139 research outputs found
Remarks on some of the Smarandache's problem. Part 2
No full textIn 1999, the second author of this remarks published a book over 30 of Smarandache's problems in area of elementary number theory (see [1, 2]). After this, we worked over new 20 problems that we collected in our book [28]. These books contain Smarandache's problems, described in [10, 16]. The present paper contains some of the results from [28]
Diagnostic and Prognostic Role of Cardiac Magnetic Resonance in MINOCA: Systematic Review and Meta-Analysis
No full textBackground: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is common in current clinical practice. Cardiac magnetic resonance (CMR) plays an important role in its management and is increasingly recommended by all the current guidelines. However, the prognostic value of CMR in patients with MINOCA is still undetermined. Objectives: The purpose of this study was to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA. Methods: A systematic review was performed to identify studies reporting the results of CMR findings in patients with MINOCA. Random effects models were used to determine the prevalence of different disease entities: myocarditis, myocardial infarction (MI), or takotsubo syndrome. Pooled odds ratios (ORs) and 95% CIs were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. Results: A total of 26 studies comprising 3,624 patients were included. The mean age was 54.2 ± 5.3 years, and 56% were men. MINOCA was confirmed in only 22% (95% CI: 0.17-0.26) of the cases and 68% of patients with initial MINOCA were reclassified after the CMR assessment. The pooled prevalence of myocarditis was 31% (95% CI: 0.25-0.39), and takotsubo syndrome 10% (95% CI: 0.06-0.12). In a subgroup analysis of 5 studies (770 patients) that reported clinical outcomes, CMR diagnosis of confirmed MI was associated with an increased risk of major adverse cardiovascular events (pooled OR: 2.40; 95% CI: 1.60-3.59). Conclusions: In patients with MINOCA, CMR has been demonstrated to add an important diagnostic and prognostic value, proving to be crucial for the diagnosis of this condition. Sixty-eight percent of patients with initial MINOCA were reclassified after the CMR evaluation. CMR-confirmed diagnosis of MINOCA was associated with an increased risk of major adverse cardiovascular events at follow-up
GW28-e1010 Successful recanalization of coronary chronic total occlusions with contemporary antegrade methods reduces one-year mortality
No full textClinical Verification of a Theory for Predicting Side Branch Stenosis after Main Vessel Stenting in Coronary Bifurcation Lesions
No full textArtykuł oryginalnyZmiany średnic tętnic wieńcowych tworzących rozgałęzienie po implantacji stentu w głównym naczyniu – znaczenie pozycji ostrogi
No full textBackground and aim: Bifurcation lesions are relatively frequently encountered in everyday interventional practice. Stenting of the vessel chosen to be main (usually the larger one) frequently leads to stenosis at the ostium of the side branch (SB) and compromises its flow (side branch compromise – SBC). The relative dependence of main and side branch diameters, based on the concept of carina displacement of stent struts, was examined in a cohort of patients with bifurcation stenting. Methods: We accept that the basic mechanism for SBC after stent placement in the parent vessel is carina shifting from expanded stent struts. The ostial SB minimal lumen diameter (MLD), percentage diameter stenosis (%DS) at maximal and calculated actual carina displacement, as well as distal limb diameter (DLD) in the main branch were calculated and compared with actually observed values. Results: A group of 55 consecutive patients with acceptable quality angiograms formed the study population. General patient characteristics were similar to other bifurcation studies. Left anterior descending artery was predominantly treated in 73% of patients. There was worsening SB ostial stenosis after stent implantation (%DS increase from 48%±23% to 69%±21%, pWprowadzenie i cel: Zwężenia zlokalizowane w rozgałęzieniach wieńcowych (tzw. zwężenia bifurkacyjne) występują stosunkowo często w klinicznej praktyce kardiologa interwencyjnego. Najczęściej stosowana technika leczenia takich zwężeń, polegająca na stentowaniu naczynia uznanego za główne (zwykle o większej średnicy), często prowadzi do zawężenia ujścia naczynia bocznego (SB), a tym samym do upośledzenia w nim przepływu (SBC). W pracy analizowano zmiany w średnicach składowych rozgałęzienia wieńcowego dokonujące się pod wpływem implantacji stentu do naczynia głównego. Do analiz wykorzystywano koronarogramy wykonane przed zabiegiem i po nim oraz stosowne wzory stworzone na podstawie własnej koncepcji zachowania się ostrogi (łac. carina). Metodyka: W pracy przyjęto założenie, iż głównym mechanizmem SBC po implantacji stentu do naczynia głównego jest przesunięcie ostrogi przez elementy strukturalne stentu (ang. struts), odpowiadające za utrzymanie jego światła. Analizie poddano: minimalną średnicę (MLD) w ujściu SB, stopień redukcji jej światła (%DSSB) oraz średnicę dalszego ramienia naczynia głównego (DLD) i zmiany pozycji ostrogi. Wartości ww. parametrów uzyskane z pomiarów angiogramów były porównywane z wartościami obliczanymi ze stosownych wzorów. Wyniki: Na populację badaną składało się 55 kolejnych chorych ze zwężeniami bifurkacyjnymi, zakwalifikowanymi do leczenia przezskórnego z użyciem stentu w naczyniu głównym. Charakterystyka kliniczna chorych była podobna do populacji przedstawianych w innych pracach dotyczących leczenia zmian bifurkacyjnych. Implantacja stentu najczęściej (73%) miała miejsce w tętnicy przedniej zstępującej. Analiza udowodniła, iż taki zabieg powodował istotne pogorszenie zwężenia w ujściu SB (z 48±23% DS do 69±21% DS, odpowiednio przed i po;
The impact of COVID-19 Epidemic on Teaching and Learning
