The PRECOMBAT trial compared percutaneous coronary intervention (PCI) using sirolimus-eluting stents to coronary artery bypass grafting (CABG) for treating unprotected left main coronary artery disease over 1 and 2 year follow-ups. The trial found no significant differences in rates of death, heart attack, stroke, or other major cardiac events between PCI and CABG at 1 year. However, the rate of repeat revascularization of the target vessel was significantly lower with CABG than PCI at 2 years. The results met criteria for non-inferiority of PCI to CABG, but the study was underpowered with a wide margin so the findings are not considered definitive.
Tenecteplase is a newer generation tissue plasminogen activator which can be given as a bolus dose than continuous infusion. Genentech, the same company that manufactures Alteplase makes Tenecteplase. Phase 2 RCTs have been done on Tenecteplase comparing its feasibility and safety against Alteplase and so far the studies have been encouraging. In a pooled meta analysis from the Australian TNKase trial and ATTEST trials, tenecteplase seems to be better in recanalizing LVO compared to Alteplase which also showed to improve functional outcome in the first 24hrs and 3 months mRS. But it is difficult to extrapolate the evidence into clinical practice yet as this is a very small number of patients and phase 3 RCTs will answer further questions. This tPA sibling to Alteplase is cheaper and widely available due to its use in Acute coronary syndrome management and its ease of administration demonstrate better profile. But as Genentech is the same company that manufactures both, there is skepticism that it will do any company led phase 3 RCTs to build the evidence for TNKase in Acute ischemic stroke as it is cheaper than Alteplase and they even increased the price of alteplase to >100% since its introduction into the market.
Pharmacological management of cerebral vasospasm in subarachnoid hemorrhagePrisma Health Upstate
Medical management of vasospasm in subarachnoid hemorrhage patients. Despite targeting multiple pathophysiological mechanisms of DCI and vasospasm, most of the trials did not yield results that could translate to clinical practice. Fasudil and emerging therapies like cisternal irrigation and lumbar drainage combined with intrathecal vasodilators and phosphodiesterase medications showed promising results but need to be tested in a randomized clinical trial for effectiveness.
Tenecteplase is a newer generation tissue plasminogen activator which can be given as a bolus dose than continuous infusion. Genentech, the same company that manufactures Alteplase makes Tenecteplase. Phase 2 RCTs have been done on Tenecteplase comparing its feasibility and safety against Alteplase and so far the studies have been encouraging. In a pooled meta analysis from the Australian TNKase trial and ATTEST trials, tenecteplase seems to be better in recanalizing LVO compared to Alteplase which also showed to improve functional outcome in the first 24hrs and 3 months mRS. But it is difficult to extrapolate the evidence into clinical practice yet as this is a very small number of patients and phase 3 RCTs will answer further questions. This tPA sibling to Alteplase is cheaper and widely available due to its use in Acute coronary syndrome management and its ease of administration demonstrate better profile. But as Genentech is the same company that manufactures both, there is skepticism that it will do any company led phase 3 RCTs to build the evidence for TNKase in Acute ischemic stroke as it is cheaper than Alteplase and they even increased the price of alteplase to >100% since its introduction into the market.
Pharmacological management of cerebral vasospasm in subarachnoid hemorrhagePrisma Health Upstate
Medical management of vasospasm in subarachnoid hemorrhage patients. Despite targeting multiple pathophysiological mechanisms of DCI and vasospasm, most of the trials did not yield results that could translate to clinical practice. Fasudil and emerging therapies like cisternal irrigation and lumbar drainage combined with intrathecal vasodilators and phosphodiesterase medications showed promising results but need to be tested in a randomized clinical trial for effectiveness.
La Dra. Silvia Valbuena López repasa los resultados del estudio con ticagrelor y prasugrel en pacientes con síndrome coronario agudo, presentado en ESC Congress 2019.
