Contribution to a better understanding of different behaviour patterns observed with organic coatings evaluated by electrochemical impedance spectroscopy

In the present paper, three different coatings (epoxy, alkyd, polyurethane paints) were characterized by electrochemical impedance measurements, permeability tests, free-standing film impedance and local impedance measurements. The increase in resistance with immersion time of alkyd paint was linked to the nature of the polymeric network and not to phenomena occurring at the metal/paint interface. For polyurethane paint, local impedance was not able to detect defects in the paint, which was attributed to the fact that the defects are smaller than those observed in alkyd paint and also that they are less active and homogeneously distributed through the coating. Although electrochemical impedance methods (global and local) are excellent tools to monitor the behaviour of organic coatings, these techniques alone are not sufficient to screen different paints

Initial Experience of a TAVI Program: Analysis of the Anesthetic Decision and its Evolution

Introduction: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team’s experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. Material and Methods: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique. Results: From our patients’ sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) – p 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years. Discussion: The choice of anesthetic technique depends on the patient’s characteristics, experience and preference of the team. Conclusion: Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure

Aorto-left ventricular tunnel : a rare cause of heart failure in the newborn

Aorto-left ventricular tunnel is a rare congenital cardiac anomaly, consisting of a short abnormal pathway, usually from a sinus of Valsalva into the left ventricular cavity. It is usually diagnosed with echocardiography. We report a case of a newborn presenting with heart murmur and rapid progression to heart failure and left ventricular enlargement due to an aorto-left ventricular tunnel. Despite successful closure of the tunnel, the patient required a Ross procedure due to progressive aortic disease.peer-reviewe

Usefulness of TNFR1 as biomarker of intracranial aneurysm in patients with spontaneous subarachnoid hemorrhage

To determine the utility of TNF-α receptor (TNFR1) as a biomarker for the presence of aneurysms in patients with acute subarachnoid hemorrhage (SAH). This is a prospective study in patients with acute spontaneous SAH. Arterial blood from catheter near aneurysm and peripheral venous blood samples are collected. TNFR1 levels were analyzed in patients with and without aneurysm. 80 patients were included, 58 were analyzed. 41 patients (70.7%) had an aneurysm. Venous TNFR1 levels >1658 pg/ml had 46.3% sensitivity and 94.1% specificity for aneurysms presence. TNFR1 >1658 pg/ml was also an independent predictor for its presence (odds ratio = 12.03 [1.13–128.16]; p = 0.039). High levels of TNFR1 in peripheral venous blood are associated with the presence of aneurysm in patients with acute SAH. Subarachnoid hemorrhage (SAH) is a neurological emergency, in many cases caused by the rupture of a cerebral aneurysm. Usually aneurysms are detected in imaging tests, but sometimes they can be very small and go unnoticed. TNF-α is an inflammatory biomarker related to the presence and rupture of intracranial aneurysms and its receptor, TNFR1, could be detected in peripheral blood. This study demonstrates that elevated peripheral blood TNFR1 values are related to the presence of intracranial aneurysms in patients with acute subarachnoid hemorrhage. Following further research, it could become a useful tool for detecting small aneurysms in addition to conventional imaging tests

Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery : A systematic review and meta-analysis

Background and purpose Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study-level meta-analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0-2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results Twelve studies with a total of 679 patients were included in the meta-analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83-70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35-55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30-20.93) and 12.3% (95% CI 8.64-17.33). sICH occurred in 4.2% (95% CI 2.47-7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75-5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.Peer reviewe

Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in the Early and Extended Window

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct. Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5. Design, setting, and participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score. Exposure: All patients underwent MT in one of the included centers. Main outcomes and measures: A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset). Results: A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful recanalization; P = .007). Having a low ASPECTS (odds ratio, 0.60; 95% CI, 0.38-0.85; P = .002) and presenting in the extended window (odds ratio, 0.69; 95% CI, 0.55-0.88; P = .001) were associated with worse 90-day outcome after controlling for potential confounders, without significant interaction between these 2 factors (P = .64). Conclusions and relevance: In this cohort study, more than 1 in 5 patients presenting with an ASPECTS of 2 to 5 achieved 90-day functional independence after MT. A favorable outcome was nearly 5 times more likely for patients with low ASPECTS who had successful recanalization. The association of a low ASPECTS with 90-day outcomes did not differ for patients presenting in the early vs extended MT window

Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy

Importance: There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy. Objective: To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI). Design, setting, and participants: In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022. Exposures: Selection by NCCT, CTP, or DWI. Main outcomes and measures: Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days. Results: Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P = .37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P = .99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P = .12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P = .29) were similar among groups. Conclusions and relevance: In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window