Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions.

BACKGROUND: Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM: Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS: From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION: In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

Kinetic modelling of total organic carbon degradation in dairy wastewater.

Several treatment strategies have been proposed to minimize the environmental impact of dairy wastewaters. However, their complex and variable composition makes it difficult to predict the degradation kinetics of organic compounds. In this study, we used a mathematical approach to describe the kinetics of total organic carbon degradation in real dairy wastewater by photo-Fenton oxidation. The reactions were conducted under different ultraviolet light intensities, pH, temperature and Fenton reagent concentrations, obtaining a maximum TOC removal of 90.84%. The kinetic model was developed based on well-established photo-Fenton reactions. The present approach considers that account that small and large molecules of unknown contaminants are present in the effluent, and the smaller molecules are consumed first. The specific degradation rate (kd) was considered as an exponential function of total organic carbon conversion, comprising this effect of molecular size distribution on the treatment process. Fitting of experimental data to model predictions provided mean R2 values of 0.843-0.953.

Solar photo-Fenton oxidation of mature landfill leachate: empirical model and chemical inferences.

In this study, a stochastic model was applied to investigate the degradation of landfill leachate by solar photo-Fenton processes. The coefficient of determination (R2) between experimental and predicted data ranged from 0.9958-0.9995. The optimal conditions for the initial phase (lasting 5-22 min) were high Fe2+ level, low pH level, and intermediate H2O2 level. For the second phase, optimal leachate degradation percentages were obtained by maintaining the pH, increasing H2O2, and decreasing Fe2+ to the lowest level. Determination of optimal reaction conditions (such as pH, Fe2+, and H2O2 values) for both degradation phases is of paramount importance for process scale-up. The major contribution of this study was the development of a tool that considers the effects of one or more reactions on organic carbon degradation. This was achieved by assessing the significance of the effects of experimental conditions on model parameters for the fast and slow steps of leachate degradation by advanced oxidation processes.

Chronic total occlusion percutaneous coronary intervention in Latin America.

OBJECTIVES: To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. BACKGROUND: CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. METHODS: An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. RESULTS: We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re-entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In-hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% CONCLUSIONS: CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

Carbonaceous decomposition of a recalcitrant effluent treated by the photo-Fenton process: a kinetic approach.

Natural effluents with marked variation in their chemical composition over decomposition time in the matrix from which they are generated have a complex composition and are not totally known in most cases. Landfill leachate can be considered an effluent with complex composition, requiring imminent and more comprehensive studies on organic load degradation. Such complexity of numerous organic compounds (most of them recalcitrant humic and fulvic substances) demands a large number of kinetic equations to satisfactorily describe the temporal evolution of such conversion. Thereby, this work aims to study a kinetic approach grounded on previously consolidated chemical reactions of radical generation through the photo-Fenton mechanism. A molar balance was developed for each species in a batch photo-Fenton process and the resulting ordinary differential equations were numerically solved in MATLABTM. The kinetic model satisfactorily described an organic load conversion of the effluent under the various experimental conditions studied herein. Experimental trends could be represented by a free-radical mechanism and a degradation rate equation of first order for organic carbon, hydroxyl radical and H+. The model fittings revealed a hydroxyl radical/organic carbon stoichiometric ratio of 2:1. The kinetic study has confirmed the importance of pH levels for the reaction medium, and indicated that degradation rate depends on the medium organic composition, which provided an exponential function of conversion for the degradation rate coefficient. The model simulations corroborated the positive effect of sunlight on the radical generation through [Formula: see text] decomposition reaction with a rate coefficient in the range 4 × 10-3-2 × 10-1 s-1.

Case Report: Bladder adenocarcinoma: primary or urachal?

Background: Bladder adenocarcinoma (AC) is a scarce histological variant and there are few studies on its proper management. No previous case reports present the management of a urachal tumor and the incidental finding of bladder adenocarcinoma. Clinical case: We present the case of a young woman with nonspecific symptoms, who presented with a prior history of dysuria, bladder tenesmus, suprapubic pain and urinary urgency for one year, which had been treated as recurrent urinary tract infection. A partial cystectomy plus extended lymphadenectomy was scheduled. We found a bladder tumor with characteristics of a urachal tumor and the pathological report indicated a primary bladder AC. The patient had a complete recovery at one year of follow-up. Conclusions: A patient can present with a tumor with urachal characteristics; however, the pathology report can show primary AC. The decision to perform partial cystectomy was an appropriate option for the location of this tumor, with optimal surgical results. Still, a long-term follow-up is necessary. More specific management guidelines are required for the treatment of AC.

