The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a widely used risk assessment tool in patients with severe aortic stenosis to determine operability and to select patients for alternative therapies such as transcatheter aortic valve implantation. The objective of this study was to determine the accuracy of the EuroSCORE in predicting mortality following aortic valve replacement (AVR).</p> <p>Methods</p> <p>The logistic EuroSCORE was determined for all consecutive patients that underwent conventional AVR between 1995 and 2005 at our institution. Provincial Vital Statistics were used to determine all-cause mortality. The accuracy of the prognostic risk prediction provided by logistic EuroSCORE was assessed by comparing observed and expected operative mortality.</p> <p>Results</p> <p>During the study period, a total of 1,421 patients underwent AVR including 237 patients (16.7%) that had a logistic EuroSCORE > 20. Among these patients, the mean predicted operative mortality was 38.7% (SD = 18.1). The actual mortality of these patients was significantly lower than that predicted by EuroSCORE (11.4% vs. 38.7%, observed/expected ratio 0.29, 95% CI 0.15–0.52, P < 0.05). The EuroSCORE overestimated mortality within all strata of predicted risk. Although medium-term mortality is significantly higher among patients with EuroSCORE > 20 (log rank P = 0.0001), approximately 60% are alive at five years.</p> <p>Conclusion</p> <p>Actual operative mortality in patients undergoing AVR is significantly lower than that predicted by the logistic EuroSCORE. Additionally, medium-term survival following AVR is acceptable in high-risk patients with EuroSCORE > 20. More accurate risk prediction models are needed for risk-stratifying patients with severe aortic stenosis.</p

Encapsulated deep eutectic solvent for esterification of free fatty acid

A novel encapsulated deep eutectic solvent (DES) was introduced for biodiesel production via a two-step process. The DES was encapsulated in medical capsules and were used to reduce the free fatty acid (FFA) content of acidic crude palm oil (ACPO) to the minimum acceptable level (< 1%). The DES was synthesized from methyltriphenylphosphonium bromide (MTPB) and p-toluenesulfonic acid (PTSA). The effects pertaining to different operating conditions such as capsule dosage, reaction time, molar ratio, and reaction temperature were optimized. The FFA content of ACPO was reduced from existing 9.61% to less than 1% under optimum operating conditions. This indicated that encapsulated MTPB-DES performed high catalytic activity in FFA esterification reaction and showed considerable activity even after four consecutive recycling runs. The produced biodiesel after acid esterification and alkaline transesterification met the EN14214 international biodiesel standard specifications. To our best knowledge, this is the first study to introduce an acidic catalyst in capsule form. This method presents a new route for the safe storage of new materials to be used for biofuel production. Conductor-like screening model for real solvents (COSMO-RS) representation of the DES using σ-profile and σ-potential graphs indicated that MTPB and PTSA is a compatible combination due to the balanced presence and affinity towards hydrogen bond donor and hydrogen bond acceptor in each constituent

Utilizing Risk Scores in Determining the Optimal Revascularization Strategy for Complex Coronary Artery Disease

Percutaneous coronary intervention (PCI) of multivessel and/or left main stem disease have been shown to be potentially legitimate revascularization alternatives in appropriately selected patients. Risk stratification is an important component in guiding patients to identify the most appropriate revascularization modality (PCI or coronary artery bypass grafting [CABG]) in conjunction with the Heart Team. The aim of this paper is to give the clinician a concise overview of the important established and evolving contemporary risk models in aiding this decision-making process. Risk models, based on clinical and anatomical variables alone, the novel concept of functional anatomical risk scores, and risk models combining aspects from both clinical and anatomical scores, are all discussed. The emerging concepts of the patient-empowered risk/benefit tradeoff between PCI and CABG to help personalize the choice of revascularization modality are also explored

Cyclic voltammetry of metallic acetylacetonate salts in quaternary ammonium and phosphonium based deep eutectic solvents

Seven commercially sourced acetylacetonate salts were investigated in deep eutectic solvents (DESs that were prepared from ethylene glycol and trifluoroacetamide hydrogen bond donors) by cyclic voltammetry, to identify electrolytes suitable for future applications in electrochemical energy storage devices. Although the solubilities are low and on the order of 0.02 mol·L−1 for the most soluble salts, some were found to display encouraging quasi-reversible electrochemical kinetics. For instance, the diffusion coefficients of copper(II) acetylacetonate and iron(III) acetylacetonate in the trifluoroacetamide based DES are 1.14 × 10−8 and 5.12 × 10−9 cm2·s−1, which yields rate constants of 3.16 × 10−3 and 8.43 × 10−6 cm·s−1, respectively. These results are better than those obtained with the DESs prepared from ethylene glycol. The poor kinetics of the iron(III) acetylacetonate system was possibly due to the hygroscopic nature of the DESs that resulted in a continuous build-up of moisture in the system in spite of the maintenance of an inert atmosphere by means of a plastic glove bag. Further work is thus envisaged in an inert dry box that could lead to H-type glass cell charge/discharge experiments in the future