate the vascular diameter or patency at those lesions. FIESTA is a useful technique of non-enhanced MRA for non-invasive diagnosis of congenital heart disease. However, MRA by FIESTA was not adequate for multiplanar reconstruction. (author)

Assessing Uncertainties in Boundary Layer Transition Predictions for HIFiRE-1 at Non-zero Angles of Attack

Science.gov (United States)

Marek, Lindsay C.

2011-01-01

Boundary layer stability was analyzed for the HIFiRE-1 flight vehicle geometry for ground tests conducted at the CUBRC LENS I hypersonic shock test facility and the Langley Research Center (LaRC) 20- inch Mach 6 Tunnel. Boundary layer stability results were compared to transition onset location obtained from discrete heat transfer measurements from thin film gauges during the CUBRC test and spatially continuous heat transfer measurements from thermal phosphor paint data during the LaRC test. The focus of this analysis was on conditions at non-zero angles of attack as stability analysis has already been performed at zero degrees angle of attack. Also, the transition onset data obtained during flight testing was at nonzero angles of attack, so this analysis could be expanded in the future to include the results of the flight test data. Stability analysis was performed using the 2D parabolized stability software suite STABL (Stability and Transition Analysis for Hypersonic Boundary Layers) developed at the University of Minnesota and the mean flow solutions were computed using the DPLR finite volume Navier-Stokes computational fluid dynamics (CFD) solver. A center line slice of the 3D mean flow solution was used for the stability analysis to incorporate the angle of attack effects while still taking advantage of the 2D STABL software suite. The N-factors at transition onset and the value of Re(sub theta)/M(sub e), commonly used to predict boundary layer transition onset, were compared for all conditions analyzed. Ground test data was analyzed at Mach 7.2 and Mach 6.0 and angles of attack of 1deg, 3deg and 5deg. At these conditions, the flow was found to be second mode dominant for the HIFiRE-1 slender cone geometry. On the leeward side of the vehicle, a strong trend of transition onset location with angle of attack was observed as the boundary layer on the leeward side of the vehicle developed inflection points at streamwise positions on the vehicle that correlated to

Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort

DEFF Research Database (Denmark)

Miller, Joy; Edwards, Lisa D; Agustí, Alvar

2013-01-01

stable COPD subjects, 337 smokers and 245 non-smokers with normal lung function. COPD patients had a higher prevalence of osteoporosis, anxiety/panic attacks, heart trouble, heart attack, and heart failure, than smokers or nonsmokers. Heart failure (Hazard Ratio [HR] 1.9, 95% Confidence Interval [CI] 1...

Prevention of Contrast-Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob

2012-01-01

-acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced...... the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

HEART FAILURE – KEEPING STEP WITH THE PROGRESS

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Camelia Diaconu

2018-06-01

countries across North America (NA, Central and South America (CSA, Western (WE and Eastern Europe (EE, the Eastern Mediterranean and Africa (EMA, South East Asia (SEA and the Western Pacific (WP, under the study co-chairs, Prof. Gerasimos Filippatos (Greece and Prof. Mihai Gheorghiade (USA. Inter-regional differences in the hospital entry point, comorbidities and precipitants have been observed. Ischemia was a common precipitant in SEA, WP and EMA, whereas non-adherence to diet and medication was more common in NA. There have been also observed differences regarding the treatment, especially in time to initial intravenous therapy. Patients in NA have significantly longer time to first therapy, compared with other regions; this may impact the symptoms, because the sooner the IV therapies are delivered, the sooner symptoms will improve. There are differences regarding the implementation of international heart failure guidelines, which may influence the patients’ outcomes. Researchers from the Institute of Molecular Biotechnology at the Vienna BioCenter have studied the first systems for heart regeneration following complex heart attacks in mammals. In vivo neonatal models showed that, after a heart attack, mice underwent total repair of cardiac injury. This type of repair had been encountered previously in fish, but not in mammals. The researchers set up now genetic systems to identify the molecular signals that mediate this regeneration of the heart. Biotechnologies may become the future of the heart failure treatment.

Comparison of bioavailability and antiplatelet action of ticagrelor in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: A prospective, observational, single-centre study.

Directory of Open Access Journals (Sweden)

Piotr Adamski

Full Text Available Data from available studies suggest that the presence of ST-elevation myocardial infarction (STEMI may be associated with delayed and attenuated ticagrelor bioavailability and effect compared with non-ST-elevation myocardial infarction (NSTEMI.In a single-center, prospective, observational trial 73 patients with myocardial infarction (STEMI n = 49, NSTEMI n = 24 underwent a pharmacokinetic and pharmacodynamic assessment after a 180 mg ticagrelor loading dose (LD. Ticagrelor and its active metabolite (AR-C124910XX plasma concentrations were determined with liquid chromatography tandem mass spectrometry, and their antiplatelet effect was measured with the VASP assay and multiple electrode aggregometry.During the first six hours after ticagrelor LD, STEMI patients had 38% and 34% lower plasma concentration of ticagrelor and AR-C124910XX, respectively, than NSTEMI (ticagrelor AUC(0-6: 2491 [344-5587] vs. 3991 [1406-9284] ng*h/mL; p = 0.038; AR-C124910XX AUC(0-6: 473 [0-924] vs. 712 [346-1616] ng*h/mL; p = 0.027. STEMI patients also required more time to achieve maximal concentration of ticagrelor (tmax: 4.0 [3.0-12.0] vs. 2.5 [2.0-6.0] h; p = 0.012. Impaired bioavailability of ticagrelor and AR-C124910XX seen in STEMI subjects was associated with diminished platelet inhibition in this group, which was most pronounced during the initial hours of treatment.Plasma concentrations of ticagrelor and AR-C124910XX during the first hours after ticagrelor LD were one third lower in STEMI than in NSTEMI patients. This reduced and delayed ticagrelor bioavailability was associated with weaker antiplatelet effect in STEMI.ClinicalTrials.gov identifier: NCT02602444 (November 09, 2015.

77 FR 5373 - American Heart Month, 2012

Science.gov (United States)

2012-02-03

...; its victims are fathers and daughters, grandparents and siblings, cherished friends and community... Federal agencies and forging new public-private partnerships to prevent one million heart attacks and... research to unlock new treatments for cardiovascular disease. And the Centers for Disease Control and...

Preexisting Cardiovascular Risk and Subsequent Heart Failure Among Non-Hodgkin Lymphoma Survivors

DEFF Research Database (Denmark)

Salz, Talya; Zabor, Emily C; de Nully Brown, Peter

2017-01-01

Purpose The use of anthracycline chemotherapy is associated with heart failure (HF) among survivors of non-Hodgkin lymphoma (NHL). We aimed to understand the contribution of preexisting cardiovascular risk factors to HF risk among NHL survivors. Methods Using Danish registries, we identified adults...... diagnosis, 39% had ≥ 1 cardiovascular risk factor; 92% of survivors were treated with anthracycline-containing regimens. In multivariable analysis, intrinsic heart disease diagnosed before lymphoma was associated with increased risk of HF (HR, 2.71; 95% CI, 1.15 to 6.36), whereas preexisting vascular...

Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4)

DEFF Research Database (Denmark)

Räber, Lorenz; Taniwaki, Masanori; Zaugg, Serge

2015-01-01

AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phen......AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition......-infarct-related epicardial coronary arteries (non-IRA) after successful primary PCI. Patients were treated with high-intensity rosuvastatin (40 mg/day) throughout 13 months and serial intracoronary imaging with the analysis of matched segments was available for 82 patients with 146 non-IRA. The primary IVUS end...

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

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Khalil Alimohammadzadeh

2017-07-01

Full Text Available   Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI.Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase needs to be discussed.Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02. Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05. Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01.Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy

Palliative Care in Heart Failure

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Hatice Mert

2012-04-01

Full Text Available Heart failure is an important health problem since its incidence and prevalence is increasing year by year. Since symptom burden and mortality are high in heart failure, supportive and palliative care should be provided. However, very few patients are referred to palliative care services. In comparison with cancer patients, it is difficult to identify end of life care for patients with heart failure, because these patients are hospitalized when the signs of acute decompensation appear, and their symptoms decrease and functional status improve before they are discharged. Therefore, palliative care, which is a holistic approach aiming to improve patients’ quality of life, to detect and treat the attacks of the disease before they become severe, and to deal with patients’ physical, psychological, social, and mental health altogether during their care, should be integrated into heart failure patients’ care. [TAF Prev Med Bull 2012; 11(2.000: 217-222

Countermeasures for unintentional and intentional video watermarking attacks

Science.gov (United States)

Deguillaume, Frederic; Csurka, Gabriela; Pun, Thierry

2000-05-01

These last years, the rapidly growing digital multimedia market has revealed an urgent need for effective copyright protection mechanisms. Therefore, digital audio, image and video watermarking has recently become a very active area of research, as a solution to this problem. Many important issues have been pointed out, one of them being the robustness to non-intentional and intentional attacks. This paper studies some attacks and proposes countermeasures applied to videos. General attacks are lossy copying/transcoding such as MPEG compression and digital/analog (D/A) conversion, changes of frame-rate, changes of display format, and geometrical distortions. More specific attacks are sequence edition, and statistical attacks such as averaging or collusion. Averaging attack consists of averaging locally consecutive frames to cancel the watermark. This attack works well for schemes which embed random independent marks into frames. In the collusion attack the watermark is estimated from single frames (based on image denoising), and averaged over different scenes for better accuracy. The estimated watermark is then subtracted from each frame. Collusion requires that the same mark is embedded into all frames. The proposed countermeasures first ensures robustness to general attacks by spread spectrum encoding in the frequency domain and by the use of an additional template. Secondly, a Bayesian criterion, evaluating the probability of a correctly decoded watermark, is used for rejection of outliers, and to implement an algorithm against statistical attacks. The idea is to embed randomly chosen marks among a finite set of marks, into subsequences of videos which are long enough to resist averaging attacks, but short enough to avoid collusion attacks. The Bayesian criterion is needed to select the correct mark at the decoding step. Finally, the paper presents experimental results showing the robustness of the proposed method.

Antioxidant status in acute asthmatic attack in children

International Nuclear Information System (INIS)

Al-Abdulla, N.O.; Al-Naama, L.M.; Hassan, M.K.

2010-01-01

Objectives: To determine the oxidant - antioxidant imbalance in asthmatic children, by measuring the levels of malondialdehyde (MDA) as an oxidant marker of lipid peroxidation as well as antioxidant compounds like vitamin C, vitamin E and uric acid and to investigate whether their concentrations are associated with more severe asthma. Methods: This case controlled prospective study was conducted on 219 children aged 1-12 years, attending Basra Maternity and Children Hospital. Included were 98 asthmatic children during acute attack and 121 non asthmatic, apparently healthy children. Serum malondialdehyde (MDA) as an oxidant marker of lipid peroxidation, and vitamin C, vitamin E and uric acid (as antioxidants) were estimated in asthmatic children during acute attack and compared with non-asthmatic children. Results: Asthmatic children during exacerbation of their asthma have significant lower serum levels of antioxidant compounds like vitamin C, vitamin E and uric acid (p<0.001) and significantly high malondialdehyde as compared with the controls. MDA was significantly elevated (P< 0.001), while that of vitamin C, vitamin E and uric acid were significantly decreased with increasing severity of asthmatic attack (P<0.001). A significant negative correlation between MDA with vitamin C (P<0.05, r = - 0.44) was observed in severe asthmatic attacks. Conclusion: Asthmatic patients during acute attack suffer a high degree of reactive oxygen species formation causing considerable oxidative stress that is indicated by the high level of oxidants (MDA) and low level of antioxidants. (author)

Is diet an essential risk factor for coronary heart disease?

OpenAIRE

Ball, K. P.

1980-01-01

Cigarette smoking, hypertension and diet each play a major role in the development of coronary heart attacks in most industrialized nations. In some countries where cigarette smoking and hypertension are prevalent there is a low risk of coronary heart disease (CHD). Hyperlipidaemia resulting from national food habits appears to be the essential factor in the high rates of CHD in developed countries.

Blood pressure, risk of ischemic cerebrovascular and ischemic heart disease, and longevity in alpha(1)-antitrypsin deficiency

DEFF Research Database (Denmark)

Dahl, Morten; Tybjaerg-Hansen, Anne; Sillesen, Henrik

2003-01-01

Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity.......Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity....

Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI) for Acute ST-Segment Elevation Myocardial Infarction (STEMI).

Science.gov (United States)

Cao, Bangming; Wang, Haipeng; Zhang, Chi; Xia, Ming; Yang, Xiangjun

2018-02-19

BACKGROUND The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. RESULTS Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (PPCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO.

Non-selective beta-blockers decrease thrombotic events in patients with heart failure

NARCIS (Netherlands)

De Peuter, Olav R.; Souverein, Patrick C.; Klungel, Olaf H.; Lip, Gregory Y.; Buller, Harry R.; De Boer, Anthonius; Kamphuisen, Pieter W.

2010-01-01

Background: Beta-blockers are often prescribed to patients with heart failure (HF) without distinctions between types of beta-blockers. The 2002 COMET study showed superiority of carvedilol (a non-selective beta-blocker) over metoprolol (selective beta-blocker) on mortality and cardiovascular events

Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial.

Science.gov (United States)

Elias, Joëlle; van Dongen, Ivo M; Hoebers, Loes P; Ouweneel, Dagmar M; Claessen, Bimmer E P M; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; van der Schaaf, René J; Ioanes, Dan; Nijveldt, Robin; Tijssen, Jan G; Hirsch, Alexander; Henriques, José P S

2017-07-19

The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.

Non-Contact Monitoring of Heart and Lung Activity by Magnetic Induction Measurement

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M. Steffen

2008-01-01

Full Text Available In many clinical applications, the monitoring of heart and lung activity is of vital importance. State-of-the-art monitoring involves the use of electrodes or other contact based sensors (electrocardiogram (ECG, impedance cardiography (ICG, pulse oximetry or equivalent. With the equipment that is used, side effects like skin irritation, difficult application or additional cabling may occur. In contrast, this paper describes a method for non-contact monitoring of heart and lung activity, which is solely based on magnetic induction. This method allows simultaneous monitoring of heart and lung activity, and has the potential of an integrated application in a personal healthcare scenario. To illustrate the performance, a simple test-setup has been developed and the first results are presented here (some of which have been previously presented on the Poster 2008 [10]. 

Mental Health and Stressful Life Events in Coronary Heart Disease Patients and Non- Patients

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Samaneh Nateghian

2008-07-01

Full Text Available "nObjective: "n The main goal of this study is to compare stressful life events and mental health in coronary heart disease (CHD patients and non-patients. "nMethod: In this research, 120 participants (n=68 male, n= 52 female were divided into two groups of patients (n=60 and non-patients (n=60. They were selected from Vali Asr Hospital of Meshginshahr (Iran and completed the  General Health Questionnaire (GHQ and Stressful Life Events Inventory . "nResults: Data was analyzed using independent t-test. The results showed significant differences between CHD patients and non-patients in mental health and stressful life events. CHD patients showed high rates of physical symptoms and anxiety of GHQ . "nConclusion: CHD patients reported more stressful life events. Therefore, it can be inferred that psychological factors are important in coronary heart disease.

Chess therapy: A new approach to curing panic attack.

Science.gov (United States)

Barzegar, Kazem; Barzegar, Somayeh

2017-12-01

To study the effect of playing cell phone chess game on treating panic attack. The chess game on an android cell phone was played by the researcher who was affected by panic attack as a post-traumatic disorder immediately after or before feeling of the start of symptoms. The right level of difficulty, i.e., levels 2-4, was selected for optimal results. Playing chess game on the android cell phone prevented the manifestation of panic attack and led to the cure of this traumatic condition. Chess therapy with the right level of difficulty can be recommended as a very effective non-pharmaceutical method for the successful treatment of panic attacks. Copyright © 2017 Elsevier B.V. All rights reserved.

75 FR 70273 - National Heart, Lung, and Blood Institute; Notice of Closed Meetings

Science.gov (United States)

2010-11-17

... Institute Special Emphasis Panel, The Antihypertensive and Lipid-Lowering to Prevent Heart Attack Trial... Research Demonstration and Dissemination Projects. Date: December 14, 2010. Time: 8 a.m. to 2 p.m. Agenda... Assistance Program Nos. 93.233, National Center for Sleep Disorders Research; 93.837, Heart and Vascular...

Restoration of heart functions using human embryonic stem cells derived heart muscle cells.

Science.gov (United States)

Gepstein, Lior; Kehat, Izhak

2005-02-01

Extract: Recent advances in molecular and cellular biology and specifically in the areas of stem cell biology and tissue engineering have paved the way for the development of a new field in biomedicine, regenerative medicine. This exciting approach seeks to develop new biological solutions, using the mobilization of endogenous stem cells or delivery of exogenous cells to replace or modify the function of diseased, absent, or malfunctioning tissue. The adult heart represents an attractive candidate for these emerging technologies, since adult cardiomyocytes have limited regenerative capacity. Thus, any significant heart cell loss or dysfunction, such as occurs during heart attack, is mostly irreversible and may lead to the development of progressive heart failure, one of the leading causes of world-wide morbidity and mortality. Similarly, dysfunction of the specialized electrical conduction system within the heart may result in inefficient rhythm initiation or impulse conduction, leading to significant slowing of the heart rate, usually requiring the implantation of a permanent electronic pacemaker. Replacement of the dysfunctional myocardium (heart muscle) by implantation of external heart muscle cells is emerging as a novel paradigm for restoration of the myocardial electromechanical properties, but has been significantly hampered by the paucity of cell sources for human heart cells and by the relatively limited evidence for functional integration between grafted and host cells. The recently described human embryonic stem cell (hESC) lines may provide a possible solution for the aforementioned cell sourcing problem.

201thallium myocardial scintigraphy. A non-invasive method for diagnosis of ischaemic heart disease

International Nuclear Information System (INIS)

Kyst Madsen, J.; Utne, H.E.

1982-01-01

Myocardial perfusion scintigraphy with the isotope 201 thallium is a new non-invasive technique for the diagnosis of ischaemic heart disease. This article presents the results of scintigraphy in four persons with presumably healthy hearts and 12 with ischaemic heart disease. In addition, some foreign works are reviewed. The method possesses only slightly greater nosographical sensitivity than the exercise ECG alone but can be employed to advantage if the results of the exercise ECG are inconclusive e.g. on account of bundle branch block, digoxin therapy etc. Another, although somewhat more special indication, is employment prior to and after coronary artery by-pass operation with subsequent control of the result. (authors)

Dissociative experiences and quality of life in patients with non-epileptic attack disorder.

Science.gov (United States)

Mitchell, James W; Ali, Fizzah; Cavanna, Andrea E

2012-11-01

Dissociative experiences are commonly reported by patients with non-epileptic attack disorder (NEAD). This cross-sectional study examined the prevalence and characteristics of dissociative experiences in patients with NEAD and assessed their association with health-related quality of life (HRQoL). Fifty-three patients diagnosed with NEAD were consecutively recruited (70.0% female, mean age=42 years, 22.0% with comorbid epilepsy) from a specialist neuropsychiatric clinic. Our sample reported high levels of dissociative experiences, with 36.7% of patients scoring ≥30 on the Dissociative Experiences Scale (DES). Significant negative correlations were found between total DES scores and HRQoL, as measured by the QOLIE-31 questionnaire (r=-0.64, pdissociative experiences in this patient population, highlighting the importance of routinely screening patients for dissociative symptoms and their impact on patients' lives. Copyright © 2012 Elsevier Inc. All rights reserved.

Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

Directory of Open Access Journals (Sweden)

Mohindra R

2002-01-01

Full Text Available The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluation to understand the abnormal anatomy and physiology, and related anaesthetic implications. No anaesthetic agent is an absolute contraindication, although drugs beneficial for one lesion may be detrimental for another. Regional anaesthesia has also been safely used in children with congenital heart disease. However the anaesthesiologist must have a detailed understanding of the pathophysiology of the lesion and the pharmacology of drugs being used to be able to provide safe anaesthesia for children with congenital heart disease.

Mending broken hearts : Cardiac regeneration in zebrafish

NARCIS (Netherlands)

kruse, fabian

2017-01-01

Cardiovascular disease is the leading global cause of death, accounting for more than 30% of all deaths. It claims more lives than all forms of cancer combined. Bearing these facts in mind, research in this field is direly needed. A heart attack, also known as myocardial infarction (MI), happens

Calculating Adversarial Risk from Attack Trees: Control Strength and Probabilistic Attackers

NARCIS (Netherlands)

Pieters, Wolter; Davarynejad, Mohsen

2015-01-01

Attack trees are a well-known formalism for quantitative analysis of cyber attacks consisting of multiple steps and alternative paths. It is possible to derive properties of the overall attacks from properties of individual steps, such as cost for the attacker and probability of success. However, in

Does body fat percentage predict post-exercise heart rate response in non-obese children and adolescents?

Science.gov (United States)

Jezdimirovic, Tatjana; Stajer, Valdemar; Semeredi, Sasa; Calleja-Gonzalez, Julio; Ostojic, Sergej M

2017-05-24

A correlation between adiposity and post-exercise autonomic regulation has been established in overweight and obese children. However, little information exists about this link in non-obese youth. The main purpose of this cross-sectional study was to describe the relationship between body fat percentage (BFP) and heart rate recovery after exercise [post-exercise heart rate (PEHR)], a marker of autonomic regulation, in normal-weight children and adolescents. We evaluated the body composition of 183 children and adolescents (age 15.0±2.3 years; 132 boys and 51 girls) who performed a maximal graded exercise test on a treadmill, with the heart rate monitored during and immediately after exercise. A strong positive trend was observed in the association between BFP and PEHR (r=0.14; p=0.06). Hierarchical multiple regression revealed that our model explained 18.3% of the variance in PEHR (p=0.00), yet BFP accounted for only 0.9% of the variability in PEHR (p=0.16). The evaluation of the contribution of each independent variable revealed that only two variables made a unique statistically significant contribution to our model (pfatness seems to poorly predict PEHR in our sample of non-obese children and adolescents, while non-modifiable variables (age and gender) were demonstrated as strong predictors of heart rate recovery. The low amount of body fat reported in non-obese young participants was perhaps too small to cause disturbances in autonomic nervous system regulation.

Results of a non-specific immunomodulation therapy on chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial

DEFF Research Database (Denmark)

Torre-Amione, G.; Anker, S.D.; Bourge, R.C.

2008-01-01

Background Evidence suggests that inflammatory mediators contribute to development and progression of chronic heart failure. We therefore tested the hypothesis that immunomodulation might counteract this pathophysiological mechanism in patients. Methods We did a double-blind, placebo-controlled s......Background Evidence suggests that inflammatory mediators contribute to development and progression of chronic heart failure. We therefore tested the hypothesis that immunomodulation might counteract this pathophysiological mechanism in patients. Methods We did a double-blind, placebo......-controlled study of a device-based non-specific immunomodulation therapy (IMT) in patients with New York Heart Association (NYHA) functional class II-IV chronic heart failure, left ventricular (LV) systolic dysfunction, and hospitalisation for heart failure or intravenous drug therapy in an outpatient setting......-0 . 95; p=0.02) and a 39% (0.61; 95% CI 0 . 46-0.80; p=0 . 0003) reduction in the risk of primary endpoint events, respectively. Interpretation Non-specific immunomodulation may have a role as a potential treatment for a large segment of the heart failure population, which includes patients without...

Clinical profile and 30-day outcome of women with acute coronary syndrome as a first manifestation of ischemic heart disease: A single-center observational study

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Veena Nanjappa

2016-03-01

Results and conclusion: The mean age was 64.4 ± 11 years. The mean BMI was 23.64 ± 3.23 kg/m2. Diabetes was present in 58.3% in NSTEMI, 65.1% in STEMI, and 57.1% in UA group. Hypertension was found in 75% of NSTEMI, 60.2% of STEMI, and 71.4% of UA group. Severe MR was found in 11.1% of NSTEMI and 3.6% of STEMI patients. 8.3% of NSTEMI and 15.7% of STEMI patients presented in Killips class IV. Single vessel disease was most commonly found across the spectrum of ACS. 68.7% patients in STEMI group underwent primary angioplasty. 5.6% of NSTEMI and 7.2% in STEMI group had contrast-induced nephropathy (CIN. All deaths were noted in STEMI group with eight in-hospital deaths and three during 30-day follow-up period. Killips class III and IV and higher grace score (>150 were predictors of in-hospital mortality. Chronic kidney disease, ischemic mitral regurgitation, LV clot, and in-hospital cardiac arrest were associated with higher risk.

A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

DEFF Research Database (Denmark)

Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A

2014-01-01

BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P heart failure, this simple...

Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

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Muntner, Paul; Davis, Barry R; Cushman, William C; Bangalore, Sripal; Calhoun, David A; Pressel, Sara L; Black, Henry R; Kostis, John B; Probstfield, Jeffrey L; Whelton, Paul K; Rahman, Mahboob

2014-11-01

Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH. © 2014 American Heart Association, Inc.

Study of Serum Uric Acid Levels in Myocardial Infarction and Its Association With Killip Class.

