[Percutaneous coronary intervention and coronary artery bypass grafting in patients with triple vessel disease and left main stenosis - a retrospective study of quality of care in Uppsala University Hospital]. / Svårt att välja behandlingsmetod vid utbredda kranskärlsstenoser.

Percutaneous coronary intervention and coronary artery bypass grafting are two methods for treating patients with extensive coronary artery disease (CAD). Choosing method of treatment is difficult for both physicians and patients. European guidelines recommend multidisciplinary decision-making when choosing which procedure to utilize. The purpose of this local quality improvement study was to examine how patients with extensive CAD, defined as stenosis in the three major coronary arteries or in the main stem of two coronary arteries, were treated in Uppsala University Hospital during 2020. We found that 29 out of 95 patients were treated without previous multidisciplinary discussions, but plausible reasons for this were found in the medical records of 26 out of 29 patients. How these patients should be treated in regards to guidelines, efficient use of resources, and informed consent is a difficult task. We hope to raise a discussion of how these patients are treated in other hospitals.

High on-treatment platelet reactivity: risk factors and 5-year outcomes in patients with acute myocardial infarction.

OBJECTIVE: The aim of the present study was to assess long-term prognostic value of high on-treatment platelet reactivity (HTPR) in patients after acute myocardial infarction (MI) and its association with possible risk factors. METHODS: This prospective, case-control study was an observation of 198 patients who had acute MI. Response to aspirin and clopidogrel was assessed using impedance aggregometry. Patients were divided into groups of adequate response, dual poor responsiveness (DPR), poor responsiveness to aspirin (PRA), and poor responsiveness to clopidogrel (PRC). Simultaneously, potential risk factors of HTPR development were recorded. After 5 years, MI recurrence and overall mortality were assessed. RESULTS: HTPR was more frequent in New York Heart Association Class III and IV patients, and in patients with left ventricle systolic dysfunction. Five-year mortality rate was higher in all groups of patients with HTPR compared to patients with sufficient response to antiplatelet treatment: in PRA patients, 38.1% vs. 19.2%, p<0.01; in PRC patients, 45.2% vs. 17.3%, p<0.001; and in DPR patients, 50.0% vs. 19.9%, p<0.05. Risk of repeat MI also increased (hazard ratio [HR] 4.0, p<0.05 for DPR group; HR 4.37, p<0.01 for PRA group; and HR 3.25, p<0.05 for PRC group). CONCLUSION: PRA, PRC, and DPR are independent predictors of increased 5-year mortality and risk of repeat non-fatal MI. The study has demonstrated that HTPR is frequently observed in patients with severe heart failure and left ventricle systolic dysfunction.

Light-mimicking cockroaches indicate Tertiary origin of recent terrestrial luminescence.

Bioluminescence is a common feature of the communication and defence of marine organisms, but this phenomenon is highly restricted in the terrestrial biota. Here, we present a geographical distribution of only the third order of luminescent insects--luminescent cockroaches, with all 13 known and/or herein reported new living species (based on deposited specimens). We show that, for the first time, photo-characteristics of three examined species are nearly identical with those of toxic luminescent click beetles, which they mimic. These observations are the evidence for the mimicry by light--a new type of defensive, batesian and interordinal mimicry. Our analysis surprisingly reveals an evolutionary novelty of all living luminescent insects, while in the sea (and possibly in the soil) luminescence is present also phylogenetically in very primitive organisms.

Good short-term but not long-term reproducibility of the antiplatelet efficacy laboratory assessment.

BACKGROUND: The antiplatelet effect of acetylsalicylic acid (ASA) varies among individual patients. We assessed the short-term reproducibility (STR) and long-term reproducibility (LTR) of light transmission aggregometry (LTA). METHODS: Residual platelet reactivity was measured twice using LTA in a group of 207 consecutive patients (56 females, mean age 67 ± 9 years) on ASA therapy in 10 ± 6 months interval. The STR was assessed in 15 patients (6 females, mean age 61 ± 7 years) with 10 measurements on 2 consecutive days. RESULTS: There was no correlation between both measurements in the long-term part of the study, and also Bland-Altman plot showed a diverging pattern. However, LTA STR was good with a correlation coefficient of .800 (P < .05) confirmed by Bland-Altman plot. CONCLUSIONS: Although short-term intraindividual reproducibility of LTA assessment of platelet reactivity is very good, in the long-term perspective the antiplatelet ASA effectivity may be influenced by additional variables and repeated measurements are warranted.