The impact of a dedicated coronavirus disease 2019 primary angioplasty protocol on time components related to ST-segment elevation myocardial infarction management in a 24/7 primary percutaneous coronary intervention�capable hospital

Background Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST-segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID-19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols. aims We aimed to investigate the impact of our dedicated COVID-19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study. methods Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real-time reverse transcriptase�polymerase chain reaction (rRT-PCR) tests were performed in patients suspected of having COVID-19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019. results Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT-PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID-19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70-day mortality rate before and during the pandemic was 2.73 and 4.49, respectively (P = 0.4). conclusions The implementation of the dedicated COVID-19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short-term clinical outcomes, and staff safety as in the prepandemic era. Copyright by the Author(s), 2020

Comparison of outcomes of percutaneous coronary intervention on proximal versus non-proximal left anterior descending coronary artery, proximal left circumflex, and proximal right coronary artery: A cross-sectional study

BACKGROUND: Previous studies have shown that lesions in proximal left anterior descending coronary artery (LAD) may develop more restenosis after balloon angioplasty than lesions in other coronary segments. However, stenting seems to have reduced this gap. In this study, we compared outcomes of percutaneous coronary intervention (PCI) on proximal LAD versus proximal left circumflex (LCX) or right coronary artery (RCA) and proximal versus non-proximal LAD. METHODS: From 1737 patients undergoing PCI between March 2004 and 2005, those with cardiogenic shock, primary PCI, total occlusions, and multivessel or multi-lesion PCI were excluded. Baseline characteristics and in-hospital outcomes were compared in 408 patients with PCI on proximal LAD versus 133 patients with PCI on proximal LCX/RCA (study I) and 244 patients with PCI on non-proximal LAD (study II). From our study populations, 449 patients in study I and 549 patients in study II participated in complete follow-up programs, and long-term PCI outcomes were compared within these groups. The statistical methods included Chi-square or Fisher's exact test, student's t-test, stratification methods, multivariate logistic regression and Cox proportional hazards model. RESULTS: In the proximal LAD vs. proximal LCX/RCA groups, smoking and multivessel disease were less frequent and drug-eluting stents were used more often (p = 0.01, p < 0.001, and p < 0.001, respectively). Patients had longer and smaller-diameter stents (p = 0.009, p < 0.001, respectively). In the proximal vs. non-proximal LAD groups, multivessel disease was less frequent (p = 0.05). Patients had larger reference vessel diameters (p < 0.001) and were more frequently treated with stents, especially direct stenting technique (p < 0.001). Angiographic success rate was higher in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups (p = 0.004 and p = 0.05, respectively). In long-term follow-up, major adverse cardiac events showed no difference. After statistical adjustment for significant demographic, angiographic or procedural characteristics, long-term PCI outcomes were still similar in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups. CONCLUSION: Despite the known worse prognosis of proximal LAD lesions, in the era of stenting, our long-term outcomes were similar in patients with PCI on proximal LAD versus proximal LCX/RCA and non-proximal LAD. Furthermore, we had better angiographic success rates in patients with PCI on proximal LAD

Different irradiation machines and their effects on testes exposure levels and sex hormones profile in patients with rectal cancer

Objective: Complications of pelvic irradiation for rectal cancer have gained more attention because of increased survival of patients. The aim of this study was to compare testes doses when pelvis is irradiated using Cobalt 60 (Co60) for rectal cancer in comparison with linear accelerator (LINAC) and its effect on sex hormones levels. Materials and Methods: In a cohort study, 28 rectal cancer patients that were candidate to receive pelvic radiotherapy were recruited in the study consecutively. They were sequentially assigned to receive radiotherapy using Co60 teletherapy or LINAC. Serum sex hormones levels were measured before and 3-6 weeks after irradiation. Testes absorption doses were measured three times during whole course of irradiation in nine patients. Results: Testes doses in LINAC group were significantly lower than Co60 group (p < 0.001). Serum follicular-stimulating hormone (FSH) and luteinising hormone (LH ) levels increased after irradiation in both groups and there was not a significant relation between FSH and LH levels with treatment machine (p < 0.2 and p < 0.6, respectively). Serum testosterone level decreased significantly in Co60 group (p < 0.05) but not in LINAC group (p < 0.3). Discussion: It seems using LINAC for pelvic irradiation in patient with rectal cancer cannot prevent hormonal changes and we suggest using extra shield to decrease testes doses below the toxic levels. Copyright © Cambridge University Press 2010

Electrical discharge machining characteristics of nickel-titanium shape memory alloy based on full factorial design

Among many shape memory alloys, nickel\u2013titanium (NiTi) alloys are popular due to their superior properties in shape memory effect and superelasticity. They are presently often used in microengineering and medical technology especially in orthopedic and ..

