TCT-319 Use of Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Background: There are limited data on the limited antegrade subintimal tracking (LAST) crossing technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed the frequency of use and outcomes of LAST among 2,003 CTO PCIs performed with antegrade dissection and re-entry (ADR) in the PROGRESS-CTO Registry between 2012 and 2021 at 39 centers. Results: LAST was used in 144 cases (7.2%), primary LAST in 113 (5.6%), and secondary LAST in 31 cases (1.5%). The Stingray system was used in 905 cases (45.2%), subintimal tracking and re-entry (STAR) in 333 cases (16.6%), and contrast-guided STAR in 29 cases (1.4%). The mean patient age was 64.2 ± 10 years, 86% were men, and 34.9% had prior coronary artery bypass graft surgery. Cases in which LAST was used were less complex with a lower J-CTO score (2.50 ± 1.32 vs. 2.95 ± 1.10, P \u3c 0.001). There was no difference in technical (75.0% vs 78.4%, P = 0.337) and procedural success (72.2% vs 75.5%, P = 0.384) and major cardiac adverse events (MACEs) (2.08% vs 3.55%, P = 0.352) between LAST and non-LAST cases. However, cases in which the LAST technique was used required less procedure and fluoroscopy time (Figure 1A). A primary LAST technique was associated with higher technical and procedural success rates and a similar MACE rate compared with a secondary LAST technique (Figure 1B). Conclusion: LAST is used in 7.2% of ADR CTO PCI cases and is associated with similar technical and procedural success rates and major complication rates but lower procedural and fluoroscopy time compared with ADR cases that did not use LAST

Toll-like receptor 9 and the inflammatory response to surgical trauma and cardiopulmonary bypass

Objectives Cardiac surgery can lead to post-operative end-organ complications secondary to activation of systemic inflammatory response. We hypothesize that surgical trauma or cardiopulmonary bypass (CPB) may initiate systemic inflammatory response via release of mitochondrial DNA (mtDNA) signaling Toll-like receptor 9 (TLR9) and interleukin-6 production (IL-6). Materials and methods The role of TLR9 in systemic inflammatory response in cardiac surgery was studied using a murine model of sternotomy and a porcine model of sternotomy and CPB. mtDNA and IL-6 were measured with and without TLR9-antagonist treatment. To study ischemia-reperfusion injury, we utilized an ex-vivo porcine kidney model. Results In the rodent model (n = 15), circulating mtDNA increased 19-fold (19.29 ± 3.31, p < 0.001) and plasma IL-6 levels increased 59-fold (59.06 ± 14.98) at 1-min post-sternotomy compared to pre-sternotomy. In the murine model (n = 11), administration of TLR-9 antagonists lowered IL-6 expression post-sternotomy when compared to controls (59.06 ± 14.98 vs. 5.25 ± 1.08) indicating that TLR-9 is a positive regulator of IL-6 after sternotomy. Using porcine models (n = 10), a significant increase in circulating mtDNA was observed after CPB (Fold change 29.9 ± 4.8, p = 0.005) and along with IL-6 following renal ischaemia-reperfusion. Addition of the antioxidant sulforaphane reduced circulating mtDNA when compared to controls (FC 7.36 ± 0.61 vs. 32.0 ± 4.17 at 60 min post-CPB). Conclusion CPB, surgical trauma and ischemic perfusion injury trigger the release of circulating mtDNA that activates TLR-9, in turn stimulating a release of IL-6. Therefore, TLR-9 antagonists may attenuate this response and may provide a future therapeutic target whereby the systemic inflammatory response to cardiac surgery may be manipulated to improve clinical outcomes

Transcriptome Kinetics of Circulating Neutrophils during Human Experimental Endotoxemia

Polymorphonuclear cells (neutrophils) play an important role in the systemic inflammatory response syndrome and the development of sepsis. These cells are essential for the defense against microorganisms, but may also cause tissue damage. Therefore, neutrophil numbers and activity are considered to be tightly regulated. Previous studies have investigated gene transcription during experimental endotoxemia in whole blood and peripheral blood mononuclear cells. However, the gene transcription response of the circulating pool of neutrophils to systemic inflammatory stimulation in vivo is currently unclear. We examined neutrophil gene transcription kinetics in healthy human subjects (n = 4) administered a single dose of endotoxin (LPS, 2 ng/kg iv). In addition, freshly isolated neutrophils were stimulated ex vivo with LPS, TNFα, G-CSF and GM-CSF to identify stimulus-specific gene transcription responses. Whole transcriptome microarray analysis of circulating neutrophils at 2, 4 and 6 hours after LPS infusion revealed activation of inflammatory networks which are involved in signaling of TNFα and IL-1α and IL-1β. The transcriptome profile of inflammatory activated neutrophils in vivo reflects extended survival and regulation of inflammatory responses. These changes in neutrophil transcriptome suggest a combination of early activation of circulating neutrophils by TNFα and G-CSF and a mobilization of young neutrophils from the bone marrow