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Mehrpooya, Maryam; Larti, Farnoosh; Nozari, Younes; Sattarzadeh-Badkoobeh, Roya; Zand Parsa, Amir Farhang; Zebardast, Jayran; Tavoosi, Anahita; Shahbazi, Fatemeh

2017-02-01

The present study aimed to compare the serum level of uric acid in patients with and without heart failure and also to determine the association between uric acid level and clinical status by Killip class in patients with STEMI. This case-control study was conducted on 50 consecutives as control group and 50 patients with acute heart failure, (20 patients had acute STEMI), who documented by both clinical conditions and echocardiography assessment. The mean plasma level of uric acid in the case group was 7.6±1.6 milligrams/deciliter (mg/dL) and in the control group was 4.5±1.5 respectively (Puric acid and Killip classes (Puric acid level between HFrEF (HF with reduced EF) and severe LV systolic dysfunction (0.049). In STEMI patients with culprit LAD, mean uric acid was significantly higher than cases with culprit LCX [(9.7±0.98 versus 8.6±0.52 respectively) P=0.012]. Regarding  treatment plan in patients with STEMI, mean level of uric acid in those considered for CABG was significantly higher than who were considered for PCI, 9.9±0.82 versus 8.9±0.76 respectively, P=0.029. In STEMI patients with higher killip class, higher level of uric acid was seen. Also, the severity of LV systolic dysfunction was associated with higher level of uric acid.

Personality characteristics of victims of illegal attacks on the Internet

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Safuanov F.S.

2016-01-01

Full Text Available The article examines the personality characteristics of victims of illegal attacks on the Internet. We used methods as follow: 16 factors Cattell personality questionnaire, subjective control level, life-style index, Buss-Perry questionnaire, Spielberger State-Trait Anxiety Inventory, a COPE inventory. 78 internet users were divided into two groups of 38 persons: the main group included people falling victim to illegal attacks on the Internet, the control group participants were not attacked on the internet. We identified specific aggregated symptoms of individual psychological characteristics of internet attack victims and show that victims of "non-forced" and "forced" offenses have different levels of situational and personal anxiety, aggression and locus of control.

The impact of tort reform on intensity of treatment: evidence from heart patients.

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Avraham, Ronen; Schanzenbach, Max

2015-01-01

This paper analyzes the effect of non-economic damage caps on the treatment intensity of heart attack victims. We focus on whether a patient receives a major intervention in the form of either a coronary artery by-pass or angioplasty. We find strong evidence that treatment intensity declines after a cap on non-economic damages. The probability of receiving a major intervention in the form of either an angioplasty or bypass declines by 1.25-2 percentage points after non-economic damage caps are enacted, and this effect is larger a year or two after reform. However, we also find clear evidence of substitution between major interventions. When doctors have discretion to perform a by-pass and patients have insurance coverage, caps on non-economic damages increase the probability that a by-pass is performed. The effect of non-economic damage caps on costs is not always statistically significant, but in models with state-specific trends, total costs decline by as much as four percent. We conclude that tort reform reduces treatment intensity overall, even though it changes the mix of treatments. Using the Center for Disease Control's Vital Statistics data, we find that tort reform is not associated with an increase in mortality from coronary heart disease; if anything, mortality declines. Copyright © 2014 Elsevier B.V. All rights reserved.

Liver fat content, non-alcoholic fatty liver disease, and ischaemic heart disease

DEFF Research Database (Denmark)

Lauridsen, Bo Kobberø; Stender, Stefan; Kristensen, Thomas Skårup

2018-01-01

Aims: In observational studies, non-alcoholic fatty liver disease (NAFLD) is associated with high risk of ischaemic heart disease (IHD). We tested the hypothesis that a high liver fat content or a diagnosis of NAFLD is a causal risk factor for IHD. Methods and results: In a cohort study...

Prospective Heart Tracking for Whole-heart Magnetic Resonance Angiography

Science.gov (United States)

Moghari, Mehdi H.; Geva, Tal; Powell, Andrew J.

2015-01-01

Purpose To develop a prospective respiratory-gating technique (Heart-NAV) for use with contrast-enhanced 3D inversion recovery (IR) whole-heart magnetic resonance angiography (MRA) acquisitions that directly tracks heart motion without creating image inflow artifact. Methods With Heart-NAV, 1 of the startup pulses for the whole-heart steady-state free precession MRA sequence is used to collect the centerline of k-space, and its 1-dimensional reconstruction is fed into the standard diaphragm-navigator (NAV) signal analysis process to prospectively gate and track respiratory-induced heart displacement. Ten healthy volunteers underwent non-contrast whole-heart MRA acquisitions using the conventional diaphragm-NAV and Heart-NAV with 5 and 10 mm acceptance windows in a 1.5T scanner. Five patients underwent contrast-enhanced IR whole-heart MRA using a diaphragm-NAV and Heart-NAV with a 5 mm acceptance window. Results For non-contrast whole-heart MRA with both the 5 and 10 mm acceptance windows, Heart-NAV yielded coronary artery vessel sharpness and subjective visual scores that were not significantly different than those using a conventional diaphragm-NAV. Scan time for Heart-NAV was 10% shorter (p<0.05). In patients undergoing contrast-enhanced IR whole-heart MRA, inflow artifact was seen with the diaphragm-NAV but not with Heart-NAV. Conclusion Compared to a conventional diaphragm-NAV, Heart-NAV achieves similar image quality in a slightly shorter scan time and eliminates inflow artifact. PMID:26843458

Impact of pre-infarction angina on angiographic and echocardiographic outcomes in patients with acute ante

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Ahmed El Missiri

2016-09-01

Conclusions: For patients suffering from a first attack of acute anterior wall STEMI, pre-infarction angina is associated with a better Killip class at presentation, better TIMI flow grade after PPCI, less incidence of TMP 0 flow grade.

Bluetooth security attacks comparative analysis, attacks, and countermeasures

CERN Document Server

Haataja, Keijo; Pasanen, Sanna; Toivanen, Pekka

2013-01-01

This overview of Bluetooth security examines network vulnerabilities and offers a comparative analysis of recent security attacks. It also examines related countermeasures and proposes a novel attack that works against all existing Bluetooth versions.

Design a Wearable Device for Blood Oxygen Concentration and Temporal Heart Beat Rate

Science.gov (United States)

Myint, Cho Zin; Barsoum, Nader; Ing, Wong Kiing

2010-06-01

The wireless network technology is increasingly important in healthcare as a result of the aging population and the tendency to acquire chronic disease such as heart attack, high blood pressure amongst the elderly. A wireless sensor network system that has the capability to monitor physiological sign such as SpO2 (Saturation of Arterial Oxygen) and heart beat rate in real-time from the human's body is highlighted in this study. This research is to design a prototype sensor network hardware, which consists of microcontroller PIC18F series and transceiver unit. The sensor is corporate into a wearable body sensor network which is small in size and easy to use. The sensor allows a non invasive, real time method to provide information regarding the health of the body. This enables a more efficient and economical means for managing the health care of the population.

CPR in the Schools: Training Students to Save Heart Attack Victims.

Science.gov (United States)

Britton, Royce J.

1978-01-01

A community cardiac emergency medical plan should include training of family and co-workers of high risk patients, including teenage students. The American Heart Association lists ways to introduce cardiopulmonary resuscitation (CPR) into school curricula and describes the plan implemented in Pennsylvania. (MF)

Perceptions of personal health risks by medical and non-medical workers in a university medical center: a survey study

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Nap Raoul E

2010-11-01

Full Text Available Abstract Background Health care workers (HCWs are faced with many work-related choices which may depend on how they perceive risk, such as whether or not to comply with safety regulations. Little research has investigated risk perception in medical workers in comparison with non-medical workers and the extent to which risk perception differs in these groups. The current study thus investigates risk perception of medical and non-medical workers to inform and complement future research on safety compliance. The study has implications for the design of intervention programmes to increase the level of compliance of HCWs. Methods A survey study was conducted in which questionnaires were distributed to 6380 HCWs. The questionnaire asked for ratings of risk perception for cold, annual influenza, pandemic influenza, cancer, heart attack and food poisoning. Of 2495 returned questionnaires (response rate: 39%, 61.40% were from medical workers (24.1% of these were from physicians, 39.7% from nurses and 36.2% from paramedics and 38.60% were from non-medical workers. Results Medical workers gave lower risk perception ratings than did non-medical workers for cancer, but not for other health risks. Within the medical workers, physicians rated the risk of getting a cold as higher, but of having a heart attack as lower than did nurses and paramedics; physicians also rated their risk of getting cancer as lower than did nurses. Perceived risk was higher as a function of age for pandemic influenza, cancer and heart attack, but lower for cold and annual influenza. HCWs who lived with a partner and children rated the risk of getting a cold or annual influenza higher than those who lived alone or with a partner only. Full-time HCWs gave lower ratings for annual influenza than did part-time HCWs. Conclusions Different base levels of risk perception between medical and non-medical workers need to be taken into account for successful implementation of safety regulations

Chronic oral pathology and ischemic heart disease and its complications

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Ivaschenko Y.Y.

2013-09-01

Full Text Available Objective: to establish the relationship of chronic generalized periodontitis, multiple cavities and dentofacial anomalies with various forms of coronary heart disease and its complications. Material and methods. The study included 294 patients with coronary heart disease and its complications. The patients were divided into two groups. Group I included 89 patients with acute Q-myocardial infarction, which was placed in the presence of at least 2 of the following criteria identified on the basis of a comprehensive clinical and instrumental examination: clinical, laboratory confirmation (CK-MB, electrocardiographic signs of damage or myocardial necrosis. The following statistical methods were used: multi-variate and univariate analysis of variance, non-parametric tests, crosstabulation, chi-square test, Fisher»s exact test. As a measure of variability of the normal distribution standard deviation was used. Results. It is noted that in patients with myocardial infarction more likely than in patients without coronary heart attack in history severe generalized periodontitis, dentofacial anomalies and multiple dental caries have appeared. In patients with acute myocardial infarction, severe periodontal disease has been associated with increased fibrinogen levels in the blood and an increase in the dispersion of the interval QT, which are known to be indicators of poor prognosis in acute coronary disease.

Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area.

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Grieco, Niccolò; Sesana, Giovanni; Corrada, Elena; Ieva, Francesca; Paganoni, Annamaria; Marzegalli, Maurizio

2012-09-01

Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.

[Rare cause of heart failure in an elderly woman in Djibouti: left ventricular non compaction].

Science.gov (United States)

Massoure, P L; Lamblin, G; Bertani, A; Eve, O; Kaiser, E

2011-10-01

The purpose of this report is to describe the first case of left ventricular non compaction diagnosed in Djibouti. The patient was a 74-year-old Djiboutian woman with symptomatic heart failure. Echocardiography is the key tool for assessment of left ventricular non compaction. This rare cardiomyopathy is probably underdiagnosed in Africa.

Distinguishing attack and second-preimage attack on encrypted message authentication codes (EMAC)

Science.gov (United States)

Ariwibowo, Sigit; Windarta, Susila

2016-02-01

In this paper we show that distinguisher on CBC-MAC can be applied to Encrypted Message Authentication Code (EMAC) scheme. EMAC scheme in general is vulnerable to distinguishing attack and second preimage attack. Distinguishing attack simulation on AES-EMAC using 225 message modifications, no collision have been found. According to second preimage attack simulation on AES-EMAC no collision found between EMAC value of S1 and S2, i.e. no second preimage found for messages that have been tested. Based on distinguishing attack simulation on truncated AES-EMAC we found collision in every message therefore we cannot distinguish truncated AES-EMAC with random function. Second-preimage attack is successfully performed on truncated AES-EMAC.

Design and baseline characteristics of a coronary heart disease prospective cohort: two-year experience from the strategy of registry of acute coronary syndrome study (ERICO study

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Alessandra C. Goulart

2013-01-01

Full Text Available OBJECTIVES: To describe the ERICO study (Strategy of Registry of Acute Coronary Syndrome, a prospective cohort to investigate the epidemiology of acute coronary syndrome. METHODS: The ERICO study, which is being performed at a secondary general hospital in São Paulo, Brazil, is enrolling consecutive acute coronary syndrome patients who are 35 years old or older. The sociodemographic information, medical assessments, treatment data and blood samples are collected at admission. After 30 days, the medical history is updated, and additional blood and urinary samples are collected. In addition, a retinography, carotid intima-media thickness, heart rate variability and pulse-wave velocity are performed. Questionnaires about food frequency, physical activity, sleep apnea and depression are also applied. At six months and annually after an acute event, information is collected by telephone. RESULTS: From February 2009 to September 2011, 738 patients with a diagnosis of an acute coronary syndrome were enrolled. Of these, 208 (28.2% had ST-elevation myocardial infarction (STEMI, 288 (39.0% had non-ST-elevation myocardial infarction (NSTEMI and 242 (32.8% had unstable angina (UA. The mean age was 62.7 years, 58.5% were men and 77.4% had 8 years or less of education. The most common cardiovascular risk factors were hypertension (76% and sedentarism (73.4%. Only 29.2% had a prior history of coronary heart disease. Compared with the ST-elevation myocardial infarction subgroup, the unstable angina and non-ST-elevation myocardial infarction patients had higher frequencies of hypertension, diabetes, prior coronary heart disease (p<0.001 and dyslipidemia (p = 0.03. Smoking was more frequent in the ST-elevation myocardial infarction patients (p = 0.006. CONCLUSIONS: Compared with other hospital registries, our findings revealed a higher burden of CV risk factors and less frequent prior CHD history.

Up-regulation of alpha-smooth muscle actin in cardiomyocytes from non-hypertrophic and non-failing transgenic mouse hearts expressing N-terminal truncated cardiac troponin I

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Stephanie Kern

2014-01-01

Full Text Available We previously reported that a restrictive N-terminal truncation of cardiac troponin I (cTnI-ND is up-regulated in the heart in adaptation to hemodynamic stresses. Over-expression of cTnI-ND in the hearts of transgenic mice revealed functional benefits such as increased relaxation and myocardial compliance. In the present study, we investigated the subsequent effect on myocardial remodeling. The alpha-smooth muscle actin (α-SMA isoform is normally expressed in differentiating cardiomyocytes and is a marker for myocardial hypertrophy in adult hearts. Our results show that in cTnI-ND transgenic mice of between 2 and 3 months of age (young adults, a significant level of α-SMA is expressed in the heart as compared with wild-type animals. Although blood vessel density was increased in the cTnI-ND heart, the mass of smooth muscle tissue did not correlate with the increased level of α-SMA. Instead, immunocytochemical staining and Western blotting of protein extracts from isolated cardiomyocytes identified cardiomyocytes as the source of increased α-SMA in cTnI-ND hearts. We further found that while a portion of the up-regulated α-SMA protein was incorporated into the sarcomeric thin filaments, the majority of SMA protein was found outside of myofibrils. This distribution pattern suggests dual functions for the up-regulated α-SMA as both a contractile component to affect contractility and as possible effector of early remodeling in non-hypertrophic, non-failing cTnI-ND hearts.

Characteristics of asthma attack with long-term management for bronchial asthma.

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Kawahara, Noriko; Hasegawa, Shunji; Hashimoto, Kunio; Matsubara, Tomoyo; Ichiyama, Takashi; Furukawa, Susumu

2009-10-01

There have been no reports on the evaluation of the usefulness of long-term asthma management based on the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2005 (JPGL 2005). The purpose of the present study was to retrospectively investigate the records of 350 patients admitted to Yamaguchi University Hospital who had asthma attacks from January 2006 to June 2008. There were 149 patients who were treated for more than 3 months in accordance with the guideline (long-term management group) and 201 who were not (non-long-term management group). The patients were divided into three age groups: 100 infants, 159 toddlers, and 91 schoolchildren. The onset age of asthma in the long-term management group was earlier than that in the non-long-term management group in toddlers and schoolchildren. The white blood cell counts and C-reactive protein levels were higher in the non-long-term management group in schoolchildren, suggesting the complication of some infections. The severity of asthma in the long-term management group was greater than that in the non-long-term management group among all three age groups. There were no significant differences, however, in the severity of asthma attack at admission between the long-term and non-long-term management groups in the three age groups. Patients who had severe asthma tended to be treated with long-term management, which suggests that long-term asthma management according to JPGL 2005 may reduce the severity of asthma attack at that admission, because the severity of asthma in patients undergoing long-term management correlates with the severity of asthma attack.

Cooperating attackers in neural cryptography.

Science.gov (United States)

Shacham, Lanir N; Klein, Einat; Mislovaty, Rachel; Kanter, Ido; Kinzel, Wolfgang

2004-06-01

A successful attack strategy in neural cryptography is presented. The neural cryptosystem, based on synchronization of neural networks by mutual learning, has been recently shown to be secure under different attack strategies. The success of the advanced attacker presented here, called the "majority-flipping attacker," does not decay with the parameters of the model. This attacker's outstanding success is due to its using a group of attackers which cooperate throughout the synchronization process, unlike any other attack strategy known. An analytical description of this attack is also presented, and fits the results of simulations.

Crony Attack: Strategic Attack’s Silver Bullet

Science.gov (United States)

2006-11-01

physical assets or financial assets. The form of crony attack that most closely resembles classic strategic attack is to deny, degrade, or destroy a money...February 1951. Reprinted in Airpower Studies Coursebook , Air Command and Staff College, Maxwell AFB, AL, 2002, 152–58. Hirsch, Michael. “NATO’s Game of

Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke

DEFF Research Database (Denmark)

Ricci, Cristian; Wood, Angela; Muller, David

2018-01-01

OBJECTIVE: To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. DESIGN: Multicentre case-cohort study. SETTING: A study of cardiovascular disease (CVD) determinants within the European Prospecti...

Asthma-like attacks terminated by slow pathway ablation

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Selcuk Ozturk

2017-01-01

Full Text Available Asthma is a chronic airway disease in which the pathological mechanisms are reversible airway obstruction, bronchial hyper reactivity, and constriction of the lower airways. Supraventricular tachycardia (SVT is a common arrhythmia which originates above the bundle of His and causing heart rates exceeding 150 beats/min. SVT patients present with palpitation, chest pain, chest discomfort, dyspnea, hyperventilation, and lightheadedness, occasionally. Besides, extraordinary presentations of SVT are available in literature. In this report, we describe a case of a patient presenting with treatment-resistant asthma-like attacks lasting for 20 years whom was suspected SVT as an underlying etiology and treated by slow pathway radiofrequency ablation.

Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary.

Science.gov (United States)

Heidbuchel, Hein; Verhamme, Peter; Alings, Marco; Antz, Matthias; Diener, Hans-Christoph; Hacke, Werner; Oldgren, Jonas; Sinnaeve, Peter; Camm, A John; Kirchhof, Paulus

2017-07-14

In 2013, the European Heart Rhythm Association (EHRA) published a Practical Guide on the use of non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) (Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, European Heart Rhythm A. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094-2106). The document received widespread interest, not only from cardiologists but also from neurologists, geriatricians, and general practitioners, as became evident from the distribution of >350 000 copies of its pocket version (the EHRA Key Message Booklet) world-wide. Since 2013, numerous new studies have appeared on different aspects of NOAC therapy in AF patients. Therefore, EHRA updated the Practical Guide, including new information but also providing balanced guiding in the many areas where prospective data are still lacking. The outline of the original guide that addressed 15 clinical scenarios has been preserved, but all chapters have been rewritten. Main changes in the Update comprise a discussion on the definition of 'non-valvular AF' and eligibility for NOAC therapy, inclusion of finalized information on the recently approved edoxaban, tailored dosing information dependent on concomitant drugs, and/or clinical characteristics, an expanded chapter on neurologic scenarios (ischaemic stroke or intracranial haemorrhage under NOAC), an updated anticoagulation card and more specifics on start-up and follow-up issues. There are also many new flow charts, like on appropriate switching between anticoagulants (VKA to NOAC or vice versa), default scenarios for

Level of complement activity predicts cardiac dysfunction after acute myocardial infarction treated with primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Haahr-Pedersen, Sune; Bjerre, Mette; Flyvbjerg, Allan

2009-01-01

BACKGROUND: The positive effect of reperfusion after ST-elevation myocardial infarction (STEMI) can be reduced by ischemic/reperfusion (I/R) injury.Mannose-binding-lectin (MBL) and soluble C5b-9 (membrane-attack-complex) are involved in complement-driven cell lysis and may play a role in human...... with increased risk of cardiac dysfunction in STEMI patients treated with pPCI, probably due to increased complement activity during the ischemic and reperfusion process. The predictive value of low peripheral plasma sC5b-9 may be explained by an accumulation and activation of sC5b-9 in the infarcted myocardium....

Identification and predictive value of interleukin-6+ interleukin-10+ and interleukin-6-interleukin-10+ cytokine patterns in st-elevation acute myocardial infarction

KAUST Repository

Ammirati, Enrico

2012-08-29

from other STEMI patients. These observations could have potential implications for risk-oriented patient stratification and immune-modulating therapies. © 2012 American Heart Association, Inc.

Biomarker evaluation as a potential cause of gender differences in obesity paradox among patients with STEMI.

Science.gov (United States)

Baumann, Stefan; Koepp, Johanna; Becher, Tobias; Huseynov, Aydin; Bosch, Katharina; Behnes, Michael; Fastner, Christian; El-Battrawy, Ibrahim; Renker, Matthias; Lang, Siegfried; Weiß, Christel; Borggrefe, Martin; Lehmann, Ralf; Akin, Ibrahim

2016-03-01

Obesity with its worldwide growing prevalence is an established cardiovascular risk factor with increased morbidity and mortality. However, the phenomenon, that mild to moderate obesity seems to represent a protective effect on diseases has been termed the "obesity paradox". We retrospectively assessed 529 patients (72.6% male, mean age 59.7±12.7years) admitted with ST-elevation myocardial infarction (STEMI). The female and male study populations were separated into four body mass index (BMI) groups: ≤24.9kg/m(2), 25.0-29.9kg/m(2), 30.0-34.9kg/m(2) and ≥35.0kg/m(2). Blood samples of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were analyzed. With increasing BMI group the rate of major adverse cardiac events (MACE) decreased in all patients (test for trend p=0.041). No gender difference between MACE and BMI could be noticed (p=0.16). A higher risk for MACE was indicated in group BMI ≤18.5kg/m(2) in comparison to group BMI 25.0-29.9kg/m(2) (OR: 7.93; 95% CI: 1.75-35.89; p=0.0091), whereas group BMI 30.0-34.9kg/m(2) was significant associated with a lower risk in comparison to group BMI 25.0-29.9kg/m(2) (OR: 0.65; 95% CI: 0.21-1.96; p=0.044). An association between HDL-c (p=0.55) or LDL-c (p=0.10) and MACE could not be detected. The study demonstrates that patients with STEMI and a BMI of 30.0-34.9kg/m(2) have a decreased risk for MACE compared to patients with normal BMI. No gender related differences were indicated. An association between MACE and lipoproteins could not be detected. Copyright © 2016 Elsevier Inc. All rights reserved.

Composite Dos Attack Model

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Simona Ramanauskaitė

2012-04-01

Full Text Available Preparation for potential threats is one of the most important phases ensuring system security. It allows evaluating possible losses, changes in the attack process, the effectiveness of used countermeasures, optimal system settings, etc. In cyber-attack cases, executing real experiments can be difficult for many reasons. However, mathematical or programming models can be used instead of conducting experiments in a real environment. This work proposes a composite denial of service attack model that combines bandwidth exhaustion, filtering and memory depletion models for a more real representation of similar cyber-attacks. On the basis of the introduced model, different experiments were done. They showed the main dependencies of the influence of attacker and victim’s properties on the success probability of denial of service attack. In the future, this model can be used for the denial of service attack or countermeasure optimization.

The predictive value of P-wave duration by signal-averaged electrocardiogram in acute ST elevation myocardial infarction.

Science.gov (United States)

Shturman, Alexander; Bickel, Amitai; Atar, Shaul

2012-08-01

The prognostic value of P-wave duration has been previously evaluated by signal-averaged ECG (SAECG) in patients with various arrhythmias not associated with acute myocardial infarction (AMI). To investigate the clinical correlates and prognostic value of P-wave duration in patients with ST elevation AMI (STEMI). The patients (n = 89) were evaluated on the first, second and third day after admission, as well as one week and one month post-AMI. Survival was determined 2 years after the index STEMI. In comparison with the upper normal range of P-wave duration ( 40% (128.79 +/- 28 msec) (P = 0.001). P-wave duration above 120 msec was significantly correlated with increased complication rate; namely, sustained ventricular tachyarrhythmia (36%), congestive heart failure (41%), atrial fibrillation (11%), recurrent angina (14%), and re-infarction (8%) (P = 0.012, odds ratio 4.267, 95% confidence interval 1.37-13.32). P-wave duration of 126 msec on the day of admission was found to have the highest predictive value for in-hospital complications including LVEF 40% (area under the curve 0.741, P < 0.001). However, we did not find a significant correlation between P-wave duration and mortality after multivariate analysis. P-wave duration as evaluated by SAECG correlates negatively with LVEF post-STEMI, and P-wave duration above 126 msec can be utilized as a non-invasive predictor of in-hospital complications and low LVEF following STEMI.

Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery

Directory of Open Access Journals (Sweden)

Rakhee Goyal

2013-01-01

Full Text Available The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger′s syndrome, 2-Tetralogy of Fallot. The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation.This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.

Elective Inactivation of Total Artificial Heart Technology in Non-Futile Situations: Inpatients, Outpatients and Research Participants

Science.gov (United States)

Bramstedt, Katrina A.

