Revascularization of the Infarct-Related Artery: Never Too Late?

During the early phase of an acute myocardial infarction (MI), current consensus is that reperfusion of the infarct-related artery (IRA) should be implemented as soon as possible, more effectively accomplished via percutaneous coronary intervention (PCI). The clinical approach to the occluded IRA late after MI remains controversial, but current practice shows a strong trend in favour of PCI, which is based on the late open artery hypothesis. However, late PCI on IRAs also has the potential for harm from procedure-related complications. An attempt is made herein to critically overview the current data on this important topic, mainly based on recent meta-analyses with somewhat diverging results, indicating that clinical judgment and an individualized approach still remains a valid guide

Revascularization of the Infarct-Related Artery: Never Too Late?

During the early phase of an acute myocardial infarction (MI), current consensus is that reperfusion of the infarct-related artery (IRA) should be implemented as soon as possible, more effectively accomplished via percutaneous coronary intervention (PCI). The clinical approach to the occluded IRA late after MI remains controversial, but current practice shows a strong trend in favour of PCI, which is based on the late open artery hypothesis. However, late PCI on IRAs also has the potential for harm from procedure-related complications. An attempt is made herein to critically overview the current data on this important topic, mainly based on recent meta-analyses with somewhat diverging results, indicating that clinical judgment and an individualized approach still remains a valid guide

Pulmonary Embolism: Clinical Features and Diagnosis

Pulmonary embolism is a lethal yet treatable disease. Given the significant overlap of symptoms and signs between the presentation of pulmonary embolism and acute coronary syndromes, it becomes clear that emergency room physicians must be familiar with the diagnosis of pulmonary embolism. A critical issue is always to consider pulmonary embolism in the differential diagnosis of chest pain. However, the clinical diagnosis of pulmonary embolism remains problematic due to the nonspecific presenting symptoms, signs, electrocardiographic abnormalities, arterial blood gas and chest X-ray findings. D-dimers are becoming a widely available useful laboratory tool in the diagnosis of suspected pulmonary embolism. In this concise overview, the diagnostic value of clinical assessment in patients with possible pulmonary embolism will be explored

Cardiac Amyloidosis : Mini Review and a Case Report

Amyloidosis is a rare heterogeneous group of systemic disorders, which result due to extra cellular deposition of an insoluble, amorphous, eosinophilic, substance known as amyloid. The disease is often characterized by a restrictive cardiomyopathy with a poor prognosis and survival. The treatment of cardiac amyloidosis depends on the underlying etiology. However, the diagnosis of the type of cardiac amyloidosis is not always straightforward. We present here a case of cardiac amyloidosis and we discuss the different forms

First Diagnosed Heart Failure Due to Churg-Strauss Syndrome. A Case Report

Churg Strauss Syndrome (CSS)is an autoimmune condition that causes inflammation of small and medium-sized blood vessels. It is a non-infectious systemic vasculitis, which affects mainly the lungs but also other tissues and organs. CSS is considered a highly variable condition in terms of its presentation and its course. The most serious complication of the vasculitic stage is congestive heart failure with reduced ejection fraction. We present a case with first diagnosed heart failure because of CSS and review of the literature

Discrete and phase field methods for linear elastic fracture mechanics: a comparative study and state-of-the-art review

© 2019 by the authors. Three alternative approaches, namely the extended/generalized finite element method (XFEM/GFEM), the scaled boundary finite element method (SBFEM) and phase field methods, are surveyed and compared in the context of linear elastic fracture mechanics (LEFM). The purpose of the study is to provide a critical literature review, emphasizing on the mathematical, conceptual and implementation particularities that lead to the specific advantages and disadvantages of each method, as well as to offer numerical examples that help illustrate these features

Towards the new Thematic Core Service Tsunami within the EPOS Research Infrastructure

Tsunamis constitute a significant hazard for European coastal populations, and the impact of tsunami events worldwide can extend well beyond the coastal regions directly affected. Understanding the complex mechanisms of tsunami generation, propagation, and inundation, as well as managing the tsunami risk, requires multidisciplinary research and infrastructures that cross national boundaries. Recent decades have seen both great advances in tsunami science and consolidation of the European tsunami research community. A recurring theme has been the need for a sustainable platform for coordinated tsunami community activities and a hub for tsunami services. Following about three years of preparation, in July 2021, the European tsunami community attained the status of Candidate Thematic Core Service (cTCS) within the European Plate Observing System (EPOS) Research Infrastructure. Within a transition period of three years, the Tsunami candidate TCS is anticipated to develop into a fully operational EPOS TCS. We here outline the path taken to reach this point, and the envisaged form of the future EPOS TCS Tsunami. Our cTCS is planned to be organised within four thematic pillars: (1) Support to Tsunami Service Providers, (2) Tsunami Data, (3) Numerical Models, and (4) Hazard and Risk Products. We outline how identified needs in tsunami science and tsunami risk mitigation will be addressed within this structure and how participation within EPOS will become an integration point for community development.publishedVersio

Towards the new Thematic Core Service Tsunami within the EPOS Research Infrastructure

publishedVersio

Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis

Background & Aims Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. Methods We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) using standardized questionnaires. Our final analysis included 1,612 patients with acute pancreatitis (median age, 49 years; 53% male, 62% white) enrolled from August 2015 through January 2018. Results Biliary (45%) and alcoholic acute pancreatitis (21%) were the most common etiologies. Based on the revised Atlanta classification, 65% of patients developed mild disease, 23% moderate, and 12% severe. The mean age of patients in Europe (58 years) was older than mean age for all 4 regions (46 years) and a higher proportion of patients in Europe had comorbid conditions (73% vs 50% overall). The predominant etiology of acute pancreatitis in Latin America was biliary (78%), whereas alcohol-associated pancreatitis accounted for the highest proportion of acute pancreatitis cases in India (45%). Pain was managed with opioid analgesics in 93% of patients in North America versus 27% of patients in the other 3 regions. Cholecystectomies were performed at the time of hospital admission for most patients in Latin America (60% vs 15% overall). A higher proportion of European patients with severe acute pancreatitis died during the original hospital stay (44%) compared with the other 3 regions (15%). Conclusions We found significant variation in demographics, etiologies, management practices, and outcomes of acute pancreatitis worldwide

Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study

Background: Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective: We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods: Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results: Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83-5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01-2.69) were independent risk factors for oral feeding intolerance. Conclusion: Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology