Wire-based antegrade dissection re-entry technique for coronary chronic total occlusions percutaneous revascularization: Experience from the ERCTO Registry

Background

The recent development and widespread adoption of antegrade dissection re-entry (ADR) techniques have been underlined as one of the antegrade strategies in all worldwide CTO consensus documents. However, historical wire-based ADR experience has suffered from disappointing long-term outcomes.

Aims

Compare technical success, procedural success, and long-term outcome of patients who underwent wire-based ADR technique versus antegrade wiring (AW).

Methods

One thousand seven hundred and ten patients, from the prospective European Registry of Chronic Total Occlusions (ERCTO), underwent 1806 CTO procedures between January 2018 and December 2021, at 13 high-volume ADR centers. Among all 1806 lesions attempted by the antegrade approach, 72% were approached with AW techniques and 28% with wire-based ADR techniques.

Results

Technical and procedural success rates were lower in wire-based ADR than in AW (90.3% vs. 96.4%, p < 0.001; 87.7% vs. 95.4%, p < 0.001, respectively); however, wire-based ADR was used successfully more often in complex lesions as compared to AW (p = 0.017). Wire-based ADR was used in most cases (85%) after failure of AW or retrograde procedures. At a mean clinical follow-up of 21 ± 15 months, major adverse cardiac and cerebrovascular events (MACCEs) did not differ between AW and wire-based ADR (12% vs. 15.1%, p = 0.106); both AW and wire-based ADR procedures were associated with significant symptom improvements.

Conclusions

As compared to AW, wire-based ADR is a reliable and effective strategy successfully used in more complex lesions and often after the failure of other techniques. At long-term follow-up, patient's MACCEs and symptoms improvement were similar in both antegrade techniques.     

Differences that hurt: self-perceived health inequalities in Croatia and the European Union

Aim

To investigate the differences in self-reported health status and access to health care according to different income groups, urbanization level, and regional distribution in Croatia and European Union (EU) countries.

Method

Data for the EU countries were taken from the European Quality of Life Survey database, which examines different aspects of quality of life including health and health care. The survey was conducted in 2003 and covered 28 countries, although not Croatia. The survey in Croatia was conducted in 2006 by the United Nations Development Program Croatia. EU countries were divided into two groups – 15 “old” EU member states which joined the EU before May 2004 (EU15) and 10 new member states which joined the EU in May 2004 (NMS). The samples were representative and comprised persons aged 18 and over. Statistical differences in health status and access to health care between categories and groups (income groups, urban-rural divide, and analytical regions in case of Croatia) were tested by χ² test or analysis of variance.

Results

Significant differences were found among 4 income quartiles in Croatia and two EU country groups in all indicators: self-perceived health status, satisfaction with health, having long-standing illness or disability, access to health care according to four indicators (distance to the nearest medical facility, delay in getting an appointment, waiting time to see the doctor on the day of the appointment, and the cost of seeing the doctor), and the quality of health services. Higher proportion of the Croatian citizens in the lowest income quartile reported poor health (27.8%) than their counterparts in the EU15 (9.2%) or NMS (18.6%). In Croatia, 26% respondents in the lowest quartile perceived the distance to the nearest medical facility as a very serious problem, compared with 5.4% in the EU15 and 9.4% in the NMS. Rural urban proportion ratio of those who reported poor health was about 80% higher in Croatia than in both EU country groups. Rural-urban proportion ratio of those who reported the cost of seeing the doctor as a very serious problem was almost 2-fold higher than in the two EU country groups.

Conclusion

Health inequalities were more marked in Croatia than in EU countries, which should be taken into serious consideration in shaping health care reforms in Croatia.The issue of health inequalities is certainly among widely researched areas in a number of European countries. Health inequalities are defined as differences in health and health care among different social groups as a result of their different social positions (1). They are mainly associated with socio-economic inequalities, but can also be related to ethnic and gender inequalities (2). Health inequalities attract an increasing interest not only from researchers but also from politicians and the general public, since health care is considered to be a social benefit that should be equally accessed by anyone. Accordingly, the social policy approach to the health area cannot ignore the issue of health inequalities (3,4). Obviously, health inequalities persist, but it remains to be answered which inequalities are perceived as inevitable or normal and which as unjust or immoral.The issue of health inequalities is of great interest for transitional countries, including Croatia, which has undergone deep changes in all aspects of health care system (5). In addition, transitional countries have faced challenges typical for the developed countries: rising costs connected with demographic aging, rising expectations concerning health care rights, as well as constraints in financing health care (6). It seems that in transition period health inequalities rise with rising social inequalities (7). Contrary to this, scientific research and articles about health inequalities in Croatia are very limited. The study conducted in 1994 confirmed that the burden of increasing out-of-pocket expenditures was not equally distributed among income groups, as low income groups were paying six times larger share of their income than high income groups (8). The existence of inequalities in different social groups was also confirmed by the studies from 1999/2000 and 2003 (9,10). However, health inequalities and rising dissatisfaction with the health care system are not taken seriously in designing reforms. Although these issues are indeed a subject of public discussion, the process of designing reforms is still excessively under the influence of financial difficulties and conflicting interests (11). In addition, health inequalities between different minorities or genders have not been investigated enough. The notable exception is the Human Development Report (UNDP) – Croatia 2006, which partly focuses on the access to health care of different groups at the risk of social exclusion (12).The aim of this report was to examine the self-reported health status and access to health services in Croatia and the European Union (EU). Countries of the EU were divided into the group of old member states (EU15) and the group of new member states (NMS). We wanted to assess the health status, prevalence of chronic illness and disability, as well as satisfaction with health in and between the above-mentioned countries. In addition, the intention was to assess some aspects of access to and quality of health services, as well as distrust in the health care system. The primary aim was to analyze self-reported health status and different aspects of access to health services by income groups. Health inequalities were also analyzed according to the urbanization level, and in the case of Croatia according to analytical regions.     

