Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions

BACKGROUND

Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications.

AIM

Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use.

RESULTS

From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups.

CONCLUSION

In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

How can policymakers incorporate uncertainty (as modelled through foresight) into policy evaluation?

Background

Using a robust policy evaluation framework is critical to inform policymakers about the relevance of a policy in a structured way, clarifying its implications and providing arguments and criteria to compare competing options and decide which policy should be prioritised. In the current context of complex societal, environmental and public health challenges, decision-makers demand tools that allow a comparative assessment of the effectiveness of multisectoral policies and their comparison under different scenarios.

Methods

This presentation will detail a socio-technical “desirability-doability” framework (2xD). In 2xD, an additive value model is constructed to measure the desirability of public policies, and their doability is appraised under two contrasted scenarios. For these purposes, the MACBETH approach is used in developing the three group modelling phases of 2xD: (I) Structuring facilitated workshops, (II) Evaluation decision conference, and (III) Desirability-doability decision conference. Tailor-made interactive protocols or questioning procedures are used to elicit group judgements, based on which objective-specific value scores are assigned to the policies, and the objectives are weighted (in II). Finally, we elicit doability scores for the policies under each scenario (in III).

Results

We present how the 2xD framework was applied in Lisbon's urban health policymaking setting and discuss case insights regarding the role of scenario analysis in the appraisal and selection of policies.

Conclusions

The 2xD framework advances knowledge on how to assist policymakers in evaluating and selecting policies and contributes to the literature on overall policy formulation and evaluation. Specifically, the framework enabled a group of policymakers to balance (multicriteria) desirability versus doability of policies under the light of two contrasting scenarios, therefore incorporating uncertainty in their decision-making process.

Analysis of accessibility for buildings of a graduation school--an experiment in ergonomics training curriculum

This article presents a description of a study experience developed in the Discipline of Supervised Internship of the Industrial Design Course of the Federal University of Paraíba. The study is based on focused on ergonomics analysis and accessibility as an object of study, access into and out of buildings of classrooms and laboratories of the same institution. Among the buildings selected, which encompass where the course is established, is a contemporary building and a renovated building of historical and artistic values for current use. The study is characterized by a description of the objects of study, analysis of the reference literature and recommendations for adjustments in the event of any inconsistency with the accessibility standards. The experience of this supervised training provided an opportunity to perform design activities to a group of students in applied ergonomics, as well as enabling contact with professional practice, adding the contact with the appropriate guidelines governing intervention in historic heritage buildings.

Performance of the Striped Mealybug Ferrisia virgata Cockerell (Hemiptera: Pseudococcidae) under Variable Conditions of Temperature and Mating

Mealybugs have strong associations with their host plants due to their limitations for dispersal. Thus, environmental conditions and host quality may impact the biological traits of mealybugs. To the best of our knowledge, we are the first to report on the biology of a Brazilian population of the striped mealybug Ferrisia virgata Cockerell (Hemiptera: Pseudococcidae), which has recently been reported to infest cotton in Brazil. We evaluated the development and reproductive performance of F. virgata reared under different temperatures (25, 27, and 28°C) and mating status. The type of reproduction was also studied with insects reared on a factitious host and on cotton plants. Shorter development was obtained at 28°C as follows: nymphs generating males and females exhibited three and four instars with a mean duration of 19.1 and 20.5 days, respectively. The nymphal viability ranged from 77 to 96%, and was highest at 25°C. Females reared at 28°C initiated reproduction earlier (16.4 days), but the reproductive period was similar in all temperatures (∼16.2 days). Females produced more nymphs at 27 and 28°C (440 and 292 neonates) than at 25°C (277 neonates), although they lived longer at 25°C (63 days). Ferrisia virgata females exhibited only sexual reproduction. Thus, only mated females produced offspring, whereas unmated females died without reproducing. Therefore, the studied population of F. virgata exhibited only sexual reproduction with high survival and offspring production when fed cotton. Furthermore, pumpkin is a feasible host for mass rearing this mealybug species in the laboratory, an opening avenue for future studies.

