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Accredited Assessment Colleagues in the Chronilogical age of Telemedicine: A new System Through Neurology.
We aimed to study long-term clinical outcomes in patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI) over the last 10 years with respect to the completeness of revascularisation at a tertiary care hospital.

A total of 2,960 consecutive MVD patients taken for PCI between 2008 to 2017 were enrolled in the study with baseline demographic, procedural, and follow-up details retrieved from custom-made departmental software. Of those, 2,598 patients with follow-up details constituted the study cohort. Erastin Complete revascularisation (CR) was achieved in 1,854 (71.4%) and incomplete revascularisation (IR) in 744 (28.6%) patients. Propensity matching was performed and 740 matched pairs identified in the two groups. The primary endpoint was survival free of any major adverse cardiovascular events (MACE) with each individual MACE event being a secondary endpoint. IR occurred more often in patients with acute coronary syndrome (64.1% vs 58.3%, p=0.003), complex lesion intervention (40.7% vs 29.6%, p<0.001) and in those with mean stent length ≥38 mm per vessel intervened (21.0% vs 13.5%, p<0.001). Median follow-up was 54 months (interquartile range 31-84 months). After propensity matching, CR resulted in a better survival free of all adverse events, i.e., 86.4% vs 81.1% (HR 1.52, CI 1.21-2.02; p<0.01). link2 Individual MACE endpoints were, however, not statistically different between the groups.

In MVD patients undergoing PCI, CR results in better survival free of all adverse events including all-cause mortality, non-fatal MI, repeat revascularisation and recurrent angina.
In MVD patients undergoing PCI, CR results in better survival free of all adverse events including all-cause mortality, non-fatal MI, repeat revascularisation and recurrent angina.Appropriate and timely management of ST-elevation myocardial infarction is a major challenge in developing countries due to inadequate infrastructure and trained manpower. The TN-STEMI Program was a successful STEMI system of care that was run in the South Indian state of Tamil Nadu. Lessons learnt from this programme could help to understand the challenges and provide solutions to running similar programmes in low- and middle-income countries.
A telemedicine-guided strategy increases the access to and efficiency of ST-elevation myocardial infarction (STEMI) networks resulting in increased access to, and reduced disparities in, acute myocardial infarction (AMI) care between rural and urban areas.

The Latin America Telemedicine Infarct Network (LATIN) was developed for poor and remote regions in Brazil and Colombia that lacked coordinated AMI systems of care. It strategically connects small clinics and primary care health centres (spokes) to hubs with 24/7 percutaneous coronary intervention (PCI) capability. Experts at three remote sites provide urgent electrocardiogram (ECG) diagnosis and tele-consultation for the entire network. Data from the busiest LATIN site, the Santa Marcelina Hospital in Sao Paolo, Brazil, were compared with health statistics from Sistema Unico de Saude (Brazilian Public Health System - SUS). A total of 192 centres were networked using standardised and guideline-based protocols for AMI care. Overall, 313,897 patients were remotely screened, 3,572 AMI diagnosed (1.1%), and 1,636 AMI urgently reperfused (45.8%), mainly by primary PCI (n=1,351; 83%).

In conclusion, a comparison between a pre-LATIN cohort from SUS (1,015) and a LATIN cohort from Santa Marcelina Hospital (1,247) revealed increased reperfusion with PCI (65.52% vs 75.2%), increased cost ($2,037.12 vs $2,246.40, p<0.005), a statistically significant reduction in PCI mortality (8.5% vs 4.3% p<0.01) and a non-significant reduction in mortality overall amongst all treatment pathways (9.69% vs 9.43%, p=0.931).
In conclusion, a comparison between a pre-LATIN cohort from SUS (1,015) and a LATIN cohort from Santa Marcelina Hospital (1,247) revealed increased reperfusion with PCI (65.52% vs 75.2%), increased cost ($2,037.12 vs $2,246.40, p less then 0.005), a statistically significant reduction in PCI mortality (8.5% vs 4.3% p less then 0.01) and a non-significant reduction in mortality overall amongst all treatment pathways (9.69% vs 9.43%, p=0.931).In percutaneous coronary intervention, the knuckle wire technique is one of the approaches to cross the long and ambiguous course of the occluded segment. However, this technique is generally used as a last alternative, when all other techniques fail. Although knuckle wiring expedites chronic total occlusion crossing, it can also complicate the percutaneous coronary intervention strategy irreversibly. Therefore, understanding the various aspects of the knuckle wire technique is a prerequisite in a chronic total occlusion setting. The authors herein intend to describe in detail the knuckle wire technique and its safe and effective approach in various chronic total occlusion wiring strategies, while befitting to the scope of a mainstream interventionist.
Mitral valve surgery (MVS) is the gold-standard treatment for severe symptomatic mitral regurgitation. Percutaneous mitral valve interventions such as the MitraClip procedure offer another dimension to its management particularly in high-risk patients. We meta-analysed the outcomes of MitraClip and MVS.