Biolimus-Eluting StenT For de-novo coRonary artery dIsease in patiENts with Diabetes mellituS: the BESTFRIENDS multicentre registry.

AIMS: Coronary inflammation and healing influence outcomes of diabetic patients treated with Percutaneous coronary revascularization (PCI). Stents covered with biodegradable polymers (bp) may offer advantages over nonerodible polymer ones, because polymer reabsorption extinguish coronary inflammation and favours healing. Aim of our study was to assess the safety and efficacy of bp-biolimus-eluting stent (bp-BES) in a large series of consecutive diabetic patients. METHODS: From 2009 to 2013 we retrospectively enrolled consecutive diabetic patients treated with PCI and bp-BES implantation. Primary end points were target lesion revascularization (TLR) and stent thrombosis rates. RESULTS: Study cohort counted 747 patients. Multivessel disease was present in 48.2% with a mean stent/patient ratio of 1.860.78. During the hospital stay no stent thrombosis occurred. At 3-year follow-up we observed a 1.5% cumulative incidence of cardiac death, 1.1% of myocardial infarction and 6.3% of TLR. Stent thrombosis occurred in 1.1% of patients, all in the first 2 years of follow-up. Kaplan-Meier analysis showed a TLR-free survival at 1 and 3 years of 97.2 and 96.1%, respectively. CONCLUSION: PCI with bp-BES seems to be well tolerated and effective in a large unselected population of diabetic patients. The good results observed were maintained at 3 years of follow-up.

Isotermas de adsorção de Freundlich para o crômio (III) em Latossolos

Environmental impacts caused by tannery waste application to agricultural soils must be studied to avoid biota and groundwater contamination. Soil chromium adsorption is very important, when the soil adsorptive capacity is exceeded and, potentially, the metals become available for leaching. The objectives of this study were to verify if the isotherm of Freundlich describes adequately the chromium adsorption by Oxisols, to study chromium adsorption considering different soils and horizons, as well as some chemical and physical attributes, and to evaluate the influence of the pH level on chromium adsorption. Samples of the A and B horizons of two soils were collected in the São Paulo State - Brazil: a) Typic Eutrorthox (LVe) and b) Typic Haplorthox (LVd). The pH alteration of the surface horizons was performed with the addition of calcium carbonate to reach 70% base saturation. Samples were shaken with CrCl3 solutions (prepared in Ca(NO3)2 5 mmol L-1 as the support electrolyte) of different initial chromium concentrations Co: 0; 0.5; 1.0; 2.5; 5.0; 10.0 and 50.0 mg L-1, using two replicates for each treatment. Freundlich isotherms were adjusted to describe the chromium adsorption by the soil. This isoterm fitted well to the experimental data. Chromium adsorption was higher in the Typic Eutrorthox than in the Typic Haplorthox. The adsorption was also favored by liming in both soils. There was no difference between chromium adsorption by the two horizons of the soils.

