Restenting at the time of intracoronary radiation therapy (IRT) for in-stent restenosis (ISR) potentially increases the risk of late total occlusion (LTO) of the treated vessel. Prolonged antiplatelet therapy with clopidogrel (6 months) has been shown to be effective in reducing LTO risk. The purpose of this study was to assess the impact of restenting on clinical outcomes following IRT for ISR with 6 months of clopidogrel. We retrospectively evaluated 1,275 patients with 6-months clinical follow-up who were enrolled in radiation trials for ISR using gamma- and beta-emitters conducted at Washington Hospital Center. Patients were analyzed according to whether additional stents were deployed at the time of IRT. The predominant indication for restenting was to optimize the final angiographic result in the event of tissue prolapse or to cover edge dissections. All patients received a minimum of 6 months of clopidogrel. Baseline clinical and angiographic characteristics were similar between the restented and nonrestented groups. Radiation was delivered successfully in all cases. At 6 months, patients treated with additional stents and IRT had a significantly higher rate of target vessel revascularization than patients without additional stents (24.6% vs. 18.7%; P = 0.011). Restenting caused more frequent late thrombosis, late total occlusion, and Q-wave myocardial infarction than no restenting (4.0% vs. 2.2%, P = 0.09; 6.1% vs. 4.3%, P = 0.14; and 1.9% vs. 0.4%, P = 0.009, respectively). Restenting for the treatment of ISR is associated with increased adverse events and should be avoided after intracoronary radiation therapy for in-stent restenosis, as restenting results in a higher recurrence rate and the potential for increased late total occlusion.
The proliferation of technology in today’s world has led consumers to gain insight into brands via digital communication and shape their purchase intentions accordingly. However, brand awareness alone might not be sufficient to enhance consumers’ purchase intentions in the age of digital communication. Therefore, to paint a more comprehensive picture of this relationship, the paper seeks to address how and when does brand awareness lead to purchase intention in the age of digital communication? Based on the quantitative design, 208 responses conveniently collected were analyzed, and PLS-SEM was employed to examine the hypothesized relationships. The study clarifies empirically the indirect effect of brand awareness, consumer attitude, and purchase intention in the age of digital communication. The study also provides new insights into the moderated-meditation relationship, results indicate that brand awareness in the presence of celebrity endorsement will develop a positive attitude that will positively affect purchase intention. The findings of the study not only contribute to advancing the mediating effect of consumer attitude but also verify the buffering role of celebrity endorsement. In conclusion, companies that use digital communication technologies and take into consideration celebrities who are well-liked by the target market may be able to attract consumers’ attention, shape attitude, and influence them to make a purchase. In the end, both theoretical and practical implications are discussed.
Objective: To assess the clinical efficacy, cost effectiveness and side effect profile of trimetazidine in the managementof stable angina pectoris. Patients a n d M e t h o d s : An open label, uncontrolled study was conducted in 200 patients with stable angina inarmed forces institute of cardiology, Rawalpindi Pakistan. Patients were treated for 4weeks with modified release trimetazidine tablet (35mg)twice daily in addition to their conventional therapy. R e s u l t s : As compared to base line trimetazidine significantly reduced the number ofanginal episodes per week from 10 to 3 (p<0.005), improved exercise duration time on standard exercise tolerance test (ETT) (410 vs. 370sec; p<0.01), time to onset of typical angina (380 vs, 290sec; p<0.05), time to 1mm or more ST segment depression (340 vs. 290 sec;p<0.01)).There was no drop out of patients due to side effects or non compliance. C o n c l u s i o n : These results indicate that trimetazidineis effective and well tolerated when used in combination with existing antianginal therapy in patients with angina pectoris
There has been an increase in uncivil behaviors in the 21st century workplace, emphasizing the need for discussion. The current study is aimed at extending the literature available on workplace incivility by examining the impact of experienced workplace incivility on instigated workplace incivility. The study proposes that stress mediates the relationship between experienced workplace incivility and instigated workplace incivility. Furthermore, it is hypothesized that Islamic work ethics moderates the relationship between experienced and instigated workplace incivility, and between stress and instigated workplace incivility. Data were collected at three-time lags from respondents (N = 258) working in the sustainable public service sector. Results supported the hypotheses that experienced workplace incivility impacts instigated workplace incivility. The results also supported mediation and moderation hypotheses, confirming that stress is a mediator, and Islamic work ethics is a moderator. Theoretical and practical implications are discussed followed by limitations.
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