2004-01-01

Total artificial heart technology as a potential clinical therapy raises the issue of elective device inactivation in both futile and non-futile situations. This article explores elective device inactivation in non-futile situations. In reply to such requests for inactivation, the medical team should reflect on the individual's decision-making…

Studies on sulfate attack: Mechanisms, test methods, and modeling

Science.gov (United States)

Santhanam, Manu

The objective of this research study was to investigate various issues pertaining to the mechanism, testing methods, and modeling of sulfate attack in concrete. The study was divided into the following segments: (1) effect of gypsum formation on the expansion of mortars, (2) attack by the magnesium ion, (3) sulfate attack in the presence of chloride ions---differentiating seawater and groundwater attack, (4) use of admixtures to mitigate sulfate attack---entrained air, sodium citrate, silica fume, and metakaolin, (5) effects of temperature and concentration of the attack solution, (6) development of new test methods using concrete specimens, and (7) modeling of the sulfate attack phenomenon. Mortar specimens using portland cement (PC) and tricalcium silicate (C 3S), with or without mineral admixtures, were prepared and immersed in different sulfate solutions. In addition to this, portland cement concrete specimens were also prepared and subjected to complete and partial immersion in sulfate solutions. Physical measurements, chemical analyses and microstructural studies were performed periodically on the specimens. Gypsum formation was seen to cause expansion of the C3S mortar specimens. Statistical analyses of the data also indicated that the quantity of gypsum was the most significant factor controlling the expansion of mortar bars. The attack by magnesium ion was found to drive the reaction towards the formation of brucite. Decalcification of the C-S-H and its subsequent conversion to the non-cementitious M-S-H was identified as the mechanism of destruction in magnesium sulfate attack. Mineral admixtures were beneficial in combating sodium sulfate attack, while reducing the resistance to magnesium sulfate attack. Air entrainment did not change the measured physical properties, but reduced the visible distress of the mortars. Sodium citrate caused a substantial reduction in the rate of damage of the mortars due to its retarding effect. Temperature and

Attack Detection/Isolation via a Secure Multisensor Fusion Framework for Cyberphysical Systems

Directory of Open Access Journals (Sweden)

Arash Mohammadi

2018-01-01

Full Text Available Motivated by rapid growth of cyberphysical systems (CPSs and the necessity to provide secure state estimates against potential data injection attacks in their application domains, the paper proposes a secure and innovative attack detection and isolation fusion framework. The proposed multisensor fusion framework provides secure state estimates by using ideas from interactive multiple models (IMM combined with a novel fuzzy-based attack detection/isolation mechanism. The IMM filter is used to adjust the system’s uncertainty adaptively via model probabilities by using a hybrid state model consisting of two behaviour modes, one corresponding to the ideal scenario and one associated with the attack behaviour mode. The state chi-square test is then incorporated through the proposed fuzzy-based fusion framework to detect and isolate potential data injection attacks. In other words, the validation probability of each sensor is calculated based on the value of the chi-square test. Finally, by incorporation of the validation probability of each sensor, the weights of its associated subsystem are computed. To be concrete, an integrated navigation system is simulated with three types of attacks ranging from a constant bias attack to a non-Gaussian stochastic attack to evaluate the proposed attack detection and isolation fusion framework.

Hypergraph Representations: A Study of Carib Attacks on Colonial Forces, 1509-1700

Directory of Open Access Journals (Sweden)

Termeh Shafie

2017-10-01

Full Text Available Network data consisting of recorded historical events can be represented as hyper-graphs where the ties or events can connect any number of nodes or event related attributes. In this paper, we perform a centrality analysis of a directed hypergraph representing attacks by indigenous peoples from the Lesser Antilles on European colonial settlements, 1509–1700. The results of central attacks with respect to at- tacked colonial force, member of attack alliances, and year and location of attack are discussed and compared to a non-relational exploratory analysis of the data. This comparison points to the importance of a mixed methods approach to enhance the analysis and to obtain a complementary understanding of a network study.

Seven Deadliest Wireless Technologies Attacks

CERN Document Server

Haines, Brad

2010-01-01

How can an information security professional keep up with all of the hacks, attacks, and exploits? One way to find out what the worst of the worst are is to read the seven books in our Seven Deadliest Attacks Series. Not only do we let you in on the anatomy of these attacks but we also tell you how to get rid of them and how to defend against them in the future. Countermeasures are detailed so that you can fight against similar attacks as they evolve. Attacks featured in this book include:Bluetooth AttacksCredit Card, Access Card, and Passport AttacksBad Encryption

Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Stone, Gregg W; Mehran, Roxana; Goldstein, Patrick

2015-01-01

BACKGROUND: In the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) treated with bivalirudin had lower......, given the evolution in primary PCI. METHODS: Databases from HORIZONS-AMI and EUROMAX were pooled for patient-level analysis. The Breslow-Day test evaluated heterogeneity between trials. RESULTS: A total of 5,800 patients were randomized to bivalirudin (n = 2,889) or heparin ± GPI (n = 2,911). The radial....... Bivalirudin resulted in increased acute (events were lower with bivalirudin (8.8% vs. 11.9%; RR: 0.74; 95% CI: 0...

A taxonomy and discussion of software attack technologies

Science.gov (United States)

Banks, Sheila B.; Stytz, Martin R.

2005-03-01

Software is a complex thing. It is not an engineering artifact that springs forth from a design by simply following software coding rules; creativity and the human element are at the heart of the process. Software development is part science, part art, and part craft. Design, architecture, and coding are equally important activities and in each of these activities, errors may be introduced that lead to security vulnerabilities. Therefore, inevitably, errors enter into the code. Some of these errors are discovered during testing; however, some are not. The best way to find security errors, whether they are introduced as part of the architecture development effort or coding effort, is to automate the security testing process to the maximum extent possible and add this class of tools to the tools available, which aids in the compilation process, testing, test analysis, and software distribution. Recent technological advances, improvements in computer-generated forces (CGFs), and results in research in information assurance and software protection indicate that we can build a semi-intelligent software security testing tool. However, before we can undertake the security testing automation effort, we must understand the scope of the required testing, the security failures that need to be uncovered during testing, and the characteristics of the failures. Therefore, we undertook the research reported in the paper, which is the development of a taxonomy and a discussion of software attacks generated from the point of view of the security tester with the goal of using the taxonomy to guide the development of the knowledge base for the automated security testing tool. The representation for attacks and threat cases yielded by this research captures the strategies, tactics, and other considerations that come into play during the planning and execution of attacks upon application software. The paper is organized as follows. Section one contains an introduction to our research

Blocking of Brute Force Attack

OpenAIRE

M.Venkata Krishna Reddy

2012-01-01

A common threat Web developers face is a password-guessing attack known as a brute-force attack. A brute-force attack is an attempt to discover a password by systematically trying every possible combination of letters, numbers, and symbols until you discover the one correct combination that works. If your Web site requires user authentication, you are a good target for a brute-force attack. An attacker can always discover a password through a brute-force attack, but the downside is that it co...

Impact of persistence and non-persistence in leisure time physical activity on coronary heart disease and all-cause mortality

DEFF Research Database (Denmark)

Schnohr, Peter; O'Keefe, James H.; Lange, Peter

2017-01-01

Aims: The aim of this study was to investigate the impact of persistence and non-persistence in leisure time physical activity on coronary heart disease and all-cause mortality. Methods and results: In the Copenhagen City Heart Study, we prospectively followed 12,314 healthy subjects for 33 years...

Retrospective evaluation of coyote attacks in dogs: 154 cases (1997-2012).

Science.gov (United States)

Frauenthal, Virginia M; Bergman, Philip; Murtaugh, Robert J

2017-05-01

To describe the clinical presentation and outcome of known attacks in client-owned dogs caused by the common coyote, Canis latrans. Retrospective observational study. Private referral hospital. One hundred fifty-four client-owned dogs known to be attacked by coyotes. None. Records from a private referral hospital from May 1997 through December 2012 were reviewed. Time of day and month/season of year, signalment, body temperature, heart rate, respiratory rate, body weight, location and severity of wounds inflicted, common injuries, length of hospitalization, necessity of surgical wound repair under anesthesia, antimicrobial use and mortality were recorded. Eighty-six percent of dogs presenting following coyote attack weighed Dogs with bite wounds to the thorax had the highest mortality at 21.3%. Criteria for systemic inflammatory response syndrome (SIRS) based on admission vital signs were met in 58.8% of dogs and the presence of SIRS was significantly associated with mortality (P hernia (9/154; 5.8%), and abdominal penetrating wounds (8/146; 5.5%). Dogs dogs are a problem in Southern California and are associated with substantial morbidity and mortality, especially in dogs with wounds to the thorax. Aggressive management involving surgical wound repair was associated with survival to discharge. © Veterinary Emergency and Critical Care Society 2017.

Association between non-high-density lipoprotein cholesterol concentrations and mortality from coronary heart disease among Japanese men and women: the Ibaraki Prefectural Health Study.

Science.gov (United States)

Noda, Hiroyuki; Iso, Hiroyasu; Irie, Fujiko; Sairenchi, Toshimi; Ohtaka, Emiko; Ohta, Hitoshi

2010-02-01

The aim of this study was to examine whether non-high-density lipoprotein cholesterol (non-HDL-cholesterol) raises the risk of coronary heart disease in a dose-response fashion in a non-obese population with low total cholesterol levels and high HDL-cholesterol levels, such as Japanese. A total of 30,802 men and 60,417 women, aged 40 to 79 years with no history of stroke or coronary heart disease, completed a baseline risk factor survey in 1993 under the auspices of the Ibaraki Prefectural Health Study. Systematic mortality surveillance through 2003 identified 539 coronary heart disease deaths. The mean values for non-HDL-cholesterol were 140 mg/dL for men and 151 mg/dL for women. The corresponding mean values were 193 mg/dL and 208 mg/dL total cholesterol and 52 mg/dL and 57 mg/dL HDL-cholesterol, respectively. Men with non-HDL-cholesterol > or = 180 mg/dL had a two-fold higher age-adjusted risk of mortality from coronary heart disease than did those with non-HDL-cholesterol or = 180 mg/dL versus <100 mg/dL of non-HDL-cholesterol was 2.22 (95% confidence interval: 1.37 to 3.62) for men and 0.71 (0.37 to 1.34) for women. Higher concentrations of non-HDL-cholesterol were associated with an increased risk of mortality from coronary heart disease for men, but not for women.

Solidarity under Attack

DEFF Research Database (Denmark)

Meret, Susi; Goffredo, Sergio

2017-01-01

https://www.opendemocracy.net/can-europe-make-it/susi-meret-sergio-goffredo/solidarity-under-attack......https://www.opendemocracy.net/can-europe-make-it/susi-meret-sergio-goffredo/solidarity-under-attack...

Attack surfaces

DEFF Research Database (Denmark)

Gruschka, Nils; Jensen, Meiko

2010-01-01

The new paradigm of cloud computing poses severe security risks to its adopters. In order to cope with these risks, appropriate taxonomies and classification criteria for attacks on cloud computing are required. In this work-in-progress paper we present one such taxonomy based on the notion...... of attack surfaces of the cloud computing scenario participants....

DAILY CHANGES OF CENTRAL HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE WITH NIGHT-TIME DYSPNOEA ATTACK

Directory of Open Access Journals (Sweden)

S. A. Dovgolis

2006-01-01

Full Text Available Aim. To study daily changes of central hemodynamics (CHD in patients with chronic heart failure (CHF and the effects of therapy. Materials and methods. 22 patients with ischemic heart disease and CHF of III-IV functional class (FC by NYHA, age 60,5±10,5 were observed. Patients were suffering from night-time dyspnoea attacks and had pulmonary artery occlusion pressure (PAOP 15-20 mm Hg. CHD was monitored invasively before the treatment and after 4 weeks of CHF treatment. Results. According to the cardiac index (CI at admission patients were split into two groups. 9 patients of group-I had CI ≤2,15 l\\min\\m2, and 13 patients of group-II had CI >2,15 l\\min\\m2. In patients of group-I CI increased in 4 weeks of treatment. The treatment caused considerable clinical improvement in all patients. The CHD indexes also improved. Initially evening-night-time peaks of PAOP (р≤0,002, systolic (SBP (р≤0,003, diastolic (DBP (р=0,002 and average (BPa (р=0,0007 blood pressure (BP as well as double multiplication (DM (р≤0,008 were registered in patients of group-I. At the end of treatment only evening-night increase in DBP (р=0,002 and BPa (р≤0,006 were noted. In patients of group-II after 4 weeks of treatment CI decreased or didn’t change. Towards 28-th day of treatment 10 patients had clinical improvements. Only one patient’s FC NYHA increased. At the end of treatment the normalization of CHD was registered totally in group. Initially evening-night-time peaks of PAOP (р≤0,002, SBP (р≤0, 0001, CI (р=0,057 and DM (р=0,084 were registered in patients of group-II. At the end of treatment evening-night-time peaks of PAOP (р≤0,015, SBP (р≤0,044, CI (р≤0,005 and DM (р≤0,044 still remained. Besides, evening-night-time peaks of cardiac output (р≤0,01 and systolic index (р≤0, 06 have added. Conclusion. In patients with CHF with initial CI ≤2,15 l\\min\\m2 treatment results in the normalization of CHD and its daily

Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long-Term Outcome.

Science.gov (United States)

Ciccarelli, Giovanni; Barbato, Emanuele; Golino, Marco; Cimmino, Giovanni; Bartunek, Jozef; Di Serafino, Luigi; Di Girolamo, Domenico; De Bruyne, Bernard; Wijns, William; Golino, Paolo

2017-02-01

Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients. Seven-hundred and thirteen consecutive STEMI patients undergoing PPCI, admitted to the S. Anna and S. Sebastiano Hospital (Caserta, Italy) and to the OLV Clinic (Aalst, Belgium), between March 2009 and December 2011, were retrospectively enrolled. Rescue PCI was the only exclusion criterion. Primary end-point was the combination of death for all causes, re-infarction, stroke, and target lesion revascularization (TLR). Patients already on DAPT at admission (26.4%) showed a significant increase in the event rate at univariate analysis (HR 2.34, CI 1.62-3.75, P 1 were more frequently present than in patients not on DAPT), Cox regression analysis confirmed that both DAPT (HR 1.74, 95%CI 1.20-2.53, P value. © 2016, Wiley Periodicals, Inc.

Psychological distress and prejudice following terror attacks in France.

Science.gov (United States)

Goodwin, Robin; Kaniasty, Krzysztof; Sun, Shaojing; Ben-Ezra, Menachem

2017-08-01

Terrorist attacks have the capacity to threaten our beliefs about the world, cause distress across populations and promote discrimination towards particular groups. We examined the impact of two different types of attacks in the same city and same year on psychological distress and probable posttraumatic stress symptoms, and the moderating effects of religion or media use on distress/posttraumatic symptoms and inter-group relations. Two panel surveys four weeks after the January 2015 Charlie Hebdo attack (N = 1981) and the November 2015 Bataclan concert hall/restaurant attacks (N = 1878), measured intrinsic religiosity, social and traditional media use, psychological distress (K6), probable posttraumatic stress symptoms (proposed ICD-11), symbolic racism and willingness to interact with Muslims by non-Muslims. Prevalence of serious mental illness (K6 score > 18) was higher after November 2015 attacks (7.0% after the first attack, 10.2% the second, χ2 (1) = 5.67, p < 0.02), as were probable posttraumatic stress symptoms (11.9% vs. 14.1%; χ2 (1) = 4.15, p < 0.04). In structural equation analyses, sex, age, geographic proximity, media use and religiosity were associated with distress, as was the interaction between event and religiosity. Distress was then associated with racism symbolism and willingness to interact with Muslims. Implications are considered for managing psychological trauma across populations, and protecting inter-group harmony. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke.

Science.gov (United States)

Thijs, Vincent; Grittner, Ulrike; Fazekas, Franz; McCabe, Dominick J H; Giese, Anne-Katrin; Kessler, Christof; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Schmidt, Reinhold; Tanislav, Christian; Putaala, Jukka; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt; Enzinger, Christian

2017-09-01

We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P =0.065; 29.1% versus 16.5% for old lesions, P ischemic attack and ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2017 American Heart Association, Inc.

Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition

DEFF Research Database (Denmark)

Zannad, F.; Stough, W.G.; Pitt, B.

2008-01-01

Specific criteria have been established to define the occurrence of myocardial infarction (MI) and stroke in cardiovascular clinical trials, but there is not a consistent definition for heart failure. Heart failure events appear to occur at a rate that is similar to stroke and MI in trials...... of hypertension, hyperlipidaemia, diabetes, and coronary heart disease, yet a consistent approach to defining heart failure events has not yet been realized. The wide range of definitions used in clinical trials makes it difficult to interpret new data in the context of existing literature. This inconsistency has...... led to challenges in determining the incidence of heart failure in cardiovascular studies and the effects of interventions on these endpoints. This paper examines issues related to defining heart failure events in cardiovascular clinical trials and presents a definition to formally address this issue...

Non-linear indices of heart rate variability during endodontic treatment.

Science.gov (United States)

Santana, Milana Drumond Ramos; Pita Neto, Ivo Cavalcante; Martiniano, Eli Carlos; Monteiro, Larissa Raylane Lucas; Ramos, José Lucas Souza; Garner, David M; Valenti, Vitor Engácia; Abreu, Luiz Carlos de

2016-01-01

Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

[EARLY RATHER THAN IMMEDIATE PCI IN NSTEMI; IS TIME EQUAL TO MUSCLE ONCE AGAIN?

Science.gov (United States)

Carasso, Shemy; Nassar, Ali; Kuzniec, Fabio; Hazanov, Yevgeni; Salman, Nabeeh; Halhla, Yussra; Amir, Offer; Ghanem, Diab

2017-10-01

Current guidelines advocate immediate vs. non-immediate percutaneous coronary intervention (PCI) strategy in ST elevation vs. non ST elevation myocardial infarction (STEMI, NSTEMI). There is however increasing concern that "next-day PCI" in NSTEMI may adversely affect LV systolic and/or diastolic function and a more urgent aggressive approach should be taken in NSTEMI, similar to that in STEMI. In the current study we compared echocardiographic data between patients with STEMI and NSTEMI who had either primary or early PCI respectively. Prospective data of 165 consecutive patients with an acute MI were analyzed. Patients had primary PCI if they had STEMI and non-emergent PCI if they had NSTEMI. Demographic information, laboratory test results, procedure time and post-PCI echocardiographic assessment were compared between the two groups. Patients with STEMI were younger compared to patients with NSTEMI. Time to intervention was significantly longer in NSTEMI, reflecting guideline derived intervention strategy (1.9±1.7days, (median 1day) vs. 30±15min, for NSTEMI and STEMI, respectively, pPCI up to 72 hours in patients with NSTEMI did not adversely affect left ventricular systolic and/or diastolic function compared to immediate PCI in patients with STEMI. Based on current data, we conclude that early PCI intervention rather than an immediate one is appropriate in NSTEMI patients.

Seven Deadliest Microsoft Attacks

CERN Document Server

Kraus, Rob; Borkin, Mike; Alpern, Naomi

2010-01-01

Do you need to keep up with the latest hacks, attacks, and exploits effecting Microsoft products? Then you need Seven Deadliest Microsoft Attacks. This book pinpoints the most dangerous hacks and exploits specific to Microsoft applications, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Windows Operating System-Password AttacksActive Directory-Escalat

Phosphoproteomic profiling of human myocardial tissues distinguishes ischemic from non-ischemic end stage heart failure.

Directory of Open Access Journals (Sweden)

Matthew A Schechter

Full Text Available The molecular differences between ischemic (IF and non-ischemic (NIF heart failure are poorly defined. A better understanding of the molecular differences between these two heart failure etiologies may lead to the development of more effective heart failure therapeutics. In this study extensive proteomic and phosphoproteomic profiles of myocardial tissue from patients diagnosed with IF or NIF were assembled and compared. Proteins extracted from left ventricular sections were proteolyzed and phosphopeptides were enriched using titanium dioxide resin. Gel- and label-free nanoscale capillary liquid chromatography coupled to high resolution accuracy mass tandem mass spectrometry allowed for the quantification of 4,436 peptides (corresponding to 450 proteins and 823 phosphopeptides (corresponding to 400 proteins from the unenriched and phospho-enriched fractions, respectively. Protein abundance did not distinguish NIF from IF. In contrast, 37 peptides (corresponding to 26 proteins exhibited a ≥ 2-fold alteration in phosphorylation state (p<0.05 when comparing IF and NIF. The degree of protein phosphorylation at these 37 sites was specifically dependent upon the heart failure etiology examined. Proteins exhibiting phosphorylation alterations were grouped into functional categories: transcriptional activation/RNA processing; cytoskeleton structure/function; molecular chaperones; cell adhesion/signaling; apoptosis; and energetic/metabolism. Phosphoproteomic analysis demonstrated profound post-translational differences in proteins that are involved in multiple cellular processes between different heart failure phenotypes. Understanding the roles these phosphorylation alterations play in the development of NIF and IF has the potential to generate etiology-specific heart failure therapeutics, which could be more effective than current therapeutics in addressing the growing concern of heart failure.

From Mars to Venus: Gender Differences in the Management and Outcomes of Acute Coronary Syndromes.

Science.gov (United States)

Tan, Nigel S; Yan, Andrew T

2016-01-01

Ischemic heart disease remains a leading cause of morbidity and mortality in industrialized nations, and contributes substantially to healthcare expenditure worldwide. As the evidence base in acute coronary syndromes (ACS) has expanded dramatically over decades, longitudinal data demonstrate improvements in risk factor modification, organization of healthcare systems, and disease management that have substantially attenuated the adverse prognosis of both ST-segment elevation myocardial infarction (STEMI) and non-STsegment elevation ACS (NSTE-ACS). Nevertheless, discrepancies remain between genders, and women with ACS often sustain worse outcomes than men. In this review, we focus on the gender and sex-specific commonalities and differences in the pathophysiology, clinical presentations, diagnosis, and risk stratification of ACS. We highlight available data on the interactions between gender and efficacy of current pharmacological and interventional treatment for NSTE-ACS and STEMI. We also examine gender differences in the trends of clinical outcomes, and possible mechanisms that account for persistent care gaps where future efforts can be directed.

Whispering through DDoS attack

OpenAIRE

Miralem Mehic; Jiri Slachta; Miroslav Voznak

2016-01-01

Denial of service (DoS) attack is an attempt of the attacker to disable victim's machine by depleting network or computing resources. If this attack is performed with more than one machine, it is called distributed denial of service (DDoS) attack. Covert channels are those channels which are used for information transmission even though they are neither designed nor intended to transfer information at all. In this article, we investigated the possibility of using of DDoS attack for purposes o...

Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

Science.gov (United States)

Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

2018-03-29

The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

DEFF Research Database (Denmark)

Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby

2016-01-01

-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1......-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage...

Exploiting Hardware Vulnerabilities to Attack Embedded System Devices: a Survey of Potent Microarchitectural Attacks

Directory of Open Access Journals (Sweden)

Apostolos P. Fournaris

2017-07-01

Full Text Available Cyber-Physical system devices nowadays constitute a mixture of Information Technology (IT and Operational Technology (OT systems that are meant to operate harmonically under a security critical framework. As security IT countermeasures are gradually been installed in many embedded system nodes, thus securing them from many well-know cyber attacks there is a lurking danger that is still overlooked. Apart from the software vulnerabilities that typical malicious programs use, there are some very interesting hardware vulnerabilities that can be exploited in order to mount devastating software or hardware attacks (typically undetected by software countermeasures capable of fully compromising any embedded system device. Real-time microarchitecture attacks such as the cache side-channel attacks are such case but also the newly discovered Rowhammer fault injection attack that can be mounted even remotely to gain full access to a device DRAM (Dynamic Random Access Memory. Under the light of the above dangers that are focused on the device hardware structure, in this paper, an overview of this attack field is provided including attacks, threat directives and countermeasures. The goal of this paper is not to exhaustively overview attacks and countermeasures but rather to survey the various, possible, existing attack directions and highlight the security risks that they can pose to security critical embedded systems as well as indicate their strength on compromising the Quality of Service (QoS such systems are designed to provide.