PubMed, MEDLINE, Embase, Cochrane and Scopus from 1980/01-2019/06 were searched for eligible studies. Data were extracted and pooled using random-effects models. After screening 959 studies and reviewing 21 full-text articles, nine studies totalling 640 MitraClip and 531 MVS (91% valve repair) procedures were included in the meta-analysis. MitraClip patients were older, with a higher prevalence of previous cardiac surgery, coronary disease and a higher EuroSCORE (all p<0.05) than MVS patients. Pooled operative mortality was similar for MitraClip, 3%, versus MVS, 5%, odds ratio (OR) 0.58, 95%, CI 0.28-1.19, as well as at 1 year mortality, OR 1.09, CI 0.71-1.68 and 3-year mortality, OR 1.08, CI 0.72-0.163. MitraClip patients had higher rates of early and late significant mitral regurgitation (MR) and more cardiovascular readmissions, while MVS had higher rates of in-hospital bleeding and pacemaker implantation (all p<0.05).

MitraClip patients had a higher baseline risk than MVS, but there were no significant differences in short- and long-term mortality. MitraClip patients had higher rates of cardiovascular admissions and significant MR post-operatively, while MVS patients had more procedural complications.
MitraClip patients had a higher baseline risk than MVS, but there were no significant differences in short- and long-term mortality. MitraClip patients had higher rates of cardiovascular admissions and significant MR post-operatively, while MVS patients had more procedural complications.
We developed a catheter simulator for percutaneous transvenous mitral commissurotomy (PTMC) based on the data from a patient with mitral valve stenosis. The simulator has the following characteristics 1) the simulator is portable and easy to assemble and disassemble, 2) the cardiac portion is created using a 3D-printer, based on patient computed tomography data, 3) the simulator uses a foot-operated water pump to create pulsatile flow, and 4) the fossa ovalis in the atrial septum of the heart model is made of a thin polyurethane membrane and is interchangeable. link3 We aimed to assess the effectiveness of this novel simulator for training in PTMC using the Inoue balloon in developing countries.

We used this simulator for training in the National Institute of Cardiovascular Diseases in Bangladesh (13 physicians), and in Kenyatta National Hospital in Kenya (11 physicians). The effectiveness of training was evaluated by questionnaire and the procedure time in simulation. The questionnaire obtained from the trainees showed that the model scored 4.7±0.5 for realism, utility of pulsatile flow scored 4.7±0.5, simulator utility scored 4.9±0.3, and the effect of training on PTMC performance scored 4.9±0.5. The procedure time in simulation was shortened from 30.0±12.6 min (first time), to 23.4±11.9 min (second time) and to 20.4 ± 11.1 min (third time) (p<0.01).

The novel portable assembly catheter simulator using a 3D-printed heart model for PTMC received positive comments and improved the skills of trainees.
The novel portable assembly catheter simulator using a 3D-printed heart model for PTMC received positive comments and improved the skills of trainees.The production of value added C1 and C2 compounds within CO2 electrolyzers has reached sufficient catalytic performance that system and process performance - such as CO2 utilization - have come more into consideration. Efforts to assess the limitations of CO2 conversion and crossover within electrochemical systems have been performed, providing valuable information to position CO2 electrolyzers within a larger process. Currently missing, however, is a clear elucidation of the inevitable trade-offs that exist between CO2 utilization and electrolyzer performance, specifically how the faradaic efficiency of a system varies with CO2 availability. Such information is needed to properly assess the viability of the technology. In this work, we provide a combined experimental and 3D modelling assessment of the trade-offs between CO2 utilization and selectivity at 200 mA cm-2 within a membrane-electrode assembly CO2 electrolyzer. Using varying inlet flow rates we demonstrate that the variation in spatial concentration of CO2 leads to spatial variations in faradaic efficiency that cannot be captured using common 'black box' measurement procedures. Specifically, losses of faradaic efficiency are observed to occur even at incomplete CO2 consumption (80%). Modelling of the gas channel and diffusion layers indicated that at least a portion of the H2 generated is considered as avoidable by proper flow field design and modification. The combined work allows for a spatially resolved interpretation of product selectivity occurring inside the reactor, providing the foundation for design rules in balancing CO2 utilization and device performance in both lab and scaled applications.This study examines two strategies-homo- and heterogeneous approaches for the light-driven oxidation of benzyl alcohol in dye-sensitised photoelectrochemical cells (DSPECs). The DSPEC consists of a mesoporous anatase TiO2 film on FTO (fluorine-doped tin oxide), sensitised with the thienopyrroledione-based dye AP11 as the photoanode and an FTO-Pt cathode combined with a redox-mediating catalyst. The homogeneous catalyst approach entails the addition of the soluble 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO) to the DSPEC anolyte, while the heterogeneous strategy employs immobilisation of a TEMPO analogue with a silatrane anchor (S-TEMPO) onto the photoanode. Irradiation of the photoanode oxidises the TEMPO-moiety to TEMPO+, both in the homogeneous and the heterogeneous system, which is a chemical oxidant for benzyl alcohol oxidation. Photoanodes containing the heterogeneous S-TEMPO+ demonstrate decreased photocurrent, attributed to introducing alternative pathways for electron recombination. Moreover, the immobilised S-TEMPO demonstrates an insufficient ability to mediate electron transfer from the organic substrate to the photooxidised dye, resulting in device instability.
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