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1.  Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial 
Newby, David E | Williams, Michelle C | Flapan, Andrew D | Forbes, John F | Hargreaves, Allister D | Leslie, Stephen J | Lewis, Steff C | McKillop, Graham | McLean, Scott | Reid, John H | Sprat, James C | Uren, Neal G | van Beek, Edwin J | Boon, Nicholas A | Clark, Liz | Craig, Peter | Flather, Marcus D | McCormack, Chiara | Roditi, Giles | Timmis, Adam D | Krishan, Ashma | Donaldson, Gillian | Fotheringham, Marlene | Hall, Fiona J | Neary, Paul | Cram, Louisa | Perkins, Sarah | Taylor, Fiona | Eteiba, Hany | Rae, Alan P | Robb, Kate | Barrie, Dawn | Bissett, Kim | Dawson, Adelle | Dundas, Scot | Fogarty, Yvonne | Ramkumar, Prasad Guntur | Houston, Graeme J | Letham, Deborah | O’Neill, Linda | Pringle, Stuart D | Ritchie, Valerie | Sudarshan, Thiru | Weir-McCall, Jonathan | Cormack, Alistair | Findlay, Iain N | Hood, Stuart | Murphy, Clare | Peat, Eileen | Allen, Barbara | Baird, Andrew | Bertram, Danielle | Brian, David | Cowan, Amy | Cruden, Nicholas L | Dweck, Marc R | Flint, Laura | Fyfe, Samantha | Keanie, Collette | MacGillivray, Tom J | Maclachlan, David S | MacLeod, Margaret | Mirsadraee, Saeed | Morrison, Avril | Mills, Nicholas L | Minns, Fiona C | Phillips, Alyson | Queripel, Laura J | Weir, Nicholas W | Bett, Fiona | Divers, Frances | Fairley, Katie | Jacob, Ashok J | Keegan, Edith | White, Tricia | Gemmill, John | Henry, Margo | McGowan, James | Dinnel, Lorraine | Francis, C Mark | Sandeman, Dennis | Yerramasu, Ajay | Berry, Colin | Boylan, Heather | Brown, Ammani | Duffy, Karen | Frood, Alison | Johnstone, Janet | Lanaghan, Kirsten | MacDuff, Ross | MacLeod, Martin | McGlynn, Deborah | McMillan, Nigel | Murdoch, Laura | Noble, Colin | Paterson, Victoria | Steedman, Tracey | Tzemos, Nikolaos
Trials  2012;13:184.
Background
Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic.
Methods/design
The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014.
Discussion
This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease.
Trial registration
ClinicalTrials.gov Identifier: NCT01149590
doi:10.1186/1745-6215-13-184
PMCID: PMC3667058  PMID: 23036114
Computed tomography; Coronary heart disease; Rapid access chest pain clinic
2.  An animal paired crossover ePTFE arteriovenous graft model 
Purpose
Previously, we developed a porcine model for Arterio Venous Graft (AVG) failure to allow assessment of new access strategies. This model was limited concerning graft length. In the present technical report, we describe a modification of our model allowing the assessment of long AVGs.
Technique
In 4 pigs, AVGs of 15 cm length were created bilaterally in a cross-over fashion between the carotid artery and the contralateral jugular vein. Two days (2 pigs) and two weeks (2 pigs) after AV shunting, graft patency was evaluated by angiography, showing all four grafts to be patent, with no sign of angiographic or macroscopic narrowing at the anastomoses sites.
Conclusions
In this modified pig AVG failure model, implantation of a bilateral cross-over long AVG is a feasible approach. The present model offers a suitable tool to study local interventions or compare various long graft designs aimed at improvement of AVG patency.
doi:10.1186/1750-1164-4-7
PMCID: PMC3006397  PMID: 21110903

Results 1-2 (2)