Seven deadliest USB attacks

CERN Document Server

Anderson, Brian

2010-01-01

Do you need to keep up with the latest hacks, attacks, and exploits effecting USB technology? Then you need Seven Deadliest USB Attacks. This book pinpoints the most dangerous hacks and exploits specific to USB, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks detailed in this book include: USB Hacksaw USB Switchblade USB Based Virus/Malicous Code Launch USB Device Overflow RAMdum

Neuroradiological study of transient ischemic attack

Energy Technology Data Exchange (ETDEWEB)

Takusagawa, Yoshihiko; Fujiwara, Yasuhiro; Ichiki, Ken; Suga, Takeshi; Nishigaki, Shinichi

1986-08-01

Fifty-two patients with carotid TIAs and thirteen patients with vertebrobasilar TIAs were investigated by angiography and computed tomography. TIA was diagnosed by clinical symptoms in accordance with the criteria for TIA of the Joint Committee for Stroke Facilities in the U.S.A. (1974). The 65 patients with TIAs included 49 males and 16 females with average age of 63.5 years old at the initial episode of TIA. As for the diseases associated with TIA, hypertension (51 %), diabetes mellitus (15 %) and ischemic heart diseases (11 %) were the major disorders. Atrial fibrillation was observed in 2 cases. Intervals from last TIA attack to angiography were less than 7 days in 22 cases, 8 -- 30 days in 19 cases, 1 -- 4 monthes in 14 cases and more than 4 monthes in 10 cases, respectively. The cases in which angiography was done earlier after attacks displayed more abnormal findings. In 52 patients with caroted TIAs the artherosclerotic change of extracranial portion of the internal carotid artery was found in 14 cases (27 %), that of intracranial portion of the artery in 11 cases (21 %) and both lesions in 2 cases (4 %). On the other hand, in 13 patients with vertebrobasilar TIAs, this change was observed in 4 cases at the extracranival potion and in 1 case at the intracranial potion (siphon) of the internal carotid artery. Abnormal CT findings were found in 29 of 65 patients, namely 9 had ventricular dilatation and brain atrophy, 6 had cerebral infarction which was not associated with associated with symptoms of TIA. In carotid TIAs, Cerebral infarction was associated with symptoms of TIAs in 15 cases, namely 10 had a small low density area in the basal ganglia near the internal capsule and 5 had a low density area in the cortical or subcortical region. All of these 5 cases had cerebral embolism, which recanalized after attacks. (J.P.N.).

Neuroradiological study of transient ischemic attack

International Nuclear Information System (INIS)

Takusagawa, Yoshihiko; Fujiwara, Yasuhiro; Ichiki, Ken; Suga, Takeshi; Nishigaki, Shinichi

1986-01-01

Fifty-two patients with carotid TIAs and thirteen patients with vertebrobasilar TIAs were investigated by angiography and computed tomography. TIA was diagnosed by clinical symptoms in accordance with the criteria for TIA of the Joint Committee for Stroke Facilities in the U.S.A. (1974). The 65 patients with TIAs included 49 males and 16 females with average age of 63.5 years old at the initial episode of TIA. As for the diseases associated with TIA, hypertension (51 %), diabetes mellitus (15 %) and ischemic heart diseases (11 %) were the major disorders. Atrial fibrillation was observed in 2 cases. Intervals from last TIA attack to angiography were less than 7 days in 22 cases, 8 ∼ 30 days in 19 cases, 1 ∼ 4 monthes in 14 cases and more than 4 monthes in 10 cases, respectively. The cases in which angiography was done earlier after attacks displayed more abnormal findings. In 52 patients with caroted TIAs the artherosclerotic change of extracranial portion of the internal carotid artery was found in 14 cases (27 %), that of intracranial portion of the artery in 11 cases (21 %) and both lesions in 2 cases (4 %). On the other hand, in 13 patients with vertebrobasilar TIAs, this change was observed in 4 cases at the extracranival potion and in 1 case at the intracranial potion (siphon) of the internal carotid artery. Abnormal CT findings were found in 29 of 65 patients, namely 9 had ventricular dilatation and brain atrophy, 6 had cerebral infarction which was not associated with associated with symptoms of TIA. In carotid TIAs, Cerebral infarction was associated with symptoms of TIAs in 15 cases, namely 10 had a small low density area in the basal ganglia near the internal capsule and 5 had a low density area in the cortical or subcortical region. All of these 5 cases had cerebral embolism, which recanalized after attacks. (J.P.N.)

Seven Deadliest Unified Communications Attacks

CERN Document Server

York, Dan

2010-01-01

Do you need to keep up with the latest hacks, attacks, and exploits effecting Unified Communications technology? Then you need Seven Deadliest Unified Communication Attacks. This book pinpoints the most dangerous hacks and exploits specific to Unified Communications, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks featured in this book include: UC Ecosystem Attacks Insecure Endpo

Invisible Trojan-horse attack.

Science.gov (United States)

Sajeed, Shihan; Minshull, Carter; Jain, Nitin; Makarov, Vadim

2017-08-21

We demonstrate the experimental feasibility of a Trojan-horse attack that remains nearly invisible to the single-photon detectors employed in practical quantum key distribution (QKD) systems, such as Clavis2 from ID Quantique. We perform a detailed numerical comparison of the attack performance against Scarani-Ac´ın-Ribordy-Gisin (SARG04) QKD protocol at 1924 nm versus that at 1536 nm. The attack strategy was proposed earlier but found to be unsuccessful at the latter wavelength, as reported in N. Jain et al., New J. Phys. 16, 123030 (2014). However at 1924 nm, we show experimentally that the noise response of the detectors to bright pulses is greatly reduced, and show by modeling that the same attack will succeed. The invisible nature of the attack poses a threat to the security of practical QKD if proper countermeasures are not adopted.

The natural history of prevalent ischaemic heart disease in middle-aged men.

Science.gov (United States)

Lampe, F C; Whincup, P H; Wannamethee, S G; Shaper, A G; Walker, M; Ebrahim, S

2000-07-01

To describe the long-term outcome of different forms of symptomatic and asymptomatic ischaemic heart disease in middle-aged men. 7735 men aged 40-59, randomly selected from 24 general practices in Britain were classified into one of seven ischaemic heart disease groups according to a questionnaire and electrocardiogram (ECG): I=diagnosed myocardial infarction; II=unrecognized myocardial infarction; III= diagnosed angina; IV=angina symptoms; V=possible myocardial infarction symptoms; VI=ECG ischaemia or possible myocardial infarction; VII=no evidence of ischaemic heart disease. The association of disease group with a range of fatal and non-fatal outcomes during 15 years of follow-up was assessed. At baseline 25% of men had evidence of ischaemic heart disease (groups I-VI). Risks of major ischaemic heart disease events, total and cardiovascular mortality, stroke, and major cardiovascular events tended to increase strongly from group VII to I. Diagnosed myocardial infarction was associated with a much poorer prognosis than all other groups (including unrecognized infarction) for all cardiovascular outcomes other than stroke. The relative risk associated with ischaemic heart disease at baseline declined dramatically over time. However, men with myocardial infarction who survived event-free for 10 years continued to experience a high excess risk in the subsequent 5 years, in contrast to event-free survivors of angina and other ischaemic heart disease. Adjusted to an average age of 50, the percentage of men surviving for 15 years free of a new major cardiovascular event was 44 for diagnosed myocardial infarction, 52 for unrecognized myocardial infarction, 66 for diagnosed angina, 68 for angina symptoms, 73 for possible myocardial infarction symptoms, 73 for ECG ischaemia, and 79 for no ischaemic heart disease. Comparison of outcome between prevalent and incident myocardial infarction illustrated the improved prognosis of men surviving the initial years after their event

Whispering through DDoS attack

Directory of Open Access Journals (Sweden)

Miralem Mehic

2016-03-01

Full Text Available Denial of service (DoS attack is an attempt of the attacker to disable victim's machine by depleting network or computing resources. If this attack is performed with more than one machine, it is called distributed denial of service (DDoS attack. Covert channels are those channels which are used for information transmission even though they are neither designed nor intended to transfer information at all. In this article, we investigated the possibility of using of DDoS attack for purposes of hiding data or concealing the existing covert channel. In addition, in this paper we analyzed the possibility of detection of such covert communication with the well-known statistical method. Also, we proposed the coordination mechanisms of the attack which may be used. A lot of research has been done in order to describe and prevent DDoS attacks, yet research on steganography on this field is still scarce.

Effect of intracoronary nitroprusside injection on flow recovery during primary PCI in acute STEMI patients.

Science.gov (United States)

Yang, Lixia; Mu, Lihua; Sun, Linhui; Qi, Feng; Guo, Ruiwei

2017-04-01

The no/slow reflow phenomenon during primary percutaneous coronary intervention (PPCI) causes the destruction of the coronary microcirculation and further myocardial damage. Some studies have shown that intracoronary nitroprusside infusion is a safe and effective method for managing the no/slow reflow phenomenon. However, it is uncertain whether the injection of nitroprusside at a specific time point during PPCI can most effectively prevent no-reflow. In this study, we investigated the effect of the timing of an intracoronary nitroprusside injection on flow recovery during PPCI in patients with ST elevation acute myocardial infarction (STEMI). One hundred twenty consecutive patients with STEMI who underwent PPCI were enrolled in the study. Patients who fulfilled the eligibility criteria were randomly allocated to three groups: control group (N.=40) received no nitroprusside before they completed PCI; the second group (N.=40) received nitroprusside before balloon dilatation; and the third group (N.=40) received nitroprusside after each balloon dilatation and before contrast agent refilling. The baseline clinical variables and the details of the PCI procedure were collected. The thrombolysis in myocardial infarction (TIMI) flow grades and the corrected TIMI frame count (cTFC) were evaluated immediately after stent implantation was completed. There were no significant differences in the baseline characteristics, antithrombotic drugs given before PCI, and details of the PCI procedure among the three groups (P>0.05). The incidence of TIMI grade 3 after PCI was significantly higher in the nitroprusside group than in the control group (P=0.025), whereas cTFC was significantly lower in the nitroprusside group (26.6±15.2) than in the control group (38.1±21.3, P=0.001). The incidence of TIMI grade 3 after PCI was significantly higher in the third group than in the second group (P=0.045), and cTFC was significantly lower in the third group (21.5±9.5) than in the second

Unique fatality due to claw injuries in a tiger attack: a case report.

Science.gov (United States)

Pathak, Hrishikesh; Dixit, Pradeep; Dhawane, Shailendra; Meshram, Satin; Shrigiriwar, Manish; Dingre, Niraj

2014-11-01

This paper describes a unique case of a fatal tiger attack in the wild. In the present case, a tiger fatally mauled a 34-year-old female with its claws, instead of the usual mechanism of killing by the bite injury to the neck. The autopsy revealed multiple fatal and non-fatal injuries caused by the tiger claws. The characteristic injuries due to the tooth impacts were absent as the teeth of the offending tiger were either fallen or non-functional. To the best of our knowledge, probably this rare case would be the first reported human fatality due to the tiger claw injuries in the world. The purpose of the present article is to highlight the fatal injuries due to the tiger claws, as the claw-induced fatal injuries in a tiger attack are not reported in the medico-legal literature. Moreover, this report would be an illustrative one for differentiation between the fatal injuries due to the claws and tooth impacts in a tiger attack. Furthermore, the present report establishes the importance of the tiger claws as a source of fatal injuries in a tiger attack. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.

Science.gov (United States)

Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe; Aquino, Melissa; Stone, Gregg W; Sartori, Samantha; Steg, Philippe Gabriel; Wijns, William; Smits, Pieter C; Jeger, Raban V; Leon, Martin B; Windecker, Stephan; Serruys, Patrick W; Morice, Marie-Claude; Camenzind, Edoardo; Weisz, Giora; Kandzari, David; Dangas, George D; Mastoris, Ioannis; Von Birgelen, Clemens; Galatius, Soren; Kimura, Takeshi; Mikhail, Ghada; Itchhaporia, Dipti; Mehta, Laxmi; Ortega, Rebecca; Kim, Hyo-Soo; Valgimigli, Marco; Kastrati, Adnan; Chieffo, Alaide; Mehran, Roxana

2015-09-15

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women. Published by Elsevier Inc.

Women's knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women's Health in Midlife Study.

Science.gov (United States)

Blumstein, Tzvia; Benyamini, Yael; Boyko, Valentina; Lerner-Geva, Liat

2016-01-01

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about "warning signs of a heart attack" and "family history." Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients' personal status by health providers.

Heart Disease and African Americans

Science.gov (United States)

... Minority Population Profiles > Black/African American > Heart Disease Heart Disease and African Americans Although African American adults are ... were 30 percent more likely to die from heart disease than non-Hispanic whites. African American women are ...

Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study).

Science.gov (United States)

Zühlke, Liesl; Karthikeyan, Ganesan; Engel, Mark E; Rangarajan, Sumathy; Mackie, Pam; Cupido-Katya Mauff, Blanche; Islam, Shofiqul; Daniels, Rezeen; Francis, Veronica; Ogendo, Stephen; Gitura, Bernard; Mondo, Charles; Okello, Emmy; Lwabi, Peter; Al-Kebsi, Mohammed M; Hugo-Hamman, Christopher; Sheta, Sahar S; Haileamlak, Abraham; Daniel, Wandimu; Goshu, Dejuma Yadeta; Abdissa, Senbeta G; Desta, Araya G; Shasho, Bekele A; Begna, Dufera M; ElSayed, Ahmed; Ibrahim, Ahmed S; Musuku, John; Bode-Thomas, Fidelia; Yilgwan, Christopher C; Amusa, Ganiyu A; Ige, Olukemi; Okeahialam, Basil; Sutton, Christopher; Misra, Rajeev; Abul Fadl, Azza; Kennedy, Neil; Damasceno, Albertino; Sani, Mahmoud U; Ogah, Okechukwu S; Elhassan, Taiwo OlunugaHuda H M; Mocumbi, Ana Olga; Adeoye, Abiodun M; Mntla, Phindile; Ojji, Dike; Mucumbitsi, Joseph; Teo, Koon; Yusuf, Salim; Mayosi, Bongani M

2016-11-08

There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18-40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80-3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70-2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32-2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10-1.78), and older age (HR, 1.02; 95% CI, 1.01-1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54-0.85) and female sex (HR, 0.65; 95% CI, 0.52-0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle-income countries had significantly higher age- and sex

Attack Trees for Practical Security Assessment: Ranking of Attack Scenarios with ADTool 2.0

NARCIS (Netherlands)

Gadyatskaya, Olga; Jhawar, Ravi; Kordy, P.T.; Lounis, Karim; Mauw, Sjouke; Trujillo-Rasua, Rolando

2016-01-01

In this tool demonstration paper we present the ADTool2.0: an open-source software tool for design, manipulation and analysis of attack trees. The tool supports ranking of attack scenarios based on quantitative attributes entered by the user; it is scriptable; and it incorporates attack trees with

Protecting Database Centric Web Services against SQL/XPath Injection Attacks

Science.gov (United States)

Laranjeiro, Nuno; Vieira, Marco; Madeira, Henrique

Web services represent a powerful interface for back-end database systems and are increasingly being used in business critical applications. However, field studies show that a large number of web services are deployed with security flaws (e.g., having SQL Injection vulnerabilities). Although several techniques for the identification of security vulnerabilities have been proposed, developing non-vulnerable web services is still a difficult task. In fact, security-related concerns are hard to apply as they involve adding complexity to already complex code. This paper proposes an approach to secure web services against SQL and XPath Injection attacks, by transparently detecting and aborting service invocations that try to take advantage of potential vulnerabilities. Our mechanism was applied to secure several web services specified by the TPC-App benchmark, showing to be 100% effective in stopping attacks, non-intrusive and very easy to use.

Non-contact Real-time heart rate measurements based on high speed circuit technology research

Science.gov (United States)

Wu, Jizhe; Liu, Xiaohua; Kong, Lingqin; Shi, Cong; Liu, Ming; Hui, Mei; Dong, Liquan; Zhao, Yuejin

2015-08-01

In recent years, morbidity and mortality of the cardiovascular or cerebrovascular disease, which threaten human health greatly, increased year by year. Heart rate is an important index of these diseases. To address this status, the paper puts forward a kind of simple structure, easy operation, suitable for large populations of daily monitoring non-contact heart rate measurement. In the method we use imaging equipment video sensitive areas. The changes of light intensity reflected through the image grayscale average. The light change is caused by changes in blood volume. We video the people face which include the sensitive areas (ROI), and use high-speed processing circuit to save the video as AVI format into memory. After processing the whole video of a period of time, we draw curve of each color channel with frame number as horizontal axis. Then get heart rate from the curve. We use independent component analysis (ICA) to restrain noise of sports interference, realized the accurate extraction of heart rate signal under the motion state. We design an algorithm, based on high-speed processing circuit, for face recognition and tracking to automatically get face region. We do grayscale average processing to the recognized image, get RGB three grayscale curves, and extract a clearer pulse wave curves through independent component analysis, and then we get the heart rate under the motion state. At last, by means of compare our system with Fingertip Pulse Oximeter, result show the system can realize a more accurate measurement, the error is less than 3 pats per minute.

The work-averse cyber attacker model : theory and evidence from two million attack signatures

NARCIS (Netherlands)

Allodi, L.; Massacci, F.; Williams, J.

The typical cyber attacker is assumed to be all powerful and to exploit all possible vulnerabilities. In this paper we present, and empirically validate, a novel and more realistic attacker model. The intuition of our model is that an attacker will optimally choose whether to act and weaponize a new

Non-selective vs. selective beta-blocker treatment and the risk of thrombo-embolic events in patients with heart failure

NARCIS (Netherlands)

de Peuter, Olav R.; Souverein, Patrick C.; Klungel, Olaf H.; Büller, Harry R.; de Boer, Anthonius; Kamphuisen, Pieter W.

2011-01-01

Aims Heart failure (HF) is associated with a prothrombotic state, resulting in an increased risk for thrombo-embolic events. Studies suggest a reduced prothrombotic state when non-selective beta-blockers relative to selective beta-blockers are given. We studied the influence of non-selective

Web server attack analyzer

OpenAIRE

Mižišin, Michal

2013-01-01

Web server attack analyzer - Abstract The goal of this work was to create prototype of analyzer of injection flaws attacks on web server. Proposed solution combines capabilities of web application firewall and web server log analyzer. Analysis is based on configurable signatures defined by regular expressions. This paper begins with summary of web attacks, followed by detection techniques analysis on web servers, description and justification of selected implementation. In the end are charact...

Network Protection Against DDoS Attacks

Directory of Open Access Journals (Sweden)

Petr Dzurenda

2015-03-01

Full Text Available The paper deals with possibilities of the network protection against Distributed Denial of Service attacks (DDoS. The basic types of DDoS attacks and their impact on the protected network are presented here. Furthermore, we present basic detection and defense techniques thanks to which it is possible to increase resistance of the protected network or device against DDoS attacks. Moreover, we tested the ability of current commercial Intrusion Prevention Systems (IPS, especially Radware DefensePro 6.10.00 product against the most common types of DDoS attacks. We create five scenarios that are varied in type and strength of the DDoS attacks. The attacks intensity was much greater than the normal intensity of the current DDoS attacks.

Attack Tree Generation by Policy Invalidation

DEFF Research Database (Denmark)

Ivanova, Marieta Georgieva; Probst, Christian W.; Hansen, Rene Rydhof

2015-01-01

through brainstorming of experts. In this work we formalize attack tree generation including human factors; based on recent advances in system models we develop a technique to identify possible attacks analytically, including technical and human factors. Our systematic attack generation is based......Attacks on systems and organisations increasingly exploit human actors, for example through social engineering, complicating their formal treatment and automatic identification. Formalisation of human behaviour is difficult at best, and attacks on socio-technical systems are still mostly identified...... on invalidating policies in the system model by identifying possible sequences of actions that lead to an attack. The generated attacks are precise enough to illustrate the threat, and they are general enough to hide the details of individual steps....

Heart rate reactivity associated to positive and negative food and non-food visual stimuli.

Science.gov (United States)

Kuoppa, Pekka; Tarvainen, Mika P; Karhunen, Leila; Narvainen, Johanna

2016-08-01

Using food as a stimuli is known to cause multiple psychophysiological reactions. Heart rate variability (HRV) is common tool for assessing physiological reactions in autonomic nervous system. However, the findings in HRV related to food stimuli have not been consistent. In this paper the quick changes in HRV related to positive and negative food and non-food visual stimuli are investigated. Electrocardiogram (ECG) was measured from 18 healthy females while being stimulated with the pictures. Subjects also filled Three-Factor Eating Questionnaire to determine their eating behavior. The inter-beat-interval time series and the HRV parameters were extracted from the ECG. The quick change in HRV parameters were studied by calculating the change from baseline value (10 s window before stimulus) to value after the onset of the stimulus (10 s window during stimulus). The paired t-test showed significant difference between positive and negative food pictures but not between positive and negative non-food pictures. All the HRV parameters decreased for positive food pictures while they stayed the same or increased a little for negative food pictures. The eating behavior characteristic cognitive restraint was negatively correlated with HRV parameters that describe decreasing of heart rate.

Terrorists and Suicide Attacks

National Research Council Canada - National Science Library

Cronin, Audrey K

2003-01-01

Suicide attacks by terrorist organizations have become more prevalent globally, and assessing the threat of suicide attacks against the United States and its interests at home and abroad has therefore...

Stochastic Model of TCP SYN Attacks

Directory of Open Access Journals (Sweden)

Simona Ramanauskaitė

2011-08-01

Full Text Available A great proportion of essential services are moving into internet space making the threat of DoS attacks even more actual. To estimate the real risk of some kind of denial of service (DoS attack in real world is difficult, but mathematical and software models make this task easier. In this paper we overview the ways of implementing DoS attack models and offer a stochastic model of SYN flooding attack. It allows evaluating the potential threat of SYN flooding attacks, taking into account both the legitimate system flow as well as the possible attack power. At the same time we can assess the effect of such parameters as buffer capacity, open connection storage in the buffer or filte­ring efficiency on the success of different SYN flooding attacks. This model can be used for other type of memory depletion denial of service attacks.Article in Lithuanian

Attack Trees with Sequential Conjunction

NARCIS (Netherlands)

Jhawar, Ravi; Kordy, Barbara; Mauw, Sjouke; Radomirović, Sasa; Trujillo-Rasua, Rolando

2015-01-01

We provide the first formal foundation of SAND attack trees which are a popular extension of the well-known attack trees. The SAND at- tack tree formalism increases the expressivity of attack trees by intro- ducing the sequential conjunctive operator SAND. This operator enables the modeling of

Isolated Non-Compaction of the Left Ventricle in a Patient with New-Onset Heart Failure: Morphologic and Functional Evaluation with Cardiac Multidetector Computed Tomography

Energy Technology Data Exchange (ETDEWEB)

Lee, Heon [Soonchuhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kim, Seok Yeon [Seoul Medical Center, Seoul (Korea, Republic of); Schoepf, U. Joseph [Medical University of South Carolina, SC (United States)

2012-03-15

We describe a case of new-onset heart failure in a patient in whom cardiac CT enabled the non-invasive diagnosis of isolated non-compaction and associated functional abnormalities of the left ventricle with the concomitant evaluation of coronary arteries. This case highlights the utility of cardiac CT for the morphological and functional evaluation of the heart as a single imaging modality.

Investigating the Possibility to Individualize Asthma Attack Therapy Based on Attack Severity and Patient Characteristics

Directory of Open Access Journals (Sweden)

Sárkány Zoltán

2016-03-01

Full Text Available Introduction: The objective of this study was to investigate with the help of a computerized simulation model whether the treatment of an acute asthma attack can be individualized based on the severity of the attack and the characteristics of the patient. Material and Method: A stochastic lung model was used to simulate the deposition of 1 nm - 10 μm particles during a mild and a moderate asthma attack. Breathing parameters were varied to maximize deposition, and simulation results were compared with those obtained in the case of a severe asthma attack. In order to investigate the effect of height on the deposition of inhaled particles, another series of simulations was carried out with identical breathing parameters, comparing patient heights of 155 cm, 175 cm and 195 cm. Results: The optimization process yielded an increase in the maximum deposition values of around 6-7% for each type of investigated asthma attack, and the difference between attacks of different degree of severity was around 5% for both the initial and the optimized values, a higher degree of obstruction increasing the amount of deposited particles. Conclusions: Our results suggest that the individualization of asthma attack treatment cannot be based on particles of different size, as the highest deposited fraction in all three types of attacks can be obtained using 0.01 μm particles. The use of a specific set of breathing parameters yields a difference between a mild and a moderate, as well as a moderate and a severe asthma attack of around 5%.

Analytical Characterization of Internet Security Attacks

Science.gov (United States)

Sellke, Sarah H.

2010-01-01

Internet security attacks have drawn significant attention due to their enormously adverse impact. These attacks includes Malware (Viruses, Worms, Trojan Horse), Denial of Service, Packet Sniffer, and Password Attacks. There is an increasing need to provide adequate defense mechanisms against these attacks. My thesis proposal deals with analytical…

Global Ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction

DEFF Research Database (Denmark)

Stengaard, Carsten; Sørensen, Jacob Thorsted; Andersen, M.P.

2011-01-01

, Department of Cardiology, Heart Center - Tampere - Finland, 5Duke University Medical Center, Department of Medicine, Division of Cardiology - Durham - United States of America, Topic(s): Infarction acute phase STEMI Citation: European Heart Journal ( 2011 ) 32 ( Abstract Supplement ), 1054 Purpose: A global...... occlusion of 4.3%. Mortality in patients with GIP was significantly higher compared to patients without GIP (preports...

Taking radionuclides to heart

International Nuclear Information System (INIS)

Kleynhans, P.H.T.; Lotter, M.G.; Van Aswegen, A.; Minnaar, P.C.; Iturralde, M.; Herbst, C.P.; Marx, D.