No full textRecently articles in Newspapers, University News Bulletins and Scientific Literature report about negative aspects of the wellbeing of students caused by COVID-19 epidemic. Half of the students have mental problems and don't participate in the teaching learning process anymore. In the Netherlands, Universities are surveyed by questionnaires, researching the mental health problems of students. In this paper we focus on students of Delft University of Technology. It proved from surveys, that many students complain about loneliness, fear, sleep deprivation and lack of study motivation. In this paper we report about experiments at the Faculty of Electrical Engineering, Mathematics and Computer Science, how students can be activated, motivated and socialized via study activities presented at the website of one of the Study Societies and via study-buddy groups. Students were personally invited to take part in discussions via a Forum, to enroll in group activities and to visit special lectures. A special COVID-19 didactics has been developed to stimulate students to make assignments in Calculus and Programing via Massive Open Online Courses developed in the framework EdX, an online learning destination and MOOC provider. Interactive Intelligenc
Infarct size, inflammatory burden, and admission hyperglycemia in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: a multicenter international registry
No full textBACKGROUND: The inflammatory response occurring in acute myocardial infarction (AMI) has been proposed as a potential pharmacological target. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) currently receive intense clinical interest in patients with and without diabetes mellitus (DM) for their pleiotropic beneficial effects. We tested the hypothesis that SGLT2-I have anti-inflammatory effects along with glucose-lowering properties. Therefore, we investigated the link between stress hyperglycemia, inflammatory burden, and infarct size in a cohort of type 2 diabetic patients presenting with AMI treated with SGLT2-I versus other oral anti-diabetic (OAD) agents. METHODS: In this multicenter international observational registry, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled. Based on the presence of anti-diabetic therapy at the admission, patients were divided into those receiving SGLT2-I (SGLT-I users) versus other OAD agents (non-SGLT2-I users). The following inflammatory markers were evaluated at different time points: white-blood-cell count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and C-reactive protein. Infarct size was assessed by echocardiography and by peak troponin levels. RESULTS: The study population consisted of 583 AMI patients (with or without ST-segment elevation): 98 SGLT2-I users and 485 non-SGLT-I users. Hyperglycemia at admission was less prevalent in the SGLT2-I group. Smaller infarct size was observed in patients treated with SGLT2-I compared to non-SGLT2-I group. On admission and at 24 h, inflammatory indices were significantly higher in non-SGLT2-I users compared to SGLT2-I patients, with a significant increase in neutrophil levels at 24 h. At multivariable analysis, the use of SGLT2-I was a significant predictor of reduced inflammatory response (OR 0.457, 95% CI 0.275–0.758, p = 0.002), independently of age, admission creatinine values, and admission glycemia. Conversely, peak troponin values and NSTEMI occurrence were independent predictors of a higher inflammatory status. CONCLUSIONS: Type 2 diabetic AMI patients receiving SGLT2-I exhibited significantly reduced inflammatory response and smaller infarct size compared to those receiving other OAD agents, independently of glucose-metabolic control. Our findings are hypothesis generating and provide new insights on the cardioprotective effects of SGLT2-I in the setting of coronary artery disease. Trial Registration: Data are part of the ongoing observational registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov Identifier: NCT 05261867
Prevalence of coronary microvascular disease and coronary vasospasm in patients with nonobstructive coronary artery disease: systematic review and meta‐analysis
No full textBackground:
A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary arteries. However, the prevalence of coronary microvascular disease (CMD) and coronary spasm in patients with nonobstructive coronary artery disease remains to be determined. The objective of this study was to determine the prevalence of coronary CMD and coronary vasospastic angina in patients with no obstructive coronary artery disease.
Methods and Results:
A systematic review and meta‐analysis of studies assessing the prevalence of CMD and vasospastic angina in patients with no obstructive coronary artery disease was performed. Random‐effects models were used to determine the prevalence of these 2 disease entities. Fifty‐six studies comprising 14 427 patients were included. The pooled prevalence of CMD was 0.41 (95% CI, 0.36–0.47), epicardial vasospasm 0.40 (95% CI, 0.34–0.46) and microvascular spasm 24% (95% CI, 0.21–0.28). The prevalence of combined CMD and vasospastic angina was 0.23 (95% CI, 0.17–0.31). Female patients had a higher risk of presenting with CMD compared with male patients (risk ratio, 1.45 [95% CI, 1.11–1.90]). CMD prevalence was similar when assessed using noninvasive or invasive diagnostic methods.
Conclusions:
In patients with no obstructive coronary artery disease, approximately half of the cases were reported to have CMD and/or coronary spasm. CMD was more prevalent among female patients. Greater awareness among physicians of ischemia with no obstructive coronary arteries is urgently needed for accurate diagnosis and patient‐tailored management
Personalized digital fitness coach
No full textThe Corona crisis limits the mobility of people and it proves that many people have an increased body mass index. A lot of people want to increase their fitness and to boost their immune system. There is a run-on fitness schools and fitness equipment for the home environment. At fitness schools, fitness coaches are available for personalized instructions and supervision. Fitness in the home environment lacks personalized instruction and supervision and can cause serious injuries. In this paper a digital coach will be introduced providing digital support and supervision. The digital coach offers personalized fitness program, supervises athletes during fitness exercises and provides a supporting system concerning injuries. A prototype of the developed system can be downloaded as an app on a smart phone.Interactive Intelligenc
Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?
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