Abstract Background Baltic States remains one of the few regions in the Europe without a dedicated particle therapy center. An initiative since 2021 has been started by CERN Baltic Group on a novel ...particle therapy center development in the region in partnership with CERN NIMMS collaboration. With a conceptual design idea in early 2022 and stakeholder engagement activities in late 2022 - next step forward was necessary for the initiative for a more in-depth analysis. Methods A dedicated workshop “ Particle therapy - future for the Baltic States? State-of-play, synergies and challenges ” was held. The workshop was attended by medical community from the Baltics, as well as CERN technical experts and particle therapy practicing clinicians, with scientific programme split in 5 main areas of investigation. Results Current cancer epidemiology statistics and RT technological possibilities in the region were analyzed, with first estimates of eligible number of patients calculated. Technological development level of the proposed accelerator complex was discussed, as well the clinical needs and synnergy possibilities with the nuclear medicine field. Conclusions The current state and calculated first estimates presented here have shown a promising starting point, which prompts even further in-depth work – a feasibility study for development of a novel particle therapy center in the Baltic States.
We compared the ST elevation myocardial infarction (STEMI) incidence during COVID-19 pandemic (March 2020) to January-February 2020 and to same time period in earlier years 2017-2019 in five ...Nordic-Baltic tertiary centers. During 2017-2019, there were no marked differences in STEMI incidence between January, February and March. During 2020, there was an average drop of 32% in STEMI incidence in March. The isolation measures may decrease the risk for respiratory virus infection and contribute to the lower STEMI incidence and that we might benefit from firmer suggestions on hand hygiene and social distancing during flu season at least among high-risk individuals.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives. The study aimed to investigate the long-term outcomes of a double stent scaffold strategy in patients with left main (LM) bifurcation lesions involving the ostium of the left circumflex ...artery (LCX), utilizing a drug-eluting stent (DES) in the LM extending into the left anterior descending artery (LAD) and a bioresorbable vascular scaffold (BVS) in the LCX ostium. Background. The high occurrence of in-stent restenosis of the LCX ostium is the major limitation of percutaneous coronary intervention (PCI) for LM lesions with a two-stent strategy. Methods. This was a single-center, prospective, single-arm study of 46 consecutively enrolled patients with a stable coronary artery disease and significant unprotected LM distal bifurcation disease. Patients underwent imaging-guided PCI using DES in the LM-LAD and BVS in the LCX using a T-stent or mini-crush technique. The primary outcome at four years was the composite of death, myocardial infarction, stroke, and target lesion revascularization (TLR). Results. At four years, the primary outcome was identified in 9 patients (19.6%). All events were TLRs except one myocardial infarction due to BVS thrombosis. Seven of the eight TLRs were a result of side branch BVS restenosis. Univariate predictors of the 4-year outcome were higher LDL cholesterol and BVS size ≤2.5 mm. On multivariate analysis, LCX lesion preparation with a cutting balloon and post-procedure use of intravascular ultrasound for optimization were found to be independent protective factors of MACE. Conclusions. In selected patients with LM distal bifurcation disease, an imaging-guided double stent scaffold strategy with DES in the LM and BVS in the LCX ostium was technically successful in all patients and was reasonably safe and effective for four years.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated.
Data on 5036 consecutive patients who underwent ...PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected.
Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%).
At multivariable Cox regression, left ventricular ejection fraction ≤30% (P < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 0.05) as additional independent predictors of MACE.
Beyond traditional risk factors, multivessel disease, the length of the SB lesion, “bail-out” stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.
•In PCI on coronary bifurcations age, diabetes, ACS and reduced LVEF are clinical variables independently associated with MACE.•Among angiographic variables, multivessel CAD and the SB lesion length, not Medina, are independent predictors of MACE.•In the treatment strategy, a “bail-out” placement of stent beyond planning is independently associated with adverse events.•Discontinuation from DAPT <6 months in patients with SCAD and <12 months with after an ACS is an independent predictor of MACE.
