Multivessel Coronary Angioplasty with Drug Eluting Stents in a Chronically Hemodialyzed Diabetic Patient with Impaired Left Ventricular Systolic Function

We present a case of staged multivessel percutaneous coronary intervention (PCI) with drug-eluting-stents (DES) in a diabetic patient with three-vessel coronary heart disease (CHD), dialysis-dependent chronic renal failure and impaired left ventricular (LV) systolic function. The optimal method of coronary revascularization in dialysis patients is controversial. Surgical treatment (CABG) is a high-risk procedure. CABG in the pre- DES era was associated with a better long-term prognosis, but at the cost of higher in-hospital mortality. PCI using DES may be a feasible therapeutic alternative.The revascularization strategy is reviewed

Smart cities as hubs: Connect, collect and control city flows

Regardless the Smart City (SC) broad scope, which ranges from a service-oriented ecosystem with the use of almost all the emerging technologies to a resilient urban environment, practice shows that the SC is mostly capitalized for utility upgrades, urban renovation, and real-time city monitoring. Moreover, recent city implementations register attempts to utilize technology for controlling the entire city flows. The aim of this communication paper is to discuss the SC hubness and more specifically the fact that the SC can become a “hub” that collects, processes, and transmits data; brings together people to co-design and evolve; and controls service, material and people flows in all city types. As a result, this paper defines the role, the uses and the architecture of this “SC-as-a-Hub” operation labeled “SCHub”, which can standardize and control all the city flows

Severe accordion effect: Myocardial ischemia due to wire complication during percutaneous coronary intervention: A case report

A mechanical alteration during manoeuvring of stiff guidewires in tortuous coronary arteries frequently induces vessel wall shortening and coronary psedostenosis, referred as accordion phenomenon. Subtraction of the guidewires normally leads to the entire resolution of the lesions. A case of this transient angiographic finding, during percutaneous coronary intervention in a tortuous right coronary artery, which resulted in a flow limiting effect and myocardial ischemia, is described in the present report. Differential diagnosis from potential procedure complications and interventional methodology issues are discussed, while similar reports are reviewed

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

BACKROUND: Primary percutaneous coronary intervention (PCI) has been shown to be a better reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) compared with thrombolysis, particularly when applied early. The objective of the present study was to report our experience from treating patients presenting to the emergency room of our hospital with STEMI with primary PCI. PATIENTS AND METHODS: The population of the study included 100 patients who presented to our hospital with STEMI and underwent primary PCI over a 12-month period. Patients’ clinical and angiographic data were retrospectively collected and patients were followed up for 9 months. Technical details of the primary PCI, including stent implantation, and use of drug eluting stents, thrombus aspiration catheter, or platelet glycoprotein IIb/ΙΙΙa inhibitors were recorded and correlated to clinical and angiographic patient data. RESULTS: Of 196 patients who presented o the emergency room with STEMI during the study period, 100 (51%) patients (85 men and 15 women) underwent primary PCI. PCI was successful with TIMI 3 flow of the infarct-related coronary artery in 79 (79%) patients. Six (6%) patients died during hospitalization and another 4 (4.3%) patients died during the 9-month follow up period. Twenty one (22%) patients required rehospitalization for acute coronary syndrome, of whom 17 needed a repeat PCI and 4 patients were submitted to coronary artery bypass grafting. Left ventricular ejection fraction (LVEF) was <50% in 54 (54%) patients. In 52 patients primary PCI was performed in less than 4 hours from onset of symptoms. In his cohort, 19 patients were thrombolyzed before arriving to the catheterization laboratory. Antithrombotic therapy with platelet glycoprotein IIb/IIIa inhibitors was used in 48 (48%) patients. Univariate analysis showed that the odds of achieving TIMI 3 flow were higher after using IIb/ΙΙΙa inhibitors (odds ratio-OR 6.4) or if the LVEF ≥50% (vs LVEF < 50%) at the beginning of the PCI (OR 6.4). If the time from the onset of symptoms to PCI was >4 hours, the odds of achieving TIMI 3 flow were reduced by 23.4% compared to time from symptoms to PCI <4 hours. The presence of TIMI 3 flow of the infarct-related artery reduced the odds of death by 10.2% compared to the absence of TIMI 3 flow of the infarct-related coronary artery. CONCLUSION: Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of LVEF >50% and the importance of achieving TIMI 3 flow in the IRA at the end of the procedure

Smart Cities as Hubs: A Use Case in Public School Buildings

Contextual data are receiving increasing attention in Smart Cities as they enable the development and delivery of smart services for their citizens. The homogenization of contextual data flows has become an important topic for standardization bodies as they attempt to enable data flow control and vendor-independent solutions. Buildings are a critical component of cities, due to their role in several dimensions of Smart Cities (including the United Nations Sustainable Development Goals); these may include the monitoring of their operation, maintenance, energy consumption, ability to respond in emergencies, and people flows, all of which affect the sustainability of a Smart City’s ecosystem. In this respect, Building Information Management Systems and Building Infrastructure Management Systems can benefit from this standardization. This paper presents how a novel solution named Smart-City-as-Hub can homogenize building contextual data and enable smart services’ development and delivery based on these data. The analysis of the data from several IoT deployments in public school buildings is the method used to highlight the segmentation and fragmentation of the IoT landscape and to present the benefits that the Smart-City-as-Hub provides in this context. The ways in which the Smart-City-as-Hub concept can mitigate these challenges and enable Smart City stakeholders to concentrate their efforts on developing value-added services is presented in the discussion section. By providing real-life data of the IoT devices deployed in Smart City projects, this study aims to further advance research pursuing the homogenization and standardization of Smart City flows

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

We report our experience from treating a large number of patients who presented to the Emergency Department of our Hospital with ST-elevation acute myocardial infarction (AMI) with primary percutaneous coronary intervention (PCI). Of the 196 patients who presented with ST elevation AMI over a period of 12 months, 100 (51%) patients underwent primary PCI. Clinical and angiographic data were collected and patients were followed up for 9 months. Technical details of the primary PCI, including use of balloon, use of thrombus aspiration catheter, stent implantation, use of drug eluting stents, and use of GP IIb/IIIa inhibitors were recorded and correlated to clinical and angiographic patient data. Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of left ventricular ejection fraction >50% and the importance of achieving TIMI 3 flow in the AMI related artery at the end of the procedure

Engineering of the membrane of fibroblast cells with virus-specific antibodies: a novel biosensor tool for virus detection

A novel concept for the assay of viral antigens is described. The methodological approach is based on a membrane-engineering process involving the electroinsertion of virus-specific antibodies in the membranes of fibroblast cells. As a representative example, Vero fibroblasts were engineered with antibodies against Cucumber mosaic virus (CMV) and used for the construction of an ultra-sensitive miniature cell biosensor system. The attachment of a homologous virus triggered specific changes to the cell membrane potential that were measured by appropriate microelectrodes, according to the principle of the bioelectric recognition assay (BERA). No change in the membrane potential was observed upon cell contact with the heterologous cucumber green mottle mosaic virus (CGMMV). Fluorescence microscopy observations showed that attachment of CMV particles to membrane-engineered cells was associated with membrane hyperpolarization and increased [Ca2+]cyt. In an additional field-based application, we were able to detect CMV-infected tobacco plants at an essentially 100% level of accuracy

Endovascular Treatment of Aneurysm With Side Branches - A Simple Method. Myth or Reality?

PURPOSE: The aim of this study is to present performance data on the use of the multilayer stent which is a 3-dimensional (3D) braided mesh made of interconnected layers, particularly in patients with side branches within the aneurysm. METHODS:  A study protocol was designed to examine the safety and efficacy of the multilayer stent in patients with aneurysms in different target vessels. Between December 2006 and November 2009, 19 patients were enrolled in the study. Four patients had a renal aneurysm (1 male / 3 females) (mean diameter: 18 mm), while the other 15 patients (all males) had iliac artery (n=12, mean diameter: 25 mm),  popliteal artery (n=1, diameter: 55 mm), thoracic aorta (n=1, diameter: 57mm) and abdominal aorta (n=1, diameter: 97.3 mm) aneurysms. RESULTS: The multilayer stent was successfully deployed in all patients (100% technical success); Mean follow-up for the peripheral aneurysms was 28 months (range 12 to 36) and for the aortic aneurysms was 3 months. The occlusion rate of the aneurysm at the peripheral arteries was 100% and all the side branches remained patent. For the thoracic and the abdominal aneurysms, the 3 months computed tomography angiography (CTA) showed patent artery side branches and reduced blood flow inside the sac. CONCLUSION: The multilayer stent seems to be efficient with regard to the side branches which remain patent and the aneurysm is excluded. The question remains about the time needed to achieve the exclusion of the aneurysm in large arteries such as the thoracic and abdominal aorta; we believe this is related to the number and size of the branches within the aneurysm as well as the size of the target vessel itself. A larger multi center study is needed to confirm the suitability of the multilayer stent for the large thoracic, abdominal and thoracoabdominal aneurysms