Netcare Sunninghill Hospital

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This study explores the safety and efficacy of thin strut MeRes100 sirolimus-eluting bioresorbable vascular scaffold (BRS) in patients with de novo coronary artery lesions. In interventional cardiology, the emergence of BRS technology is catalyzing the next paradigm shift. The MeRes-1 Extend was a multicenter, prospective, single-arm, open-label study enrolling 64 patients in Spain, Macedonia, Brazil, South Africa, Malaysia, and Indonesia. The safety endpoint was major adverse cardiac events (MACE) which composed of cardiac death, myocardial infarction (MI), and ischemia-driven target lesion revascularization (ID-TLR). The imaging efficacy endpoint was mean in-scaffold late lumen loss (LLL) evaluated by quantitative coronary angiography (QCA). Optical coherence tomography (OCT) imaging was performed at baseline and 6-month follow-up. A total of 69 target lesions were identified in 64 enrolled patients (mean age 58.30 ± 9.02 years). Of the treated lesions, 49 (71.01%) lesions were of type B2/C. Procedural and device success was achieved in 64 and 62 patients, respectively. At 2-year follow-up, MACE was reported in one patient (1.61%) in the form of ID-TLR. There was no case of MI, cardiac death or scaffold thrombosis through 2-year. In a subset of 32 patients, paired QCA showed mean in-scaffold LLL of 0.18 ± 0.31 mm at 6-month follow-up. In a subset of 21 patients, OCT revealed 97.95 ± 3.69% strut coverage with mean scaffold area of 7.56 ± 1.79 mm2 and no evidence of strut malapposition. The clinical and imaging outcomes of MeRes-1 Extend trial demonstrated favorable safety and efficacy of MeRes100 sirolimus-eluting BRS in patients with de novo coronary artery lesions.

Abstract An essential component of safety analyses is the investigation of accident scenarios. In this paper water ingress scenarios of spent fuel containers, as they may occur during transport or storage, are examined. In the main body of this paper, a number of paths are studied through which water can gain access to the spent fuel cask and eventually reach the fuel pellet, potentially resulting in an increase in reactivity as a result of over-moderation. The primary objective of this project was to perform an assessment of what, in the unlikely event of a Fukushima- type accident, the impact would be on the reactivity of the cask by analyzing a gradual increase in water level in the spent fuel casks. In addition, the way the keff of the system responds to such an increase is discussed. The paper also provides the results of an assessment of the reactivity effect of water ingress via various pathways/channels.

Africa is witnessing an epidemic of cardiovascular disease (CVD), with staggering morbidity and mortality. The spectrum of CVD includes hypertension, rheumatic heart disease, cardiomyopathy, atherosclerotic disease, congenital heart disease and tuberculous pericarditis. Opportunities exist to alter the trajectory of CVD epidemiology but require committed policy makers, functional health systems and an engaged citizenry.

In this paper, the effect of weathering on the mineralogy and flotation performance of a weathered Platinum group metal (PGM) ore was investigated. A comprehensive characterisation of the weathered ore was carried out, where physical, chemical, and mineralogical and liberation properties of the sample were determined. The performance of the weathered ore during flotation was investigated using a pilot plant. It was found that the ore contains 3g/t of 4E PGMs (Pt, Pd, Ru and Au). An average recovery of the 4E PGMs was between 25 to 92% depending on the depth of the pit. The average selectivity was trending upwards as mining progresses to deeper depth, but there is insufficient data at this point in time to determine whether there is a good correlation. More work will be done on determining the degree of weathering with depth.

Back ground: South Africa, which has a multi-ethnic population of over fifty million, is considered to have a medium (5-30/100 000) prevalence rate of Multiple Sclerosis. Teriflunomide is one of two oral disease modifying agents that have been registered in this country. We describe the real-world experience of this drug in South Africa with respect to efficacy, tolerability and side effects. Methods: A retrospective analysis was undertaken of the demographics, clinical presentation, number of preceding relapses, date of last relapse, degree of disability (Expanded Disability Status Scale–EDSS- score) and the magnetic resonance imaging (MRI) changes at initiation of therapy with teriflunomide (14 mg daily orally) and the subsequent course. Tolerability and side effects were recorded. Any preceding disease modifying therapy was recorded. The treating neurologists were asked about the effectiveness of teriflunomide in the patients under their care. Results: Data for 32 patients was analysed. The majority were women (75%) and of white race (78.1%). The mean age (±SD) was 41.1 (11.5) years at the time of initial assessment. Twenty six of the 32 (81%) patients were on prior disease modifying therapy (DMT) which consisted of an interferon-beta 1a or 1b and glatiramer acetate. One patient was on teriflunomide at initiation of the study. The duration on treatment with DMTs prior to teriflunomide ranged from 7.0 to 236.6 months with a mean (±SD) of 96.5 (71.2) months. The duration of therapy with teriflunomide varied from 3 to 24 months with a mean (±SD) of 12.3 (5.0) months. Fourteen patients experienced mild to moderate relapses while on teriflunomide treatment, with 56% remaining relapse free over the study period. The mean (±SD) EDSS score on teriflunomide was 2.5 (1.6), remaining relatively stable compared to the baseline score 2.6 (1.3). The drug was well tolerated in 24 patients, satisfactorily tolerated in 7 and not tolerated in 1. The treating neurologists’ assessment was that the drug was an effective treatment choice in 87.1% of patients, with 96.9% of patients remaining on therapy at the time of analysis. One patient experienced 2 relapses in the year of treatment and one experienced a relapse and progression of the gait disturbance. Conclusions: This small “real world” study confirms that teriflunomide is an effective DMT for patients with mild to moderate MS, prolonged disease duration and switching from other DMTs. It has a tolerable side effect profile. The oral administration compared to the interferons will appeal to many patients. The drug was also effective in patients who were on previous DMTs.