Manipulating the Hype: contemporary art's response to media cliches

Manipulating the Hype addresses art’s reaction to the barrage of signs produced by the media. The paper researches contemporary art’s response to clichéd media stereotypes and elucidates artists’ multifaceted perspective on overtly obvious yet widely embraced paradigms marketed by the media. Contemporary art’s strategic reconfiguration of media stereotypes is a valuable introspection upon the superficiality and impracticability of advertising and entertainment industry constructs. By reconsidering the mediated image, art has the ability to inspire reevaluation of cultural values. The thesis additionally attempts to ascertain the reinterpretation of media stereotypes as a common thread linking principal art movements and historically significant artworks from around the world since 1960. How does contemporary art respond to the extensive cultural influence of the media? Is a reaction to mass media a thematic commonality linking contemporary artists in the age of globalization? Manipulating the Hype is a dual outcome investigation comprised of written thesis and studio practice. The written thesis combines experience from a lengthy professional practice with historical and theoretical research. The visual thesis consists of twelve photographic works taken at on the Big Island of Hawaii. The images juxtapose artificial icons of power from popular culture with the natural force of the active lava flow. The process of research discloses how the advertising and entertainment industries capitalize upon innate human desires through the manipulative proliferation of archetypal imagery. Furthermore, the thesis establishes the widespread retort to media clichés as a palpable commonality in studio practices worldwide. The findings in the research make evident that although contemporary art does not have sufficient influence to reform the media, it can heighten public awareness of media tactics

Prediction of 305 days milk yield from early records in dairy cattle using on fuzzy inference system

In the present investigation, Adaptive Neuro Fuzzy Inference System (ANFIS) was implemented to predict 305 d milk yield using partial lactation records of Jersey dairy cattle. The input variables for the system in the study were age, lactation number and milk yields for the first three test-days. The output variable from the system was 305 d milk yield. ANFIS results related to the milk yields were compared with observed values. Three criteria considered in order to control the reliability of system predictions were the ratio of mean, determination coefficient, and root mean square error. In addition to, the accuracies of ANFIS were compared using the absolute difference between the observed and predicted 305 d milk yield. R2, RMSE, and RoM values are in the acceptable range. As a conclusion, ANFIS predictions at the beginning of the lactation are related closely to the observed 305 d-lactation yield. The results indicated that ANFIS can be successfully applied for 305 d milk yield early prediction. © 2018, Pakistan Agricultural Scientists Forum. All rights reserved

PREDICTION OF 305 DAYS MILK YIELD FROM EARLY RECORDS IN DAIRY CATTLE USING ON FUZZY INFERENCE SYSTEM

WOS: 000441325100006In the present investigation, Adaptive Neuro Fuzzy Inference System (ANFIS) was implemented to predict 305 d milk yield using partial lactation records of Jersey dairy cattle. The input variables for the system in the study were age, lactation number and milk yields for the first three test-days. The output variable from the system was 305 d milk yield. ANFIS results related to the milk yields were compared with observed values. Three criteria considered in order to control the reliability of system predictions were the ratio of mean, determination coefficient, and root mean square error. In addition to, the accuracies of ANFIS were compared using the absolute difference between the observed and predicted 305 d milk yield. R-2, RMSE, and RoM values are in the acceptable range. As a conclusion, ANFIS predictions at the beginning of the lactation are related closely to the observed 305 d-lactation yield. The results indicated that ANFIS can be successfully applied for 305 d milk yield early prediction

Determination of the Relationship between Patient Satisfaction and Some Global Economic Indicators Using Multidimensional Scaling

