Long onlay bypass grafting using the left internal mammary artery for proximal and mid stenosis of the left anterior descending artery

Aim of the study: According to the literature, many surgeons aim to obtain complete revascularization during coronary artery surgery. This becomes an issue when the left anterior descending (LAD) artery is diffusely diseased. This study presents the results of revascularization surgery of LAD arteries with multiple stenoses and the subsequent angiographic control examinations. Material and methods: Forty-seven patients with proximal and mid-segment left anterior descending (LAD) artery disease were included in the study. Left anterior descending arteries were bypassed with left internal mammary arteries (LIMAs). Left anterior descending arteries were longitudinally opened over the mid stenotic segments 4-5 mm distally and proximally from the stenosis. The LIMAs were then anastomosed to the LAD arteries with a running suture, using 7-0 polypropylene sutures. Thirteen patients, who provided their informed consent, were angiographically evaluated at a mean of 12.5 ± 3.7 months after the operation (range 6-18 months). Results: The mean age of the patients was 64.1 ± 8.9 years. The mean number of distal anastomoses was 3.5 ± 0.9 (range 1-6). The mean length of LAD anastomoses was 1.88 ± 0.54 cm (range 1.5-4 cm). Cardiac troponin I levels were below perioperative myocardial infarction thresholds. Mean postoperative hospitalization was 6.10 ± 0.98 days (range 5-9 days). There was no mortality in the study group. Control angiography revealed patent bypass grafts in all patients. Conclusions: Long anastomosis to the LAD artery provides excellent mid-term patency. It is safe and effective in perfusing the proximal and distal non-stenotic segments of the LAD artery, as well as in perfusing the unoccluded side branches originating from the stenotic segments. © 2014 Termedia Sp. z o.o. All rights reserved