Social sustainability of treatment technologies for bioenergy generation from the municipal solid waste using best worst method

Despite the fundamental role of the social aspect in the implementation of sustainability in the bio-based industries, most of the sustainability assessments research have addressed the environmental and economic dimensions. However, the social dimension has been neglected and it can cause an irreparable outcome in the biotechnology industries. Following this issue, this study propounds a modified systemic approach for a social sustainability impact assessment of the treatment technologies for converting waste into bioenergy, based on a review on the common social assessment methods. As it is known, the guideline presented by the United Nations Environment Program (UNEP) and the Society of Environmental Toxicology and Chemistry (2009) due to considering social life cycle assessment has a comprehensive look at the stakeholders. Therefore, in this paper, UNEP method was selected. However, it needs to be modified based on the bio-energy supply chain derived from municipal solid waste. For this purpose, the bioenergy value chain derived from municipal solid waste was designed and combined with UNEP guideline, to complete the level of stakeholder subgroups and the levels of the indicators. The final method of the social assessment system was presented to the board of experts and finalized. In order to design the measurement part of the social assessment system, because of a multi criteria decision making nature of the social sustainability evaluation of the conversion technologies of municipal solid waste to bio-energies, a recent developed multi-criteria decision making method so-called Best Worst Method (BWM) was used in two stages. The criteria are ranked according to their average weight obtained through Best Worst method. One of the major novelties in this research is the way of application of the best worst technique in the second stage. The model was implemented in the case of Tehran as one of the pioneering Iranian municipalities with high potential to produce bioenergy. The results of this study help decision makers to decide where to concentrate their attention during the implementation stage, and to increase social sustainability in their bioenergy supply chains derived waste

Study on the role of environmental parameters and HIF-1A gene polymorphism in coronary collateral formation among patients with ischemic heart disease

Objectives: To evaluate the association between collateral formation and some environmental factors along with a polymorphism in HIF-1A gene in selected Iranian patients with CAD. Design and methods: Patients with >= 70 narrowing in at least one coronary vessel according to coronary angiography were enrolled. The patients' demographic, clinical and biochemical data were collected. The presence of C1772T polymorphisms within HIF-1A was analyzed using the polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). Results: There is no significant difference between the patients with and without collaterals according to the frequency of T allele or HIF-1A variants. The higher severity of coronary vessel obstruction was positive predictor of collateral formation (OR = 1.026, 95, CI: 1.02-0.04, p<0.001), whereas aging and cigarette smoking were negative predictors (OR = 0.95, 95 Cl: 0.91-0.99, p<0.05; OR = 0.30, 95 CI: 0.11-0.79, p <0.05; respectively). Conclusions: The findings indicate not any significant association between collateral formation and polymorphic variants of HIF-1A and P582S substitution does not appear to influence the collateral formation in patients with myocardial ischemia (C) 2011 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved

Clinical outcomes of percutaneous coronary intervention with drug eluting stents in diabetic patients

Background: Several randomized controlled trials have demonstrated the safety and efficacy of drug eluting stents (DES) in selected groups of patients with less complicated diabetes. We conducted this study to determine how an unselected group of diabetic patients in Iran fare following DES implantation. Methods: Data were collected on 147 consecutive diabetic patients who underwent percutaneous coronary intervention (PCI) with the implantation of at least one DES at the Tehran Heart Center from June 2003 to September 2005. Clinical follow-up was performed by timely scheduled visits at one, four and nine months following DES implantation. Nine months of follow-up was completed for 94.5% of the patients. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which include cardiac death, myocardial infarction and target vessel revascularization (TVR). In-hospital complications were the secondary endpoint.Results: A total of 158 coronary artery lesions were treated with DES in 147 diabetic patients (mean age = 56.4&amp;plusmn;8.92 years, 57.1% were men). During the nine-month follow-up, MACE occurred in 3.4% of patients, with a myocardial infarction rate of 1.4% and TVR rate of 1.4%. Considering one patient who underwent TVR due to acute stent thrombosis following angioplasty (during hospitalization) the total number of TVR reached 3 (2%). Only one patient (0.7%) died of cardiac death, which occurred after the procedure and before discharge. In-hospital complications occurred in six patients (4.1%); five patients suffered from myocardial infarction. Conclusions: PCI with DES seems to be safe and effective in diabetic patients. However, more studies with larger study populations and longer follow-up are required to confirm this issue

Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation

Aim. The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits on heart rate recovery (HRR) as non-diabetic coronary individuals after cardiac rehabilitation, assessing separately male and female subjects separately. Methods. Data used for the analyses were from an eight-week phase H cardiac rehabilitation including 284 patients with ischemic heart disease who were managed at Tehran Heart Center between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic subjects before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction. Results. Among men, non-diabetic patients achieved greater improvement in peak heart rate and HRR. Additionally, lower resting heart rate was found in non-diabetic men after rehabilitation. In women 50 years, there was no significant difference between diabetic and non-diabetic. The non-diabetic women Conclusion. These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women 50 years. The response to cardiac rehabilitation in women may appear to be more influenced by age at menopause rather than diabetes mellitus