Selection of coronary stents

AbstractIn clinical practice, the operator must decide which stent is most appropriate for the patient. This article focuses on the features of stent design that make a specific stent more or less suitable for a particular type of lesion or anatomy: the “average” coronary lesion, the lesion situated on a curve, the ostial lesion, the bifurcational lesion, the lesion located at the left main stem, the calcified lesion, the chronic total occlusion, the small vessel, the saphenous vein graft, acute or threatened vessel closure, and special situations such as coronary aneurysms and perforations

The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population

A novel framework for fluid/structure interaction in rapid subjectspecific simulations of blood flow in coronary artery bifurcations

Background/Aim. Practical difficulties, particularly long model development time, have limited the types and applicability of computational fluid dynamics simulations in numerical modeling of blood flow in serial manner. In these simulations, the most revealing flow parameters are the endothelial shear stress distribution and oscillatory shear index. The aim of this study was analyze their role in the diagnosis of the occurrence and prognosis of plaque development in coronary artery bifurcations. Methods. We developed a novel modeling technique for rapid cardiovascular hemodynamic simulations taking into account interactions between fluid domain (blood) and solid domain (artery wall). Two numerical models that represent the observed subdomains of an arbitrary patient-specific coronary artery bifurcation were created using multi-slice computed tomography (MSCT) coronagraphy and ultrasound measurements of blood velocity. Coronary flow using an in-house finite element solver PAK-FS was solved. Results. Overall behavior of coronary artery bifurcation during one cardiac cycle is described by: velocity, pressure, endothelial shear stress, oscillatory shear index, stress in arterial wall and nodal displacements. The places where (a) endothelial shear stress is less than 1.5, and (b) oscillatory shear index is very small (close or equal to 0) are prone to plaque genesis. Conclusion. Finite element simulation of fluid-structure interaction was used to investigate patient-specific flow dynamics and wall mechanics at coronary artery bifurcations. Simulation model revealed that lateral walls of the main branch and lateral walls distal to the carina are exposed to low endothelial shear stress which is a predilection site for development of atherosclerosis. This conclusion is confirmed by the low values of oscillatory shear index in those places

Potrebe u proteinima u ishrani mlađi šarana

Protein level and quality are of utmost important to growth of fish. Although common carp is a popular experimental fish, contradictory results on protein requirement have been reported by different works. An experiment lasting for 3 months included different protein level in 4 diets: 38.1%, 38.5%, 41.5% and 43.7%. Carp yearlings (body mass 95.5g) were fed in order to investigate effects on growth rate. There were no significant differences in the final individual weights, weight gains, specific growth rates (SGR), feed conversion rate (FCR) and thermal growth coefficient (TGC) among fish fed different diets (P>0.05)

MULTI-CRITERIA ASSESMENT OF THE SMART GRID EFFICIENCY USING THE FUZZY ANALITICAL HYERARCHY PROCESS

In this paper, the key performance indicators related to the smart grid efficiency, as the key factor of any energy management system implementation have been analysed. The authors are proposing multi-criteria fuzzy AHP methodology for the determination of overall smart grid efficiency. Four criteria (technology, costs, user satisfaction, and environmental protection) and seven performances (according to EU and US initiatives for analysis of benefits and effects of smart grid systems) for the selection of optimal smart grid project are defined. The analysis shows that the dominant performances of the optimal smart grid project are efficiency, security and quality of supply. The methodology is illustrated on the choice of smart grid development strategy for the medium size power distribution company

Sex Differences in Heart Failure Following Acute Coronary Syndromes

Background: There have been conflicting reports regarding outcomes in women presenting with an acute coronary syndrome (ACS). Objectives: The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation. Methods: This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes-ARCHIVES (ISACS-ARCHIVES; NCT04008173). Acute HF was defined as Killip classes ≥2. Participants were stratified according to ACS presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale. Results: A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio [RR]: 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR: 1.18; 95% CI: 1.09-1.28; Pinteraction <0.001). Acute HF was more common in women when compared to men with STEMI (RR: 1.24; 95% CI: 1.20-1.29) but not in those with NSTE-ACS (RR: 1.02; 95% CI: 0.97-1.08) (Pinteraction <0.001). The presence of acute HF increased the risk of mortality for both sexes (odds ratio: 6.60; 95% CI: 6.25-6.98)

Expression Pattern of Long Non-Coding RNA Growth Arrest-Specific 5 in the Remission Induction Therapy in Childhood Acute Lymphoblastic Leukemia

Background: Long non-coding RNA growth arrest-specific 5 (GAS5) is deregulated in many cancers because of its role in cell growth arrest and apoptosis. Additionally, GAS5 interacts with glucocorticoid receptor, making it a potential pharmacotranscription marker of glucocorticoid (GC) therapy. In this study, we aimed at analysing GAS5 expression in the remission induction therapy phase of childhood acute lymphoblastic leukemia (ALL), in which GCs are mandatorily used, and to correlate it with therapy response. Methods: GAS5 expression was measured in peripheral blood mononuclear cells taken from 29 childhood ALL patients at diagnosis, on day 15 and day 33 ofremission induction therapy using RT-qPCR methodology. Results: Our results have shown interindividual differences in GAS5 expression at all time points. For each ALL patient, GAS5 expression was higher on day 15 in comparison to its level at diagnosis (p<0.0005). On day 33, the level of GAS5 expression decreased in comparison with day 15 (p<0.0005), but it was still significantly higher than at diagnosis for the majority of patients (p=0.001). Patients whose number of blasts on day 8 was below 100 per mL of peripheral blood had a higherGAS5 expression at diagnosis (p=0.016), and lower ratio day 15/diagnosis (p=0.009). Conclusions: Our results suggest that the expression level of GAS5 could be a potential marker of therapy response in remission induction therapy of childhood ALL