Search

This work investigates the microstructure and magnetic–dielectric properties of the CaTiO 3 (CTO) and Y 3 Fe 5 O 12 (YIG) composite ceramic. CTO is a paramagnetic ceramic, presents a positive value of Resonant Frequency Temperature Coefficients ( τ f ) and has high dielectric permittivity ( ε r ) while YIG is ferromagnetic, has low ε r and negative τ f values. Therefore, it is expected that the composite from these individual phase shows new properties, or a mix of them derived from each component. X-ray powder diffraction (XRPD), Scanning Electron Microscope (SEM), Raman and 57 Fe Mössbauer spectroscopy were performed to confirm the phases of the composites. The dielectric and magnetic properties in Radio-Microwave frequencies were studied by impedance spectroscopy using different geometries. It was observed a densification improvement resulting from the insertion of the CTO in composites and a chemical reaction between YIG and CTO phases. This new composite has potential applications in bulk and thick/thin films devices. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore use of community treatment orders (CTOs) in adults with intellectual disability (ID) and mental health problems across England and Wales. Design/methodology/approach – A web-based exploratory survey was sent to 359 consultants on the database of the Faculty of the Psychiatry of ID, Royal College of Psychiatrists who had declared ID as their main speciality. Socio-demographic details of responding consultants, clinical characteristics of adults with ID on CTO, subjective views of consultants on using CTOs in people with ID were collected and analysed. Findings – In total, 94 consultant questionnaires were returned providing information on 115 patients detained under CTO. More than 75 per cent of the respondents had used CTO in their clinical practice. Patients subject to CTO were generally young, white males with mild ID and living in supported accommodation. CTOs were primarily used in situations of non-engagement (52.2 per cent), non-compliance with medication (47 per cent) or non-compliance with social care supports (49.6 per cent). Practical implications – Responding consultants expressed concerns about encroachment of civil liberties and ethics of using CTOs in people with ID who may lack capacity and stressed that decision to use CTOs needs to be therefore done on individual basis. Originality/value – This is the first national study to examine the practice of applying CTOs in adults with ID and mental disorders. Current practice is based on evidence from research done in adults with normal intelligence. Further research is needed to investigate the utility of CTOs in routine clinical practice in adults with ID and mental disorders. [ABSTRACT FROM AUTHOR]

Background Successful recanalization of true chronic total occlusion (CTO) has been linked to a decrease in cardiac mortality. We evaluated the effect of CTO recanalization on LVEF and regional wall motion using paired cardiac magnetic resonance imaging (cMRI) studies. Methods and results 43 patients underwent contrast enhanced cMRI prior to and 9 months after successful recanalization of a true CTO defined as thrombolysis in myocardial infarction flow 0 and duration of occlusion of more than 3 months. Regional wall motion was analyzed using the AHA model. For each segment the wall thickness (WT) was measured over the duration of one heart cycle and segmental wall thickening (SWT) was calculated. Left ventricular ejection fraction (LVEF) and volumes were measured. LVEF significantly increased by 2.4 ± 6.0% (p = 0.01). The increase was confined to patients with baseline LVEF below the median of 49.3% (4.1 ± 7.0%, p = 0.01) compared to 0.6 ± 4.0 (p = 0.48) in patients with baseline LVEF higher than the median. Segmental wall motion analysis was performed in 706 myocardial segments. SWT significantly increased in segments within the perfusion territory of the CTO vessel (5.1 ± 30.4%, p = 0.01), especially in dysfunctional segments at baseline with SWT init < 45% (13.3 ± 24.3%, p < 0.001). In addition, SWT significantly increased in segments of non-CTO vessels (4.1 ± 32.1%, p < 0.01). Conclusions In conclusion, in patients with successful recanalization of CTO left ventricular ejection fraction and regional wall motion are significantly improved, especially in patients with decreased LVEF and in dysfunctional segments. [ABSTRACT FROM AUTHOR]