Epidemic methicillin-susceptible Staphylococcus aureus lineages are the main cause of infections at an Iranian university hospital

The majority of Staphylococcus aureus infections from Isfahan, Iran, were caused by epidemic methicillin-susceptible S. aureus (MSSA) lineages, sequence type 8 (ST8), ST22, ST30, and ST6. The predominant methicillin-resistant S. aureus strain was ST239. We observed a high prevalence of Panton-Valentine leukocidin-positive MSSA strains (19.7%), which is a matter of considerable concern, since these strains have the ability to cause severe infections.     

Short-term use of continuous glucose monitoring system adds to glycemic control in young type 1 diabetes mellitus patients in the long run: a clinical trial

BACKGROUND/AIM: Balancing strict glycemic control with setting realistic goals for each individual child and family can optimize growth, ensure normal pubertal development and emotional maturation, and control long term complications in children with type 1 diabetes (T1DM). The aim of this study was to evaluate the efficacy of short-term continuous glucose monitoring system (CGMS) application in improvement of glycemic control in pediatric type 1 diabetes mellitus (T1DM) patients. METHODS. A total of 80 pediatric T1DM patients were randomly assigned into the experimental and the control group. The experimental group wore CGMS sensor for 72 hours at the beginning of the study. Self-monitored blood glucose (SMBG) levels and hemoglobin A1c (HbA1c) levels were obtained for both groups at baseline, and at 3 and 6 months. RESULTS. There was a significant improvement in HbA1c (p < 0.001), in both the experimental and the control group, without a significant difference between the groups. Nevertheless, after 6 months the improvement of mean glycemia was noticed only in the experimental group. This finding was accompanied with a decrease in the number of hyperglycemic events and no increase in the number of hypoglycemic events in the experimental group. CONCLUSIONS: The results suggest that the CGMS can be considered as a valuable tool in treating pediatric T1DM patients, however further research is needed to more accurately estimate to what extent, if any, it outperforms intensive self-monitoring of blood glucose.     

Temporary elevation of the intraocular pressure by cauterization of vortex and episcleral veins in rats causes functional deficits in the retina and optic nerve

PURPOSE: To evaluate visual function in rats with chronic elevation of intraocular pressure (IOP). METHODS: Chronic ocular hypertension was induced in the left eye of 14 adult Brown Norway rats by cauterizing 3 vortex veins and 2 major episcleral veins; the right eye served as a non-operated control. A control group (n=5) was sham operated on the left eye. Prior to surgery, the IOP was measured with a Tonopen, the pupil light reflex (PLR) evaluated with a custom-made computerized pupillometer and electroretinograms (ERGs) were recorded simultaneously from both eyes post surgically: IOP was measured on weeks 1, 3, 5 and 8 post-operatively, pupil light reflexes on weeks 1, 4 and 8 post-operatively, and ERGs on weeks 4 and 8 post-operatively. Sixty five days postoperatively, rats were euthanized and optic nerves and eye globes were prepared for histological analysis. RESULTS: Seven days after surgery 5/14 rats developed significant elevation of the IOP in operated eyes (control eyes: 25.1+/-0.5mmHg; operated eyes: 34.1+/-0.6mmHg; mean+/-SEM; p=0.0004; Paired t-test). Elevation of the IOP was sustained at 3 (p=0.002) and 5 (p=0.007) weeks postoperatively. However, IOP values did not significantly differ between control and operated eyes 8 weeks postoperatively (p=0.192, Paired t-test). Sham operated animals showed no elevation of the IOP 7 days postoperatively. When the ratio between consensual and direct PLR (PLR(ratio)=consensual/direct PLR; pupil of unoperated eye recorded) was examined in rats which developed elevation of the IOP, preoperative values were 92.2+/-4% (mean+/-SEM), 1 week postoperatively 65+/-4% (significantly different from preoperative values, p<0.05 Repeated Measures ANOVA with Dunnett's Multiple Comparison test, n=5), 4 weeks postoperatively 60.6+/-3.2% (p<0.01, n=5). By 8 weeks postoperatively, pupil responses had essentially recovered 75.4+/-6.9% (p>0.05, n=5). Rats whose IOP values did not rise after surgery and sham operated rats did not develop pupil deficits 4 weeks postoperatively. Rats with elevated IOP displayed a significant decrease in ERG amplitudes in operated eyes at 4 weeks (a-wave(operated)/a-wave(control) (a-wave ratio)=42+/-14% (mean+/-SEM); b-wave(operated)/b-wave(control) (b-wave ratio)=43+/-16%) but not at 8 weeks postoperatively (a-wave ratio=88+/-8.4%; b-wave ratio=82.9+/-9%). Sham operated and rats whose IOP values remained non-elevated after surgery did not develop ERG deficits 4 weeks after surgery. Histological analysis did not reveal any damage in the eyes of animals with elevated intraocular ocular pressure with the exception of one rat, which still had ERG and pupil deficits at the end of experiment. CONCLUSIONS: Development of ERG and PLR deficits are proportional to the elevation of the IOP in the rat model of chronic ocular hypertension. Functional monitoring of the ERG and PLR are useful objective techniques for the detection of retina and optic nerve deficits.