1980-01-01

Ischaemic heart disease is a main cause of death in South Africa. Non-invasive ECG gated radionuclide bloodpool imaging plays an increasingly useful role in the evalution of the function of the heart as a pump, and the extent of heart muscle perfusion defects is further pinpointed by invasive krypton-81m studies to improve patient management

Anger attacks in obsessive compulsive disorder

Directory of Open Access Journals (Sweden)

Nitesh Prakash Painuly

2011-01-01

Full Text Available Background: Research on anger attacks has been mostly limited to depression, and only a few studies have focused on anger attacks in obsessive compulsive disorder. Materials and Methods: In a cross-sectional study all new obsessive compulsive disorder patients aged 20-60 years attending an outpatient clinic were assessed using the anger attack questionnaire, irritability, depression and anxiety scale (for the direction of the aggressive behavior and quality of life (QOL. Results: The sample consisted of 42 consecutive subjects with obsessive compulsive disorder, out of which 21 (50% had anger attacks. The obsessive compulsive disorder subjects with and without anger attacks did not show significant differences in terms of sociodemographic variables, duration of illness, treatment, and family history. However, subjects with anger attacks had significantly higher prevalence of panic attacks and comorbid depression. Significantly more subjects with anger attacks exhibited aggressive acts toward spouse, parents, children, and other relatives in the form of yelling and threatening to hurt, trying to hurt, and threatening to leave. However, the two groups did not differ significantly in terms of QOL, except for the psychological domain being worse in the subjects with anger attacks. Conclusion: Anger attacks are present in half of the patients with obsessive compulsive disorder, and they correlate with the presence of comorbid depression.

Effects of autologous bone marrow stem cell transplantation on beta-adrenoceptor density and electrical activation pattern in a rabbit model of non-ischemic heart failure

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Ullmann Cris

2006-06-01

Full Text Available Abstract Background Since only little is known on stem cell therapy in non-ischemic heart failure we wanted to know whether a long-term improvement of cardiac function in non-ischemic heart failure can be achieved by stem cell transplantation. Methods White male New Zealand rabbits were treated with doxorubicine (3 mg/kg/week; 6 weeks to induce dilative non-ischemic cardiomyopathy. Thereafter, we obtained autologous bone marrow stem cells (BMSC and injected 1.5–2.0 Mio cells in 1 ml medium by infiltrating the myocardium via a left anterolateral thoracotomy in comparison to sham-operated rabbits. 4 weeks later intracardiac contractility was determined in-vivo using a Millar catheter. Thereafter, the heart was excised and processed for radioligand binding assays to detect β1- and β2-adrenoceptor density. In addition, catecholamine plasma levels were determined via HPLC. In a subgroup we investigated cardiac electrophysiology by use of 256 channel mapping. Results In doxorubicine-treated animals β-adrenoceptor density was significantly down-regulated in left ventricle and septum, but not in right ventricle, thereby indicating a typical left ventricular heart failure. Sham-operated rabbits exhibited the same down-regulation. In contrast, BMSC transplantation led to significantly less β-adrenoceptor down-regulation in septum and left ventricle. Cardiac contractility was significantly decreased in heart failure and sham-operated rabbits, but was significantly higher in BMSC-transplanted hearts. Norepinephrine and epinephrine plasma levels were enhanced in heart failure and sham-operated animals, while these were not different from normal in BMSC-transplanted animals. Electrophysiological mapping revealed unaltered electrophysiology and did not show signs of arrhythmogeneity. Conclusion BMSC transplantation improves sympathoadrenal dysregualtion in non-ischemic heart failure.

Acute non-atherosclerotic ST-segment elevation myocardial infarction in an adolescent with concurrent hemoglobin H-Constant Spring disease and polycythemia vera

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Ekarat Rattarittamrong

2015-09-01

Full Text Available Thrombosis is a major complication of polycythemia vera (PV and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI in a 17- year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/μL and three months later developed an acute STEMI. Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque. He was treated with plateletpheresis, hydroxyurea and antiplatelet agents. The platelet count decreased and his symptoms improved. This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

Seven Deadliest Social Network Attacks

CERN Document Server

Timm, Carl

2010-01-01

Do you need to keep up with the latest hacks, attacks, and exploits effecting social networks? Then you need Seven Deadliest Social Network Attacks. This book pinpoints the most dangerous hacks and exploits specific to social networks like Facebook, Twitter, and MySpace, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks detailed in this book include: Social Networking Infrastruct

Measurement of microvascular function in patients presenting with thrombolysis for ST elevation myocardial infarction, and PCI for non-ST elevation myocardial infarction.

Science.gov (United States)

Palmer, Sonny; Layland, Jamie; Adams, Heath; Ashokkumar, Srikkumar; Williams, Paul D; Judkins, Christopher; La Gerche, Andre; Burns, Andrew T; Whitbourn, Robert J; MacIsaac, Andrew I; Wilson, Andrew M

2018-04-12

In this prospective study, we compared the invasive measures of microvascular function in two subsets: patients with pharmacoinvasive thrombolysis for STEMI, and patients undergoing percutaneous coronary intervention (PCI) for NSTEMI. The study consisted of 17 patients with STEMI referred for cardiac catheterisation post thrombolysis, and 20 patients with NSTEMI. Coronary physiological indexes were measured in each patient before and after PCI. The median pre-PCI index of microcirculatory function (IMR) at baseline was significantly higher in the STEMI group than the NSTEMI group (26 units vs. 15 units, p = 0.02). Following PCI, IMR decreased in both groups (STEMI 20 units vs. NSTEMI 14 units, p = 0.10). There was an inverse correlation between post PCI IMR and left ventricular ejection fraction (LVEF) (r = -0.52, p = 0.001). Furthermore, post PCI IMR was an independent predictor of index admission LVEF in the total population (β = -0.388, p = 0.02). Invasive measures of microvascular function are inferior in a pharmacoinvasive STEMI group compared to a clinically stable NSTEMI group. In the STEMI population, the IMR following coronary intervention appears to predict LVEF. Copyright © 2018 Elsevier Inc. All rights reserved.

Attacks on IEEE 802.11 wireless networks

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Dejan Milan Tepšić

2013-06-01

networking it has never been easier to penetrate the network. One of the biggest problems of today's wireless networks is the lack of effective systems for intrusion detection. Forgetting to cover gaps in wireless network security may result in intrusion into the network by an attacker. Security in IEEE 802.11 wireless networks Although the IEEE 802.11 protocol defines security standards, wireless networks are one of the weakest links in the chain of computer networks. The basic security requirements of each computer network are reliable user authentication, privacy protection and user authentication. Security attacks on IEEE 802.11 wireless networks Non-technical attacks include a variety of human weaknesses, such as lack of conscience, negligence or over-confidence towards the strangers. Network attacks include a number of techniques that enable attackers to penetrate into  the wireless network, or at least to disable it. Apart from the security problems with the IEEE 802.11 protocol, there are vulnerabilities in operating systems and applications on wireless clients. The methodology of attack Before testing wireless network security vulnerabilities, it is important to define a formal testing methodology. The first step before the actual attack is footprinting. The second step is the creation of a network map that shows how the wireless system looks. For this purpose, hackers are using specific tools, such as Network Stumbler, Nmap and Fping. When basic information about the wireless network is gathered, more information can be found out through the process of system scanning (enumeration. Attacks on IEEE 802.11 wireless networks Social engineering is a technique by which attackers exploit the natural trust of most people. Radio waves do not respect defined boundaries. If radio waves are broadcasted outside of the boundaries of the defined area, then it is necessary to reduce signal strength on wireless access points. In that way, radio waves travel over shorter distances

Cache timing attacks on recent microarchitectures

DEFF Research Database (Denmark)

Andreou, Alexandres; Bogdanov, Andrey; Tischhauser, Elmar Wolfgang

2017-01-01

Cache timing attacks have been known for a long time, however since the rise of cloud computing and shared hardware resources, such attacks found new potentially devastating applications. One prominent example is S$A (presented by Irazoqui et al at S&P 2015) which is a cache timing attack against...... AES or similar algorithms in virtualized environments. This paper applies variants of this cache timing attack to Intel's latest generation of microprocessors. It enables a spy-process to recover cryptographic keys, interacting with the victim processes only over TCP. The threat model is a logically...... separated but CPU co-located attacker with root privileges. We report successful and practically verified applications of this attack against a wide range of microarchitectures, from a two-core Nehalem processor (i5-650) to two-core Haswell (i7-4600M) and four-core Skylake processors (i7-6700). The attack...

Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

Science.gov (United States)

Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry

2018-05-29

Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.

A UNIFIED APPROACH FOR DETECTION AND PREVENTION OF DDOS ATTACKS USING ENHANCED SUPPORT VECTOR MACHINES AND FILTERING MECHANISMS

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T. Subbulakshmi

2014-10-01

Full Text Available Distributed Denial of Service (DDoS attacks were considered to be a tremendous threat to the current information security infrastructure. During DDoS attack, multiple malicious hosts that are recruited by the attackers launch a coordinated attack against one host or a network victim, which cause denial of service to legitimate users. The existing techniques suffer from more number of false alarms and more human intervention for attack detection. The objective of this paper is to monitor the network online which automatically initiates detection mechanism if there is any suspicious activity and also defense the hosts from being arrived at the network. Both spoofed and non spoofed IP’s are detected in this approach. Non spoofed IP’s are detected using Enhanced Support Vector Machines (ESVM and spoofed IP’s are detected using Hop Count Filtering (HCF mechanism. The detected IP’s are maintained separately to initiate the defense process. The attack strength is calculated using Lanchester Law which initiates the defense mechanism. Based on the calculated attack strength any of the defense schemes such as Rate based limiting or History based IP filtering is automatically initiated to drop the packets from the suspected IP. The integrated online monitoring approach for detection and defense of DDoS attacks is deployed in an experimental testbed. The online approach is found to be obvious in the field of integrated DDoS detection and defense.

The effect of the cardiac rehabilitation program on obese and non-obese females with coronary heart disease

Directory of Open Access Journals (Sweden)

Fatemeh Esteki Ghashghaei

2012-01-01

Full Text Available Introduction: Obesity is strongly associated with coronary heart disease and it is known as an independent risk factor. So, the aim of this study was to investigate the effects of phase II comprehensive cardiac rehabilitation program on obesity indexes, functional capacity, lipid profiles, and fasting blood sugar in obese and non-obese female patients with coronary heart disease and to compare changes in these groups. Materials and Methods: Two hundred and five women with coronary heart disease participated in our study. At the beginning of study, body mass index, functional capacity, and lipid profiles and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had BMI≥30 were known as obese and who had BMI<30 were known as non-obese patients. All of them completed the period of cardiac rehabilitation program, and 2 months later, all risk factors were examined for the second time in each group. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t-tests and paired t-tests were used. Results: Data revealed that unless in weight (P=0.00 and functional capacity (P=0.001, there were no significant differences in obese and non-obese female patients, at baseline. As a result of the cardiac rehabilitation program, both groups had significant improvement in functional capacity (P=0.00, weight reduction (P=0.00, triglyceride (P=0.01 and P=0.02, respectively, low-density lipoprotein cholesterol (P=0.01, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.00 and P=0.003, respectively. As well, significant improvement was observed in high-density lipoprotein (P=0.01 only in obese female, and non-obese female had significant differences in total cholesterol (P=0.003. However, there were not significant changes in total cholesterol (P=0.05 and fasting blood sugar (P=0.09 in obese female. Also, non-obese females didn′t have

Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka.

Science.gov (United States)

Galappatthy, Priyadarshani; Bataduwaarachchi, Vipula R; Ranasinghe, Priyanga; Galappatthy, Gamini K S; Wijayabandara, Maheshi; Warapitiya, Dinuka S; Sivapathasundaram, Mythily; Wickramarathna, Thilini; Senarath, Upul; Sridharan, Sathasivam; Wijeyaratne, Chandrika N; Ekanayaka, Ruvan

2018-02-16

Ischaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals. ACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2-4 weeks window. Local and international recommendations were used as audit standards. Data from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20-95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (Pacute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in coronary interventions planned. In patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Safety and feasibility of performing staged non-culprit vessel percutaneous coronary intervention within the index hospitalization in patients with ST-segment elevation myocardial infarction and multivessel disease

International Nuclear Information System (INIS)

Loh, Joshua P.; Kitabata, Hironori; Torguson, Rebecca; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Pichard, Augusto D.; Lindsay, Joseph; Waksman, Ron

2013-01-01

Objectives: To determine whether staged percutaneous coronary intervention (PCI) within the same hospitalization as primary PCI is safe. Background: In ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary PCI, staged non-culprit vessel PCI at a separate session is recommended. Methods: We conducted a retrospective analysis of 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel. Patients were categorized into staged PCI in the same hospitalization (n = 184) and staged PCI at a separate hospitalization within 8 weeks of primary PCI (n = 98). Results: Baseline characteristics, presentation of STEMI, and procedural characteristics were similar in both groups. Contrast amount was higher in the separate hospitalization group for both index (175 vs. 153 ml, p = 0.011) and staged (144 vs. 120 ml, p = 0.004) procedures. More staged left main PCI was performed in the separate hospitalization group (3.9 vs. 0.3%, p = 0.008). Angiographic success of staged PCI was similar in both groups, with similar rates of vascular complications and major bleeding. Following staged PCI, in-hospital major adverse cardiac events (3.3 vs. 1.0%, p = 0.43) and mortality (2.7 vs. 0%, p = 0.17) were similar in both groups. Conclusions: Our study supports the safety and feasibility of staged PCI within the same hospitalization as primary PCI, achieving similar procedural success and in-hospital outcomes as staged PCI at a separate hospitalization. Higher contrast amount used during primary PCI and presence of left main lesion in non-culprit vessels may influence the decision to stage the PCI at a separate hospitalization

The Cyber-Physical Attacker

DEFF Research Database (Denmark)

Vigo, Roberto

2012-01-01

The world of Cyber-Physical Systems ranges from industrial to national interest applications. Even though these systems are pervading our everyday life, we are still far from fully understanding their security properties. Devising a suitable attacker model is a crucial element when studying...... the security properties of CPSs, as a system cannot be secured without defining the threats it is subject to. In this work an attacker scenario is presented which addresses the peculiarities of a cyber-physical adversary, and we discuss how this scenario relates to other attacker models popular in the security...

Gender and post-ischemic recovery of hypertrophied rat hearts

Directory of Open Access Journals (Sweden)

Popov Kirill M

2006-03-01

Full Text Available Abstract Background Gender influences the cardiac response to prolonged increases in workload, with differences at structural, functional, and molecular levels. However, it is unknown if post-ischemic function or metabolism of female hypertrophied hearts differ from male hypertrophied hearts. Thus, we tested the hypothesis that gender influences post-ischemic function of pressure-overload hypertrophied hearts and determined if the effect of gender on post-ischemic outcome could be explained by differences in metabolism, especially the catabolic fate of glucose. Methods Function and metabolism of isolated working hearts from sham-operated and aortic-constricted male and female Sprague-Dawley rats before and after 20 min of no-flow ischemia (N = 17 to 27 per group were compared. Parallel series of hearts were perfused with Krebs-Henseleit solution containing 5.5 mM [5-3H/U-14C]-glucose, 1.2 mM [1-14C]-palmitate, 0.5 mM [U-14C]-lactate, and 100 mU/L insulin to measure glycolysis and glucose oxidation in one series and oxidation of palmitate and lactate in the second. Statistical analysis was performed using two-way analysis of variance. The sequential rejective Bonferroni procedure was used to correct for multiple comparisons and tests. Results Female gender negatively influenced post-ischemic function of non-hypertrophied hearts, but did not significantly influence function of hypertrophied hearts after ischemia such that mass-corrected hypertrophied heart function did not differ between genders. Before ischemia, glycolysis was accelerated in hypertrophied hearts, but to a greater extent in males, and did not differ between male and female non-hypertrophied hearts. Glycolysis fell in all groups after ischemia, except in non-hypertrophied female hearts, with the reduction in glycolysis after ischemia being greatest in males. Post-ischemic glycolytic rates were, therefore, similarly accelerated in hypertrophied male and female hearts and higher in

Forensics Investigation of Web Application Security Attacks

OpenAIRE

Amor Lazzez; Thabet Slimani

2015-01-01

Nowadays, web applications are popular targets for security attackers. Using specific security mechanisms, we can prevent or detect a security attack on a web application, but we cannot find out the criminal who has carried out the security attack. Being unable to trace back an attack, encourages hackers to launch new attacks on the same system. Web application forensics aims to trace back and attribute a web application security attack to its originator. This may significantly reduce the sec...

Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

Directory of Open Access Journals (Sweden)

Darling CE

2013-07-01

Full Text Available Chad E Darling,1 Kimberly A Fisher,2 David D McManus,3,4 Andrew H Coles,5 Frederick A Spencer,5,6 Joel M Gore,3,4 Robert J Goldberg31Department of Emergency Medicine, 2Division of Pulmonary Critical Care, 3Department of Quantitative Health Sciences, 4Department of Medicine, 5Program for Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA, USA; 6Department of Medicine, McMaster University, Hamilton, Ontario, CanadaBackground: Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI and non-ST-segment elevation myocardial infarction (NSTEMI, especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival.Methods: We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI during 2001, 2003, 2005, and 2007.Results: A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5% were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44. Several demographic (eg, older age and clinical (eg, history of stroke factors were associated with reduced long-term survival in patients with NSTEMI and

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

Science.gov (United States)

Shams, Tanzila; Auchus, Alexander P; Oparil, Suzanne; Wright, Clinton B; Wright, Jackson; Furlan, Anthony J; Sila, Cathy A; Davis, Barry R; Pressel, Sara; Yamal, Jose-Miguel; Einhorn, Paula T; Lerner, Alan J

2017-11-01

The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542. © 2017 American Heart Association, Inc.

Critical supply network protection against intentional attacks: A game-theoretical model

International Nuclear Information System (INIS)

Bricha, Naji; Nourelfath, Mustapha

2013-01-01

A crucial issue in today's critical supply chains is how to protect facilities against intentional attacks, since it has become unacceptable to ignore the high impact of low probability disruptions caused by these attacks. This article develops a game-theoretical model to deal with the protection of facilities, in the context of the uncapacitated fixed-charge location problem. Given a set of investment alternatives for protecting the facilities against identified threats, the objective is to select the optimal defence strategy. The attacker is considered as a player who tries to maximise the expected damage while weighing against the attacks expenditures. The conflict on facilities vulnerability is modelled using the concept of contest. The vulnerability of a facility is defined by its destruction probability. Contest success functions determine the vulnerability of each facility dependent on the relative investments of the defender and the attacker on each facility, and on the characteristics of the contest. A method is developed to evaluate the utilities of the players (i.e., the defender and the attacker). This method evaluates many expected costs, including the cost needed to restore disabled facilities, the backorder cost, and the cost incurred because of the increase in transportation costs after attacks. In fact, when one or several facilities are unavailable, transportation costs will increase since reassigned customers may receive shipments from facilities which are farther away. The model considers a non-cooperative two-period game between the players, and an algorithm is presented to determine the equilibrium solution and the optimal defence strategy. An illustrative example is presented. The approach is compared to other suggested strategies, and some managerial insights are provided in the context of facility location

Predicting Factors of Zone 4 Attack in Volleyball.

Science.gov (United States)

Costa, Gustavo C; Castro, Henrique O; Evangelista, Breno F; Malheiros, Laura M; Greco, Pablo J; Ugrinowitsch, Herbert

2017-06-01

This study examined 142 volleyball games of the Men's Super League 2014/2015 seasons in Brazil from which we analyzed 24-26 games of each participating team, identifying 5,267 Zone 4 attacks for further analysis. Within these Zone 4 attacks, we analyzed the association between the effect of the attack carried out and the separate effects of serve reception, tempo and type of attack. We found that the reception, tempo of attack, second tempo of attack, and power of diagonal attack were predictors of the attack effect in Zone 4. Moreover, placed attacks showed a tendency to not yield a score. In conclusion, winning points in high-level men's volleyball requires excellent receptions, a fast attack tempo and powerfully executed of attacks.

Attack Potential Evaluation in Desktop and Smartphone Fingerprint Sensors: Can They Be Attacked by Anyone?

Directory of Open Access Journals (Sweden)

Ines Goicoechea-Telleria

2018-01-01

Full Text Available The use of biometrics keeps growing. Every day, we use biometric recognition to unlock our phones or to have access to places such as the gym or the office, so we rely on the security manufacturers offer when protecting our privileges and private life. It is well known that it is possible to hack into a fingerprint sensor using fake fingers made of Play-Doh and other easy-to-obtain materials but to what extent? Is this true for all users or only for specialists with a deep knowledge on biometrics? Are smartphone fingerprint sensors as reliable as desktop sensors? To answer these questions, we performed 3 separate evaluations. First, we evaluated 4 desktop fingerprint sensors of different technologies by attacking them with 7 different fake finger materials. All of them were successfully attacked by an experienced attacker. Secondly, we carried out a similar test on 5 smartphones with embedded sensors using the most successful materials, which also hacked the 5 sensors. Lastly, we gathered 15 simulated attackers with no background in biometrics to create fake fingers of several materials, and they had one week to attack the fingerprint sensors of the same 5 smartphones, with the starting point of a short video with the techniques to create them. All 5 smartphones were successfully attacked by an inexperienced attacker. This paper will provide the results achieved, as well as an analysis on the attack potential of every case. All results are given following the metrics of the standard ISO/IEC 30107-3.

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.

Science.gov (United States)

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources.

Overview of DOS attacks on wireless sensor networks and experimental results for simulation of interference attacks

Directory of Open Access Journals (Sweden)

Željko Gavrić

2018-01-01

Full Text Available Wireless sensor networks are now used in various fields. The information transmitted in the wireless sensor networks is very sensitive, so the security issue is very important. DOS (denial of service attacks are a fundamental threat to the functioning of wireless sensor networks. This paper describes some of the most common DOS attacks and potential methods of protection against them. The case study shows one of the most frequent attacks on wireless sensor networks – the interference attack. In the introduction of this paper authors assume that the attack interference can cause significant obstruction of wireless sensor networks. This assumption has been proved in the case study through simulation scenario and simulation results.

Securing internet by eliminating DDOS attacks

Science.gov (United States)

Niranchana, R.; Gayathri Devi, N.; Santhi, H.; Gayathri, P.

2017-11-01

The major threat caused to the authorised usage of Internet is Distributed Denial of Service attack. The mechanisms used to prevent the DDoS attacks are said to overcome the attack’s ability in spoofing the IP packets source addresses. By utilising Internet Protocol spoofing, the attackers cause a consequential load over the networks destination for policing attack packets. To overcome the IP Spoofing level on the Internet, We propose an Inter domain Packet Filter (IPF) architecture. The proposed scheme is not based on global routing information. The packets with reliable source addresses are not rejected, the IPF frame work works in such a manner. The spoofing capability of attackers is confined by IPF, and also the filter identifies the source of an attack packet by minimal number of candidate network.

Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010).

Science.gov (United States)

Lu, Hou Tee; Nordin, Rusli Bin

2013-11-06

The National Cardiovascular Disease (NCVD) Database Registry represents one of the first prospective, multi-center registries to treat and prevent coronary artery disease (CAD) in Malaysia. Since ethnicity is an important consideration in the occurrence of acute coronary syndrome (ACS) globally, therefore, we aimed to identify the role of ethnicity in the occurrence of ACS among high-risk groups in the Malaysian population. The NCVD involves more than 15 Ministry of Health (MOH) hospitals nationwide, universities and the National Heart Institute and enrolls patients presenting with ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA)]. We analyzed ethnic differences across socio-demographic characteristics, hospital medications and invasive therapeutic procedures, treatment of STEMI and in-hospital clinical outcomes. We enrolled 13,591 patients. The distribution of the NCVD population was as follows: 49.0% Malays, 22.5% Chinese, 23.1% Indians and 5.3% Others (representing other indigenous groups and non-Malaysian nationals). The mean age (SD) of ACS patients at presentation was 59.1 (12.0) years. More than 70% were males. A higher proportion of patients within each ethnic group had more than two coronary risk factors. Malays had higher body mass index (BMI). Chinese had highest rate of hypertension and hyperlipidemia. Indians had higher rate of diabetes mellitus (DM) and family history of premature CAD. Overall, more patients had STEMI than NSTEMI or UA among all ethnic groups. The use of aspirin was more than 94% among all ethnic groups. Utilization rates for elective and emergency percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were low among all ethnic groups. In STEMI, fibrinolysis (streptokinase) appeared to be the dominant treatment options (>70%) for all ethnic groups. In-hospital mortality rates for STEMI across ethnicity ranges from 8.1% to 10.1% (p = 0

Plants under dual attack

NARCIS (Netherlands)

Ponzio, C.A.M.

2016-01-01

Though immobile, plants are members of complex environments, and are under constant threat from a wide range of attackers, which includes organisms such as insect herbivores or plant pathogens. Plants have developed sophisticated defenses against these attackers, and include chemical responses

New attacks on Wi-Fi Protected Setup

OpenAIRE

Hamed Mohtadi; Alireza Rahimi

2015-01-01

Wi-Fi Protected Setup (WPS) is a network security standard that is used to secure networks in home and office, introduced in 2006 by the Wi-Fi Alliance. It provides easier configuration setup and is used in almost all recent Wi-Fi devices. In this paper we propose two attacks on this standard. The first attack is an offline brute force attack that uses imbalance on registration protocol. This attack needs user action, but it is more efficient than previous attacks. The second attack uses weak...