Background Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) may have a beneficial effect on survival through a better-preserved or improved LVEF. Current literature consists of small observational studies therefore we performed a weighted meta-analysis on the impact of revascularization of CTOs on left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and long-term mortality. Methods We conducted a meta-analysis evaluating LVEF before and after CTO PCI and long-term mortality. No language or time restrictions were applied. References from the identified articles and reviews were examined to find additional relevant manuscripts. Results Of the 812 citations, 34 studies performed between 1987-2014 in 2243 patients were eligible for LVEF and 27 studies performed between 1990-2013 in 11,085 patients with success and 4347 patients that failed CTO PCI were eligible for long-term mortality. After successful CTO PCI, LVEF increased with 4.44% (95% CI: 3.52-5.35, p < 0.01) compared to baseline. In a small cohort of ~ 70 patients, no significant difference in LVEF was observed after non-successful CTO PCI or reocclusion. Additionally, 8 studies reported the change in left ventricular end-diastolic volume (LVEDV) in a total of 412 patients. LVEDV decreased with 6.14 ml/m² (95% CI: - 9.31 to - 2.97, p < 0.01). Successful CTO PCI was also associated with reduced mortality in comparison with failed CTO PCI (OR: 0.52, 95% CI: 0.43-0.62, p-value < 0.01). Conclusions The current meta-analysis revealed that successful recanalization of a CTO resulted in an overall improvement of 4.44% absolute LVEF points, reduced adverse remodeling and an improvement of survival (OR: 0.52). [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Background Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. Methods We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. Results During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR: 0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p = 0.02) and MACE (HR: 0.44; 95% CI: 0.23 to 0.82; p = 0.01) were still significantly lower in the revascularization group than in the medication group. Conclusions In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. [ABSTRACT FROM AUTHOR]

Chronic total occlusion (CTO) is probably caused by thrombus and lipid-rich cholesterol esters that are replaced over time by collagen and calcium deposition. Experimental models showed endothelial cell necrosis in response to vessel ligation, whereas more recent models suggest that the endothelium might retain viability guiding the subsequent development of CTO, including CTO neo-revascularization, which occurs within the lumen and in various layers of the vessel wall, by the release of paracrine substances. It is uncertain whether after CTO recanalization the recovery of anterograde reverses endothelial dysfunction, thus promoting vasodilation and positive remodeling. [ABSTRACT FROM AUTHOR]

In the recent years, it has been confirmed both by theory and by practice that organisational models need to include networking strategies to cope with the current competitive environment. Different collaboration levels can characterise supply chains, virtual organisations (VO) and business communities; however, managing different networking scenarios is extremely important to allow SMEs to respond to market opportunities, ensuring a quick response, unique products with competitive prices and high product quality. This paper proposes an innovative methodological approach to support collaboration amongst SMEs for customised product design and manufacturing based on the VO concept. The work is based on mapping the methodology with the most important processes characterising the life of a VO and defining the operative practices to be performed within this type of network. This paper presents two case studies in the fashion industry, where the proposed approach for network management was tested and analysed. [ABSTRACT FROM AUTHOR]

Purpose: The evidence regarding community treatment order effectiveness has been conflicting. This systematic review aims to bring up to date the review performed by Churchill and colleagues in 2005 by assessing and interpreting evidence of CTO effectiveness defined by admission rates, number of inpatient days, community service use, and medication adherence published since 2006. Method: Databases were searched to obtain relevant studies published from January 2006 to March 2013. Results: 18 studies including one randomised controlled trial were included. There remains lack of evidence from randomised and non-randomised studies that CTOs are associated with or affected by admission rates, number of inpatient days or community service use. The most recent and largest RCT is included in this review and found no significant impact on admission rate (RR = 1.0, 95 % CI 0.75-1.33) or number of days in hospital (IR = 0.90, 95 % CI 0.65-1.26). Results from the two largest longitudinal datasets included in this review do not concur. Studies using the New York dataset found that CTOs were associated with reduced admission rates and inpatient days, while studies using the Victoria dataset generally found that they were associated with increased admission rates and inpatient days. Conclusion: There is now robust evidence in the literature that CTOs have no significant effects on hospitalisation and other service use outcomes. Non-randomised studies continue to report conflicting results. Distinguishing between CTO recall and revocation and different patterns of community contact is needed in future research to ensure differentiation between CTO process and outcome. [ABSTRACT FROM AUTHOR]