WOS: 000450148600006PubMed ID: 30417839Context: The importance of labor that contributes to the economy and economic power of the country is increasing recently. There is a strong link between health and economy. People are happier, more productive, and provide more contribution to the economy in communities of healthy individuals. In countries with strong economy, serious economic investments are made in the field of health to grow healthy individuals. Aim: The purpose of this study is to determine whether patient satisfaction in primary healthcare services is related to economic strength of countries. Materials and Methods: The data of European Patients Evaluate General/Family Practice (EUROPEP) scale from 2011 at 17 Organization for Economic Co-operation and Development (OECD) countries are used. The data were compiled from OECD reports and Republic of Turkey Ministry of Health Refik Saydam Hygiene Center Presidency School of Public Health patient satisfaction with primary healthcare services reports. Statistical Analysis Used: 17 OECD member countries in 2011 health expenditure data, some health indicators, and patient satisfaction are determined to show how grouping in two-dimensional space with the multidimensional scaling. Results: It was observed to vary by countries and groupings that they located in terms of all three criteria. In some countries' economic and health indicators, although quite high compared to the OECD average, citizen satisfaction of healthcare services was low. In some countries, although health expenditure and health indicators are far below the OECD average, citizens' satisfaction with health services has proved to be very high. Conclusion: Multidimensional scaling analysis findings reveal that countries have different positions and groups in terms of each three indicators. According to these results, it cannot be said that high expenditures in the field of health will affect patients satisfaction. Having a strong economy or spending too much money on health does not increase human satisfaction in health care. Effective expenditures on the field of health will increase healthcare service satisfaction. Policy-makers should consider international criteria and take the right steps according to citizens' expectation and satisfaction of healthcare service to implement effective spending

Determination of the relationship between patient satisfaction and some global economic indicators using multidimensional scaling

Context: The importance of labor that contributes to the economy and economic power of the country is increasing recently. There is a strong link between health and economy. People are happier, more productive, and provide more contribution to the economy in communities of healthy individuals. In countries with strong economy, serious economic investments are made in the field of health to grow healthy individuals.Aim: The purpose of this study is to determine whether patient satisfaction in primary healthcare services is related to economic strength of countries.Materials and Methods: The data of European Patients Evaluate General/Family Practice (EUROPEP) scale from 2011 at 17 Organization for Economic Co‑operation and Development (OECD) countries are used. The data were compiled from OECD reports and Republic of Turkey Ministry of Health Refik Saydam Hygiene Center Presidency School of Public Health patient satisfaction with primary healthcare services reports.Statistical Analysis Used: 17 OECD member countries in 2011 health expenditure data, some health indicators, and patient satisfaction are determined to show how grouping in two‑dimensional space with the multidimensional scaling. Results: It was observed to vary by countries and groupings that they located in terms of all three criteria. In some countries’ economic and health indicators, although quite high compared to the OECD average, citizen satisfaction of healthcare services was low. In some countries, although health expenditure and health indicators are far below the OECD average, citizens’ satisfaction with health services has proved to be very high.Conclusion: Multidimensional scaling analysis findings reveal that countries have different positions and groups in terms of each three indicators. According to these results, it cannot be said that high expenditures in the field of health will affect patients satisfaction. Having a strong economy or spending too much money on health does not increase human satisfaction in health care. Effective expenditures on the field of health will increase healthcare service satisfaction. Policy‑makers should consider international criteria and take the right steps according to citizens’ expectation and satisfaction of healthcare service to implement effective spending.Keywords: Economic indicators, health care, health expenditure, patient satisfaction, public healt

The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers

Context: The concept of burnout is an important element for efficiency in occupational groups such as health and education, which necessitate constant communication with people and have a busy schedule.Aims: The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers.Materials and Methods: A questionnaire consisting of four parts was prepared so as to measure the levels of organizational commitment, job satisfaction, and burnout of the medical staff of the institution. The data for this research were gained by a questionnaire sent to 370 medical staff (doctors, nurses, contract staff, and other employees).Statistical Analysis Used: Kolmogorov Smirnov test, t-test, ANOVA, Tukey multiple comparison test and Pearson’s correlation analysis were used to this study.Results: The average age of the employees taking part in the questionnaire was calculated as 34.30 years (min: 18 years, max: 59 years). The proportional value of the individuals with their 0-5 years working period in the institution was observed as 58.1%. An individual’s interior work satisfaction, education level, hours worked at the hospital and their titles are also statistically important (P &lt; 0.05). There is a positive correlation and significant relation between medical staffs’ emotional exhaustion and desensitization (r = 0.573). There is a positive correlation and significant relation between normative commitment sub dimension, interior and exterior job satisfaction (r = 0.449, r = 0.472).Conclusions: Efforts to reduce the job burnout and psychological support for health care workers support motivation in order to provide better services to increase significantly. Thus, both personal productivity will be increased, and gain will be obtained in the institutional sense.Keywords: Burnout, health workers, job satisfaction, organizational commitmen