Association between the mortality rate and operator volume in patients undergoing emergency or elective percutaneous coronary interventions

Background:  Previous studies have suggested that low operator and institutional volume may be associated with an increased risk of adverse events in patients undergoing percutaneous coronary intervention (PCI). Aims: The aim of the study was to assess the relationship between operator volume and procedure­ ­related mortality in the emergent and elective settings. Methods: Data were obtained from a national registry of PCIs, maintained in cooperation with the Association of Cardiovascular Interventions of the Polish Cardiac Society. Registry data for the period from January 2014 to December 2017 were collected. During the study, there were 162 active catheterization laboratories, in which a total of 456 732 PCIs were performed. Results: The median number of PCIs performed in a single laboratory was 2643.5 (interquartile range [IQR], 1875–3598.5) over 4 years. The median number of PCIs performed by a single operator was 557 (IQR, 276.25–860.5) per year. We did not confirm a significant relationship between the operator volume and mortality in the overall group of patients treated with emergency and elective PCI. However, we noted a lower mortality rate for high­‑volume operators (odds ratio [OR], 0.79; 95% CI, 0.63–0.99; P = 0.04). When the operator volume was assessed as a continuous variable, there was a trend toward significance (OR, 0.94; 95% CI; 0.88–1.0007; P = 0.052) in patients treated with emergency PCI. Conclusions: High operator volume was associated with a lower periprocedural mortality rate than low operator volume in patients undergoing PCI due to acute coronary syndromes

Metallo-Beta-Lactamases: NDM

New Delhi, an enzyme belonging to the Metallo-beta-lactamases and Carbapenemases group, is most commonly found in Klebsiella pneumoniae and Escherichia coli. It determines these bacteria resistance to the majority of known antibiotics. NDM-1 was discovered in 2008 in a man treated in New Delhi for E. coli infection. Since the first appearance, 17 subtypes of this enzyme have been discovered. Its occurrence has been reported in Europe (Great Britain, France, Belgium - where even a national alert has been issued) as well as in the United States and in Africa. Most cases of New Delhi enzyme bacterial infections are reported in India or in people who have traveled to this country. There is no treatment method described so far. Therapy is based on antibiotic susceptibility test results. Colistin shows the highest effectiveness against NDM. There are also tests suggesting that Isomargololone and Nimbolide may be effective in most cases of NDM infection

Clinical outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention stratified according to duration of pain-to-balloon time and type of myocardial infarction

Background: Based on the clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), treated with primary percutaneous coronary intervention (pPCI), this study intended to assess mortality and major adverse cardiac and cerebrovascular event (MACCE) rates according to duration of pain-to-balloon (PTB) time and type of MI.   Methods: This is a retrospective cohort study based on the prospectively collected ORPKI registry which covers PCIs performed in Poland chosen between January 2014 and December 2017. Under assessment were 1,994 STEMI and 923 NSTEMI patients. Study endpoints included mortality and MACCE rates (in-hospital, 30-day, 12- and 36-month). Predictors of all-cause mortality in the overall group, STEMI and NSTEMI were assessed by multivariable analysis. Results: Kaplan-Meier survival curve analysis did not reveal significant differences between the STEMI and NSTEMI group for all-cause mortality or MACCE at the 36-month follow-up. While in the long PTB time group, MACCE rate was significantly greater in STEMI patients when compared to NSTEMI (p = 0.004). Among STEMI patients, the short, medium and long PTB time groups differed significantly in the rate of all-cause mortality (p = 0.006) and MACCE (p = 0.04) at 1,095 days of follow-up, which were the greatest in the long PTB time group. Conclusions: Before considering the length of PTB time, there were no statistically significant differences in mortality or MACCE frequency between the STEMI and NSTEMI group at 36-month follow-up. Longer PTB times are related to significantly greater mortality at the 36-month follow-up in the STEMI, but not in the NSTEMI group

