Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Indians have high rates of cardiovascular disease. Hypertension (HTN) is an important modifiable risk factor. There are no comprehensive reviews or a nationally representative study of the burden, treatments and outcomes of HTN in India. A systematic review was conducted to study the trends in prevalence, risk factors and awareness of HTN in India. We searched MEDLINE from January 1969 to July 2011 using prespecified medical subject heading (MeSH) terms. Of 3372 studies, 206 were included for data extraction and 174 were observational studies. Prevalence was reported in 48 studies with sample size varying from 206 to 167 331. A significant positive trend (P<0.0001) was observed over time in prevalence of HTN by region and gender. Awareness and control of HTN (11 studies) ranged from 20 to 54% and 7.5 to 25%, respectively. Increasing age, body mass index, smoking, diabetes and extra salt intake were common risk factors. In conclusion, from this systematic review, we record an increasing trend in prevalence of HTN in India by region and gender. The awareness of HTN in India is low with suboptimal control rates. There are few long-term studies to assess outcomes. Good quality long-term studies will help to understand HTN better and implement effective prevention and management programs.

No abstract

The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

Particle dispersion and deposition in the region near the wall of a turbulent open channel is studied using direct numerical simulation of the flow, combined with Lagrangian particle tracking under conditions of one-way coupling. Particles with response times of 5 and 15, normalized using the wall friction velocity and the fluid kinematic viscosity, are considered. The simulations were performed until the particle phase reached a statistically stationary state before calculating relevant statistics. For both response times, particles are seen to accumulate strongly very close to the wall in the form of streamwise oriented streaks. Deposited particles were divided into two distinct populations; those with large wall-normal deposition velocities and small near-wall residence times referred to as the free-flight population, and particles depositing with negligible wall-normal velocities and large near-wall residence times (more than 1000 wall time units), referred to as the diffusional deposition population. Diffusional deposition (deposition induced by the small residual turbulent fluctuations near the wall) is found to be the dominant mechanism of deposition for both particle response times. The free-flight mechanism is shown to gain in importance only for τp+=15 particles. For τp+=5 particles only 10% deposit because of free flight, whereas the fraction is around 40% for τp+=15 particles. This result runs counter to the widely held opinion that free flight is the dominant mechanism of deposition in wall-bounded flows and clearly quantifies the relative importance of the two mechanisms. A simple relationship between the particle wall-normal velocity on deposition and the residence time for free-flight particles is presented. Particle deposition locations over the period of the entire simulation reveal that, while diffusional deposition occurs mostly along streamwise oriented lines below the near-wall particle accumulation patterns, free-flight particles deposit more evenly over the wall.