Modeling the potential distribution of the invasive golden mussel Limnoperna fortunei in the Upper Paraguay River system using limnological variables

The invasive golden mussel, Limnoperna fortunei (Dunker, 1857), was introduced into the La Plata River estuary and quickly expanded upstream to the North, into the Paraguay and Paraná rivers. An ecological niche modeling approach, based on limnological variables, was used to predict the expansion of the golden mussel in the Paraguay River and its tributaries. We used three approaches to predict the geographic distribution: 1) the spatial distribution of calcium concentration and the saturation index for calcium carbonate (calcite); 2) the Genetic Algorithm for Rule-Set Production (GARP) model; and the 3) Maximum Entropy Method (Maxent) model. Other limnological variables such as temperature, dissolved oxygen, pH, and Total Suspended Solids (TSS) were used in the latter two cases. Important tributaries of the Paraguay River such as the Cuiabá and Miranda/Aquidauana rivers exhibit high risk of invasion, while lower risk was observed in the chemically dilute waters of the middle basin where shell calcification may be limited by low calcium concentrations and carbonate mineral undersaturation.

A 10-year follow-up of the outcome of lumbar microdiscectomy

STUDY DESIGN

A retrospective analysis of the outcome of lumbar microdiscectomy, with independent assessment of outcome.

OBJECTIVES

To explore whether the initial positive outcome after microdiscectomy is maintained at long-term follow-up.

SUMMARY OF BACKGROUND DATA

Previous reports on long-term outcome after lumbar disc surgery give conflicting messages about whether an initially positive surgical outcome is maintained throughout a 10-year period. This is partly due to differing methods and the failure to include initial outcome, thereby permitting assessment of possible deterioration in the quality of outcome.

METHODS

This study presents the initial and long-term outcome after lumbar microdiscectomy, with an independent assessment of outcome. Eighty-eight consecutive patients undergoing lumbar microdiscectomy were identified. Assessment at 10 years after surgery was obtained in 79 (90%) of the cases. The initial outcome was assessed retrospectively by an independent observer at 6 months after surgery using the Macnab classification. The final outcome Macnab classification was completed by postal questionnaire by the patients themselves, who also completed a modified Roland-Morris disability questionnaire.

RESULTS

A successful outcome at 6 months was achieved in 91% of the cases. At 10-year follow-up, this result declined slightly to an 83% success rate. However, there was no statistically significant difference between these outcome results. The long-term Macnab classification results correlated well with disability, as measured by the Roland-Morris score. Patient satisfaction with the results of microdiscectomy 10 years later was high.

CONCLUSIONS

Lumbar microdiscectomy achieves a high level of initial success, and this positive outcome is maintained at a 10-year follow-up.

[Electroencephalographic changes in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency]

Electroencephalographic changes have been detected in children with premature pubarche. These findings might be the result from past or current central nervous system dysfunction, or from increased sex steroids. In order to test the last assertion we have performed electroencephalographic studies in 10 patients (7F, 3M) with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, of whom 4 classic and 6 nonclassic forms of the syndrome. Traditional neurologic examination was performed in 7 patients, the result being considered normal in everyone, while evolutional neurologic examination detected hyperactive disturbance and attention deficit in two patients. In another patient, the clinical findings were compatible with delay of neuropsychomotor development. Quantitative electroencephalography with brain mapping in patients over three years-old (n = 9), and conventional EEG in the remaining patient, were considered abnormal for age in 8 patients (80%), the record being characterized as slow in 7 patients. The high rate of electroencephalographic changes in this sample, as well as in premature pubarche, suggests that these findings might result from high inappropriate for age androgenic levels, and warns about the importance of neurologic examination and follow-up in children with CAH.

The protective effect of ß-carotene on genotoxicity induced by cyclophosphamide

The influence of beta-carotene on the clastogenicity of the indirect-acting mutagen cyclophosphamide (CPA) was investigated in mice, in vivo, for the induction of chromosome aberrations in bone marrow cells (BM). beta-Carotene (0.5, 1.0, 2.0, 5.0, 10, 25, 50, 100 and 200 mg/kg) was administered by gavage for 5 consecutive days. 4 h after the last treatment with beta-carotene, the mice were injected intraperitoneally with CPA, and the BM cells were fixed after 16, 24 and 32 h for the evaluation of the frequency of chromosome aberrations. The results showed that beta-carotene was effective in reducing chromosomal damage induced by CPA with the increase of its concentration up to a level after which this effect was not observed. This anticlastogenicity was better detected when the cells were fixed at 32 h, although a tendency in reducing the CPA clastogenicity was already observed at 16 and 24 h. Our results suggest that beta-carotene provides significant protection against the genotoxicity of CPA, although no dose-effect relationship on the frequencies of cells with chromosomal aberrations was observed.