A Game Theoretic Approach to Cyber Attack Prediction

Energy Technology Data Exchange (ETDEWEB)

Peng Liu

2005-11-28

The area investigated by this project is cyber attack prediction. With a focus on correlation-based prediction, current attack prediction methodologies overlook the strategic nature of cyber attack-defense scenarios. As a result, current cyber attack prediction methodologies are very limited in predicting strategic behaviors of attackers in enforcing nontrivial cyber attacks such as DDoS attacks, and may result in low accuracy in correlation-based predictions. This project develops a game theoretic framework for cyber attack prediction, where an automatic game-theory-based attack prediction method is proposed. Being able to quantitatively predict the likelihood of (sequences of) attack actions, our attack prediction methodology can predict fine-grained strategic behaviors of attackers and may greatly improve the accuracy of correlation-based prediction. To our best knowledge, this project develops the first comprehensive framework for incentive-based modeling and inference of attack intent, objectives, and strategies; and this project develops the first method that can predict fine-grained strategic behaviors of attackers. The significance of this research and the benefit to the public can be demonstrated to certain extent by (a) the severe threat of cyber attacks to the critical infrastructures of the nation, including many infrastructures overseen by the Department of Energy, (b) the importance of cyber security to critical infrastructure protection, and (c) the importance of cyber attack prediction to achieving cyber security.

Localization of microfibrillar-associated protein 4 (MFAP4 in human tissues: clinical evaluation of serum MFAP4 and its association with various cardiovascular conditions.

Directory of Open Access Journals (Sweden)

Helle Wulf-Johansson

Full Text Available Microfibrillar-associated protein 4 (MFAP4 is located in the extracellular matrix (ECM. We sought to identify tissues with high levels of MFAP4 mRNA and MFAP4 protein expression. Moreover, we aimed to evaluate the significance of MFAP4 as a marker of cardiovascular disease (CVD and to correlate MFAP4 with other known ECM markers, such as fibulin-1, osteoprotegerin (OPG, and osteopontin (OPN. Quantitative real-time PCR demonstrated that MFAP4 mRNA was more highly expressed in the heart, lung, and intestine than in other elastic tissues. Immunohistochemical studies demonstrated high levels of MFAP4 protein mainly at sites rich in elastic fibers and within blood vessels in all tissues investigated. The AlphaLISA technique was used to determine serum MFAP4 levels in a clinical cohort of 172 patients consisting of 5 matched groups with varying degrees of CVD: 1: patients with ST elevation myocardial infarction (STEMI, 2: patients with non-STEMI, 3: patients destined for vascular surgery because of various atherosclerotic diseases (stable atherosclerotic disease, 4: apparently healthy individuals with documented coronary artery calcification (CAC-positive, and 5: apparently healthy individuals without signs of coronary artery calcification (CAC-negative. Serum MFAP4 levels were significantly lower in patients with stable atherosclerotic disease than CAC-negative individuals (p<0.05. Furthermore, lower serum MFAP4 levels were present in patients with stable atherosclerotic disease compared with STEMI and non-STEMI patients (p<0.05. In patients with stable atherosclerotic disease, positive correlations between MFAP4 and both fibulin-1 (ρ = 0.50; p = 0.0244 and OPG (ρ = 0.62; p = 0.0014 were found. Together, these results indicate that MFAP4 is mainly located in elastic fibers and is highly expressed in blood vessels. The present study suggests that serum MFAP4 varies in groups of patients with different cardiovascular conditions

Invisible Trojan-horse attack

DEFF Research Database (Denmark)

Sajeed, Shihan; Minshull, Carter; Jain, Nitin

2017-01-01

We demonstrate the experimental feasibility of a Trojan-horse attack that remains nearly invisible to the single-photon detectors employed in practical quantum key distribution (QKD) systems, such as Clavis2 from ID Quantique. We perform a detailed numerical comparison of the attack performance...

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.

Science.gov (United States)

Soltani, Mohammadhossien; Mirzaei, Masoud; Amin, Ahmad; Emami, Mahmoud; Aryanpoor, Reza; Shamsi, Farimah; Sarebanhassanabadi, Mohammadtaghi

2016-07-01

Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

Smartphone electrographic monitoring for atrial fibrillation in acute ischemic stroke and transient ischemic attack.

Science.gov (United States)

Tu, Hans T; Chen, Ziyuan; Swift, Corey; Churilov, Leonid; Guo, Ruibing; Liu, Xinfeng; Jannes, Jim; Mok, Vincent; Freedman, Ben; Davis, Stephen M; Yan, Bernard

2017-10-01

Rationale Paroxysmal atrial fibrillation is a common and preventable cause of devastating strokes. However, currently available monitoring methods, including Holter monitoring, cardiac telemetry and event loop recorders, have drawbacks that restrict their application in the general stroke population. AliveCor™ heart monitor, a novel device that embeds miniaturized electrocardiography (ECG) in a smartphone case coupled with an application to record and diagnose the ECG, has recently been shown to provide an accurate and sensitive single lead ECG diagnosis of atrial fibrillation. This device could be used by nurses to record a 30-s ECG instead of manual pulse taking and automatically provide a diagnosis of atrial fibrillation. Aims To compare the proportion of patients with paroxysmal atrial fibrillation detected by AliveCor™ ECG monitoring with current standard practice. Sample size 296 Patients. Design Consecutive ischemic stroke and transient ischemic attack patients presenting to participating stroke units without known atrial fibrillation will undergo intermittent AliveCor™ ECG monitoring administered by nursing staff at the same frequency as the vital observations of pulse and blood pressure until discharge, in addition to the standard testing paradigm of each participating stroke unit to detect paroxysmal atrial fibrillation. Study outcome Proportion of patients with paroxysmal atrial fibrillation detected by AliveCor™ ECG monitoring compared to 12-lead ECG, 24-h Holter monitoring and cardiac telemetry. Discussion Use of AliveCor™ heart monitor as part of routine stroke unit nursing observation has the potential to be an inexpensive non-invasive method to increase paroxysmal atrial fibrillation detection, leading to improvement in stroke secondary prevention.

Radiological attacks and accidents. Medical consequences

International Nuclear Information System (INIS)

Sakuta, Hidenari

2007-01-01

Probability of the occurrence of radiological attacks appears to be elevated after the terrorist attacks against the United States on September 11 in 2001. There are a lot of scenarios of radiological attack: simple radiological device, radiological disperse device (RDD or dirty bomb), attacks against nuclear reactor, improvised nuclear device, and nuclear weapons. Of these, RDD attack is the most probable scenario, because it can be easily made and can generate enormous psychological and economic damages. Radiological incidents are occurring to and fro in the world, including several cases of theft to nuclear facilities and unsuccessful terrorist attacks against them. Recently, a former Russian spy has allegedly been killed using polonium-210. In addition, serious radiological accidents have occurred in Chernobyl, Goiania, and Tokai-mura. Planning, preparation, education, and training exercise appear to be essential factors to cope with radiological attacks and accidents effectively without feeling much anxiety. Triage and psychological first aid are prerequisite to manage and provide effective medial care for mass casualties without inducing panic. (author)

Script-viruses Attacks on UNIX OS

Directory of Open Access Journals (Sweden)

D. M. Mikhaylov

2010-06-01

Full Text Available In this article attacks on UNIX OS are considered. Currently antivirus developers are concentrated on protecting systems from viruses that are most common and attack popular operating systems. If the system or its components are not often attacked then the antivirus products are not protecting these components as it is not profitable. The same situation is with script-viruses for UNIX OS as most experts consider that it is impossible for such viruses to get enough rights to attack. Nevertheless the main conclusion of this article is the fact that such viruses can be very powerful and can attack systems and get enough rights.

Automatic classification of transient ischaemic and transient non-ischaemic heart-rate related ST segment deviation episodes in ambulatory ECG records

International Nuclear Information System (INIS)

Faganeli, J; Jager, F

2010-01-01

In ambulatory ECG records, besides transient ischaemic ST segment deviation episodes, there are also transient non-ischaemic heart-rate related ST segment deviation episodes present, which appear only due to a change in heart rate and thus complicate automatic detection of true ischaemic episodes. The goal of this work was to automatically classify these two types of episodes. The tested features to classify the ST segment deviation episodes were changes of heart rate, changes of the Mahalanobis distance of the first five Karhunen–Loève transform (KLT) coefficients of the QRS complex, changes of time-domain morphologic parameters of the ST segment and changes of the Legendre orthonormal polynomial coefficients of the ST segment. We chose Legendre basis functions because they best fit typical shapes of the ST segment morphology, thus allowing direct insight into the ST segment morphology changes through the feature space. The classification was performed with the help of decision trees. We tested the classification method using all records of the Long-Term ST Database on all ischaemic and all non-ischaemic heart-rate related deviation episodes according to annotation protocol B. In order to predict the real-world performance of the classification we used second-order aggregate statistics, gross and average statistics, and the bootstrap method. We obtained the best performance when we combined the heart-rate features, the Mahalanobis distance and the Legendre orthonormal polynomial coefficient features, with average sensitivity of 98.1% and average specificity of 85.2%

ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality.

Science.gov (United States)

Malik, Ali Osama; Abela, Oliver; Allenback, Gayle; Devabhaktuni, Subodh; Lui, Calvin; Singh, Aditi; Diep, Jimmy; Yamashita, Takashi; Yoo, Ji Won; Malhotra, Sanjay; Ahsan, Chowdhury

2017-08-01

Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed. Outpatient-onset STEMI patients were identified. The state of Nevada was divided into three divisions based on population densities, defined as population per square mile. Division A included counties with population density of 200 per square mile. Trends in use of STEMI-related therapies and the impact on in-hospital mortality rates were compared. Almost 20% of the patients with outpatient-onset STEMI do not get any STEMI-related therapy and have significantly higher mortality rate. Patients from Division A do not have direct access to percutaneous coronary intervention (PCI) centers. These patients receive less STEMI-related therapies. Low-volume PCI centers had equivalent mortality rates for STEMI patients who got PCI, compared to high-volume PCI centers. Policies must be created and processes streamlined so all STEMI patients in Nevada receive appropriate treatment. Copyright © 2017. Published by Elsevier B.V.

Heart rate variability analysis in healthy subjects, patients suffering from congestive heart failure and heart transplanted patients

Directory of Open Access Journals (Sweden)

Argentina Leite

2013-12-01

Full Text Available This study aimed to find parameters to characterize heart rate variability (HRV and discriminate healthy subjects and patients with heart diseases. The parameters used for discrimination characterize the different components of HRV memory (short and long and are extracted from HRV recordings using parametric as well as non parametric methods. Thus, the parameters are: spectral components at low frequencies (LH and high frequencies (HF which are associated with the short memory of HRV and the long memory parameter (d obtained from autoregressive fractionally integrated moving average (ARFIMA models. In the non parametric context, short memory (α1 and long memory (α2 parameters are obtained from detrended fluctuation analysis (DFA. The sample used in this study contains 24-hour Holter HRV recordings of 30 subjects: 10 healthy individuals, 10 patients suffering from congestive heart failure and 10 heart transplanted patients from the Noltisalis database. It was found that short memory parameters present higher values for the healthy individuals whereas long memory parameters present higher values for the diseased individuals. Moreover, there is evidence that ARFIMA modeling allows the discrimination between the 3 groups under study, being advantageous over DFA.

Visibility of the origin and proximal course of coronary arteries on non-ECG-gated heart CT in patients with congenital heart disease

International Nuclear Information System (INIS)

Goo, Hyun Woo; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun

2005-01-01

There is little information on the ability of non-ECG-gated cardiac CT to demonstrate the coronary arteries of children. To evaluate the visibility of the origin and proximal course of coronary arteries on non-ECG-gated cardiac CT, in which the coronary artery was not of primary diagnostic concern, in children with congenital heart disease. From December 2002 to March 2004, 126 cardiac CT examinations from 104 children (median age 11 months; age range 1 day to 15 years) were evaluated. All patients had ventriculo-arterial concordance and no malformations of the great arteries; those with coronary artery anomalies were excluded. Contrast-enhanced 16-slice spiral CT was performed without ECG-gating and multiplanar images for coronary arteries were obtained. The visibility of coronary artery origins was graded on a three-point scale, while nine segments of the arteries were graded on a four-point scale. CT images in which it was possible to trace the coronary arteries were considered diagnostic. The visibility of each whole coronary artery and the origins and proximal four segments of coronary arteries were calculated. The visibility of coronary arteries was also correlated with patient age. The percentage of CT images of diagnostic quality was 49.3% for the whole coronary artery and 81.7% for the origins and proximal four segments. There was a significant positive correlation between the visibility of coronary arteries and age. Non-ECG-gated cardiac CT, in which the coronary artery is not of primary diagnostic concern, is frequently able to visualize the origin and proximal course of coronary arteries and may be helpful in detecting coronary artery anomalies in children with congenital heart disease. (orig.)

Health behavior of patients with ischemic heart disease

Directory of Open Access Journals (Sweden)

Paweł Węgorowski

2017-06-01

Full Text Available Admission By analyzing the available scientific literature, it is possible to define ischemic heart disease as a set of disease symptoms that are a consequence of a chronic state of imbalance between the ability to supply nutrients and oxygen and the real need of myocardial cells for these substances. Adapting life-style behaviors to healthy living is a priority to prevent the onset and development of cardiovascular disease, especially ischemic heart disease, Purpose of research The aim of the study is to determine the health behavior of patients with ischemic heart disease. Materials and methods The study was conducted from 01.08.2015 to 28.12.2015 in a group of 35 people (15 women and 20 men. The research method used in the work is a diagnostic survey, the research technique used was a survey of its own author. Conclusions By analyzing the data collected, it is important to note that patients with coronary heart disease are often associated with health problems such as hypertension, diabetes and abnormal weight. The nutritional habits of the subjects studied can be described as abnormal, particularly the excessive intake of oily meat and too little fish intake. It has also been observed that most of the patients studied have familial predisposition to ischemic heart disease. Discussion Heart attacks occur mostly in people with obesity, diabetes and atherosclerosis. It is also closely related to ischemic heart disease. The health behaviors of patients suffering from Ischemic Heart Disease are moderately satisfactory and therefore the role of a nurse practitioner as a health educator is very difficult but essential in the prevention of ischemic heart disease.

Hybrid attacks on model-based social recommender systems

Science.gov (United States)

Yu, Junliang; Gao, Min; Rong, Wenge; Li, Wentao; Xiong, Qingyu; Wen, Junhao

2017-10-01

With the growing popularity of the online social platform, the social network based approaches to recommendation emerged. However, because of the open nature of rating systems and social networks, the social recommender systems are susceptible to malicious attacks. In this paper, we present a certain novel attack, which inherits characteristics of the rating attack and the relation attack, and term it hybrid attack. Furtherly, we explore the impact of the hybrid attack on model-based social recommender systems in multiple aspects. The experimental results show that, the hybrid attack is more destructive than the rating attack in most cases. In addition, users and items with fewer ratings will be influenced more when attacked. Last but not the least, the findings suggest that spammers do not depend on the feedback links from normal users to become more powerful, the unilateral links can make the hybrid attack effective enough. Since unilateral links are much cheaper, the hybrid attack will be a great threat to model-based social recommender systems.

Effects of non-invasive vagus nerve stimulation on attack frequency over time and expanded response rates in patients with chronic cluster headache: a post hoc analysis of the randomised, controlled PREVA study.

Science.gov (United States)

Gaul, Charly; Magis, Delphine; Liebler, Eric; Straube, Andreas

2017-12-01

In the PREVention and Acute treatment of chronic cluster headache (PREVA) study, attack frequency reductions from baseline were significantly more pronounced with non-invasive vagus nerve stimulation plus standard of care (nVNS + SoC) than with SoC alone. Given the intensely painful and frequent nature of chronic cluster headache attacks, additional patient-centric outcomes, including the time to and level of therapeutic response, were evaluated in a post hoc analysis of the PREVA study. After a 2-week baseline phase, 97 patients with chronic cluster headache entered a 4-week randomised phase to receive nVNS + SoC (n = 48) or SoC alone (n = 49). All 92 patients who continued into a 4-week extension phase received nVNS + SoC. Compared with SoC alone, nVNS + SoC led to a significantly lower mean weekly attack frequency by week 2 of the randomised phase; the attack frequency remained significantly lower in the nVNS + SoC group through week 3 of the extension phase (P cluster headache attack frequency within 2 weeks after its addition to SoC and was associated with significantly higher ≥25%, ≥50%, and ≥75% response rates than SoC alone. The rapid decrease in weekly attack frequency justifies a 4-week trial period to identify responders to nVNS, with a high degree of confidence, among patients with chronic cluster headache.

Attacks, applications, and evaluation of known watermarking algorithms with Checkmark

Science.gov (United States)

Meerwald, Peter; Pereira, Shelby

2002-04-01

The Checkmark benchmarking tool was introduced to provide a framework for application-oriented evaluation of watermarking schemes. In this article we introduce new attacks and applications into the existing Checkmark framework. In addition to describing new attacks and applications, we also compare the performance of some well-known watermarking algorithms (proposed by Bruyndonckx,Cox, Fridrich, Dugad, Kim, Wang, Xia, Xie, Zhu and Pereira) with respect to the Checkmark benchmark. In particular, we consider the non-geometric application which contains tests that do not change the geometry of image. This attack constraint is artificial, but yet important for research purposes since a number of algorithms may be interesting, but would score poorly with respect to specific applications simply because geometric compensation has not been incorporated. We note, however, that with the help of image registration, even research algorithms that do not have counter-measures against geometric distortion -- such as a template or reference watermark -- can be evaluated. In the first version of the Checkmark benchmarking program, application-oriented evaluation was introduced, along with many new attacks not already considered in the literature. A second goal of this paper is to introduce new attacks and new applications into the Checkmark framework. In particular, we introduce the following new applications: video frame watermarking, medical imaging and watermarking of logos. Video frame watermarking includes low compression attacks and distortions which warp the edges of the video as well as general projective transformations which may result from someone filming the screen at a cinema. With respect to medical imaging, only small distortions are considered and furthermore it is essential that no distortions are present at embedding. Finally for logos, we consider images of small sizes and particularly compression, scaling, aspect ratio and other small distortions. The challenge

Epidemiological findings of major chemical attacks in the Syrian war are consistent with civilian targeting: a short report.

Science.gov (United States)

Rodriguez-Llanes, Jose M; Guha-Sapir, Debarati; Schlüter, Benjamin-Samuel; Hicks, Madelyn Hsiao-Rei

2018-01-01

Evidence of use of toxic gas chemical weapons in the Syrian war has been reported by governmental and non-governmental international organizations since the war started in March 2011. To date, the profiles of victims of the largest chemical attacks in Syria remain unknown. In this study, we used descriptive epidemiological analysis to describe demographic characteristics of victims of the largest chemical weapons attacks in the Syrian war. We analysed conflict-related, direct deaths from chemical weapons recorded in non-government-controlled areas by the Violation Documentation Center, occurring from March 18, 2011 to April 10, 2017, with complete information on the victim's date and place of death, cause and demographic group. 'Major' chemical weapons events were defined as events causing ten or more direct deaths. As of April 10, 2017, a total of 1206 direct deaths meeting inclusion criteria were recorded in the dataset from all chemical weapons attacks regardless of size. Five major chemical weapons attacks caused 1084 of these documented deaths. Civilians comprised the majority ( n  = 1058, 97.6%) of direct deaths from major chemical weapons attacks in Syria and combatants comprised a minority of 2.4% ( n  = 26). In the first three major chemical weapons attacks, which occurred in 2013, children comprised 13%-14% of direct deaths, ranging in numbers from 2 deaths among 14 to 117 deaths among 923. Children comprised higher proportions of direct deaths in later major chemical weapons attacks, forming 21% ( n  = 7) of 33 deaths in the 2016 major attack and 34.8% ( n  = 32) of 92 deaths in the 2017 major attack. Our finding of an extreme disparity in direct deaths from major chemical weapons attacks in Syria, with 97.6% of victims being civilians and only 2.4% being combatants provides evidence that major chemical weapons attacks were indiscriminate or targeted civilians directly; both violations of International Humanitarian Law (IHL). Identifying and

Elevated T-wave alternans predicts nonsustained ventricular tachycardia in association with percutaneous coronary intervention in ST-segment elevation myocardial infarction (STEMI) patients.

Science.gov (United States)

Verrier, Richard L; Nearing, Bruce D; Ghanem, Raja N; Olson, Rachel E; Garberich, Ross F; Katsiyiannis, William T; Gornick, Charles C; Tang, Chuen Y; Henry, Timothy D

2013-06-01

Successful reperfusion with primary percutaneous coronary intervention (PCI) can paradoxically elicit temporary vulnerability to ventricular arrhythmia. We examined whether T-wave alternans (TWA) level is correlated with nonsustained ventricular tachycardia (NSVT) incidence in association with PCI in patients with acute ST-segment elevation myocardial infarction (STEMI). We analyzed continuous 24-hour ambulatory electrocardiograms in 48 STEMI patients during and after successful primary PCI, achieving Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. TWA was measured using modified moving average method. Maximum TWA was elevated in patients with (N = 22) compared to without (N = 26) NSVT (75.1 ± 6.3 vs 49.9 ± 3.6 μV, P < 0.005) during the 22-hour monitoring period. TWA ≥ 60μV predicted NSVT with sensitivity of 77%; specificity, 73%; positive predictive value, 71%; and negative predictive value, 79%. Area under receiver operator characteristic curve (AUC) was 0.87 for maximum TWA in predicting NSVT. By comparison, ST-segment levels did not differ in patients with versus without NSVT and were not predictive (AUC = 0.52). TWA was elevated prior to PCI and remained elevated at 30 minutes after balloon inflation despite restoration of TIMI grade 3 flow in all patients, declining by 22 hours (P < 0.05). Maximum ST-segment levels decreased from before PCI to 30 minutes after balloon inflation. TWA is regionally specific, with higher values prior to PCI in precordial lead V5 than in V1 for left coronary lesions. TWA may be useful in identifying individuals at heightened risk for arrhythmia in association with primary PCI and can potentially signal time-dependent changes in arrhythmia vulnerability. © 2013 Wiley Periodicals, Inc.

An Analysis of Attacks on Blockchain Consensus

OpenAIRE

Bissias, George; Levine, Brian Neil; Ozisik, A. Pinar; Andresen, Gavin

2016-01-01

We present and validate a novel mathematical model of the blockchain mining process and use it to conduct an economic evaluation of the double-spend attack, which is fundamental to all blockchain systems. Our analysis focuses on the value of transactions that can be secured under a conventional double-spend attack, both with and without a concurrent eclipse attack. Our model quantifies the importance of several factors that determine the attack's success, including confirmation depth, attacke...

Automated classification of computer network attacks

CSIR Research Space (South Africa)

Van Heerden, R

2013-11-01

Full Text Available according to the relevant types of attack scenarios depicted in the ontology. The two network attack instances are the Distributed Denial of Service attack on SpamHaus in 2013 and the theft of 42 million Rand ($6.7 million) from South African Postbank...

Haemodynamic patterns in ST-elevation myocardial infarction : incidence and correlates of elevated filling pressures

NARCIS (Netherlands)

Bergstra, A.; Svilaas, T.; van Veldhuisen, D. J.; van den Heuvel, A. F. M.; van der Horst, I. C. C.; Zijlstra, F.

Objectives. We sought to study the incidence and clinical correlates of elevated filling pressures in ST-elevation myocardial infarction (STEMI) patients, without physical signs of heart failure and treated with primary coronary angioplasty. Background. Haemodynamic data, as measured with a

Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

DEFF Research Database (Denmark)

Fakhri, Yama; Ersbøll, Mads; Køber, Lars

2016-01-01

OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF...

Cyber Attacks and Combat Behavior

Directory of Open Access Journals (Sweden)

Carataș Maria Alina

2017-01-01

Full Text Available Cyber terrorism is an intangible danger, a real over the corner threat in the life of individuals,organizations, and governments and is getting harder to deal with its damages. The motivations forthe cyber-attacks are different, depending on the terrorist group, from cybercrime to hacktivism,attacks over the authorities’ servers. Organizations constantly need to find new ways ofstrengthening protection against cyber-attacks, assess their cyber readiness, expand the resiliencecapacity and adopts international security regulations.

About Arrhythmia

Science.gov (United States)

... heart beats 60 to 100 times a minute. Electrocardiography (ECG or EKG) is a painless, non-invasive procedure that records ... patient sheets Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Attacks on public telephone networks: technologies and challenges

Science.gov (United States)

Kosloff, T.; Moore, Tyler; Keller, J.; Manes, Gavin W.; Shenoi, Sujeet

2003-09-01

Signaling System 7 (SS7) is vital to signaling and control in America's public telephone networks. This paper describes a class of attacks on SS7 networks involving the insertion of malicious signaling messages via compromised SS7 network components. Three attacks are discussed in detail: IAM flood attacks, redirection attacks and point code spoofing attacks. Depending on their scale of execution, these attacks can produce effects ranging from network congestion to service disruption. Methods for detecting these denial-of-service attacks and mitigating their effects are also presented.

Entanglement generation secure against general attacks

Science.gov (United States)

Pirker, Alexander; Dunjko, Vedran; Dür, Wolfgang; Briegel, Hans J.

2017-11-01

We present a security proof for establishing private entanglement by means of recurrence-type entanglement distillation protocols over noisy quantum channels. We consider protocols where the local devices are imperfect, and show that nonetheless a confidential quantum channel can be established, and used to e.g. perform distributed quantum computation in a secure manner. While our results are not fully device independent (which we argue to be unachievable in settings with quantum outputs), our proof holds for arbitrary channel noise and noisy local operations, and even in the case where the eavesdropper learns the noise. Our approach relies on non-trivial properties of distillation protocols which are used in conjunction with de-Finetti and post-selection-type techniques to reduce a general quantum attack in a non-asymptotic scenario to an i.i.d. setting. As a side result, we also provide entanglement distillation protocols for non-i.i.d. input states.

