No abstract

IMPORTANCE Thromboembolism is the most common complication in coiling for an unruptured aneurysm and is frequent in patients with high on-treatment platelet reactivity (HTPR) who are prescribed a standard antiplatelet preparation for its prevention.OBJECTIVE To evaluate the effect of a modified antiplatelet preparation compared with a standard preparation in patients with HTPR undergoing coiling. DESIGN, SETTING, AND PARTICIPANTSA prospective randomized open-label active-control trial with blinded outcome assessment at the Seoul National University Bundang Hospital from May 27, 2013, to April 7, 2014. Patients with HTPR were randomly assigned (1 to 1) to the standard or modified preparation group. Patients without HTPR were assigned to the non-HTPR group. A total of 228 patients undergoing coiling for unruptured aneurysms were enrolled and allocated to the study, 126 in the HTPR group (63 to the standard preparation group and 63 to the modified preparation group) and 102 to the non-HTPR group. Intent-to-treat analysis was performed. INTERVENTIONSThe modified preparation (HTPR to aspirin, 300 mg of aspirin and 75 mg of clopidogrel bisulfate; and HTPR to clopidogrel, 200 mg of cilostazol added to the standard regimen) was performed before coiling in the modified preparation group. Standard preparation (100 mg of aspirin and 75 mg of clopidogrel) was maintained in the standard preparation and non-HTPR groups. MAIN OUTCOMES AND MEASURESThe primary outcome was a thromboembolic event defined as thromboembolism during coiling and a transient ischemic attack or ischemic stroke within 7 days after coiling. The principal secondary outcome was a bleeding complication according to Thrombolysis in Myocardial Infarction bleeding criteria within 30 days after coil embolization. RESULTSThe thromboembolic event rate was low in the modified preparation group (1 of 63 [1.6%]) compared with the standard preparation group (7 of 63 [11.1%]; adjusted risk difference, −11.7% [95% CI, −21.3% to −2.0%]; P = .02), which had a higher thromboembolic risk than the non-HTPR group (1 of 102 [1.0%]; adjusted risk difference, 8.6% [95% CI, 1.0% to 16.3%]; P = .03). All bleeding complications were of minimal grade according to Thrombolysis in Myocardial Infarction bleeding criteria. The bleeding rate was not different between the modified (6 of 63 [9.5%]) and standard (4 of 63 [6.3%]) preparation groups (adjusted risk difference, 5.6% [95% CI, −4.2% to 15.4%]; P = .26). CONCLUSIONS AND RELEVANCEModified antiplatelet preparation for patients with HTPR compared with standard antiplatelet preparation reduced the thromboembolic event rate in coiling for an unruptured aneurysm without increasing bleeding.TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0000804.

We have studied thin films driven out of equilibrium under spatially uniform steady-state conditions by thermal phonon injection, microwave and optical irradiations, and quasiparticle tunneling injection. The linearized coupled kinetic equations for the quasiparticle and phonon distributions were solved numerically.Results for the change in the energy distributions of quasiparticles and phonons are given for a variety of nonequilibrium situations. Using these distributions, the changes in the ultrasonic attenuation, electrical conductivity and the superconductor-insulator-superconductor tunneling I(V) characteristic in various nonequilibrium states are obtained.

Background and purposeRAO is caused by various etiologies and subsequent vascular events may be associated with underlying etiologies. Our aim is to investigate the etiologies of RAO, the occurrence of subsequent vascular events and their association in patients with RAO.MethodsWe analyzed data from 151 consecutive patients presenting with acute non-arteritic RAO between 2003 and 2013 in a single tertiary-care hospital. The primary outcome was the occurrence of a vascular event defined as stroke, myocardial infarction, and vascular death within 365 days of the RAO onset. The Kaplan-Meier survival analysis and Cox proportional hazard model were used to estimate the hazard ratio of the vascular events.ResultsLarge artery atherosclerosis (LAA) was the etiology more frequently associated with of RAO (41.1%, 62/151). During the one year follow-up, ischemic stroke and vascular events occurred in 8.6% and 9.9% of patients, respectively. Ten vascular events occurred in RAO patients attributed to LAA and 4 occurred in undetermined etiology. RAO patients with LAA had a nearly four times higher risk of vascular events compared to those without LAA (hazard ratio 3.94, 95% confidence interval 1.21–12.81). More than a half of all events occurred within one month and over three fourths of ischemic strokes occurred ipsilateral to the RAO.ConclusionAfter occurrence of RAO, there is a high risk of a subsequent vascular event, particularly ipsilateral stroke, within one month. LAA is an independent factor for the occurrence of a subsequent vascular event. Management for the prevention of secondary vascular events is necessary in patients with RAO especially with LAA. Large clinical trials are needed to confirm these findings.

Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed. CRS patients are described as those who had (a) cryptogenic stroke with advanced or metastatic cancer; (b) no other possible causes of stroke such as cardioembolism (CE) and large artery atherosclerosis (LAA); and (c) elevated D-dimer levels or diffusion-restricted lesions in multiple vascular territories. We compared procedural and clinical outcomes at discharge among CRS, CE, and LAA patients. Results A total of 329 patients were finally enrolled in this study; of these, 19 were CRS patients. The rate of successful recanalization, defined as modified treatment in cerebral infarction grade 2b or 3, was lower in the CRS group than in the LAA and CE groups (63% versus 84% versus 84%, p = .06). CRS subtype was an independent predictor for successful recanalization after ERT in the multivariate analysis (odds ratio, 0.317; 95% confidence interval, 0.116–0.867; p < .001). No significant difference in the rate of good clinical outcomes at discharge was observed among groups. Conclusions Although clinical outcomes at discharge were similar for CE and LAA patients, complete recanalization seemed more difficult to achieve in CRS patients than in conventional stroke patients.

The authors have reproducibly obtained an atomically well-defined SrTiO3 (111) surface by a combined chemical etching and thermal annealing process. Although thermodynamic mixed termination is preferred as a means of suppressing the surface dipole, the kinetics-driven etching process, via selective etching of SrO34−, enables a single-terminated surface to be obtained. Subsequent O2 annealing of the etched surface produces a clear step-and-terrace structure. Atomically flat terraces and only one-unit-cell-high step edges are observed, signifying a single-terminated surface. This study might pave the way for constructing (111)-oriented perovskite oxide superlattices, which would be expected to demonstrate new and better physical phenomena and functionalities.

In general, the quasiparticles, phonons, and pair field in a superconductor driven by an external source are out of equilibriurn. Here we review briefly the various quasiparticle and phonon lifetimes in real metals and estimate the strengths necessary to induce a strongly nonequilibrium state. Then we investigate the properties of a thin film driven in a spatially uniform steady state by quasi_particle injection, heater phonon pumping, and microwave radiation. This analysis uses a set of coupled kinetic equations for quasiparticle and phonon distributions and the BCS gap equation with the selfconsistently determined quasiparticle distribution. Such films can be used to generate phonons with energy near 2 A. In addition, the gap enhancement in a thin film due to microwave irradiation is discussed.

To investigate the relationship among alcohol dehydrogenase-2 (ADH2) and aldehyde dehydrogenase-2 (ALDH2) genetic polymorphisms, alcohol consumption and the susceptibility to esophageal cancer in a Chinese population, we conducted a case-control study with 221 cases and 191 population-based controls in the Taixing city of Jiangsu Province of China. ADH2 and ALDH2 genotypes were examined using PCR and denaturing high-performance liquid chromatography. Alcohol drinkers with the ALDH2 A allele showed a significantly increased risk of esophageal cancer compared with drinkers with the ALDH2 G/G genotype (odds ratio (OR)¼3.08, 95% confidence interval ( Keywords: alcohol dehydrogenase 2; aldehyde dehydrogenase 2; alcohol drinking; case-control study; esophageal cancer INTRODUCTION Epidemiological studies have consistently shown that alcohol drinking is a risk factor for esophageal cancer. 1 When ethanol is consumed, it is metabolized primarily by alcohol dehydrogenase (ADH) into acetaldehyde, an intermediate metabolite, and then it is metabolized by aldehyde dehydrogenase (ALDH) into acetic acid. 2 Acetaldehyde, a well-known carcinogen in animals, has an important role in alcohol toxicity in humans. 3 Most studies, conducted mainly in Japan, have revealed associations between the ADH2 or ALDH2 polymorphism and esophageal cancer risk. [4][5][6][7][8] found that Chinese alcoholic patients with the ADH2 G and ALDH2 A alleles were more susceptible to esophageal cancer. Wu et al. 10 also found a multiplicative effect of lifetime alcoholic consumption and genotypes (ADH2 and ALDH2) on esophageal cancer risk, but those were only found in Taiwanese males.Taixing City, located in the middle part of Jiangsu Province, China, has relatively high incidence and mortality rates for esophageal cancer