Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry

Background. Inappropriate cardiac catheterization lab activation together with false-positive angiographies and no-culprit found coronary interventions are now reported as costly to the medical system, influencing STEMI process efficiency. We aimed to analyze data from a high-volume interventional centre (>1000 primary PCIs/year) exploring etiologies and reporting characteristics from all “blank” coronary angiographies in STEMI. Methods. In this retrospective observational single-centre cohort study, we reported two-year data from a primary PCI registry (2035 patients). “Angio-only” cases were assigned to one of these categories: (a) Takotsubo syndrome; (b) coronary embolisation; (c) myocardial infarction with nonobstructive coronary arteries; (d) myocarditis; (e) CABG-referred; (f) normal coronary arteries (mostly diagnostic errors); and (g)others (refusals and death prior angioplasty). Univariate analysis assessed correlations between each category and cardiovascular risk factors. Results. 412 STEMI patients received coronary angiography “only,” accounting for 20.2% of cath lab activations. Barely 77 patients had diagnostic errors (3.8% from all patients) implying false-activations. 40% of “angio-only” patients (n = 165) were referred to surgery due to severe atherosclerosis or mechanical complications. Patients with diagnostic errors and normal arteries displayed strong correlations with all cardiovascular risk factors. Probably, numerous risk factors “convinced” emergency department staff to call for an angio. Conclusions. STEMI network professionals often confront with coronary angiography “only” situations. We propose a classification according to etiologies. Next, STEMI guidelines should include audit recommendations and specific thresholds regarding “angio-only” patients, with specific focus on MINOCA, CABG referrals, and diagnostic errors. These measures will have a double impact: a better management of the patient, and a clearer perception about the usefulness of the investments

The relationship between firms’ financial performance and performance measures of circular economy sustainability: an investigation of the G7 countries

AbstractTo achieve sustainable development, companies are aware that they need to move from the ‘take-make-consume-throw away’ pattern toward an economic model based on sharing, re-use, repair, refurbishing, and recycling. Implementing the circular economy concept into a company’s business model is not an easy process, given that some eco-innovations have higher costs with direct effects on financial performance. Hence, this study aims to determine the relationship between corporate financial performance and the performance measures of the circular economy through multivariate econometric estimations. The observations considered in our sample reflect the financial and circular economy performance for 411 companies with headquarters in the European G7 members disclosed in the period 2014-2020. The EU was chosen to carry out the study because the member states subscribe to a general reporting framework and the European Green Deal agreement, making it the most active in implementing the circular economy model. The findings are based on the econometric models related to the nature and amplitude of the association relation between firms’ financial performance and circular economy in connection with firms’ performance. The results show that the performance of the circular economy has a relatively small influence on the firms’ financial performance

The Macroeconomic Implications of the Transition of the Forestry Industry towards Bioeconomy

In a global economic system where essential resources are limited, demand is increasing and environmental degradation is more pronounced, the only viable option to ensure sustainable development is to create an environmentally friendly and efficient economy in order to produce more economic value with the same or fewer resources. The aim of this paper is to provide insight into the macroeconomic implications determined by the transition to a forest bioeconomy, with a focus on the impact on the national gross value added. More specifically, this analysis assesses the relationship between the potential of the macroeconomic value creation on the forestry industry and the measures of progress on the transition towards sustainable forest management and long-term economic growth. The analysis refers to a period between 2013 and 2019, summing-up 133 observations, data that were reported by Eurostat for 23 European Union members. We propose a model that describes a construct of the potential of the value creation that can be generated by each country included in our sample, translated into an efficiency score determined using the Data Envelopment Analysis(DEA)methodology. The results highlighted that the evolution of economic, social, and environmental (ESG) context positively impacted the efficiency score. This positive evolution in time was mainly driven by the higher awareness of governments, companies, and people on the need for a transition to sustainable economic growth and sustainable forest management. Furthermore, this study highlights that the transition to sustainable economic growth implies negative changes to the cost structure of the economies, which lead to higher operational costs and lower gross value added. Moreover, our study provides more insight, from an econometric methodology perspective, regarding the synergy effect as determined by the transformation of business models in the forestry sector towards sustainable forest management

Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes

BACKGROUND: The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. METHODS AND RESULTS: The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? DISCUSSIONS: Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. CONCLUSIONS: Because viral respiratory infections and TB impede the host’s immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494

Benefits of Nanomedicine for Therapeutic Intervention in Malignant Diseases

Cancer remains one of the most difficult to manage healthcare problems. The last two decades have been considered the golden age of cancer research, with major breakthroughs being announced on a regular basis. However, the major problem regarding cancer treatment is the incapability to selectively target cancer cells, with certain populations of tumors still remaining alive after treatment. The main focus of researchers is to develop treatments that are both effective and selective in targeting malignant cells. In this regard, bioavailability can be increased by overcoming the biological barriers encountered in the active agent’s pathway, creating carrier vehicles that have the ability to target malignant cells and effectively release the active agent. Since its appearance, nanomedicine has provided many answers to these challenges, but still, some expectations were not satisfied. In this review, we focused on the most recent developments in targeted drug delivery. Furthermore, a summary of different types of nanoparticles used to deliver active therapeutic agents in oncology is presented, along with details on the nanodrugs that were clinically approved by the Food and Drug Administration (FDA), until April 2019

Subendocardial Viability Ratio Predictive Value for Cardiovascular Risk in Hypertensive Patients

Background: The subendocardial viability ratio (SEVR), also known as the Buckberg index, is a parameter of arterial stiffness with indirect prognostic value in assessing long-term cardiovascular risk. Materials and Methods: We conducted a prospective cohort study on 70 patients with uncomplicated hypertension admitted to a county medical reference hospital. We analyzed demographics, laboratory data, arterial stiffness parameters and cardiovascular risk scores (SCORE and Framingham risk scores) and aimed to identify paraclinical parameters associated with increased cardiovascular risk. Results: Of the arterial stiffness parameters, SEVR correlates statistically significantly with age, central and peripheral systolic blood pressure, as well as with heart rate. SEVR seems to have prognostic value among hypertensive patients by increasing the risk of major cardiovascular events assessed by SCORE and Framingham risk scores. SEVR correlates statistically significantly with serum fibrinogen (p = 0.02) and hemoglobin (p = 0.046). Between pulse wave velocity and lipid parameters (p = 0.021 for low-density lipoprotein cholesterol and p = 0.030 for triglycerides) a statistically significant relationship was found for the study group. The augmentation index of the aorta also correlated with serum LDL-cholesterol (p = 0.032) and the hemoglobin levels (p = 0.040) of hypertensive patients. Conclusions: Age, abdominal circumference and Framingham score are independent predictors for SEVR in our study group, further highlighting the need for early therapeutic measures to control risk factors in this category of patients