In patients undergoing percutaneous coronary intervention with rotational atherectomy radial access is safer and as efficient as femoral access

Introduction

Transfemoral approach (TFA) may be preferred access site in order to facilitate complex percutaneous procedures such as rotational atherectomy (RA). Notwithstanding, there is a growing evidence that transradial approach (TRA) is associated with lower access site complication rates and even lower mortality. The aim was to assess in‐hospital and 1‐year outcomes in patients undergoing RA using TRA, in comparison to TFA.

Methods

A single center observational study included all consecutive patients, who underwent RA from 2010 to 2015. Primary endpoints were procedural success, in‐hospital mortality and major adverse cardiovascular events (MACE). Secondary endpoints were 1‐year all‐cause mortality and MACE.

Results

The study included 177 patients, 69% in TRA group and 31% in TFA group. Except for male sex and logistic Euroscore II there were no differences in common risk factors. There was no difference in procedural success (95% vs 87%, P = 0.07) with even a trend in favor of TRA. Performing RA via TRA lower amount of contrast volume (P = 0.009) was used and hospital stay after the procedure was shorter (P = 0.004). Periprocedural complication rates were similar, however patients with TFA had significantly higher rate of major access site bleedings (13% vs 1%, P = 0.001), with no differences in mortality and other adverse events both in‐hospital and during 1‐year observation.

Conclusions

Even though RA is a demanding technique, when performed via TRA allows to maintain the same procedural success and long‐term results in comparison to TFA, reduces in‐hospital major access site bleedings, lowers the amount of contrast media and shortens hospital stay.

     

The effect of improvement in diabetic control on plasma and whole blood viscosity

Summary Rheological studies were made on the blood of 12 diabetic patients after a period of poor diabetic control (HbA₁ 12.6±0.7% (mean ± SD); mean home capillary blood glucose level 11.7±1.2 mmol/l), and after at least three months of improved control (HbA₁ 9.1±0.4%, p<0.01; mean home capillary blood glucose level 9.2±0.6 mmol/l). There were significant decreases in plasma fibrinogen levels (4.1±0.6 to 3.7±0.6 g/l, p <0.01), plasma viscosity (1.31±0.1 to 1.25±0.04, p<0.001), and whole blood viscosity at low (22.8±2.7 to 20.2±2.9, p<0.01) and high shear rates (3.4 ±0.2 to 3.1±0.2, p<0.01). Ten diabetics with clinically evident complications were matched with diabetics of similar age, sex, duration and current control of diabetes. There were no significant differnces in plasma or whole blood viscosities between the two groups. Hyperviscosity in diabetes seems strongly related to hyperglycaemia and to be influenced by the quality of diabetic control.     

Kinematics of 2 Reciprocating Endodontic Motors: The Difference between Actual and Set Values

Introduction

The aim of this study was to evaluate the kinematics of 2 reciprocating motors and compare it with manufacturers' declared values.

Methods

VDW Silver (VDW, Munich, Germany) and ATR Tecnika (Tecnika, Pistoia, Italy) were used in the study in 5 working modes: continuous rotation at 400 rpm on VDW Silver and ATR Tecnika and reciprocating motion on ATR Tecnika at 400 rpm and on VDW Silver in Reciproc and WaveOne mode. The polishing disk with an optical target was inserted in the contra-angle and recorded with a 1000–frames per second video camera. The direction and the amount of rotation were analyzed by computer, and the following kinematics parameters were calculated: engaging and disengaging angles, cycle rotational speeds, engaging and disengaging rotational speeds, net cycle angle, total cycle angle, and number of cycles to complete full rotation. One-way analysis of variance followed by planned pair-wise comparisons was used to compare kinematics parameters. The alpha error was set to 0.05.

Results

Analysis of variance revealed a difference between actual and set values of all 3 reciprocating modes in all kinematics parameters (P < .001). No significant difference between the actual engaging angle of Reciproc and that of the WaveOne mode was found. For reciprocating motion on the ATR Tecnika at 400 rpm, the actual engaging and disengaging angles were 8- and 9-fold greater, respectively, compared with set angles (P < .001).

Conclusions

The kinematics of reciprocating instrumentation is more complex than it seems as described only with angles and rotational speed. Actual kinematics values differ from manufacturers' declared values.     

Coarse-grained,foldable, physical model of the polypeptide chain

Although nonflexible, scaled molecular models like Pauling–Corey’s and its descendants have made significant contributions in structural biology research and pedagogy, recent technical advances in 3D printing and electronics make it possible to go one step further in designing physical models of biomacromolecules: to make them conformationally dynamic. We report here the design, construction, and validation of a flexible, scaled, physical model of the polypeptide chain, which accurately reproduces the bond rotational degrees of freedom in the peptide backbone. The coarse-grained backbone model consists of repeating amide and α-carbon units, connected by mechanical bonds (corresponding to φ and ψ) that include realistic barriers to rotation that closely approximate those found at the molecular scale. Longer-range hydrogen-bonding interactions are also incorporated, allowing the chain to readily fold into stable secondary structures. The model is easily constructed with readily obtainable parts and promises to be a tremendous educational aid to the intuitive understanding of chain folding as the basis for macromolecular structure. Furthermore, this physical model can serve as the basis for linking tangible biomacromolecular models directly to the vast array of existing computational tools to provide an enhanced and interactive human–computer interface.     

补气祛风法治疗小儿咳嗽变异性哮喘38例

目的观察补气祛风法治疗小儿咳嗽变异性哮喘的临床疗效。方法38例咳嗽变异性哮喘患儿均以补气祛风法为治疗原则，口服中药汤剂，并随症加减，7d后统计疗效。结果临床治愈19例，有效16例，无效3例，总有效率为92．11％。结论采用补气祛风法治疗小儿咳嗽变异性哮喘，既可提高患儿抗病能力，又可减轻机体对过敏因素的应激反应，抗复发、防演变，疗效显著。