Decision Making in Patients Undergoing Coronary Artery Revascularization : A New Era in Clinical Trial Design and Evidence-Based Practice

The clinical goals for the care of each patient with complex coronary artery disease are to ensure that the most appropriate treatment is selected, and the best available evidence is used to guide procedural techniques and modify risk factors that could impact life expectancy and health-related quality of life. In this thesis, ef

Comparative study of male and female patients undergoing surgical aortic valve replacement

BACKGROUND: Sex does have an effect on disease perception and outcomes after cardiac surgery. OBJECTIVES: The aim of this study was to quantify the differences in cardiovascular risk profiles within an age-matched cohort and assess the long-term survival differences in males and females who underwent surgical aortic valve replacement (SAVR) with or without concomitant coronary artery bypass surgery. METHODS: All-comers patients who underwent SAVR with or without coronary artery bypass surgery were included. Characteristics, clinical features and survival up to 30 years were compared between female and male patients. Propensity matching and age matching using propensity scores were used to compare both groups. RESULTS: During the total study period between 1987 and 2017, there were 3462 patients {mean age 66.8 [standard deviation (SD): 11.1] years, 37.1% female} who underwent SAVR with or without coronary artery bypass surgery at our institution. In general, female patients were older than male patients (69.1 (SD: 10.3) versus 65.5 (SD: 11.3), respectively). In the age-matched cohort, female patients were less likely to have multiple comorbidities and undergo concomitant coronary artery bypass surgery. Twenty-year survival following the index procedure was higher in age-matched female patients (27.1%) compared to male patients (24.4%) in the overall cohort (P = 0.018). CONCLUSIONS: Substantial sex differences in cardiovascular risk profile exist. However, when SAVR with or without coronary artery bypass surgery is performed, extended long-term mortality is comparable between males and females. More research regarding sex-dimorphic mechanisms of aortic stenosis and coronary atherosclerosis would promote more awareness in terms of sex-specific risk factors after cardiac surgery and contribute to more guided personalized surgery in the future.</p

Proizvodnja destilata šljive sorte Stenlej

This paper shows the distillation process of the husk obtained from Stanley plum and the redistillation of the basic distillate performed on the brandy boiler used for the household production in Serbia. Ethanol concentrations in fractions, distillate and liquid mixture in boiler versus distillate volume were shown.U radu je prikazan proces destilacije komine šljive sorte Stenlej (Stanley) i redestilacije osnovnog destilata na aparaturi kazanskog tipa koja se koristi za proizvodnju rakije u domaćinstvima u Srbiji. Predstavljeni su koncentracioni profili etanola u frakcijama, destilatu i tečnoj smeši u kazanu u zavisnosti od zapremine destilata

Mastering the Best Practices:A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.</p

Mastering the Best Practices:A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.</p

Pranje i dezinfekcija vodovodne mreže na poligonu nacionalne vozačke akademije NAVAK u Subotištu

Simply and cheap cleaning/disinfection procedure for treatment of aqueduct network from car testing polygon in Subotište was shown. Aqueduct network was exploited for three years without any water treatment. High water temperature up to 28°C and absence of disinfection, resulted in biofilm formation at pipe surface. Pipe-line was improved by cleaning and washing, neutralization, hyperchlorination and application of peroxide and silver. The effect of the process parameters (concentration and type of agent) on cleaning, washing and disinfection of pipe-line was investigated. A new, low-cost method for the use of tested chemicals based on frontal release of "plugs" was established. The results showed that prior to the treatment there was bacteriological contamination of the pipeline with Pseudomonas aeruginosa. However, after the performed cleaning, wash and water disinfection process at all points in the business premises and hydrant network, the quality of water was according to Rulebook on the bacteriological correctness of drinking water. The most effective oxidation and disinfection agent has been shown to be a composite solvent based on hydrogen peroxide and colloidal silver "Silosone" at a concentration of up to 20 mg/L.U radu je prikazan jednostavan i jeftin postupak za čišćenje i dezinfekciju vodovodnog sistema na poligonu za ispitivanje automobila u Subotištu. Vodovodni sistem je bio u eksploataciji tri godine bez ikakvog tretmana vode. Povećana temperatura vode do čak 28°C i odsustvo dezinfekcionog sredstva uzrok je pojave biofilma u cevovodu. Cevovod je saniran čišćenjem i ispiranjem, neutralizacijom, hiperhlorisanjem i primenom peroksida i srebra. Ustanovljen je efekat operativnih parametara (koncentracija i vrsta sredstva) za proces čišćenja, pranja i dezinfekcije cevovoda. Prikazan je i novi metod frontalnog puštanja „čepova“ testiranih sredstava za čišćenje i pranje, a uz minimalnu potrošnju kako bi troškovi procesa bili što niži. Rezultati su pokazali da je pre tretmana postojalo bakteriološko zagađenje cevovoda bakterijom Pseudomonas aeruginosa. Međutim, posle izvršenih procesa čišćenja, pranja i dezinfekcije voda na svim točećim mestima u poslovnim objektima i hidrantskoj mreži, bila po Pravilniku o bakteriološkoj ispravnosti pijaće vode. Pokazano je da je najefikasnije sredstvo za oksidaciju i dezinfekciju kompozitno sredstvo na bazi vodonik peroksida i koloidnog srebra „Silozon“ u koncentraciji do 20 mg/L

Great debate:myocardial infarction after cardiac surgery must be redefined

Graphical Abstract Pros and cons of redefining peri-operative myocardial infarction (PMI) to cardiac troponin (cTn) levels of at least 130-170x 99th percentile upper reference limit (URL). CABG, coronary artery bypass grafting; CK-MB, creatine kinase-myocardial band; ECG, electrocardiogram; MI, myocardial infarction; UDMI, universal definition of myocardial infarction

Acute aortic dissection in a patient with Marfan syndrome during advanced pregnancy

Pregnant patients with Marfan syndrome (MFS) are at high risk of developing aortic dissection or rupture during the third trimester and early postpartum period. This increased likelihood is the consequence of the hyperdynamic and hypervolemic cardiocirculatory state and/or pregnancy-mediated structural changes of the arterial wall in response to hemodynamic and hormonal changes. In this article, we report on the case of a 26-year-old pregnant woman with MFS in the 30th gestation w