Important Trials of the Day & Basics of Biostatistics | IACTS SCORE 2020IACTSWeb
This presentation emphasizes on the importance of biostatistics in the interpretation, analysis and design of studies and trials in the daily life of an academic surgeon. It also sheds light on some important clinical trials of the present milieu that are playing a vital role in the course that cardiothoracic surgery is taking.
Courtesy of Dr. Prasanna Simha Mohan Rao, MS, MCh, DNB, PGDHHM. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
This presentation accompanies a video that is part of the lecture series of IACTS SCORE 2020 held at the SSSIHMS Whitefield, Bengaluru between 7th and 8th March, 2020.
La Dra. Silvia Valbuena López repasa los resultados del estudio con ticagrelor y prasugrel en pacientes con síndrome coronario agudo, presentado en ESC Congress 2019.
Important Trials of the Day & Basics of Biostatistics | IACTS SCORE 2020IACTSWeb
This presentation emphasizes on the importance of biostatistics in the interpretation, analysis and design of studies and trials in the daily life of an academic surgeon. It also sheds light on some important clinical trials of the present milieu that are playing a vital role in the course that cardiothoracic surgery is taking.
Courtesy of Dr. Prasanna Simha Mohan Rao, MS, MCh, DNB, PGDHHM. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
This presentation accompanies a video that is part of the lecture series of IACTS SCORE 2020 held at the SSSIHMS Whitefield, Bengaluru between 7th and 8th March, 2020.
Presentación realizada por el Dr. José Manuel García Pinilla en el directo online ‘Lo mejor del Congreso ACC Orlando 2018’, celebrado en la SEC el 13 de marzo de 2018
Journal Article Analysis: Ticagrelor versus Clopidogrel in ACS (PLATO)Paul Pasco
A journal article analysis ("journal club") I composed of a notable clinical trial during an internship/Advanced Pharmacy Practice Experience (APPE) in a community pharmacy at a hospital.
various trial about on pump vs off pump and pci vs CABG
coronary trial
ROOBY TRAIL
DOORS TRAIL
GOPCABE TRAIL
PRAGUE 6 TRAIL
SMART STUDY
PROMOTE PATENCY TRIAL
Alt. GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using ...James Anderson
Effective Application Security in Software Delivery lifecycle using Deployment Firewall and DBOM
The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
Speakers:
Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
Gopinath Rebala
Gopinath Rebala is the CTO of OpsMx, where he has overall responsibility for the machine learning and data processing architectures for Secure Software Delivery. Gopi also has a strong connection with our customers, leading design and architecture for strategic implementations. Gopi is a frequent speaker and well-known leader in continuous delivery and integrating security into software delivery.
Removing Uninteresting Bytes in Software FuzzingAftab Hussain
Imagine a world where software fuzzing, the process of mutating bytes in test seeds to uncover hidden and erroneous program behaviors, becomes faster and more effective. A lot depends on the initial seeds, which can significantly dictate the trajectory of a fuzzing campaign, particularly in terms of how long it takes to uncover interesting behaviour in your code. We introduce DIAR, a technique designed to speedup fuzzing campaigns by pinpointing and eliminating those uninteresting bytes in the seeds. Picture this: instead of wasting valuable resources on meaningless mutations in large, bloated seeds, DIAR removes the unnecessary bytes, streamlining the entire process.
In this work, we equipped AFL, a popular fuzzer, with DIAR and examined two critical Linux libraries -- Libxml's xmllint, a tool for parsing xml documents, and Binutil's readelf, an essential debugging and security analysis command-line tool used to display detailed information about ELF (Executable and Linkable Format). Our preliminary results show that AFL+DIAR does not only discover new paths more quickly but also achieves higher coverage overall. This work thus showcases how starting with lean and optimized seeds can lead to faster, more comprehensive fuzzing campaigns -- and DIAR helps you find such seeds.
- These are slides of the talk given at IEEE International Conference on Software Testing Verification and Validation Workshop, ICSTW 2022.
