Abstract Background Percutaneous microaxial flow pump, Impella CP, is one of the most efficient mechanical circulatory devices used to support patients with cardiogenic shock (CS) and undergoing high-risk percutaneous coronary interventions (HR PCI). However, Impella use is associated with an increase in bleeding events due to large bore access, anticoagulation, device-, procedure- and patient- related risk factors, which remain not clear. Aims To determine the predictive factors of major bleeding complications in patients supported with Impella CP in the CS and HR PCI setting. Methods Univariable and multivariable logistic regression analysis were performed to predict severe bleeding complications among patients included in the multicenter, retrospective Impella -PL registry. Results Of 308 patients, 55 had CS and 253 received Impella for HR PCI. Severe bleeding complication according to the Bleeding Academic Research Consortium (BARC) definition were reported in 34.5% patients in the CS and 6.4% HR-PCI groups, respectively. In the CS cohort, the use of intravascular ultrasound was associated with increased odds of major bleeding complications (OR = 7.62; 95% CI: 1.12–51.85; p = 0.038), while manual compression of the vascular access site demonstrated a trend towards a protective effect (OR = 0.075; 95% CI: 0.005–1.04; p = 0.053). In the HR-PCI group, severe calcification (OR 2.75 ; 95% CI:1.094 –7.26; p =0.042), angioplasty of left main coronary artery (OR 8.46; 95% CI:1.56 –46.02; p = 0.013) or left circumflex artery (OR 6.63; 95% CI: 1.97–22.32; p =0.002), contrast volume (OR 1.005; 95% CI: 1.002–1.008; p = 0.002) and ultrasound guided vascular access (OR 3.30; 95% CI: 1.24 –8.77; p =0.017) were the predictors of major bleeding complication. In turn, the removal of Impella directly after the PCI procedure had a protective effect (OR 0.15; 95% CI: 0.03 –0.67; p = 0.013). Conclusion The frequency of major bleeding complications is substantially higher in CS patient supported with Impella, compared to HR-PCI. Careful patient selection, procedural planning, and post-procedure monitoring is crucial to minimize the risk of bleeding complications, especially in patients with severe calcifications and undergoing left main PCI.
Mostafa M Zidan, Fikry Mohamed Reicha, Mohamed M Mansour-Gabr
et al.
Abstract In situ electrosynthesis of new hybrid colloidal microgel particles of chitosan (CS)-pullulan (PL) self-embedded with AgNPs and introduced as a drug carrier for losartan (LOS) as a drug model. The impact of using Platinum (Pt) and Silver (Ag) sheets as anode and the electrosynthesis time on the formation mechanism, morphology, compositional and structural properties have been examined. The prepared samples characterized using uv–visible spectroscopy (UV–vis), transmission electron microscope (TEM), zeta potential, Fourier transform infrared spectroscopy (FTIR), Inductively coupled plasma optical emission spectroscopy (ICP-OES), x-ray diffraction analysis (XRD), and stability test. In addition to the Assessment of the antibacterial activity of the prepared samples. Also, incorporation of LOS in situ during the preparation of the microgel was investigated. The results demonstrated that uniform AgNPs with an average size 5.4 nm successfully in situ self-embedded within CS/PL microgel particles of a dual size distribution 151.4 and 43.5 nm with surface charge +25 mV. Besides, the incorporation of AgNPs during the electrosynthesis process played a crucial role in the morphology transition from pearl-necklace to microsphere. additionally, stability examination of the microgel particles introduced a valuable result that the single sphere containing Ag+ ions underwent a slow reduction rate in consistency with nucleation favored overgrowth. Incorporation of AgNPs within CS/PL microgel has considerably enhanced the antimicrobial potential of the realized CS/PL against both gram-positive and gram-negative bacteria Investigation of the ability of the losartan incorporation explored a stable core/shell like structure with average size 95 nm and zeta potential + 39 mV promoting the spheres stability.
This note is meant to give people who are familiar with the functional programming language Haskell a concise overview of Clean language elements and how they differ from Haskell.
A new fixed point principle for complete ordered families of equivalences (COFEs) is presented, which is stronger than the standard Banach-type fixed point principle.
We prove that the non-structural subtype entailment problem for finite and regular type expressions is in PSPACE. In this way we close a decidability and complexity gap pending since 1996.
We present an overview of some recent efforts aimed at the development of Choreographic Programming, a programming paradigm for the production of concurrent software that is guaranteed to be correct by construction from global descriptions of communication behaviour.
Every partial function from bit strings of a given length to bit strings of a possibly different given length can be computed by a finite instruction sequence that contains only instructions to set and get the content of Boolean registers, forward jump instructions, and a termination instruction. We look for an equivalence relation on instruction sequences of this kind that captures to a reasonable degree the intuitive notion that two instruction sequences express the same algorithm.
Colimits that satisfy the Van Kampen condition have interesting exactness properties. We show that the elementary presentation of the Van Kampen condition is actually a characterisation of a universal property in the associated bicategory of spans. The main theorem states that Van Kampen cocones are precisely those diagrams in a category that induce bicolimit diagrams in its associated bicategory of spans, provided that the category has pullbacks and enough colimits.
We study the correspondence between a concurrent lambda-calculus in administrative, continuation passing style and a pi-calculus and we derive a termination result for the latter.
We present a restriction of the solos calculus which is stable under reduction and expressive enough to contain an encoding of the pi-calculus. As a consequence, it is shown that equalizing names that are already equal is not required by the encoding of the pi-calculus. In particular, the induced solo diagrams bear an acyclicity property that induces a faithful encoding into differential interaction nets. This gives a (new) proof that differential interaction nets are expressive enough to contain an encoding of the pi-calculus. All this is worked out in the case of finitary (replication free) systems without sum, match nor mismatch.
Programs with constraints are hard to debug. In this paper, we describe a general architecture to help develop new debugging tools for constraint programming. The possible tools are fed by a single general-purpose tracer. A tracer-driver is used to adapt the actual content of the trace, according to the needs of the tool. This enables the tools and the tracer to communicate in a client-server scheme. Each tool describes its needs of execution data thanks to event patterns. The tracer driver scrutinizes the execution according to these event patterns and sends only the data that are relevant to the connected tools. Experimental measures show that this approach leads to good performance in the context of constraint logic programming, where a large variety of tools exists and the trace is potentially huge.