Comprehensive assessment of device-based therapy for heart failure with reduced ejection fraction

Background: Despite a recommendation by the European guidelines, the use of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF) is scarce. This might be explained by a lower risk of SCD in contemporary patients with HFrEF, so that the need for primary prevention ICD use in these patients has been questioned. Aims: The overall aim of this thesis was to further evaluate the controversies regarding the use of device-based therapy and particularly regarding the primary prevention use of ICDs in contemporary treated patients with HFrEF. The specific aims were to: - Evaluate the association between primary prevention ICD use and mortality in contemporary treated patients with HFrEF (Study I). - Investigate the association between primary prevention ICD use and mortality in contemporary treated patients with HFrEF eligible for cardiac resynchronization therapy (CRT, Study II). - Explore the association between socioeconomic status and use of device-based therapies and outcomes in patients with heart failure (Study III). - Describe the impact of the predicted risk of SCD and all-cause mortality on primary prevention ICD use, as well as on its association with mortality in patients with HFrEF (Study IV). Methods and Results: For all studies, the Swedish Heart Failure Registry (SwedeHF) was used, and patients eligible for primary prevention ICD use (Study I and IV), patients also treated with CRT (Study II) and patients with available information on socioeconomic status (Study III) were further selected. - Study I: Only 10% of the patients eligible for ICD use were actually treated with the device. In a propensity score matched cohort, ICD use was associated with a 27% lower 1-year and a 12% lower 5-year risk of all-cause mortality. The findings were consistent across several prespecified sub-groups, including older vs. younger patients and those with vs. without ischemic heart diasease. - Study II: Among patients with CRT, ICD use was less likely in older patients, females and those not referred to heart failure nurse-led outpatient clinics. In a propensity score matched cohort, combinde use of CRT and ICD was associated with a 24% lower 1-year and a 18% lower 3-year risk of all-cause mortality. - Study III: Lower socioeconomic status, defined as the prevalence of lower income and/or lower education and/or living alone, was associated with a lower likelihood of referral to specialized follow-up care and a lower likelihood of ICD use; and also with a higher risk of heart failure hospitalization and all-cause mortality, even after adjustments for heart failure severity and treatments. - Study IV: Patients elgible for primary prevention ICD use were categorized by two readily available clinical scores (Seattle Heart Failure Model and Seattle Proportional Risk Model) into four groups based on their predicted SCD/mortality risk being high/low. Even in patients with a high SCD and a low mortality risk, ICDs were only used in 18.2%. Relevant predictors of ICD non-use were follow-up in primary care (vs. specialized care) and lower socioeconomic status. Primary prevention ICD use was only associated with a lower all-cause/cardiovascular mortality risk in patients with a high predicted SCD but a low predicted mortality risk. Conclusions: In contemporary HFrEF patients, even in those treated with CRT, primary prevention ICD use was associated with a lower mortality risk (Study I and II). Nevertheless, ICDs were still underused for the primary prevention of SCD in patients with HFrEF, even if they had a high predicted SCD risk (Study I and IV). Lower quality of HF care and lower socioeconomic status were relevant barriers to the implementation of primary prevention ICD use (Study III and IV), which highlights the need to improve both HF care and the access to it (Study III). Furthermore, the relatively low magnitude of the mortality risk reduction with primary prevention ICD use in contemporary patients with HFrEF calls for better patient selection, which can be achieved by applying easily applicable clinical scores (Study IV)

Endophthalmitis Due to Microbacterium Species: Case Report and Review of Microbacterium Infections

Microbacterium species (formerly CDC [Centers for Disease Control and Prevention] coryneform group A-4 and A-5 bacteria) are widely distributed in the environment and rarely cause infections in humans. We present a case of endophthalmitis due to Microbacterium species that occurred after accidental trauma and review the literature on microbacterium infections. If the infected tissue or medical device is removed and antimicrobial therapy (preferably with β-lactams or glycopeptides) is instituted, the prognosis is usually favorable for patients with microbacterium infection

Исследование структуры и свойств оксидных нанотрубок, сформированных на подложках сплава системы Ti-Nb

В работе представлены результаты исследований оксидных нанотрубок сформированных методом электрохимического анодирования с последующим термическим отжигом с целью кристаллизации композита. Показано влияние концентрации Nb на фазовый состав сплава Ti-Nb. Выявлено влияния концентрации ниобия на морфологические параметры, состав, структуру и клеточную адгезию сформированных нанотрубок.The paper presents the results of studies of oxide nanotubes formed by electrochemical anodization with subsequent thermal annealing to crystallize the composite. The influence of the Nb concentration on the phase composition of the Ti-Nb alloy was shown. The effect of niobium concentration on the morphological parameters, composition, structure and cell adhesion of nanotubes formed was revealed

Особенности интерпретации газодинамических исследований скважин на нефтегазоконденсатном месторождении "Н" (ЯНАО)

Объектом исследования являются газодинамические исследования скважин нефтегазоконденсатного месторождения "Н" на стационарных режимах. В результате исследования проведена обработка данных пятью методами. В геологическом разделе рассмотрены общие сведения о месторождении, геологическая изученность и история открытия, геологическое строение, нефтегазоносность, характеристика продуктивных пластов, характеристика сырья, запасы газа. В главе конструкция скважин рассмотрены подземное и наземное оборудования, а также обустройство газовых кустов. В технологической части работы раскрывается основная цель. В краткой форме изложены существующие на практике методы исследования газовых скважин на стационарном режиме фильтрации, методика проведения испытания газовых скважин.The object of the study are gas dynamic studies of the wells of the oil and gas condensate field "N" under stationary conditions. As a result of the study, data were processed using five methods. In the geological section, general information on the deposit, geological knowledge and history of discovery, geological structure, oil and gas content, characteristics of reservoirs, characteristics of raw materials, gas reserves are reviewed. In the chapter the design of wells considered underground and ground equipment, as well as the arrangement of gas bushes. The main objective is revealed in the technological part of the work. In a concise form, the existing methods for studying gas wells in the stationary filtration regime

The development of data measuring systems by means of a mobile complex "Vibroregistrator-M2"

Статья посвящена вопросам развития информационно-измерительных систем на базе гидравлических агрегатов. Цель работы - создание и апробация гидравлического стенда для вибродиагностики элементов технологического оборудования посредством мобильного диагностического комплекса "Виброрегистратор-М2".The article is devoted to the development of information-measuring systems based on hydraulic units. The purpose of the work is to create and test a hydraulic stand for vibration diagnostics of process equipment elements by means of a mobile diagnostic complex "Vibroregistrator - M2"

Исследование технологической адаптации автоматической сварки неповоротных стыков магистральных трубопроводов

Цель работы – определить возможности технологической адаптации автоматической сварки неповоротных стыков магистральных трубопроводов. Автоматизация процесса сварки – перспективное направление сварочного производства. Способ сварки в среде углекислого газа импульсным питанием может быть использован для выполнения неповоротных стыков магистральных трубопроводов. Доказана экономическая эффективность, использования автоматического способа сварки импульсным питанием в среде углекислого газа при строительстве трубопроводов. Эта технология так же позволяет значительно экономить и сокращать время выполнения работ.Purpose - to identify opportunities for technological adaptation of automatic welding of pipelines orbital joints. Automation of the welding process - a promising direction of welding production. Welding process in carbon dioxide pulsed power can be used to perform a non-rotating joints of pipelines. Prove the cost-effectiveness, the use of automatic welding process pulse power in the environment of carbonic gas pipeline construction. This technology also allows significant savings and reduce the time period needed