Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study.

Background: The length of time that people with HIV on antiretroviral therapy (ART) with viral load suppression will be able to continue before developing viral rebound is unknown. We aimed to investigate the rate of first viral rebound in people that have achieved initial suppression with ART, to determine factors associated with viral rebound, and to use these estimates to predict long-term durability of viral suppression.

Methods: The UK Collaborative HIV Cohort (UK CHIC) Study is an ongoing multicentre cohort study that brings together in a standardised format data on people with HIV attending clinics around the UK.

Changes in Quality of Life Associated with Complications of Diabetes: Results from the ADVANCE Study.

Objective: To measure the impact of complications on summary measures of health-related quality of life among people with type 2 diabetes.

Methods: Patients participating in the Action in Diabetes and Vascular Disease:Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial were administered a health-related quality-of-life questionnaire, the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L), on four occasions over a 5-year period. We used two-way fixed-effects longitudinal regression models to investigate the impact of incident diabetes complications (stroke, heart failure, myocardial infarction, ischemic heart disease, renal failure, blindness, and amputation) on EQ-5D-3L utility score (where 1 = perfect health), while controlling for characteristics of individuals that do not vary over time.

The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial.

Objectives: In general populations, the adverse effects of smoking on coronary risk have been demonstrated to be greater in women than in men; whether this is true for individuals with diabetes is unclear.

Design: Cohort study.

Setting: 20 countries worldwide participating in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial.

Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial.

Objective: There is no consensus on the importance of visit-to-visit glycemic variability in diabetes. Therefore, we assessed the effects of visit-to-visit variability (VVV) in HbA1c and fasting glucose on major outcomes in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial.

Research Design And Methods: ADVANCE was a factorial randomized controlled trial of intensive glucose control and blood pressure lowering in patients with type 2 diabetes.

Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.

Aims/hypothesis: The relationship between cognitive function, cardiovascular disease and premature death is not well established in patients with type 2 diabetes. We assessed the effects of cognitive function in 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Furthermore, we tested whether level of cognitive function altered the beneficial effects of the BP-lowering and glycaemic-control regimens in the trial.

Abciximab in coronary intervention for acute myocardial infarction and stable ischemic heart disease: early investment for growing benefit.

Background: At 30 days, it is recognized that 12-hour periprocedural abciximab infusion protects against reinfarction and the need for revascularization in percutaneous coronary intervention (PCI) in acute myocardial infarction (MI). However, it is controversial whether the benefit to patients continues or fades away subsequently. We investigate whether abciximab provides a persistent advantage in terms of life-years gained in large trials of abciximab in PCI.

Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath.

Background: A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation.

Objective: To report our initial experience using this system for remotely performing catheter ablation in humans.

Methods: Consecutive patients attending for routine ablation were recruited.

Experience of ICD management at a UK center: cardiovascularly stable VT presentation predicts higher risk for appropriate ICD therapy.

Background: It would be useful to identify patients at high risk of implantable cardioverter defibrillator (ICD) therapy via additional antiarrhythmic measures to minimize the morbidity of ICD therapies.

Objective: We assessed baseline characteristics for predictors of device therapy in a general ICD population. We also compared the likelihood of therapy delivery by replacement ICDs implanted for battery depletion with the original implants.

Endoscopic suturing: now and incoming.

There is a particular need for inexpensive, simple multipurpose suturing methods that can be used for most applications. Such devices are in advanced stages of development and early clinical use. Complex procedure-specific devices that fix large-volume procedures such as reflux or obesity may well be needed but will need to prove their value in clinical studies.

Radiofrequency ablation of infarct scar-related ventricular tachycardia: correlation of electroanatomical data with post-mortem histology.

Introduction: Histological data after VT ablation in humans is rare. We present a case of a patient who had ablation for VT storm and who died remotely from non-arrhythmic causes.

Methods And Results: A 69-year-old male with ischemic cardiomyopathy and a dual-chamber implantable cardioverter defibrillator (ICD) presented with VT storm and multiple ICD therapies.

The learning curve for a colonoscopy simulator in the absence of any feedback: no feedback, no learning.

Background: The hypothesis of this study is that working on the simulator without a structured feedback does not change performance; hence, any effects shown after structured feedback would amount to useful learning of the procedure. The aim was to investigate the learning curve for the HT Immersion Medical Colonoscopy Simulator without any structured feedback. This could then be potentially applied to validate the learning curve on the simulator when structured feedback is provided.

Mechanism of pacing-induced ventricular fibrillation in the infarcted human heart.

Background: The mechanisms by which ventricular fibrillation (VF) is initiated in the infarcted human heart have not been defined.

Methods And Results: Left ventricular noncontact mapping of 8 episodes of pacing-induced VF in 6 patients (age 64.8+/-7.

Multiple distinct right atrial endocardial origins in a patient with atrial tachycardia: mapping and ablation using noncontact mapping.

Noncontact mapping identified the endocardial origins of four distinct atrial tachycardias in a young patient with drug refractory palpitations and effected successful ablation with no recurrence of symptoms in 5 months of follow-up.

A study to validate the colonoscopy simulator.

Background: The aim of this study was to investigate the relation between clinical experience and performance with regard to colonoscopic procedures performed on the HT Immersion Medical Colonoscopy Simulator. The hypothesis is that the performance of novice, intermediate, and experienced operators is different on simulators, just as it is on real patients.

Methods: 25 Postgraduate doctors were recruited and divided into three groups according to their level of colonoscopic experience.

Catheter ablation of ventricular tachycardia related to coronary artery disease: the role of noncontact mapping.

There are a number of limitations associated with conventional mapping for ablation of ventricular tachycardia (VT) in ischemic heart disease, such as the high recurrence rates after initially successful ablation. The development of a noncontact mapping system capable of producing high-resolution isopotential maps of the entire left ventricle has enabled rapid identification of diastolic activity that maintains VT for ablation. With this system it is possible to map nonsustained and fast unstable as well as stable VTs.