Why You Should Replace Windows 11 with Nitrux Linux 3.5.0 for enhanced perfor...SOFTTECHHUB
The choice of an operating system plays a pivotal role in shaping our computing experience. For decades, Microsoft's Windows has dominated the market, offering a familiar and widely adopted platform for personal and professional use. However, as technological advancements continue to push the boundaries of innovation, alternative operating systems have emerged, challenging the status quo and offering users a fresh perspective on computing.
One such alternative that has garnered significant attention and acclaim is Nitrux Linux 3.5.0, a sleek, powerful, and user-friendly Linux distribution that promises to redefine the way we interact with our devices. With its focus on performance, security, and customization, Nitrux Linux presents a compelling case for those seeking to break free from the constraints of proprietary software and embrace the freedom and flexibility of open-source computing.
Elevating Tactical DDD Patterns Through Object CalisthenicsDorra BARTAGUIZ
After immersing yourself in the blue book and its red counterpart, attending DDD-focused conferences, and applying tactical patterns, you're left with a crucial question: How do I ensure my design is effective? Tactical patterns within Domain-Driven Design (DDD) serve as guiding principles for creating clear and manageable domain models. However, achieving success with these patterns requires additional guidance. Interestingly, we've observed that a set of constraints initially designed for training purposes remarkably aligns with effective pattern implementation, offering a more ‘mechanical’ approach. Let's explore together how Object Calisthenics can elevate the design of your tactical DDD patterns, offering concrete help for those venturing into DDD for the first time!
GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using Deplo...James Anderson
Effective Application Security in Software Delivery lifecycle using Deployment Firewall and DBOM
The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
Speakers:
Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
Gopinath Rebala
Gopinath Rebala is the CTO of OpsMx, where he has overall responsibility for the machine learning and data processing architectures for Secure Software Delivery. Gopi also has a strong connection with our customers, leading design and architecture for strategic implementations. Gopi is a frequent speaker and well-known leader in continuous delivery and integrating security into software delivery.
SAP Sapphire 2024 - ASUG301 building better apps with SAP Fiori.pdfPeter Spielvogel
Building better applications for business users with SAP Fiori.
• What is SAP Fiori and why it matters to you
• How a better user experience drives measurable business benefits
• How to get started with SAP Fiori today
• How SAP Fiori elements accelerates application development
• How SAP Build Code includes SAP Fiori tools and other generative artificial intelligence capabilities
• How SAP Fiori paves the way for using AI in SAP apps
A tale of scale & speed: How the US Navy is enabling software delivery from l...sonjaschweigert1
Rapid and secure feature delivery is a goal across every application team and every branch of the DoD. The Navy’s DevSecOps platform, Party Barge, has achieved:
- Reduction in onboarding time from 5 weeks to 1 day
- Improved developer experience and productivity through actionable findings and reduction of false positives
- Maintenance of superior security standards and inherent policy enforcement with Authorization to Operate (ATO)
Development teams can ship efficiently and ensure applications are cyber ready for Navy Authorizing Officials (AOs). In this webinar, Sigma Defense and Anchore will give attendees a look behind the scenes and demo secure pipeline automation and security artifacts that speed up application ATO and time to production.
We will cover:
- How to remove silos in DevSecOps
- How to build efficient development pipeline roles and component templates
- How to deliver security artifacts that matter for ATO’s (SBOMs, vulnerability reports, and policy evidence)
- How to streamline operations with automated policy checks on container images
zkStudyClub - Reef: Fast Succinct Non-Interactive Zero-Knowledge Regex ProofsAlex Pruden
This paper presents Reef, a system for generating publicly verifiable succinct non-interactive zero-knowledge proofs that a committed document matches or does not match a regular expression. We describe applications such as proving the strength of passwords, the provenance of email despite redactions, the validity of oblivious DNS queries, and the existence of mutations in DNA. Reef supports the Perl Compatible Regular Expression syntax, including wildcards, alternation, ranges, capture groups, Kleene star, negations, and lookarounds. Reef introduces a new type of automata, Skipping Alternating Finite Automata (SAFA), that skips irrelevant parts of a document when producing proofs without undermining soundness, and instantiates SAFA with a lookup argument. Our experimental evaluation confirms that Reef can generate proofs for documents with 32M characters; the proofs are small and cheap to verify (under a second).