The Effect of Accelerated Aging on Polylactide Containing Plant Extracts

In this study, natural extracts of plant origin were used as anti-aging compounds of biodegradable polymers. Coffee (0.5–10 wt%), cocoa, or cinnamon extracts were added to the polylactide matrix. The obtained materials were subjected to an accelerated aging process (720, 1440, or 2160 h) at 45 °C and 70% relative humidity under continuous UV radiation. The effectiveness of the tested extracts was compared to a commercially available anti-aging compound, 2 wt% of butylated hydroxytoluene. Visual evaluation, scanning electron microscopy, melt flow rate, thermogravimetry, differential scanning calorimetry, tensile strength, and impact tensile tests were performed. We show that the use of smaller amounts of tested extracts is particularly advantageous, which do not adversely affect the properties of polylactide-based materials at low contents. At the same time, their effectiveness in stabilizing tested properties during the accelerated aging process is mostly comparable to or greater than the reference compound

Composting of Polylactide Containing Natural Anti-Aging Compounds of Plant Origin

The paper presents the effects of biodegradation of polylactide containing natural anti-aging compounds. Polymer containing 0.5; 5 and 10 wt % of coffee, cocoa or cinnamon extracts were subjected to industrial composting for 7, 14, 21 or 28 days. The effect of the composting process on polylactide properties was examined based on visual assessment, scanning electron microscopy, average molecular weight, differential scanning calorimetry, thermogravimetry, and tensile strength. The impact of the tested extracts on the effects of the composting process was compared with the impact of a commercially available anti-aging compound. It was found that the tested extracts in most cases did not adversely affect the effects of the composting process compared to pure polylactide, often resulting in intensification of biodegradation processes. As a result of the composting process, changes in the macro- and microscopic appearance of the samples and a decrease in molecular weight, phase transition temperatures, thermal resistance, and thermal strength were observed on a scale close to or greater than the reference anti-aging compound

Laser Activated and Electroless Metalized Polyurethane Coatings Containing Copper(II) L-Tyrosine and Glass Microspheres

Polyurethane coatings containing copper(II) L-tyrosine and glass microspheres were laser irradiated and underwent electroless metallization. Various sizes of glass microspheres were incorporated into the polyurethane coating matrix in order to examine their effects on surface activation and electroless metallization. The surface of the coatings was activated by using ArF excimer laser emitting ultraviolet radiation (λ = 193 nm) using different number of laser pulses and their fluence. The effects of surface activation and metallization were evaluated mainly based on optical and scanning electron microcopies (SEM), energy-dispersive X-ray spectroscopy (EDX) and photoelectron spectroscopy (XPS). It was found that the presence of glass microspheres enabled the reduction in copper complex content, intensified the ablation process (higher cone-like structures created) and resulted in higher content of copper metallic seeds. On the other hand, the glass microspheres concentration, which was higher for lower size microspheres, was advantageous for obtaining a fully metallized layer

Copper Filled Poly(Acrylonitrile-co-Butadiene-co-Styrene) Composites for Laser-Assisted Selective Metallization

Selective metallization of polymeric materials using the technique known as laser direct structuring (LDS) is intensively developed. In this technique, metallized products can be manufactured by injection molding or by 3D printing process if rapid prototyping is need. Special additives present in the polymer matrix enable direct electroless metallization only on the surface which was laser activated. This paper presents the results of using copper microparticles introduced into the poly(acrylonitrile-butadiene-styrene) (ABS) matrix at various amounts (up to about 5 vol %). ABS was selected due to its good processing and mechanical properties and as one of the most common thermoplastics used in 3D printing. The influence of copper on structural, mechanical, and processing properties as well as on the effects of laser surface activation were determined. Two types of infrared lasers were tested for surface activation: Nd:YAG fiber laser (λ = 1064 nm) and CO2 laser (λ = 10.6 µm). Various irradiation parameters (power, scanning speed, and frequency) were applied to find suitable conditions for laser surface activation and electroless metallization. It was found that the composites tested can be effectively metallized using the Nd:YAG laser, but only in a narrow range of radiation parameters. Activation with CO2 laser failed, regardless of applied irradiation conditions. It resulted from the fact that ablation rate and thickness of modified surface layer for CO2 were lower than for Nd:YAG laser using the same irradiation parameters (power, speed, and frequency of laser beams), thus the laser wavelength was crucial for successful surface activation