How does coronary stent implantation impact on the status of the microcirculation during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?

Aims Primary percutaneous coronary intervention (PPCI) is the optimal treatment for patients presenting with ST-elevation myocardial infarction (STEMI). An elevated index of microcirculatory resistance (IMR) reflects microvascular function and when measured after PPCI, it can predict an adverse clinical outcome. We measured coronary microvascular function in STEMI patients and compared sequential changes before and after stent implantation. Methods and results In 85 STEMI patients, fractional flow reserve, coronary flow reserve, and IMR were measured using a pressure wire (Certus, St Jude Medical, St Paul, MN, USA) immediately before and after stent implantation. Stenting significantly improved all of the measured parameters of coronary physiology including IMR from 67.7 [interquartile range (IQR): 56.2-95.8] to 36.7 (IQR: 22.7-59.5), P 40) in 28 (32.9%) patients. In 15 of these patients (17.6% of the cohort), only a partial reduction in IMR occurred and these patients were more likely to be late presenters (pain to wire time >6 h). The extent of jeopardized myocardium [standardized beta: −0.26 (IMR unit/Bypass Angioplasty Revascularization Investigation score unit), P: 0.009] and pre-stenting IMR [standardized beta: −0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after stenting (ΔIMR = post-stenting IMR − pre-stenting IMR), whereas thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit), P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm3 of stent), P: 0.01] were associated with a potentially deleterious increase in IMR. Conclusion Improved perfusion of the myocardium by stent deployment during PPCI is not universal. The causes of impaired microvascular function at the completion of PPCI treatment are heterogeneous, but can reflect a later clinical presentation and/or the location and extent of the thrombotic burde

ART DEMONSTRATES THAT FOOTBALL IS METASTASIZED, AND GIVES IT REFUGE

U ovom se radu problemski analiziraju obilježja nogometa u hit-romanu Alena Bovića Metastaze (2006) te u dvjema kasnijim obradama tog književnog djela – u kazališnoj predstavi Metastaze i istoimenom igranom filmu. Otuda ideja da se ondje zatečen, devijantnim pojavama obilježen nogomet, koji više baš i nema puno dodirnih točaka s igrom koja mu leži u korijenima, nazove metastaziralim. Umjetnička se stvarnost pritom promatra kao korespondentna društvenoj stvarnosti pa se za takvo etiketiranje nogometa prepoznaju razlozi na objema razinama. Na temelju takvog pristupa Metastazama, ali i na osnovi prethodno ponuđenog komparativnog uvida u nogometnu tematiku u nekim drugim književnim, kazališnim i filmskim ostvarenjima u Hrvatskoj i izvan nje, postavlja se teza o umjetnosti kao dokazu metastaziralog nogometa. No, još je izazovnije utvrditi može li umjetnost istodobno poslužiti i kao utočište metastaziralom nogometu tako da se njome revitalizira ponajprije estetska, ali istodobno i etička dimenzija tog sporta. Iz tih pobuda argumentacija u ovome radu uključuje tekstove i autore u širokom rasponu od književne kritike, antropologije igara i sociologije sporta do semiotike, kulturalnih studija i estetike. U ovom se radu problemski analiziraju obilježja nogometa u hit-romanu Alena Bovića Metastaze (2006) te u dvjema kasnijim obradama tog književnog djela – u kazališnoj predstavi Metastaze i istoimenom igranom filmu. Otuda ideja da se ondje zatečen, devijantnim pojavama obilježen nogomet, koji više baš i nema puno dodirnih točaka s igrom koja mu leži u korijenima, nazove metastaziralim. Umjetnička se stvarnost pritom promatra kao korespondentna društvenoj stvarnosti pa se za takvo etiketiranje nogometa prepoznaju razlozi na objema razinama. Na temelju takvog pristupa Metastazama, ali i na osnovi prethodno ponuđenog komparativnog uvida u nogometnu tematiku u nekim drugim književnim, kazališnim i filmskim ostvarenjima u Hrvatskoj i izvan nje, postavlja se teza o umjetnosti kao dokazu metastaziralog nogometa. No, još je izazovnije utvrditi može li umjetnost istodobno poslužiti i kao utočište metastaziralom nogometu tako da se njome revitalizira ponajprije estetska, ali istodobno i etička dimenzija tog sporta. Iz tih pobuda argumentacija u ovome radu uključuje tekstove i autore u širokom rasponu od književne kritike, antropologije igara i sociologije sporta do semiotike, kulturalnih studija i estetike.This article presents an analysis of the characteristics of football as depicted in the bestselling novel Metastaze (Metastases) (2006) by Alen Bović and in its two subsequent adaptations – the play Metastaze (Metastases) directed by Boris Svrtan and the film Metastaze (Metastases) directed by Branko Schmidt. Football as it appears in these three pieces is metastasized: it is deviant and in fact undergoes so many significant changes that it no longer has much in common with the original game. Artistic reality is seen as corresponding to social reality, and reasons for the metastasized nature of football are found on both levels. Based on the proposed analysis of Metastaze and a comparative analysis of descriptions of football in other books, plays and films in Croatia and abroad a hypothesis is put forward whereby art offers evidence as to the metastasized nature of football. A greater challenge still is to establish whether art might, at the same time, provide refuge to the metastasized football, revitalizing its aesthetic and ethical dimension. Given the scope of these claims, the arguments in the article are based on a wide array of texts and authors ranging from literary criticism, anthropology of games and sociology of sport to semiotics, cultural studies and aesthetics