Os impactos causados no ambiente pela aplicação de resíduos de curtume contendo crômio em solos agrícolas devem ser estudados detalhadamente para que se evite a contaminação da biota e das águas subterrâneas. A adsorção do crômio ao solo reveste-se de especial importância em estudos de movimentação de solutos, uma vez que, se a capacidade adsortiva de um solo for ultrapassada, o metal fica potencialmente disponível para ser lixiviado. Os objetivos deste trabalho foram verificar a adequação da Isoterma de Freundlich em descrever a adsorção do crômio em Latossolos; analisar o comportamento da adsorção do crômio considerando-se os diferentes solos e horizontes, bem como de alguns de seus atributos químicos e físicos, como teores de óxidos e textura, e analisar a influência do nível de pH dos horizontes A. Utilizaram-se amostras dos horizontes A e B de dois solos coletados no Estado de São Paulo, Brasil: a) LATOSSOLO VERMELHO ESCURO Eutroférrico (LVe) e b) LATOSSOLO VERMELHO AMARELO Distrófico (LVd). O pH das amostras do horizonte superficial foi alterado com adição de carbonato de cálcio para elevar a saturação por bases a 70%. Duas repetições de cada amostra foram agitadas com soluções contendo diferentes concentrações iniciais Co de crômio na forma de CrCl3: 0; 0,5; 1,0; 2,5; 5,0; 10,0 e 50,0 mg L-1. Ajustaram-se isotermas de Freundlich (exponencial) para descrever a adsorção do crômio ao solo. O modelo de Freundlich conseguiu descrever satisfatoriamente o comportamento do crômio na maioria dos tratamentos utilizados. A adsorção do crômio foi maior no LVe em relação ao LVd e foi favorecida pela calagem. Não foi possível evidenciar diferença na adsorção de crômio entre os horizontes dos dois solos estudados.

Isotermas de adsorção de Freundlich para o crômio (III) em Latossolos

Environmental impacts caused by tannery waste application to agricultural soils must be studied to avoid biota and groundwater contamination. Soil chromium adsorption is very important, when the soil adsorptive capacity is exceeded and, potentially, the metals become available for leaching. The objectives of this study were to verify if the isotherm of Freundlich describes adequately the chromium adsorption by Oxisols, to study chromium adsorption considering different soils and horizons, as well as some chemical and physical attributes, and to evaluate the influence of the pH level on chromium adsorption. Samples of the A and B horizons of two soils were collected in the São Paulo State - Brazil: a) Typic Eutrorthox (LVe) and b) Typic Haplorthox (LVd). The pH alteration of the surface horizons was performed with the addition of calcium carbonate to reach 70% base saturation. Samples were shaken with CrCl3 solutions (prepared in Ca(NO3)2 5 mmol L-1 as the support electrolyte) of different initial chromium concentrations Co: 0; 0.5; 1.0; 2.5; 5.0; 10.0 and 50.0 mg L-1, using two replicates for each treatment. Freundlich isotherms were adjusted to describe the chromium adsorption by the soil. This isoterm fitted well to the experimental data. Chromium adsorption was higher in the Typic Eutrorthox than in the Typic Haplorthox. The adsorption was also favored by liming in both soils. There was no difference between chromium adsorption by the two horizons of the soils.

Os impactos causados no ambiente pela aplicação de resíduos de curtume contendo crômio em solos agrícolas devem ser estudados detalhadamente para que se evite a contaminação da biota e das águas subterrâneas. A adsorção do crômio ao solo reveste-se de especial importância em estudos de movimentação de solutos, uma vez que, se a capacidade adsortiva de um solo for ultrapassada, o metal fica potencialmente disponível para ser lixiviado. Os objetivos deste trabalho foram verificar a adequação da Isoterma de Freundlich em descrever a adsorção do crômio em Latossolos; analisar o comportamento da adsorção do crômio considerando-se os diferentes solos e horizontes, bem como de alguns de seus atributos químicos e físicos, como teores de óxidos e textura, e analisar a influência do nível de pH dos horizontes A. Utilizaram-se amostras dos horizontes A e B de dois solos coletados no Estado de São Paulo, Brasil: a) LATOSSOLO VERMELHO ESCURO Eutroférrico (LVe) e b) LATOSSOLO VERMELHO AMARELO Distrófico (LVd). O pH das amostras do horizonte superficial foi alterado com adição de carbonato de cálcio para elevar a saturação por bases a 70%. Duas repetições de cada amostra foram agitadas com soluções contendo diferentes concentrações iniciais Co de crômio na forma de CrCl3: 0; 0,5; 1,0; 2,5; 5,0; 10,0 e 50,0 mg L-1. Ajustaram-se isotermas de Freundlich (exponencial) para descrever a adsorção do crômio ao solo. O modelo de Freundlich conseguiu descrever satisfatoriamente o comportamento do crômio na maioria dos tratamentos utilizados. A adsorção do crômio foi maior no LVe em relação ao LVd e foi favorecida pela calagem. Não foi possível evidenciar diferença na adsorção de crômio entre os horizontes dos dois solos estudados.