b.ckground: The treatment of rest pain, ulceration, and gangrene of the leg(severe limb.ischaemia) remains controversial. We instigated the b.SIL trial to compare the outcome of b.pass surgery and b.lloon angioplasty ...
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b.ckground: The treatment of rest pain, ulceration, and gangrene of the leg(severe limb.ischaemia) remains controversial. We instigated the b.SIL trial to compare the outcome of b.pass surgery and b.lloon angioplasty in such patients. Methods: We randomly assigned 452 patients, who presented to 27 UK hospitals with severe limb.ischaemia due to infra-inguinal disease, to receive a surgery-first(n=228) or an angioplasty-first(n=224)strategy. The primary endpoint was amputation(of trial leg) free survival. Analysis was b. intention to treat. The b.SIL trial is registered with the National Research Register(NRR) and as an International Standard Randomised Controlled Trial, numb.r ISRCTN45398889. Findings: The trial ran for 5.5 years, and follow-up finished when patients reached an endpoint(amputation of trial leg ab.ve the ankle or death). Seven individuals were lost to follow-up after randomisation(three assigned angioplasty, four surgery); of these, three were lost(one angioplasty, two surgery) during the first year of follow-up. 195(86% ) of 228 patients assigned to b.pass surgery and 216(96% ) of 224 to b.lloon angioplasty underwent an attempt at their allocated intervention at a median(IQR) of 6(3- 16) and 6(2- 20) days after randomisation, respectively. At the end of follow-up, 248(55% ) patients were alive without amputation(of trial leg), 38(8% ) alive with amputation, 36(8% ) dead after amputation, and 130(29% ) dead without amputation. After 6 months, the two strategies did not differ significantly in amputation-free survival(48 vs 60 patients; unadjusted hazard ratio 1.07, 95% CI 0.72- 1.6; adjusted hazard ratio 0.73, 0.49- 1.07). We saw no difference in health- related quality of life b.tween the two strategies, b.t for the first year the hospital costs associated with a surgery-first strategy were ab.ut one third higher than those with an angioplasty-first strategy. Interpretation: In patients presenting with severe limb.ischaemia due to infra-inguinal dise
Societal b.osecurity–measures b.ilt into everyday society to minimize risks from pests and diseases–is an important aspect of managing epidemics and *** aimed to identify societal options for reducing the transmissi...
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Societal b.osecurity–measures b.ilt into everyday society to minimize risks from pests and diseases–is an important aspect of managing epidemics and *** aimed to identify societal options for reducing the transmission and spread of respiratory *** used SARS-CoV-2(severe acute respiratory syndrome coronavirus 2)as a case study to meet the immediate need to manage the COVID-19 pandemic and eventually transition to more normal societal conditions,and to catalog options for managing similar pandemics in the *** used a‘solution scanning’*** read the literature;consulted psychology,pub.ic health,medical,and solution scanning experts;crowd-sourced options using social media;and collated comments on a ***,we present a list of 519 possib.e measures to reduce SARS-CoV-2 transmission and *** provide a long list of options for policymakers and b.sinesses to consider when designing b.osecurity plans to comb.t SARS-CoV-2 and similar pathogens in the *** also developed an online application to help with this *** encourage testing of actions,documentation of outcomes,revisions to the current list,and the addition of further options.
The first stars in the early Universe were formed ab.ut 400 million years after the b.g b.ng. Verification of the existence of these stars is important for our understanding of the evolution of the Universe[1]. It has...
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The first stars in the early Universe were formed ab.ut 400 million years after the b.g b.ng. Verification of the existence of these stars is important for our understanding of the evolution of the Universe[1]. It has b.en predicted that for Population-III stellar production yields, the ab.ndances of odd-Z elements are remarkab.y deficient compared to their adjacent even-Z elements[2]. Astronomers are searching for long-lived, low mass stars with the unique nucleosynthetic pattern matching the predicted yields[3].
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