The present review is designed to provide insight into population-based investigations of cardiovascular risk factors in Latvia. Most of them represent urban, rural and mixed populations. The results ...are age-standardised using the European Standard Population. All of the studies confirm a high prevalence of cardiovascular risk factors with wide differences across the studies. The differences are not consistent or regular and some of the underlying reasons are discussed. Analysis of the previous studies justifies the need for a nationwide cross-sectional epidemiological study, which in a small country can be carried out in compliance with all the requirements for a population-based epidemiological study.
A Randomized Comparison of Paclitaxel-Eluting Stents Versus Bare Metal Stents for Treatment of Unprotected Left Main Coronary Artery Stenosis Andrejs Erglis, Inga Narbute, Indulis Kumsars, Sanda ...Jegere, Iveta Mintale, Ilja Zakke, Uldis Strazdins, Andris Saltups To optimize percutaneous coronary intervention for unprotected left main (LM) disease we randomized intravascular ultrasound-guided bare metal stent (BMS; (n = 50) or paclitaxel-eluting stent (PES; n = 53) implantation after lesion pre-treatment with cutting balloon for unprotected LM lesions. Stent implantation was successful in all lesions. At 6 months’ follow-up, statistically significant benefits were observed in minimal lumen diameter late loss, in minimal lumen area late loss and neointimal volume for PES. At 6 months, major adverse cardiac event-free survival rate was 70% in the BMS group and 87% in the PES group (p = 0.036). Findings of this study demonstrate PES superiority to BMS in unprotected LM vessel.
Objectives The aim of this study was to assess the long-term safety and efficacy of the CYPHER (Cordis, Johnson and Johnson, Bridgewater, New Jersey) sirolimus-eluting coronary stent (SES) in ...percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background Concern over the safety of drug-eluting stents implanted during PCI for STEMI remains, and long-term follow-up from randomized trials are necessary. TYPHOON (Trial to assess the use of the cYPHer sirolimus-eluting stent in acute myocardial infarction treated with ballOON angioplasty) randomized 712 patients with STEMI treated by primary PCI to receive either SES (n = 355) or bare-metal stents (BMS) (n = 357). The primary end point, target vessel failure at 1 year, was significantly lower in the SES group than in the BMS group (7.3% vs. 14.3%, p = 0.004) with no increase in adverse events. Methods A 4-year follow-up was performed. Complete data were available in 501 patients (70%), and the survival status is known in 580 patients (81%). Results Freedom from target lesion revascularization (TLR) at 4 years was significantly better in the SES group (92.4% vs. 85.1%; p = 0.002); there were no significant differences in freedom from cardiac death (97.6% and 95.9%; p = 0.37) or freedom from repeat myocardial infarction (94.8% and 95.6%; p = 0.85) between the SES and BMS groups. No difference in definite/probable stent thrombosis was noted at 4 years (SES: 4.4%, BMS: 4.8%, p = 0.83). In the 580 patients with known survival status at 4 years, the all-cause death rate was 5.8% in the SES and 7.0% in the BMS group (p = 0.61). Conclusions In the 70% of patients with complete follow-up at 4 years, SES demonstrated sustained efficacy to reduce TLR with no difference in death, repeat myocardial infarction or stent thrombosis. (The Study to Assess AMI Treated With Balloon Angioplasty TYPHOON; NCT00232830 )
Objectives
To test the accuracy of clinical pre-test probability (PTP) for prediction of obstructive coronary artery disease (CAD) in a pan-European setting.
Methods
Patients with suspected CAD and ...stable chest pain who were clinically referred for invasive coronary angiography (ICA) or computed tomography (CT) were included by clinical sites participating in the pilot study of the European multi-centre DISCHARGE trial. PTP of CAD was determined using the Diamond-Forrester (D+F) prediction model initially introduced in 1979 and the updated D+F model from 2011. Obstructive coronary artery disease (CAD) was defined by one at least 50% diameter coronary stenosis by both CT and ICA.
