Impact of peripheral artery disease on prognosis after percutaneous coronary intervention: Outcomes from the multicenter prospective e-ULTIMASTER registry.

BACKGROUND AND AIMS: Patients with peripheral artery disease (PAD) represent a high risk group, and have an increased risk of cardiovascular events and worse cardiovascular outcomes. Our aim was to study the impact of PAD among patients undergoing percutaneous coronary intervention (PCI) with a newer-generation thin-strut DES. METHODS: In this analysis of the e-ULTIMASTER registry, patients with and without known PAD undergoing PCI were compared. A propensity-score was used to adjust for differences between the groups. The primary outcome was target lesion failure (TLF): a composite of cardiac death, target-vessel related myocardial infarction, and/or clinically driven target lesion revascularization at 1-year follow-up. RESULTS: Of 33,880 patients included in the analysis, PAD was present in 2255 (6.7%). Patients with PAD were older (69.0 ± 10.0 vs. 63.8 ± 11.3 years) with a higher burden of comorbidities. Patients with PAD were less likely to present with STEMI (9.6% vs. 21%), and more likely to undergo complex PCI (left main 5.5% vs. 3.0% ostial lesions 10.4% vs. 7.0%, bifurcations 14.5% vs. 12.3% and calcification 26.8% vs. 17.8%). PAD was found to be independently associated with 41% increased risk for TLF. The risk for all cause death and for cardiac death was 75% and 103% higher, respectably. No difference was found in the rates of stent thrombosis, clinically driven target lesion revascularization, or myocardial infarction (MI). CONCLUSIONS: Patients with PAD are at higher risk for (cardiac) death post PCI, but not target vessel or lesion repeat revascularizations. The PAD cohort represents a population with a higher risk clinical profile. Further research combining medical and device therapies is needed to further improve the outcomes in this high-risk population.

A New Conformal Cooling System for Plastic Collimators Based on the Use of Complex Geometries and Optimization of Temperature Profiles.

The paper presents a new design of conformal cooling channels, for application in collimator-type optical plastic parts. The conformal channels that are presented exceed the thermal and dynamic performance of traditional and standard conformal channels, since they implement new sections of complex topology, capable of meeting the high geometric and functional specifications of the optical part, as well as the technological requirements of the additive manufacturing of the mold cavities. In order to evaluate the improvement and efficiency of the thermal performance of the solution presented, a transient numerical analysis of the cooling phase has been carried out, comparing the traditional cooling with the new geometry that is proposed. The evolution of the temperature profile versus the thickness of the part in the collimating core with greater thickness and temperature, has been evaluated in a transient mode. The analysis of the thermal profiles, the calculation of the integral mean ejection temperature at each time of the transient analysis, and the use of the Fourier formula, show great improvement in the cycle time in comparison with the traditional cooling. The application of the new conformal design reduces the manufacturing cycle time of the collimator part by 10 s, with this value being 13% of the total manufacturing cycle of the plastic part. As a further improvement, the use of the new cooling system reduces the amount of thickness in the collimator core, which is above the ejection temperature of the plastic material. The improvement in the thermal performance of the design of the parametric cooling channels that are presented not only has a significant reduction in the cycle time, but also improves the uniformity in the temperature map of the collimating part surface, the displacement field, and the stresses that are associated with the temperature gradient on the surface of the optical part.

Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis.

BACKGROUND: Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders. METHODS: This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records. RESULTS: The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001). CONCLUSIONS: As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.