Defense and attack of complex and dependent systems

International Nuclear Information System (INIS)

Hausken, Kjell

2010-01-01

A framework is constructed for how to analyze the strategic defense of an infrastructure subject to attack by a strategic attacker. Merging operations research, reliability theory, and game theory for optimal analytical impact, the optimization program for the defender and attacker is specified. Targets can be in parallel, series, combined series-parallel, complex, k-out-of-n redundancy, independent, interdependent, and dependent. The defender and attacker determine how much to invest in defending versus attacking each of multiple targets. A target can have economic, human, and symbolic values, subjectively assessed by the defender and attacker. A contest success function determines the probability of a successful attack on each target, dependent on the investments by the defender and attacker into each target, and on characteristics of the contest. The defender minimizes the expected damage plus the defense costs. The attacker maximizes the expected damage minus the attack costs. Each agent is concerned about how his investments vary across the targets, and the impact on his utilities. Interdependent systems are analyzed where the defense and attack on one target impacts all targets. Dependent systems are analyzed applying Markov analysis and repeated games where a successful attack on one target in the first period impacts the unit costs of defense and attack, and the contest intensity, for the other target in the second period.

Defense and attack of complex and dependent systems

Energy Technology Data Exchange (ETDEWEB)

Hausken, Kjell, E-mail: kjell.hausken@uis.n [Faculty of Social Sciences, University of Stavanger, N-4036 Stavanger (Norway)

2010-01-15

A framework is constructed for how to analyze the strategic defense of an infrastructure subject to attack by a strategic attacker. Merging operations research, reliability theory, and game theory for optimal analytical impact, the optimization program for the defender and attacker is specified. Targets can be in parallel, series, combined series-parallel, complex, k-out-of-n redundancy, independent, interdependent, and dependent. The defender and attacker determine how much to invest in defending versus attacking each of multiple targets. A target can have economic, human, and symbolic values, subjectively assessed by the defender and attacker. A contest success function determines the probability of a successful attack on each target, dependent on the investments by the defender and attacker into each target, and on characteristics of the contest. The defender minimizes the expected damage plus the defense costs. The attacker maximizes the expected damage minus the attack costs. Each agent is concerned about how his investments vary across the targets, and the impact on his utilities. Interdependent systems are analyzed where the defense and attack on one target impacts all targets. Dependent systems are analyzed applying Markov analysis and repeated games where a successful attack on one target in the first period impacts the unit costs of defense and attack, and the contest intensity, for the other target in the second period.

Pareto Efficient Solutions of Attack-Defence Trees

DEFF Research Database (Denmark)

Aslanyan, Zaruhi; Nielson, Flemming

2015-01-01

Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes, such as proba......Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes......, such as probability or cost of attacks and defences. In case of multiple parameters most analytical methods optimise one parameter at a time, e.g., minimise cost or maximise probability of an attack. Such methods may lead to sub-optimal solutions when optimising conflicting parameters, e.g., minimising cost while...... maximising probability. In order to tackle this challenge, we devise automated techniques that optimise all parameters at once. Moreover, in the case of conflicting parameters our techniques compute the set of all optimal solutions, defined in terms of Pareto efficiency. The developments are carried out...

Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Hugo Souza Bittencourt

Full Text Available Abstract Non-invasive ventilation (NIV may perfect respiratory and cardiac performance in patients with heart failure (HF. The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients. A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP, continuous positive airway pressure (CPAP, and functional capacity (terms were searched for in English and Portuguese using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration. Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT (68.7m 95%CI: 52.6 to 84.9 in comparison to the control group. We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique.

Defending a single object against an attacker trying to detect a subset of false targets

International Nuclear Information System (INIS)

Peng, R.; Zhai, Q.Q.; Levitin, G.

2016-01-01

Deployment of false targets can be a very important and effective measure for enhancing the survivability of an object subjected to intentional attacks. Existing papers have assumed that false targets are either perfect or can be detected with a constant probability. In practice, the attacker may allocate part of its budget into intelligence actions trying to detect a subset of false targets. Analogously, the defender can allocate part of its budget into disinformation actions to prevent the false targets from being detected. In this paper, the detection probability of each false target is assumed to be a function of the intelligence and disinformation efforts allocated on the false target. The optimal resource distribution between target identification/disinformation and attack/protection efforts is studied as solutions of a non-cooperative two period min–max game between the two competitors for the case of constrained defense and attack resources. - Highlights: • A defense-attack problem is studied as a two-period min–max game. • Both intelligence contest over false targets and impact contest are considered. • Optimal defense and attack strategies are investigated with different parameters.

Cross-site scripting attacks procedure and Prevention Strategies

Directory of Open Access Journals (Sweden)

Wang Xijun

2016-01-01

Full Text Available Cross-site scripting attacks and defense has been the site of attack and defense is an important issue, this paper, the definition of cross-site scripting attacks, according to the current understanding of the chaos on the cross-site scripting, analyzes the causes and harm cross-site scripting attacks formation of attacks XXS complete process XSS attacks made a comprehensive analysis, and then for the web program includes Mobility there are cross-site scripting filter laxity given from ordinary users browse the web and web application developers two the defense cross-site scripting attacks effective strategy.

On the anatomy of social engineering attacks : A literature-based dissection of successful attacks

NARCIS (Netherlands)

Bullee, Jan-Willem; Montoya, L.; Pieters, Wolter; Junger, Marianne; Hartel, Pieter H.

The aim of this studywas to explore the extent towhich persuasion principles are used in successful social engineering attacks. Seventy-four scenarioswere extracted from 4 books on social engineering (written by social engineers) and analysed. Each scenariowas split into attack steps, containing

Liver transplantation from Maastricht category 2 non-heart-beating donors.

Science.gov (United States)

Otero, Alejandra; Gómez-Gutiérrez, Manuel; Suárez, Francisco; Arnal, Francisco; Fernández-García, Antón; Aguirrezabalaga, Javier; García-Buitrón, José; Alvarez, Joaquín; Máñez, Rafael

2003-10-15

The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support (CPS) with simultaneous application of chest and abdominal compression (n=6), and cardiopulmonary bypass (CPB; n=14), which was hypothermic (n=7) or normothermic (n=7), were used to preserve the organs from NHBDs. Factors that may influence the outcome of livers from Maastricht category 2 NHBDs were also investigated. With a minimum follow-up of 2 years, actuarial patient and graft survivals with livers from Maastricht category 2 NHBDs were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with livers from HBDs. Graft survival was 83% in livers from NHBDs preserved with CPS and 42% in those maintained with CPB. No graft failed if the duration of warm ischemia did not exceed 130 min with CPR or CPS, and if the period of CPB did not surpass 150 min when this method was used after CPR, regardless if it was hypothermic or normothermic. Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.

Uso de terapias não convencionais no manejo da crise aguda de asma refratária Non-conventional therapies to manage refractory acute asthma attack

Directory of Open Access Journals (Sweden)

RAQUEL HERMES ROSA OLIVEIRA

2002-09-01

Full Text Available Uma paciente em crise aguda de asma, refratária ao uso de beta2-agonista inalatório e intravenoso, aminofilina intravenosa e corticóide, em ventilação mecânica, foi tratada com métodos terapêuticos não convencionais: broncoscopia, lavado broncoalveolar com N-acetilcisteína e ventilação com halotano. Houve melhora dos parâmetros ventilatórios após o lavado e a resolução do broncoespasmo ocorreu após a anestesia, propiciando a extubação e alta da UTI. É feita uma revisão da literatura sobre o uso desses métodos na crise aguda de asma.A patient with an acute asthma attack refractory to inhaled and intravenous beta2-agonist, aminophylline and corticosteroids was submitted to mechanical ventilation and treated with non-conventional therapies: bronchoscopy with bronchoalveolar lavage using N-acetylcysteine and halothane inhalation. The ventilatory parameters improved after lavage, however, bronchospasm resolution occurred only after anesthesia which was followed by extubation and discharge from the ICU. A review of the use of these non-conventional therapeutic modalities for the management of acute asthma attack is presented.

DDOS ATTACK DETECTION SIMULATION AND HANDLING MECHANISM

Directory of Open Access Journals (Sweden)

Ahmad Sanmorino

2013-11-01

Full Text Available In this study we discuss how to handle DDoS attack that coming from the attacker by using detection method and handling mechanism. Detection perform by comparing number of packets and number of flow. Whereas handling mechanism perform by limiting or drop the packets that detected as a DDoS attack. The study begins with simulation on real network, which aims to get the real traffic data. Then, dump traffic data obtained from the simulation used for detection method on our prototype system called DASHM (DDoS Attack Simulation and Handling Mechanism. From the result of experiment that has been conducted, the proposed method successfully detect DDoS attack and handle the incoming packet sent by attacker.

Model checking exact cost for attack scenarios

DEFF Research Database (Denmark)

Aslanyan, Zaruhi; Nielson, Flemming

2017-01-01

Attack trees constitute a powerful tool for modelling security threats. Many security analyses of attack trees can be seamlessly expressed as model checking of Markov Decision Processes obtained from the attack trees, thus reaping the benefits of a coherent framework and a mature tool support....... However, current model checking does not encompass the exact cost analysis of an attack, which is standard for attack trees. Our first contribution is the logic erPCTL with cost-related operators. The extended logic allows to analyse the probability of an event satisfying given cost bounds and to compute...... the exact cost of an event. Our second contribution is the model checking algorithm for erPCTL. Finally, we apply our framework to the analysis of attack trees....

Infarto agudo del miocardio sin elevación del segmento T: Consideraciones fisiopatológicas y clínicas Heart attack without an elevation of the T segment: Clinical and pathophysiological

Directory of Open Access Journals (Sweden)

Maikel Rodulfo García

2010-09-01

Full Text Available Se revisaron numerosos documentos (impresos y electrónicos sobre afecciones cardiovasculares, particularmente acerca del infarto agudo del miocardio sin elevación del segmento T, teniendo en cuenta que la mortalidad hospitalaria es menor cuando se produce un síndrome coronario con esa característica. Para actualizar el tema se valoraron diversos aspectos relacionados con concepto, clasificación, fisiopatología, diagnóstico, cuadro clínico, exámenes complementarios y factores de riesgo, puesto que las enfermedades del corazón son actualmente la principal causa de muerte en naciones industrializadas y se espera que también lo sean en los países en vías de desarrollo para el 2020, entre ellos Cuba.Several documents (printed and electronic about cardiovascular diseases were reviewed, particularly heart attack without an elevation of the T-segment, taking into account that the hospital mortality is lower when a coronary syndrome with that characteristic occurs. To update the topic several aspects related to concept, classification, pathophysiology, diagnosis, clinical pattern, laboratory tests and risk factors were valued since heart diseases are actually the main cause of death in industrialized nations and it is expected that they will also be the same cause of death in developing countries for 2020, among them, Cuba.

Impact of diagnostic ECG to wire delay in STEMI patients treated with primary PCI - a DANAMI-3 substudy

DEFF Research Database (Denmark)

Nepper-Christensen, Lars; Lønborg, Jacob; Høfsten, Dan Eik

2018-01-01

AIMS: We evaluated the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation...... myocardial infarction (STEMI). METHODS AND RESULTS: We included 1492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size...... (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage of more than 0.50. In a multivariable analysis...

Culprit versus multivessel coronary intervention in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.

Science.gov (United States)

Vaidya, Satyanarayana R; Qamar, Arman; Arora, Sameer; Devarapally, Santhosh R; Kondur, Ashok; Kaul, Prashant

2018-03-01

The 2015 American College of Cardiology/American Heart Association update on primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) recommended PCI of the non-infarct-related artery at the time of primary PCI (class IIb recommendation). Despite evidence supporting complete revascularization in STEMI, its benefit on mortality rates is uncertain. We searched all available databases for randomized controlled trials comparing complete multivessel percutaneous coronary intervention (CMV PCI) with infarct-artery-only revascularization in patients with STEMI. Summary risk ratios and 95% confidence intervals (CIs) were calculated for both the efficacy and safety outcomes. Nine randomized controlled trials fulfilled the inclusion criteria, yielding 2991 patients. Follow-up periods ranged from 6 to 36 months. Compared with infarct-related artery-only PCI, CMV PCI was associated with significantly lower rates of major adverse cardiac events [relative risk (RR)=0.54, 95% CI=0.41-0.71; P<0.00001], cardiovascular mortality (RR=0.48, 95% CI=0.28-0.80; P=0.005), and repeat revascularization (RR=0.38, 95% CI=0.30-0.47; P<0.00001). Although, contrast-induced nephropathy and major bleed rates were comparable between both groups, CMV PCI failed to show any reduction in all-cause mortality (RR=0.75, 95% CI=0.53-1.07; P=0.11) and nonfatal myocardial infarction (RR=0.69, 95% CI=0.43-1.10; P=0.12). Our results suggest that in patients with STEMI and multivessel disease, complete revascularization is safe, and is associated with reduced risks of major adverse cardiac events and cardiac death along with a reduced need for repeat revascularization. However, it showed no beneficial effect on all-cause mortality and nonfatal myocardial infarction.

NETWORK SECURITY ATTACKS. ARP POISONING CASE STUDY

Directory of Open Access Journals (Sweden)

Luminiţa DEFTA

2010-12-01

Full Text Available Arp poisoning is one of the most common attacks in a switched network. A switch is a network device that limits the ability of attackers that use a packet sniffer to gain access to information from internal network traffic. However, using ARP poisoning the traffic between two computers can be intercepted even in a network that uses switches. This method is known as man in the middle attack. With this type of attack the affected stations from a network will have invalid entries in the ARP table. Thus, it will contain only the correspondence between the IP addresses of the stations from the same network and a single MAC address (the station that initiated the attack. In this paper we present step by step the initiation of such an attack in a network with three computers. We will intercept the traffic between two stations using the third one (the attacker.

General individual attack on the ping-pong protocol with completely entangled pairs of qutrits

OpenAIRE

Vasiliu, E. V.

2009-01-01

The general individual (non-coherent) attack on the ping-pong protocol with completely entangled pairs of three-dimensional quantum systems (qutrits) is analyzed. The expression for amount of the eavesdropper's information as functions from probability of attack detection is derived. It is shown, that the security of the ping-pong protocol with pairs of qutrits is higher the security of the protocol with pairs of qubits. It is also shown, that with the use by legitimate users in a control mod...

Is there any difference between Vitamin D deficiency among heart failure and Non-heart failure elderly with cardiovascular disease?

Directory of Open Access Journals (Sweden)

Zohreh Taraghi

2016-02-01

Full Text Available Vitamin D deficiency is common among the elderly with and without heart failure (HF. This study was designed to identify the degree of vitamin D deficiency among HF and Non- HF elderly with cardiovascular disease. In this study, fifty hospitalized elderly patients with HF (26 women and 24 men, age range 60-90 years and fifty elderly without HF were randomly selected. The level of serum 25-hydroxy vitamin D was measured using the Eliza method. There were no significantly difference between two groups regarding to the mean age, living location, life style parameters, mean years of disease involvement and disease severity, cardiovascular risk factors and co-morbidities, except for renal problems(P=0/039, hemoglobin levels(P=0/044, and creatinine levels (P=0/048. In both groups, the majority of patients, were moderately vitamin D deficient and there was no significantly difference between two groups. Considering the high prevalence of vitamin D deficiency among HF and Non-HF elderly with cardiovascular disease, its monitoring and correcting seems essential.

Understanding How Components of Organisations Contribute to Attacks

DEFF Research Database (Denmark)

Gu, Min; Aslanyan, Zaruhi; Probst, Christian W.

2016-01-01

Attacks on organisations today explore many different layers, including buildings infrastructure, IT infrastructure, and human factor – the physical, virtual, and social layer. Identifying possible attacks, understanding their impact, and attributing their origin and contributing factors is diffi......Attacks on organisations today explore many different layers, including buildings infrastructure, IT infrastructure, and human factor – the physical, virtual, and social layer. Identifying possible attacks, understanding their impact, and attributing their origin and contributing factors...... is difficult. Recently, system models have been used for automatically identifying possible attacks on the modelled organisation. The generated attacks consider all three layers, making the contribution of building infrastructure, computer infrastructure, and humans (insiders and outsiders) explicit. However......, this contribution is only visible in the attack trees as part of the performed steps; it cannot be mapped back to the model directly since the actions usually involve several elements (attacker and targeted actor or asset). Especially for large attack trees, understanding the relations between several model...

Remote Zone Extracellular Volume and Left Ventricular Remodeling in Survivors of ST-Elevation Myocardial Infarction

Science.gov (United States)

Carberry, Jaclyn; Carrick, David; Haig, Caroline; Rauhalammi, Samuli M.; Ahmed, Nadeem; Mordi, Ify; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, Mitchell; Davie, Andrew; Mahrous, Ahmed; Ford, Ian; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Oldroyd, Keith G.

2016-01-01

The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; Premote zone ECV (Premote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (Premote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10–2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:27354423

Attack Graph Construction for Security Events Analysis

Directory of Open Access Journals (Sweden)

Andrey Alexeevich Chechulin

2014-09-01

Full Text Available The paper is devoted to investigation of the attack graphs construction and analysis task for a network security evaluation and real-time security event processing. Main object of this research is the attack modeling process. The paper contains the description of attack graphs building, modifying and analysis technique as well as overview of implemented prototype for network security analysis based on attack graph approach.

Quantum Encryption Minimising Key Leakage under Known Plaintext Attacks

DEFF Research Database (Denmark)

Pedersen, Thomas Brochmann

2006-01-01

, or interactive encryption schemes, where the interaction does not need to occur online. In our model we show that the amount of key leaked under a known plaintext attack can be made arbitrarily small even in non-interactive encryption schemes. We also give an encryption scheme where eavesdropping can be detected....... In this encryption scheme the entire key can be safely recycled when no eavesdropping is detected....

Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction

DEFF Research Database (Denmark)

Brainin, Philip; Haahr-Pedersen, Sune; Sengeløv, Morten

2018-01-01

echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex......Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow...... incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95...

Automated Discovery of Mimicry Attacks

National Research Council Canada - National Science Library

Giffin, Jonathon T; Jha, Somesh; Miller, Barton P

2006-01-01

.... These systems are useful only if they detect actual attacks. Previous research developed manually-constructed mimicry and evasion attacks that avoided detection by hiding a malicious series of system calls within a valid sequence allowed by the model...

Dermatologia comparativa: lesão de ataque por caravela portuguesa (Physalia physalis Comparative dermatology: skin lesion produced by attack of jellyfishes (Physalia physalis

Directory of Open Access Journals (Sweden)

Maria do Carmo Araújo Palmeira Queiroz

2011-06-01

Full Text Available Demonstra-se lesão dermatológica, em caprichoso formato de coração, característica de ataque por caravela-portuguesa, em banhista do sexo feminino, 21 anosIt is reported the case of a 21-year-old female bather with a skin lesion, heart-shaped ,characteristic of attack by jellyfish

Correlation between GDF-15 gene polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction.

Science.gov (United States)

Chen, Xiao-Ping; Shang, Xiao-Sen; Wang, Yan-Bin; Fu, Zhi-Hua; Gao, Yu; Feng, Tao

2017-12-01

To explore the correlation between growth differentiation factor 15 (GDF-15) -3148C/G polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction (STEMI) in Han population of Taiyuan area. The present study included 92 STEMI patients and 56 normal controls based on coronary angiography; STEMI group was divided into collateral group and non-collateral group according to Rentrop's grading method. Polymerase chain reaction (PCR) and DNA sequencing methods were used to detect and analyze the GDF-15 -3148C/G polymorphism in all participants. There was significant difference in GDF-15 -3148C/G CC and GC distribution between STEMI group and control group (p=0.009); the allele frequencies between these two groups were also significant different (p=0.016); and the risk genotype for STEMI was CC with increased OR=2.660. For STEMI group, GDF-15 -3148C/G CC and GC distribution was also significantly different between patients with and without collateral (p=0.048), and CC genotype significantly promote the formation of collateral circulation. However, there were no significant differences in allele frequencies between these two subgroups of STEMI. There was correlation between GDF-15-3148C/G polymorphism and the formation of collateral circulation in patients with acute STEMI.

Biological rhythm in 1/f fluctuations of heart rate in asthmatic children

Directory of Open Access Journals (Sweden)

Norio Kazuma

2004-01-01

Conclusion: During an asthma attack, the rhythm of 1/f fluctuations is ultradian (cycle length under 20 h, compared with various rhythms during a non-attack period. In future, we will clarify the relevance of the ultradian rhythm of 1/f fluctuations over a 24 h period and the biological life-support system at a point of time of an asthma attack.

Transforming Graphical System Models to Graphical Attack Models

DEFF Research Database (Denmark)

Ivanova, Marieta Georgieva; Probst, Christian W.; Hansen, Rene Rydhof

2016-01-01

Manually identifying possible attacks on an organisation is a complex undertaking; many different factors must be considered, and the resulting attack scenarios can be complex and hard to maintain as the organisation changes. System models provide a systematic representation of organisations...... approach to transforming graphical system models to graphical attack models in the form of attack trees. Based on an asset in the model, our transformations result in an attack tree that represents attacks by all possible actors in the model, after which the actor in question has obtained the asset....

When Sinuses Attack! (For Kids)

Science.gov (United States)

... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... Search English Español When Sinuses Attack! KidsHealth / For Kids / When Sinuses Attack! What's in this article? What ...

Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome.

Science.gov (United States)

Mueller, Matthias; Biener, Moritz; Vafaie, Mehrshad; Doerr, Susanne; Keller, Till; Blankenberg, Stefan; Katus, Hugo A; Giannitsis, Evangelos

2012-01-01

We evaluated kinetic changes of high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute coronary syndrome (ACS) and patients with hs-cTnT increases not due to ACS to rule in or rule out non-ST-segment elevation myocardial infarction (STEMI). hs-cTnT was measured serially in consecutive patients presenting to the emergency department. Patients with ACS who had at least 2 hs-cTnT measurements within 6 h and non-ACS patients with hs-cTnT concentrations above the 99th percentile value (14 ng/L) were enrolled to compare absolute and relative kinetic changes of hs-cTnT. For discrimination of non-STEMI (n=165) in the entire study population (n=784), the absolute δ change with the ROC-optimized value of 9.2 ng/L yielded an area under the curve of 0.898 and was superior to all relative δ changes (Prise or fall of at least 9.2 ng/L in the entire study population and 6.9 ng/L in selected ACS patients seems adequate to rule-out non-STEMI. However, δ-values are useful to rule-in non-STEMI only in a specific ACS population.

Reperfusion therapy in ST-segment elevation myocardial infarction in the Veteran Administration Caribbean Healthcare System; search for improvement.

Science.gov (United States)

Escabí-Mendoza, José

2008-01-01

Patients that present with acute STEMI have proven morbidity and mortality benefit from early reperfusion therapy. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend either fibrinolytic therapy within 30 minutes or a primary percutaneous coronary intervention (PPCI) within 90 minutes of patients arrival to the Emergency Department. Despite these recommendations, some patients do not receive reperfusion therapy and less than half receive it on time. Describe and analyze our reperfusion therapy performance in patients presenting with acute ST segment elevation myocardial infarct (STEMI) in the Veteran Administration Caribbean Healthcare System (VACHS), and determine potential causes for reperfusion therapy delays and develop strategies and a tailored algorithm according to our clinical findings and available institutional resources. Retrospective analysis of patients admitted to the VACHS with a discharge diagnosis of STEMI, from 01/01/2007 until 04/10/2008. A total of 55 patients met inclusion criteria for STEMI diagnosis. Of these, only 30 patients had active indication for reperfusion therapy. Reperfusion therapy was given in 97% of the cases, 69% with PPCI and 31% with fibrinolytic therapy (tenecteplase). In general the selection of reperfusion therapy seemed adherent to ACC/AHA STEMI guidelines. The reperfusion time goal was superior with thrombolytic therapy compared to PPCI, with 43% and 15% respectively. PPCI performed off regular tour of duty was significantly delayed compared to regular day shift, with a mean time of 221 and 113 minutes respectively (p=0.027). Most of the patients presenting with STEMI to the VACHS undergo reperfusion therapy. PPCI was the most frequent selected reperfusion approach. The PPCI time goal was infrequently met. The most significant cause for PPCI delay was related to performance off regular tour of duty. These finding support the implementation of a tailored STEMI reperfusion algorithm

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

DEFF Research Database (Denmark)

Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

2015-01-01

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11......,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST......-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical...

Software-based Microarchitectural Attacks

OpenAIRE

Gruss, Daniel

2017-01-01

Modern processors are highly optimized systems where every single cycle of computation time matters. Many optimizations depend on the data that is being processed. Software-based microarchitectural attacks exploit effects of these optimizations. Microarchitectural side-channel attacks leak secrets from cryptographic computations, from general purpose computations, or from the kernel. This leakage even persists across all common isolation boundaries, such as processes, containers, and virtual ...

