Urgent pericardiocentesis is more frequently needed after left circumflex coronary artery perforation

Background: Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. Methods: From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAPIII) over a 15-year period (2005–2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAPIII and without tamponade (n = 60). Results: CAPIII were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAPIII in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAPIII in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAPIII in the remaining coronary arteries (23%) (p = 0.24). However, when CAPIII in the LCx were separated from CAPIII in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAPIII in the LCx (54%, 7 of 13) compared to subjects with CAPIII in an artery other than the LCx (21%, 14 of 68) (p = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, p = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, p = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. Conclusions: CAPIII in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes

Neonatal end-of-life care in Sweden.

A survey was carried out of Swedish neonatal end-of-life regarding practice before birth, at birth, during dying and after death using a descriptive questionnaire with close-ended questions and individual comments The practice in 32 of 38 neonatal units, as described by the head nurse or the registered nurses, was largely similar. Respectful treatment of both the neonate and the parents during neonatal end-of-life care was indicated Differences were found in pre-natal care concerning the information about the risks of pre-term birth, the opportunity for parents to view a pre-term neonate and meet its family, as well as a social worker Practice directly after birth was also different. A little less than half of the units answered that they gave a description of the seriously ill neonate to the parents before the first visit to the ward Practice during dying indicated that only a few units permitted the neonate to die at hom

New understandings of fathers’ experiences of grief and loss following stillbirth and neonatal death: a scoping review

Objective: To report on research conducted on men's experiences of grief and loss following stillbirth and neonatal death in high-income, Western countries. Design: This review was guided by the following research questions: 1. The impact of perinatal death for men 2. The meaning of the loss for a father's sense of identity 3. The extent to which men were able to express grief while supporting their partners and, 4. how men's experience of grief was mediated by the support and care received by health professionals. Data Sources: We searched the following databases: Medline; PsychINFO; CINAHL to identify relevant articles published from the year 2000 onwards. The searches were run between 1/04/2018 and 8/4/2018. Review methods: A scoping review was conducted of nursing, psychological, medical and social science databases using these key words: fathers’ grief, men's grief, perinatal loss and death, stillbirth and neonatal death. Results: Studies indicated that men reported less intense and enduring levels of psychological outcomes than women but were more likely to engage in avoidance and coping behaviours such as increased alcohol consumption. Men felt that their role was primarily as a ‘supportive partner’ and that they were overlooked by health professionals. Conclusions: Further research is needed on men's experience of grief following perinatal death, especially on their physical and mental well-being. Impact: This review addressed the problem of the lack of knowledge around paternal needs following perinatal death and highlighted areas which researchers could usefully investigate with the eventual aim of improving care for fathers

Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

<p>Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.</p> <p>Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.</p> <p>Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.</p&gt

Freedom of religion and general religious rights in Europe

The thesis concerns freedom of religion and general religious rights in Europe. The following chapters contain information regarding freedom of religion regulations which exist in the international legal system, as well as in particular European countries, including Poland. In the thesis I also tried to describe the most essential problems concerning obeying the mentioned freedom, such as equality of churches and confessional associations, or the public exposure of religious symbols.Praca dotyczy praw i wolności religijnych w Europie. Zawarte zostały w niej uregulowania prawa międzynarodowego oraz prawa poszczególnych państw europejskich, w tym Polski, dotyczące wolności religii oraz praw przysługujących kościołom i związkom wyznaniowym. W pracy poruszono kwestie głównych problemów związanych z omawianą wolnością, takie jak sprawa prezentowania symboli religijnych w miejscach publicznych czy stosunku wyznawców islamu do europejskich kryteriów wolności sumienia i wyznania. Przedstawiono także najważniejsze sprawy dotyczące wolności myśli, sumienia i wyznania, jakie toczyły się w ostatnich latach przed Europejskim Trybunałem Praw Człowieka. W pracy ukazano także główne procesy mające wpływ na podejście współczesnych Europejczyków do religii, a co za tym idzie do omawianych wolności, takie jak prywatyzacja religii, sekularyzacja czy laicyzacja społeczeństw

Economic Cooperation as a Strategy for the Growth of Small and Medium Enterprises

Wyznacznikiem efektywnego funkcjonowania współczesnych przedsiębiorstw jest umie-jętność budowania i utrzymywania odpowiednich więzi z otoczeniem, których wyrazem są różnego rodzaju relacje łączące zainteresowane podmioty. W artykule przedstawiono współ-działanie gospodarcze jako strategię umożliwiającą osiąganie przewagi konkurencyjnej przez małe i średnie przedsiębiorstwa.Ability to establish and maintain given bonds with environments, which can be realized by various relationships between concerned parties can determine the level of effective activities of enterprises. The article presents the economic cooperation as a strategy for achieving competitive advantage for small and medium-sized enterprises

CONDITIONS OF ECONOMIC COOPERATION BETWEEN SMALL AND MEDIUM-SIZED ENTERPRISES (BASED ON AGRI-FOOD INDUSTRY) D

Praca ma charakter teoretyczno-empiryczny, w której ukazano współdziałanie gospodarcze małych i średnich przedsiębiorstw branży rolno-spożywczej w województwie podkarpackim i czynniki określające tę współpracę na podstawie literatury przedmiotu i wyników własnych badań. Na treść pracy składają się następujące zagadnienia: istota współdziałania gospodarczego oraz rodzaje, poziomy i klasyfikacje jego form, przyczyny i czynniki determinujące współdziałanie gospodarcze małych i średnich przedsiębiorstw, współczesne formy i modele współdziałania sektora MSP, w tym sieci ich powiązań, organizacje wirtualne oraz klastry, analiza procesów współdziałania małych i średnich przedsiębiorstw branży rolno-spożywczej w województwie podkarpackim oraz czynniki kształtujące formy ich współdziałania.The research is both theoretical and empirical, in which business co-operation of small and medium enterprises of agricultural and food industry sector in Podkarpacie region and factors which influence these relations based on literature and on research results. The research consists of: co-operation principles and their kinds, levels and classifications of co-relation forms, reasons and factors leading to business co-operation of small and medium enterprises, current forms and models of co-operation of SME, which involve networks of co-operation, virtual organizations and clusters