Güneş enerjisi destekli zeolit iklimlendirme sistemi

TÜBİTAK MAG01.01.2009Güneş enerjisi ekonomik, temiz ve yenilenebilir bir enerji türüdür. Çevresel faktörler ve artmakta olan enerji talepleri dikkate alındığında bu enerji türünün kullanımı büyük önem kazanmaktadır. Güneş enerjili adsorplanmalı soğutma (GEAS) sistemleri gelecekte yaygın olarak kullanılması düşünülen ve ticarileşmesi için yoğun bir şekilde çaba sarf edilen termal enerji destekli soğutma sistemlerindendir. Bu sistemlerin başarılı bir şekilde çalışması büyük ölçüde adsorban- adsorplanan çiftinin doğru seçimine bağlıdır. Zeolit-su, zeolit-organik soğutucular, silika jel-su ve activated karbon-methanol katı adsorplanmalı güneş enerjili soğutma sistemlerinde kulanılabilecek uygun adsorban- adsorplanan çiftlerinden bazılarıdır. Adsorban malzemenin adsorplama kapasitesi, x=f (P, T), adsorpsiyon basıncı ve adsorban malzemenin sıcaklığı ile değişmektedir ve bu değişim çoğunlukla eş sıcaklık eğrileri çizilerek ifade edilmektedir. Bu çalışmada ilk olarak, zeolit-su çalışma çiftine ait eş sıcaklık eğrilerini elde etmek için adsorpsiyon deney düzeneği tasarlanmış ve imal edilmiştir. Daha sonra, bu düzenek üzerinde bir takım deneyler yapılmıştır. Bu deneyler sonucunda, zeolit-su çalışma çiftine ait eş sıcaklık eğrileri, adsorpsiyon ve desorpsiyon prosesleri için farklı adsorban o sıcaklıkları(40-150 C)veadsorpsiyonbasınçları(0.87-7.38kPa)altındadeneyselolarakelde edilmiştir. Ayrıca, adsorpsiyon ve desorpsiyon prosesleri için elde edilen eş sıcaklık eğrilerine Dubinin–Astakhov denklemi uyarlanmıştır. Đkinci olarak, adsorpsiyon deneylerinden elde edilen sonuçlar çerçevesinde, zeolit-su çalışma çiftini kullanan güneş enerjisi destekli adsorpsiyonlu örnek soğutma grubu tasarlanmış ve imalatı gerçekleştirilmiştir. Daha sonra, adsorpsiyonlu örnek soğutma grubunun termal performansı farklı buharlaştırıcı sıcaklıklarında deneysel olarak incelenmiştir. Desorpsiyon prosesi sırasında zeolit yatağının yenilenmesi için gerekli enerji, güneş enerjisi yerine elektrik enerjisiyle ısıtılan ısı transfer sıvısının gövde ile adsorban yatak arasında dolaştırılmasıyla sağlanmıştır. Diğer bir ifade ile güneş enerjisi elektrik enerjisi kullanılarak benzeştirilmiştir. Deneyler sonucunda, soğutma grubunun COP değeri ortalama 0, 25 olarak bulunmuştur. Son olarak, GEAS sistemlerini başarısı çalışma çiftinin doğru seçiminin yanı sıra sistemde kullanılacak güneş toplaçlarının performansına ve ekonomik maliyetinede büyük ölçüde bağlıdır. Dolayısıyla bu çalışmada, soğutma sisteminin güneş enerjisi destekli olması sebebiyle bir yıl boyunca düzlemsel ve vakumlu boru tipi güneş toplaçlarının performansı Ankara ili iklim koşulları altında deneysel olarak incelenmiştir. Ayrıca, güneş enerjisi destekli zeolit-su çalışma çiftini kullanan xi adsorpsiyonlu soğutma sisteminin yıllık analizlerini yapmak üzere TRNSYS programı yardımıyla sayısal bir model tasarlanmıştır.Solar energy is economical, clean and renewable. The use of solar energy is gaining more attention due to environmental factors and increasing demand for energy. Solar powered adsorption cooling (SPAC) systems are considered to have a large potential for use in the future and extensive efforts have been expended to make the thermal powered adsorption cooling systems commercial. The successful operation of these systems mostly depends on the correct choice of the adsorbent-adsorbate working pair. Zeolite-water, zeolite-organic refrigerants, silica gel-water and activated carbon-methanol are some of the suitable adsorbent-adsorbate pairs that can be used in solar powered adsorption cooling systems. Adsorption capacity of the adsorbent material, x=f (P, T), varies with the adsorption pressure and adsorbent temperature and this variation is commonly represented by isotherms of the adsorbent investigated. In this study, firstly, an adsorption experimental set-up was designed and constructed to obtain the isotherms of a natural zeolite-water working pair. After that, a set of experiments was conducted using this set-up. As a result of these experiments, isotherms of the zeolite-water pair were obtained experimentally under various adsorbent o temperatures (40-150 C) and adsorption pressures (0.87-7.38 kPa). In addition, the Dubinin– Astakhov equation was used to fit the isotherm data that were obtained for adsorption and desorption processes. Secondly, within the framework of the results of the adsorption experiments, a prototype of the solar powered adsorption cooling system using the natural zeolite-water working pair was designed and constructed. Afterwards, the thermal performance of the prototype was investigated experimentally under different evaporation temperatures. In these experiments, during the desorption process, the solar energy that is needed to dry out the saturated adsorbent was simulated by using electrical energy. As a result, the average COP value of the prototype studied was found as 0,25. Finally, in addition to the correct choice of the adsorbent-adsorbate pair, the success of the (SPAC) systems depends largely on the thermal performance and cost of the solar collectors. Therefore, in this study, the performance of flat plate and evacuated tube collectors were investigated under the climatic conditions of Ankara for one year. Additionally, a numerical model of the solar powered adsorption cooling system using zeolite-water pair was developed with the help of the TRNSYS program to analyze the annual performance of this system

Manual thrombus aspiration and the improved survival of patients with unstable angina pectoris treated with percutaneous coronary intervention (30 months follow-up)

The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris. We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015. Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.801.11 vs 4.230.89, P=0.012; troponin T: 0.0120.014 vs 0.0180.008, P=0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean followup period of 28.876.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16-18.21, P=0.029). Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better survival over a 30-month follow-up period. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication