Poliomijelitis i njegovo liječenje u bolnici Stara Gora, Slovenija (In memoriam Dr Hilda Veličkov)

In the years between 1956 – 1958 Slovenia faced a poliomyelitis epidemic in which around 400 people were affected, one tenth of them died, and a big part of the population was left with consequences of this disease and its long-lasting rehabilitation. From 1952 to 1962 the facility of Stara Gora offered shelter and physical rehabilitation with up-to-date treatments such as oscillation and minimal joint mobilisation, hydrotherapy, irradiation, and electrical stimulation to 1124 children. During this period 200 children suffering from poliomyelitis were admitted to a specialized ward. This number represented 18% of overall admissions, second only to congenital hip displacement. In 1957 a non-mandatory vaccination program started, which eventually became mandatory in 1964. The consequences of the poliomyelitis epidemic were very serious: 199 out of the 200 admissions were in need of medical rehabilitation. These patients had one of the longest average hospitalization times (376 days) and one of the lowest percentages of independent daily life activities after hospitalization (94 children out of 200, or 47%). Normally, the rehabilitation would start with hydrotherapy in warm water or irradiation with IR rays and progress to the ultimate treatment, electrical stimulation and walking exercises in front of a mirror to correct the posture and the limb movements.U godinama između 1956. i 1958. Slovenija se suočila s epidemijom poliomijelitisa koja je pogodila oko 400 ljudi, od kojih je jedna desetina umrla, a velik dio populacije ostao je s posljedicama ove bolesti i dugotrajnom rehabilitacijom. Od 1952. do 1962. objekt Stara Gora ponudio je zaštitu i fizikalnu rehabilitaciju uz suvremene tretmane kao što su oscilacija i minimalna mobilizacija zglobova, hidroterapija, iradijacija i električna stimulacija za 1124 djeteta. U tom je razdoblju 200 djece oboljelih od poliomijelitisa bilo primljeno na specijalizirani odjel. Ovaj broj je predstavljao 18% cjelokupnog prijema pacijenata, odmah iza kongenitalnog pomaka kuka. Godine 1957. započeo je neobvezujući program cijepljenja, koji je konačno postao obvezan 1964. Posljedice epidemije poliomijelitisa bile su vrlo ozbiljne: od 200 primljenih pacijenata, za njih 199 bila je potrebna medicinska rehabilitacija. Ovi pacijenti imali su jednu od najdužih prosječnih hospitalizacija (376 dana) i jedan od najnižih postotaka samostalnih svakodnevnih aktivnosti nakon hospitalizacije (94 djeteta od 200 ili 47%). Rehabilitacija obično započinje hidroterapijom u toploj vodi ili iradijacijom IR zrakama i napreduje do krajnjeg liječenja, električnom stimulacijom i vježbom hodanja ispred zrcala radi ispravljanja držanja i pokreta udova

A formula to calculate the contrast volume required for optimal imaging quality in optical coherence tomography with non-occlusive technique

Background: Non-occlusive technique is universally accepted for acquisition of coronary optical coherence tomography (OCT), but the amount of contrast infused is still inconsistently calculated. Proposed herein, is an empirical formula for accurate contrast volume calculation. Methods: In an observational prospective study, contrast volume of consecutive patients undergoing OCT was either calculated with formula, or eyeballed based on manufacturer recommendations. The quality of pullback, defined as % of high quality cross-sections (CS) in the segment of interest (SOI), was analyzed by two independent operators and compared between groups, together with the amount of contrast per pullback. Results: Sixty patients (115 pullbacks, 4252 CS) were imaged using the formula, vs. 18 patients (22 pullbacks, 777 CS) eyeballing the contrast volume. The formula group used 18 mm/s as pullback speed more often (82.6% vs. 40.9%, p = 0.0001), but there were no significant differences between groups in SOI length or vessel imaged. The formula resulted in higher pullback quality than eyeballing (96.55% vs. 63.55%, p < 0.0001), interobserver agreement Kappa 0.903 (p < 0.0001), and tended to use less contrast per pullback than the eyeball group (13.03 mL vs. 14.55 mL, p = 0.057). After adjusting for pullback speed, SOI length and vessel in multivariate linear regression, the use of the formula significantly reduced the amount of contrast in 4.50 mL on average. Conclusions: Optical coherence tomography acquisition with the non-occlusive technique can be substantially eased with the use of a novel formula to calculate the contrast volume required. This method optimises the quality of the images whilst reducing the amount of contrast per pullback

Very late stent thrombosis in everolimus-eluting stent with predisposing mechanical factors: Differential features