Integrating cyber attacks within fault trees

International Nuclear Information System (INIS)

Nai Fovino, Igor; Masera, Marcelo; De Cian, Alessio

2009-01-01

In this paper, a new method for quantitative security risk assessment of complex systems is presented, combining fault-tree analysis, traditionally used in reliability analysis, with the recently introduced Attack-tree analysis, proposed for the study of malicious attack patterns. The combined use of fault trees and attack trees helps the analyst to effectively face the security challenges posed by the introduction of modern ICT technologies in the control systems of critical infrastructures. The proposed approach allows considering the interaction of malicious deliberate acts with random failures. Formal definitions of fault tree and attack tree are provided and a mathematical model for the calculation of system fault probabilities is presented.

Integrating cyber attacks within fault trees

Energy Technology Data Exchange (ETDEWEB)

Nai Fovino, Igor [Joint Research Centre - EC, Institute for the Protection and Security of the Citizen, Ispra, VA (Italy)], E-mail: igor.nai@jrc.it; Masera, Marcelo [Joint Research Centre - EC, Institute for the Protection and Security of the Citizen, Ispra, VA (Italy); De Cian, Alessio [Department of Electrical Engineering, University di Genova, Genoa (Italy)

2009-09-15

In this paper, a new method for quantitative security risk assessment of complex systems is presented, combining fault-tree analysis, traditionally used in reliability analysis, with the recently introduced Attack-tree analysis, proposed for the study of malicious attack patterns. The combined use of fault trees and attack trees helps the analyst to effectively face the security challenges posed by the introduction of modern ICT technologies in the control systems of critical infrastructures. The proposed approach allows considering the interaction of malicious deliberate acts with random failures. Formal definitions of fault tree and attack tree are provided and a mathematical model for the calculation of system fault probabilities is presented.

Attack and Vulnerability Penetration Testing: FreeBSD

Directory of Open Access Journals (Sweden)

Abdul Hanan Abdullah

2013-07-01

Full Text Available Computer system security has become a major concern over the past few years. Attacks, threasts or intrusions, against computer system and network have become commonplace events. However, there are some system devices and other tools that are available to overcome the threat of these attacks. Currently, cyber attack is a major research and inevitable. This paper presents some steps of penetration in FreeBSD operating system, some tools and new steps to attack used in this experiment, probes for reconnaissance, guessing password via brute force, gaining privilege access and flooding victim machine to decrease availability. All these attacks were executed and infiltrate within the environment of Intrusion Threat Detection Universiti Teknologi Malaysia (ITD UTM data set. This work is expected to be a reference for practitioners to prepare their systems from Internet attacks.

Simulating SQL-Injection Cyber-attacks using GNS3

OpenAIRE

Al-Mahrouqi, Aadil; Tobin, Patrick; Abdalla, Sameh; Kechadi, Tahar

2015-01-01

Network Forensics is a subtopic of Digital Forensics wherein research on artificat investigations and intrusions evidence acquisition is addressed. Among many challenges in the field, the problem of losing data artifacts in the state of flux, (i.e., live volatile data), when network devices are suddenly non-operational remains a topic of interest to many investigators. The main objective of this article is to simulate an SQL injection attack scenarios in a complex network environment. We desi...

Superposition Attacks on Cryptographic Protocols

DEFF Research Database (Denmark)

Damgård, Ivan Bjerre; Funder, Jakob Løvstad; Nielsen, Jesper Buus

2011-01-01

of information. In this paper, we introduce a fundamentally new model of quantum attacks on classical cryptographic protocols, where the adversary is allowed to ask several classical queries in quantum superposition. This is a strictly stronger attack than the standard one, and we consider the security......Attacks on classical cryptographic protocols are usually modeled by allowing an adversary to ask queries from an oracle. Security is then defined by requiring that as long as the queries satisfy some constraint, there is some problem the adversary cannot solve, such as compute a certain piece...... of several primitives in this model. We show that a secret-sharing scheme that is secure with threshold $t$ in the standard model is secure against superposition attacks if and only if the threshold is lowered to $t/2$. We use this result to give zero-knowledge proofs for all of NP in the common reference...

Coping with Feelings

Medline Plus

Full Text Available ... a Heart Attack Treatment of a Heart Attack Life After a Heart Attack Heart Failure About Heart Failure Causes and Risks for Heart ... Cardiac Rehab? How Can I Live With Heart Failure? Medication Chart | Spanish Medical Contact List Preparing for ... Attack website Caregivers Nutrition Center Cardiac ...

Recurrent spontaneous attacks of dizziness.

Science.gov (United States)

Lempert, Thomas

2012-10-01

This article describes the common causes of recurrent vertigo and dizziness that can be diagnosed largely on the basis of history. Ninety percent of spontaneous recurrent vertigo and dizziness can be explained by six disorders: (1) Ménière disease is characterized by vertigo attacks, lasting 20 minutes to several hours, with concomitant hearing loss, tinnitus, and aural fullness. Aural symptoms become permanent during the course of the disease. (2) Attacks of vestibular migraine may last anywhere from minutes to days. Most patients have a previous history of migraine headaches, and many experience migraine symptoms during the attack. (3) Vertebrobasilar TIAs affect older adults with vascular risk factors. Most attacks last less than 1 hour and are accompanied by other symptoms from the posterior circulation territory. (4) Vestibular paroxysmia is caused by vascular compression of the eighth cranial nerve. It manifests itself with brief attacks of vertigo that recur many times per day, sometimes with concomitant cochlear symptoms. (5) Orthostatic hypotension causes brief episodes of dizziness lasting seconds to a few minutes after standing up and is relieved by sitting or lying down. In older adults, it may be accompanied by supine hypertension. (6) Panic attacks usually last minutes, occur in specific situations, and are accompanied by choking, palpitations, tremor, heat, and anxiety. Less common causes of spontaneous recurrent vertigo and dizziness include perilymph fistula, superior canal dehiscence, autoimmune inner ear disease, otosclerosis, cardiac arrhythmia, and medication side effects. Neurologists need to venture into otolaryngology, internal medicine, and psychiatry to master the differential diagnosis of recurrent dizziness.

Multivariate Autoregressive Model Based Heart Motion Prediction Approach for Beating Heart Surgery

Directory of Open Access Journals (Sweden)

Fan Liang

2013-02-01

Full Text Available A robotic tool can enable a surgeon to conduct off-pump coronary artery graft bypass surgery on a beating heart. The robotic tool actively alleviates the relative motion between the point of interest (POI on the heart surface and the surgical tool and allows the surgeon to operate as if the heart were stationary. Since the beating heart's motion is relatively high-band, with nonlinear and nonstationary characteristics, it is difficult to follow. Thus, precise beating heart motion prediction is necessary for the tracking control procedure during the surgery. In the research presented here, we first observe that Electrocardiography (ECG signal contains the causal phase information on heart motion and non-stationary heart rate dynamic variations. Then, we investigate the relationship between ECG signal and beating heart motion using Granger Causality Analysis, which describes the feasibility of the improved prediction of heart motion. Next, we propose a nonlinear time-varying multivariate vector autoregressive (MVAR model based adaptive prediction method. In this model, the significant correlation between ECG and heart motion enables the improvement of the prediction of sharp changes in heart motion and the approximation of the motion with sufficient detail. Dual Kalman Filters (DKF estimate the states and parameters of the model, respectively. Last, we evaluate the proposed algorithm through comparative experiments using the two sets of collected vivo data.

Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis.

Science.gov (United States)

Schmucker, J; Seide, S; Wienbergen, H; Fiehn, E; Stehmeier, J; Günther, K; Ahrens, W; Hambrecht, R; Pohlabeln, H; Fach, A

2017-09-22

The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants  3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

Non-contact procedure to measure heart and lung activities in preterm pediatric patients with skin disorders

Science.gov (United States)

Marchionni, P.; Scalise, L.; Antognoli, L.; Nobile, S.; Carnielli, V. P.

2018-04-01

Preterm patients can have an higher risk of fatalities and can be subjected to long-term disability. With many organs still in the phase of development, the earlier the delivery, the higher the risk and they are therefore hospitalized in specialized neonatal intensive care units) where heart rate and lungs activity are continuously assessed. These are mostly monitored by set of electrodes placed in contact with skin (two in thorax area and one in abdominal area). This paper address the problem of preterm cardiac and respiratory monitoring in a patient with severe skin disorders who can not monitored with standard electrodes because of his dry, thickened, scaly skin. As a solution, we propose a fully non-contact measurement method, based on laser Doppler vibrometry, able to continuously record the movements of wall-chest and extract from this signal, the heart rate and the respiratory activity of the patient. The results show a good agreement between the standard contact measurement methods and the proposed one (no statistical difference between data) with a data uncertainty of 2.9% for the heart rate data and of 9.5% for the respiration rate (k=2), in line with the classical measurement methods.

Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial).

Science.gov (United States)

Popovic, Batric; Girerd, Nicolas; Rossignol, Patrick; Agrinier, Nelly; Camenzind, Edoardo; Fay, Renaud; Pitt, Bertram; Zannad, Faiez

2016-11-15

The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

Predictive Value of Elevated Uric Acid in Turkish Patients Undergoing Primary Angioplasty for ST Elevation Myocardial Infarction.

Science.gov (United States)

Akgul, Ozgur; Uyarel, Huseyin; Pusuroglu, Hamdi; Gul, Mehmet; Isiksacan, Nilgun; Turen, Selahattin; Erturk, Mehmet; Surgit, Ozgur; Cetin, Mustafa; Bulut, Umit; Baycan, Omer Faruk; Uslu, Nevzat

2014-03-01

Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum UA levels have been correlated with all major forms of death from cardiovascular disease, including acute, subacute, and chronic forms of coronary artery disease (CAD), heart failure, and stroke. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of UA in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We prospectively enrolled 434 consecutive Turkish STEMI patients (mean age 55.4 ± 12.4 years, 341 male, 93 female) undergoing primary PCI. The study population was divided into tertiles based on admission UA values. The high UA group (n = 143) was defined as a value in the third tertile (> 5.7 mg/dl), and the low UA group (n = 291) included those patients with a value in the lower two tertiles (≤ 5.7 mg/dl). Clinical characteristics, in-hospital and six-month outcomes of primary PCI were analyzed. Compared to the low UA group, only Killip class > 1 at admission was more prevalent in the high UA group (3.4% vs. 17.5%, p 5.7 mg/dl) was found to be a powerful independent predictor of six-month all-cause mortality (hazard ratio: 5.57, 95% confidence interval: 1.903-16.3, p = 0.002). These results suggest that a high level of UA on admission was associated with increased in-hospital cardiovascular mortality, and six-month all-cause mortality in Turkish patients with STEMI undergoing primary PCI. Primary angioplasty; ST elevation myocardial infarction; Uric acid.

Final infarct size measured by cardiovascular magnetic resonance in patients with ST elevation myocardial infarction predicts long-term clinical outcome

DEFF Research Database (Denmark)

Lønborg, Jacob Thomsen; Vejlstrup, Niels Grove; Kelbæk, Henning Skov

2013-01-01

AIMS: Tailored heart failure treatment and risk assessment in patients following ST-segment elevation myocardial infarction (STEMI) is mainly based on the assessment of the left ventricular (LV) ejection fraction (EF). Assessment of the final infarct size in addition to the LVEF may improve...

Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

NARCIS (Netherlands)

Hemradj, V.V.; Ottervanger, J.P.; Boer, M.J. de; Suryapranata, H.

2017-01-01

BACKGROUND: Cardiogenic shock (CS) is a strong predictor of mortality in patients with ST-elevation myocardial infarction (STEMI), but there is evidence that shock index (SI), taking into account both blood pressure and heart rate, is a more sensitive and powerful predictor. We investigated the

Shark Attack Project - Marine Attack at Towed Hydrophone Arrays

National Research Council Canada - National Science Library

Kalmijn, Adrianus J

2005-01-01

The original objective of the SIO Marine Attack project was to identify the electric and magnetic fields causing sharks to inflict serious damage upon the towed hydrophone arrays of US Navy submarines...

Novel Method For Low-Rate Ddos Attack Detection

Science.gov (United States)

Chistokhodova, A. A.; Sidorov, I. D.

2018-05-01

The relevance of the work is associated with an increasing number of advanced types of DDoS attacks, in particular, low-rate HTTP-flood. Last year, the power and complexity of such attacks increased significantly. The article is devoted to the analysis of DDoS attacks detecting methods and their modifications with the purpose of increasing the accuracy of DDoS attack detection. The article details low-rate attacks features in comparison with conventional DDoS attacks. During the analysis, significant shortcomings of the available method for detecting low-rate DDoS attacks were found. Thus, the result of the study is an informal description of a new method for detecting low-rate denial-of-service attacks. The architecture of the stand for approbation of the method is developed. At the current stage of the study, it is possible to improve the efficiency of an already existing method by using a classifier with memory, as well as additional information.

Exploratory study into the awareness of heart diseases among Emirati women (UAE) and their health seeking behaviour- a qualitative study.

Science.gov (United States)

Khan, Sarah; Khoory, Ayesha; Al Zaffin, Dhabia; Al Suwaidi, Meera

2016-11-07

Cardiovascular diseases were the leading cause of death in women in the United Arab Emirates (UAE) in 2010. The UAE is expected to experience a tripling of heart diseases in the next two decades as risk factors for heart diseases increase. Research shows that first year survival rates of younger women suffering from a heart attack are lower than in men. Women present with a wider range of symptoms for heart diseases than men; non-recognition of atypical symptoms may explain the delay in seeking treatment and poor prognosis following heart diseases in women. No known study on awareness of heart diseases among women has been carried out in the Middle Eastern region. Social constructionist and interpretivist epistemological approaches have been considered in this qualitative study to explore the awareness of heart diseases and the health seeking behavior of Emirati women. Convenience sampling was used to recruit 41 Emirati women. Three focus groups and six in-depth semi-structured interviews were conducted to obtain data. Thematic content analysis was applied to the data following transcription and translation of recordings. Emirati women had limited knowledge on heart diseases. Women were generally unaware of the atypical symptoms, commonly experienced by women however they identified most risk factors associated with heart diseases. Lack of awareness of disease severity and symptoms, sociocultural influences and distrust in the healthcare system were considered the main barriers to seeking prompt treatment. This study clearly identified gaps and inaccuracies in knowledge of heart diseases, which could contribute to delayed health seeking action and possibly poorer prognosis among Emirati women. Absence of initiatives to educate women on cardiovascular diseases in UAE has erroneously deemed it a less serious concern among Emirati women. The findings from this study provide clear indications of the need to increase accountability of the healthcare system and to

Automatic Classification of Attacks on IP Telephony

Directory of Open Access Journals (Sweden)

Jakub Safarik

2013-01-01

Full Text Available This article proposes an algorithm for automatic analysis of attack data in IP telephony network with a neural network. Data for the analysis is gathered from variable monitoring application running in the network. These monitoring systems are a typical part of nowadays network. Information from them is usually used after attack. It is possible to use an automatic classification of IP telephony attacks for nearly real-time classification and counter attack or mitigation of potential attacks. The classification use proposed neural network, and the article covers design of a neural network and its practical implementation. It contains also methods for neural network learning and data gathering functions from honeypot application.

Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program.

Science.gov (United States)

Deedwania, Prakash; Acharya, Tushar; Kotak, Kamal; Fonarow, Gregg C; Cannon, Christopher P; Laskey, Warren K; Peacock, W Frank; Pan, Wenqin; Bhatt, Deepak L

2017-05-01

To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS). Study population consisted of 151,270 patients admitted with ACS from 2002 through 2008 at 411 sites participating in the American Heart Association's Get with the Guidelines (GWTG) program. Demographic variables, physical exam findings, laboratory data, left ventricular ejection fraction, length of stay, in-hospital mortality and discharge medications were compared between diabetic and non-diabetic patients. Temporal trends in compliance with guidelines directed therapy were evaluated. Of 151,270 patients, 48,938 (32%) had diabetes. Overall, diabetic patients were significantly older and more likely non-white. They had significantly more hypertension, atherosclerotic disease, CKD, and LV dysfunction and were more likely to present as NSTEMI. They had longer hospital stay and higher hospital mortality than non-diabetic patients. Diabetic patients were less likely to get LDL checks (65% vs 70%) and less frequently prescribed statins (85% vs 89%), RAAS blockers for LV dysfunction (80% vs 84%) and dual-antiplatelet therapy (69% vs 74%). Diabetic patients were less likely to achieve BP goals before discharge (75% vs 82%). Fewer diabetic patients met first medical contact to PCI time for STEMI (44% vs 52%). Temporal trends, however, showed continued progressive improvement in most performance measures from 2002 to 2008 (all P<.001). These data from a large cohort of ACS patients demonstrate gaps in compliance with guidelines directed therapy in diabetic patients but also indicate significant and continued improvement in most performance measures over time. Concerted efforts are needed to continue this positive trend. Copyright © 2017. Published by Elsevier Inc.

Further attacks on Yeung-Mintzer fragile watermarking scheme

Science.gov (United States)

Fridrich, Jessica; Goljan, Miroslav; Memon, Nasir D.

2000-05-01

In this paper, we describe new and improved attacks on the authentication scheme previously proposed by Yeung and Mintzer. Previous attacks assumed that the binary watermark logo inserted in an image for the purposes of authentication was known. Here we remove that assumption and show how the scheme is still vulnerable, even if the binary logo is not known but the attacker has access to multiple images that have been watermarked with the same secret key and contain the same (but unknown) logo. We present two attacks. The first attack infers the secret watermark insertion function and the binary logo, given multiple images authenticated with the same key and containing the same logo. We show that a very good approximation to the logo and watermark insertion function can be constructed using as few as two images. With color images, one needs many more images, nevertheless the attack is still feasible. The second attack we present, which we call the 'collage-attack' is a variation of the Holliman-Memon counterfeiting attack. The proposed variation does not require knowledge of the watermark logo and produces counterfeits of superior quality by means of a suitable dithering process that we develop.

Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients.

Science.gov (United States)

Moumneh, Thomas; Richard-Jourjon, Vanessa; Friou, Emilie; Prunier, Fabrice; Soulie-Chavignon, Caroline; Choukroun, Jacques; Mazet-Guilaumé, Betty; Riou, Jérémie; Penaloza, Andréa; Roy, Pierre-Marie

2018-03-02

In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0-1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0-0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

Pareto Efficient Solution of Attack-Defence Trees

NARCIS (Netherlands)

Aslanyan, Zaruhi; Nielson, Flemming

Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes, such as

Genetic attack on neural cryptography.

Science.gov (United States)

Ruttor, Andreas; Kinzel, Wolfgang; Naeh, Rivka; Kanter, Ido

2006-03-01

Different scaling properties for the complexity of bidirectional synchronization and unidirectional learning are essential for the security of neural cryptography. Incrementing the synaptic depth of the networks increases the synchronization time only polynomially, but the success of the geometric attack is reduced exponentially and it clearly fails in the limit of infinite synaptic depth. This method is improved by adding a genetic algorithm, which selects the fittest neural networks. The probability of a successful genetic attack is calculated for different model parameters using numerical simulations. The results show that scaling laws observed in the case of other attacks hold for the improved algorithm, too. The number of networks needed for an effective attack grows exponentially with increasing synaptic depth. In addition, finite-size effects caused by Hebbian and anti-Hebbian learning are analyzed. These learning rules converge to the random walk rule if the synaptic depth is small compared to the square root of the system size.

Genetic attack on neural cryptography

International Nuclear Information System (INIS)

Ruttor, Andreas; Kinzel, Wolfgang; Naeh, Rivka; Kanter, Ido

2006-01-01

Different scaling properties for the complexity of bidirectional synchronization and unidirectional learning are essential for the security of neural cryptography. Incrementing the synaptic depth of the networks increases the synchronization time only polynomially, but the success of the geometric attack is reduced exponentially and it clearly fails in the limit of infinite synaptic depth. This method is improved by adding a genetic algorithm, which selects the fittest neural networks. The probability of a successful genetic attack is calculated for different model parameters using numerical simulations. The results show that scaling laws observed in the case of other attacks hold for the improved algorithm, too. The number of networks needed for an effective attack grows exponentially with increasing synaptic depth. In addition, finite-size effects caused by Hebbian and anti-Hebbian learning are analyzed. These learning rules converge to the random walk rule if the synaptic depth is small compared to the square root of the system size

Genetic attack on neural cryptography

Science.gov (United States)

Ruttor, Andreas; Kinzel, Wolfgang; Naeh, Rivka; Kanter, Ido

2006-03-01

Different scaling properties for the complexity of bidirectional synchronization and unidirectional learning are essential for the security of neural cryptography. Incrementing the synaptic depth of the networks increases the synchronization time only polynomially, but the success of the geometric attack is reduced exponentially and it clearly fails in the limit of infinite synaptic depth. This method is improved by adding a genetic algorithm, which selects the fittest neural networks. The probability of a successful genetic attack is calculated for different model parameters using numerical simulations. The results show that scaling laws observed in the case of other attacks hold for the improved algorithm, too. The number of networks needed for an effective attack grows exponentially with increasing synaptic depth. In addition, finite-size effects caused by Hebbian and anti-Hebbian learning are analyzed. These learning rules converge to the random walk rule if the synaptic depth is small compared to the square root of the system size.

Ischaemic heart disease

International Nuclear Information System (INIS)

Ruttley, M.

1985-01-01

Radiology has an important role in the diagnosis and management of ischaemic heart disease, notably in the investigation of angina pectoris, the monitoring of acute myocardial infarction and the assessment of its non-fatal complications; recent application of catheter techniques to the treatment of ischaemic heart disease has been a progression from Dotter's original work on peripheral arterial dilation made possible by Gruntzig's development of a suitable dilating catheter for coronary stenosis

Attacks on the AJPS Mersenne-based cryptosystem

NARCIS (Netherlands)

K. de Boer (Koen); L. Ducas (Léo); S. Jeffery (Stacey); R. M. de Wolf (Ronald)

2018-01-01

textabstractAggarwal, Joux, Prakash and Santha recently introduced a new potentially quantum-safe public-key cryptosystem, and suggested that a brute-force attack is essentially optimal against it. They consider but then dismiss both Meet-in-the-Middle attacks and LLL-based attacks. Very soon after

The political attack ad

Directory of Open Access Journals (Sweden)

Palma Peña-Jiménez, Ph.D.

2011-01-01

Full Text Available During election campaigns the political spot has a clear objective: to win votes. This message is communicated to the electorate through television and Internet, and usually presents a negative approach, which includes a direct critical message against the opponent, rather than an exposition of proposals. This article is focused on the analysis of the campaign attack video ad purposely created to encourage the disapproval of the political opponent among voters. These ads focus on discrediting the opponent, many times, through the transmission of ad hominem messages, instead of disseminating the potential of the political party and the virtues and manifesto of its candidate. The article reviews the development of the attack ad since its first appearance, which in Spain dates back to 1996, when the famous Doberman ad was broadcast, and examines the most memorable campaign attack ads.

Robust Detection of Stepping-Stone Attacks

National Research Council Canada - National Science Library

He, Ting; Tong, Lang

2006-01-01

The detection of encrypted stepping-stone attack is considered. Besides encryption and padding, the attacker is capable of inserting chaff packets and perturbing packet timing and transmission order...

A Framework for Attack-Resilient Industrial Control Systems : Attack Detection and Controller Reconfiguration

OpenAIRE

Paridari, Kaveh; O'Mahony, Niamh; Mady, Alie El-Din; Chabukswar, Rohan; Boubekeur, Menouer; Sandberg, Henrik

2017-01-01

Most existing industrial control systems (ICSs), such as building energy management systems (EMSs), were installed when potential security threats were only physical. With advances in connectivity, ICSs are now, typically, connected to communications networks and, as a result, can be accessed remotely. This extends the attack surface to include the potential for sophisticated cyber attacks, which can adversely impact ICS operation, resulting in service interruption, equipment damage, safety c...

Cardio MRI right heart assessment

International Nuclear Information System (INIS)

Genova, K.

2013-01-01

Full text: Introduction: In recent years, the evaluation of the function and morphology of the right heart caused increasing interest as right sided dysfunction is an important prognostic factor in many cardiovascular diseases. Modern MRI technique is the method of choice for precise assessment of the morphology and function of the right heart and is increasingly used in routine practice. What you will learn: Selecting appropriate techniques tailored to the morphology and function of right heart and conform to accepted standards is crucial for obtaining diagnostic imaging. This requires, as knowledge of the art of study, and diseases that assessment of right heart is key. The various techniques used and the specifics of the study protocol in the underlying disease leading to right dysfunction, consistent with standards and based on our experience will be presented. Discussion: The function of the right heart and in particular right sided function affects the prognosis of a number of cardiovascular diseases. Right sided morphology and function are assessed in terms of hemodynamic and prognostic significance in a number of heart and lung diseases. This enables clinicians to refine therapy, monitoring the effect of treatment and appropriate adjustment and precise timing invasive procedure or surgery. Knowing the capabilities and limitations of the method, combined with clinically - oriented approach are prerequisites for accurate and informative assessment of the right heart. Conclusion: Cardiac MRI is a method that allows precise , non-invasive and non- ionizing radiation morphological and functional assessment of the right heart, with the evaluation of the pulmonary circulation, which determines its key importance in conditions requiring assessment of right heart

An Adaptive Approach for Defending against DDoS Attacks

Directory of Open Access Journals (Sweden)

Muhai Li

2010-01-01