Paper: https://eprint.iacr.org/2023/1886
Climate Impact of Software Testing at Nordic Testing DaysKari Kakkonen
My slides at Nordic Testing Days 6.6.2024
Climate impact / sustainability of software testing discussed on the talk. ICT and testing must carry their part of global responsibility to help with the climat warming. We can minimize the carbon footprint but we can also have a carbon handprint, a positive impact on the climate. Quality characteristics can be added with sustainability, and then measured continuously. Test environments can be used less, and in smaller scale and on demand. Test techniques can be used in optimizing or minimizing number of tests. Test automation can be used to speed up testing.
Essentials of Automations: The Art of Triggers and Actions in FMESafe Software
In this second installment of our Essentials of Automations webinar series, we’ll explore the landscape of triggers and actions, guiding you through the nuances of authoring and adapting workspaces for seamless automations. Gain an understanding of the full spectrum of triggers and actions available in FME, empowering you to enhance your workspaces for efficient automation.
We’ll kick things off by showcasing the most commonly used event-based triggers, introducing you to various automation workflows like manual triggers, schedules, directory watchers, and more. Plus, see how these elements play out in real scenarios.
Whether you’re tweaking your current setup or building from the ground up, this session will arm you with the tools and insights needed to transform your FME usage into a powerhouse of productivity. Join us to discover effective strategies that simplify complex processes, enhancing your productivity and transforming your data management practices with FME. Let’s turn complexity into clarity and make your workspaces work wonders!
Encryption in Microsoft 365 - ExpertsLive Netherlands 2024Albert Hoitingh
In this session I delve into the encryption technology used in Microsoft 365 and Microsoft Purview. Including the concepts of Customer Key and Double Key Encryption.
The Art of the Pitch: WordPress Relationships and SalesLaura Byrne
Clients don’t know what they don’t know. What web solutions are right for them? How does WordPress come into the picture? How do you make sure you understand scope and timeline? What do you do if sometime changes?
All these questions and more will be explored as we talk about matching clients’ needs with what your agency offers without pulling teeth or pulling your hair out. Practical tips, and strategies for successful relationship building that leads to closing the deal.
2. INTRODUCTION
• Recent registry and sub-study results have shown
that percutaneous coronary intervention (PCI) is safe
and effective in patients with unprotected left main
coronary artery (ULMCA) stenosis.
• However, due to the lack of randomized clinical trials,
the comparability of PCI with coronary artery bypass
graft (CABG) remains uncertain.
3. PRECOMBAT Trial Premier of Randomized Comparison of Bypass
Surgery versus Angioplasty Using Sirolimus-Eluting Stent in
Patients with Left Main Coronary Artery Disease
• DESIGN: a prospective, randomized clinical trial
• OBJECTIVE: To compare PCI with sirolimus-eluting
stents and CABG surgery for optimal revascularization of
patients with ULMCA stenosis.
• PRINCIPAL INVESTIGATOR
Seung-Jung Park, MD, PhD, Asan Medical Center,
Seoul, Korea
5. MAJOR INCLUSION CRITERIA
• 18 years of age.
• Significant de novo ULMCA stenosis (>50%)
• Left main lesion and lesions outside ULMCA (if
present) potentially comparably treatable with PCI
and CABG.