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Implantation of bioresorbable scaffolds under guidance of optical coherence tomography: Feasibility and pilot clinical results of a systematic protocol

Background: Herein is hypothesised that a comprehensive optical coherence tomography (OCT)-guided implantation protocol for bioresorbable scaffolds (BRS) can improve expansion and apposition, thus resulting in better clinical outcomes, particularly in reducing thrombotic events.Methods: Patients considered suitable for BRS therapy in de novo coronary lesions underwent OCT. The predominant type of plaque was classified as lipidic, fibrous or calcific. Accordingly they underwent tailored plaque preparation. After proper sizing, BRS was deployed and final OCT was acquired. Post-dilation was performed only in cases of suboptimal deployment. Procedural and 12 month clinical follow-up is reported.Results: Twenty nine patients (41 lesions) who were considered clinically and angiographically suitable for BRS were enrolled, including challenging clinical scenarios such as ST-segment elevation myocardial infarction or CTOs. The OCT-guided protocol was feasible in 90.2% of the lesions: 14 (37.8%) lipidic, 11 (29.7%) fibrous, and 12 (32.4%) calcific. Three (8%) lesions classified as calcific were changed to treatment with metallic stent. BRS were implanted in 34 (91.9%) lesions, thereof 30 (88.2%) with optimal deployment in OCT. One (3.6%) periprocedural MI occurred, resulting in 3.6% target vessel failure and 0% scaffold thrombosis of any kind after a 12 month follow-up.Conclusions: OCT-guided BRS implantation is feasible in 90.2% of de novo lesions and results in optimal expansion and apposition, correlating with 3.6% incidence of target vessel failure and 0% scaffold thrombosis at 12 m follow-up, probably due to better selection of lesions amenable for BRS treatment and to a possibility of tailoring intervention to the type of plaque. These encouraging pilot results require confirmation in larger clinical studies

A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen­tial coronary stenosis without balloon inflation is hereby proposed. Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu­la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls’ formula. FFR of the remaining lesion was finally recorded (measured FFR). Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls’ formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640–0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy

Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives

Cardiovascular disease (CVD) is still a leading cause of morbidity and mortality, despite all the progress achieved as regards to both prevention and treatment. Having high levels of lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease that operates independently. It can increase the risk of developing cardiovascular disease even when LDL cholesterol (LDL-C) levels are within the recommended range, which is referred to as residual cardiovascular risk. Lp(a) is an LDL-like particle present in human plasma, in which a large plasminogen-like glycoprotein, apolipoprotein(a) [Apo(a)], is covalently bound to Apo B100 via one disulfide bridge. Apo(a) contains one plasminogen-like kringle V structure, a variable number of plasminogen-like kringle IV structures (types 1–10), and one inactive protease region. There is a large inter-individual variation of plasma concentrations of Lp(a), mainly ascribable to genetic variants in the Lp(a) gene: in the general po-pulation, Lp(a) levels can range from 1000 mg/dL. Concentrations also vary between different ethnicities. Lp(a) has been established as one of the risk factors that play an important role in the development of atherosclerotic plaque. Indeed, high concentrations of Lp(a) have been related to a greater risk of ischemic CVD, aortic valve stenosis, and heart failure. The threshold value has been set at 50 mg/dL, but the risk may increase already at levels above 30 mg/dL. Although there is a well-established and strong link between high Lp(a) levels and coronary as well as cerebrovascular disease, the evidence regarding incident peripheral arterial disease and carotid atherosclerosis is not as conclusive. Because lifestyle changes and standard lipid-lowering treatments, such as statins, niacin, and cholesteryl ester transfer protein inhibitors, are not highly effective in reducing Lp(a) levels, there is increased interest in developing new drugs that can address this issue. PCSK9 inhibitors seem to be capable of reducing Lp(a) levels by 25–30%. Mipomersen decreases Lp(a) levels by 25–40%, but its use is burdened with important side effects. At the current time, the most effective and tolerated treatment for patients with a high Lp(a) plasma level is apheresis, while antisense oligonucleotides, small interfering RNAs, and microRNAs, which reduce Lp(a) levels by targeting RNA molecules and regulating gene expression as well as protein production levels, are the most widely explored and promising perspectives. The aim of this review is to provide an update on the current state of the art with regard to Lp(a) pathophysiological mechanisms, focusing on the most effective strategies for lowering Lp(a), including new emerging alternative therapies. The purpose of this manuscript is to improve the management of hyperlipoproteinemia(a) in order to achieve better control of the residual cardiovascular risk, which remains unacceptably high