Results
In total, 1440 patients (654 female, 786 male) were included at 25 clinical sites from May 2014 until July 2017. Of these patients, 725 underwent CT, while 715 underwent ICA. Both prediction models overestimated the prevalence of obstructive CAD (31.7%, 456 of 1440 patients, PTP: initial D+F 58.9% (28.1–90.6%), updated D+F 47.3% (34.2–59.9%), both
p
< 0.001), but overestimation of disease prevalence was higher for the initial D+F (
p
< 0.001). The discriminative ability was higher for the updated D+F 2011 (AUC of 0.73 95% confidence interval CI 0.70–0.76 versus AUC of 0.70 CI 0.67–0.73 for the initial D+F;
p
< 0.001; odds ratio (or) 1.55 CI 1.29–1.86, net reclassification index 0.11 CI 0.05–0.16,
p
< 0.001).
Conclusions
Clinical PTP calculation using the initial and updated D+F prediction models relevantly overestimates the actual prevalence of obstructive CAD in patients with stable chest pain clinically referred for ICA and CT suggesting that further refinements to improve clinical decision-making are needed.
Trial registration
https://www.clinicaltrials.gov/ct2/show/NCT02400229
Key Points
• Clinical pre-test probability calculation using the initial and updated D+F model overestimates the prevalence of obstructive CAD identified by ICA and CT.
• Overestimation of disease prevalence is higher for the initial D+F compared with the updated D+F.
• Diagnostic accuracy of PTP assessment varies strongly between different clinical sites throughout Europe.
The most common reasons for major skin loss are thermal trauma — burns and scalds that can result in rapid, extensive, deep wounds as well as chronic non-healing wounds. Treatment using common ...techniques is poor and depending on the trauma level can result in death. There is a substantial need for skin integrity restoration. The main goal of this study was to develop an autologous 3D skin model that could eventually be translated into clinical applications. The study examined a variety of factors — extracellular matrix components, cell count, culture medium modification and role of structurally and functionally high-quality 3D skin dermis layer tissue culture production. The results of this study are an essential prerequisite to standardise the use of both clinical, as well as in vitro test systems. Dermal cell lines applied in the study were isolated form patient biopsies obtained at Pauls Stradiņš Clinical University Hospital. Blood plasma type AB was used for fibrin matrix formation. As catalysts, CaCl
or calcium gluconate, and tranexamic acid were applied. 3D tissue functionality was assessed by evaluation of gene expression and changes in growth factor secretion. Fibrin matrix formulations with 1% and 1.5% CaCl
and 5 mg, 7 mg and 10 mg tranexamic acid concentration were tested. Better matrix properties were observed with higher concentration of CaCl
and tranexamic acid. Differences in levels of collagen gene expression and growth factor secretion were observed. Changes in levels of fibroblast growth factor and gene expression were observed in fibrin matrix samples and the surface-cultivated cell culture monolayer, but structural protein synthesis was not detected.
Background
Randomized trials have shown that fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) improves clinical outcome and reduces costs compared with visually guided ...PCI. FFR has been measured during invasive coronary angiography (ICA), but can now be derived noninvasively from coronary computed tomography (CT) angiography (cCTA) images (FFRCT). The potential value of FFRCT in clinical decision making is unknown.
Hypothesis
Use of FFRCT can reduce costs and improve outcomes among patients with suspected coronary artery disease.
Methods
We used clinical data from 96 patients in the DISCOVER‐FLOW (Diagnosis of Ischemia‐Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and outcomes data from the literature to project the initial management costs and 1‐year death/myocardial infarction rates associated with 5 clinical strategies: (1) ICA with PCI based on visual angiographic assessment, (2) ICA with FFRICA‐guided PCI, (3) cCTA followed by ICA and PCI based on visual assessment, (4) cCTA followed by ICA with FFRICA‐guided PCI, and (5) cCTA FFRCT and PCI of lesions with FFRCT ≤0.80.
Results
The projected initial management costs were highest for the ICA/visual strategy ($10 702), and lowest for the cCTA/FFRCT/ICA strategy ($7674). The use of FFRCT to select patients for ICA and PCI would result in 30% lower costs and 12% fewer events at 1 year compared with the most commonly used ICA/visual strategy.
Conclusions
A strategy of using FFRCT to guide the selection of patients for ICA and PCI might reduce costs and improve clinical outcomes in patients with suspected coronary artery disease.
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