• Objective evidence of ischemia or ischemic symptom
with angina or NSTEMI
6. MAJOR EXCLUSION CRITERIA
• Any contraindication to dual antiplatelet therapy
• Any previous PCI within 1 year
• Previous CABG
• Chronic total occlusion > 1
• AMI within 1 week
• Shock or LV EF < 30%
• Planned surgery
• Disabling stroke
• Other comorbidity, such as CRF, liver disease, etc
7. STUDY PROCEDURES
• Sirolimus-eluting Cypher stent for all lesions
• Strong recommendation of IVUS-guidance
• Other adjunctive devices at the operator’s discretion
• Use of LIMA to LAD anastomosis
• Off- or on-pump surgery at the operator’s discretion
• Dual antiplatelet therapy at least for 6 months after
PCI
• Standard medical treatment after PCI and CABG
8. FOLLOW-UP
• Clinical follow-up at 30 days and 6, 9, and 12 months
via clinic visit or telephone interview.
• Routine angiographic follow-up at 8-10 months after
PCI.
• Ischemia-guided angiographic follow-up after CABG.
• Retrospective SYNTAX score measurement in the
Core Lab, CVRF, Seoul, Korea
9. PRIMARY END POINT
• A composite of major adverse cardiac or
cerebrovascular events (MACCE) for the 12-month
period after randomization including
– Death from any cause
– Myocardial infarction (MI)
– Stroke
– Ischemia-driven target vessel revascularization (TVR)
10. POWER CALCULATION
• A non-inferiority margin : 7%
• A one-sided type I error rate : 0.05
• Power : 80%
• Assumption : a total of 572 patients (286 per group)
• A final sample size : 600 patients (300 per group)
assuming 5% of loss
12. The baseline clinical characteristics of the PCI and
CABG groups were similar.
Mean age of participants- 62 years
76.5% were men.
The baseline angiographic characteristics of the
two groups were also similar.
13. PROCEDURAL CHARACTERISTICS OF THE STUDY
GROUPS
.
Complete revascularization
68.3% in the PCI group
70.3% in the CABG group (P = 0.60).
Duration of the hospital stay after the procedure
8.4±14.5 days in the CABG group
3.1±5.8 days in the PCI group (P<0.001).
At the time of discharge, patients in the PCI group
more consistently received medications.
Follow-up angiography at 8 to 10 months
performed more frequently in the PCI group
16. TRIAL END POINT
median follow-up period was 24.0 months in both the
PCI and CABG groups.
The primary end point of major adverse cardiac or
cerebrovascular events at 12 months
occurred in 26 patients assigned to PCI
20 patients assigned to CABG
21. INFERENCE
No significant between-group differences in the cumulative incidence rates of
the individual components of the primary end point .
2-year rate of ischemia-driven target-vessel revascularization was significantly
lower in the CABG group than in the PCI group.
There was no significant differences between the PCI and CABG groups in the
registry cohort with respect to the rates of most of the major trial end points
at 1 or 2 years.
The exception was the end point of ischemia-driven target-vessel
revascularization, which occurred significantly more frequently in
PCI group.
22. DISCUSSION: COMPARISON WITH SYNTAX TRIAL
PRECOMBAT SYNTAX
Lower CV or cerebrovascular Higher event rate
event rate. Event rate similar in
Lower in stent thrombosis PCI/CABG
Pt. had less complex coronary Mean SYNTAX score=30
lesions & clinical settings. Mean EUROSCORE=3.8
Mean SYNTAX score=25 US & European population
Mean EUROSCORE=2.7
Better device & technique
Asian population
23. LIMITATIONS OF THE STUDY
Underpowered study due to low event rate
Wide inferiority margin of 7% point, so findings can
not be considered clinically directive.
Relatively high rate of cross over between PCI & CABG
group.
2 yr follow up period may not be enough for
comparison.
Restricted sample size. Difficult to extrapolate.
24. CONCLUSION
At 1 yr, rate of CV or cerebrovascular events are similar
in PCI & CABG groups .
Meets the pre-specified criteria on non-inferiority of
PCI to CABG.
However due to low power and wide inferiority margin
of trial, findings can not be considered as clinically
directive.