Highlights: [•] The study was done in 2 bench scale partial-nitrification Submerged bed bioreactors. [•] Nitrifying bacteria were studied using Nxra and CTO genes by PCR-TGGE fingerprinting. [•] We focused the study in the influence of the hydraulic retention time (HRT). [•] The HRT effect in the microbial communities was confirmed by multivariate analysis. [•] In the supplementary data denitrifying bacteria were studied using nosZ gen. [ABSTRACT FROM AUTHOR]

Optimal treatment of chronic total occlusions (CTOs) remains one of the major challenges in interventional cardiology. A number of factors, including both patient clinical conditions and technical procedural considerations, have been identified to affect percutaneous coronary intervention (PCI) success and long-term outcomes, in large multicenter cohorts as well as smaller patient groups. As opposed to patient-centered factors, technical factors can be managed and as a result, a lot of research aims at improving stent technology and imaging guidance, toward enhancing PCI efficiency, in regards to patient safety. [ABSTRACT FROM AUTHOR]

Introduction: The minimalistic hybrid approach (MHA) is an algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The current study aims to evaluate the distribution of patients among the five different treatment strategies, the different techniques used in each strategy, the overall procedural success, and the safety of the MHA algorithm., Methods: Data from a consecutive series of patients with a CTO who underwent elective PCI between February 2019 and July 2021 were prospectively collected and retrospectively analyzed., Results: One hundred and forty-three CTOPCI in 135 patients were approached according to the MHA algorithm: 134 CTO (93.7%) were successfully recanalized and 9 procedures failed. About half of the procedures (48.3%) were approached using strategy A: antegrade "blind wiring" with contralateral retrograde options, making this the most popular strategy. A total of 89 procedures (62.2%) were completed with a single guiding catheter; in 86 (96.6%) a forearm approach was used. The remaining 54 cases were performed with dual access; in the majority of these patients (90.7%), a bilateral forearm approach was used. The only reason to use the femoral access was inadequate forearm access. One hundred and fifty-four out of 197 (78.2%) access sites were 6 French sheaths., Conclusion: MHA is a stepwise approach focused on the forearm approach to reduce the number of access sites and catheter size used in CTOPCI while maintaining proficiency and safety. Operators should be warned that this approach should be adopted only by experienced CTO operators who master all the strategies of the classic hybrid algorithm and the forearm approach., (© 2022 Wiley Periodicals LLC.)

Aim: The impact of Grade III coronary perforations (G3-CP) in the setting of CTO-PCI is not well assessed., Methods and Results: We reviewed 7773 CTO-PCI and 98,819 non CTO-PCI performed in 10 European centers: G3 perforation occurred in 87 patients (1.1%) during CTO PCI and 224 patients (0.22%) during non CTO-PCI (p < 0.001). G3-CP involved the CTO segment in 68% of patients and the retrograde channels in 14% of cases. In the CTO PCI group, wire induced G3-CP (50.5% vs. 32.5%, p = 0.02) occurred predominantly when dedicated CTO tapered and highly penetrative wires were used. Intra-procedural and in-hospital death rates were 4.6% vs. 5.8% and 3.6% vs. 7.5% respectively for CTO PCI and non-CTO PCI groups (p = NS). At a median follow up of 24 months, the overall mortality and MAE were respectively 7.8% and MAE 19% without difference among groups., Conclusions: We showed similar in-hospital and long-term outcomes when G3 perforations occurred during CTO PCI and non CTO-PCI., (© 2022 Wiley Periodicals LLC.)

Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of a coronary artery can provide benefits in terms of myocardial function and survival but the procedure is complex and the success rate is relatively low. To assess these benefits, myocardial function, ischemia and viability should be clearly determined by means of a reliable diagnostic test. This study aimed to assess ventricular function and myocardial ischemia before and after PCI for CTO using cardiac magnetic resonance (CMR). NYHA functional class was also assessed before and after PCI. Methods and results: CMR studies were performed in 43 consecutive patients (7 females; aged 64±9.6y.o.) with CTO scheduled for PCI and repeated 6months post-PCI. PCI was successful in 33 (77%) of them. In this group CMR had shown inducible perfusion defects in 26 (79%) before PCI, while they were observed in 10 (30%) post-PCI CMR study (p<0.001). The number of segments showing inducible perfusion defect (3.4±2 prevs. 2.9±4.5 post-PCI, p=0.002) was significantly reduced in this group. Regional contractile function of segments showing viability also improved significantly in the group with successful CTO PCI compared to the group with an unsuccessful procedure. NYHA functional class for angina also improved in patients with successful revascularization while it remained unchanged in the group with unsuccessful procedures. Conclusions: A successful CTO PCI leads to a reduction in inducible myocardial ischemia and to an improvement in regional wall motion, which results in clinical improvement. [ABSTRACT FROM AUTHOR]

Abstract: Aims & method: This study seeks to explore the nature and extent of any increase, along with the impact of the increase on the workload of the MHA/DoLs practitioners. Retrospective collection of data from MHA department and Guardianship/Deprivation of Liberty coordinators was followed by statistically evaluating the data. Results: Over all, there was 56% increase in the use of the MHA over the previous year; the number of Guardianship orders increased by 85% while CTO increased by 825% and the number of tribunal appeals increased by 260%. Guardianship orders were 100% for S7 with an average length of 24 months. 36% of Guardianship orders lasted less than a year. In 2009/10 there were 98 DoLs authorisations. 70% of DoLs authorisations were supervised by the Local Authorities compared to 30% by the Local Health Board. Rate of DoLs authorisations per 100,000 populations was 42.3 for Local Authorities and 6.6 for Local Health Board. The average time consumed for the all new assessments amounted to 234.4 extra days per year. Clinical implications: The study shows increase in the volume of MHA, Guardianships and DoLs assessments. The amendments of the Act 2007 also attract an increase in the appeal process. The use of both the Act and the Deprivation of Liberty has increased workload for all involved practitioners. [Copyright &y& Elsevier]

Aims To evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS). Methods and results A total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5-year follow-up with a landmark set at 30 days. In patients without CS (n = 4409), only MVD with a CTO was an independent predictor for 30-day [hazard ratio (HR) 2.8, P < 0.01] and 5-year mortality (HR 1.7, P < 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients (n = 609), MVD with and without a CTO were independent predictors for 30-day mortality (HR 2.2, P < 0.01 and HR 1.8, P < 0.01). In 30-day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P = 0.06). Conclusion In non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality. [ABSTRACT FROM PUBLISHER]

The implementation of the Community Treatment Order (CTO) has created controversy surrounding its beneficence. The study aims at examining the effectiveness of the CTO in reducing the rate and duration of revolving door admissions for patients who were made subject to this Order. All patients who were made subject to CTO between November 2008 and August 2009 in South Essex were involved in the study where patients acted as their own control through comparing their pre-CTO, during CTO and post-CTO's admission rate and duration. There was a significant reduction in the rate and duration of admissions in the period during and post-CTO state. The CTO proved to be effective in reducing revolving door admissions and it has a beneficial carryover effect in the post-CTO state. [ABSTRACT FROM AUTHOR]

Background: Distal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures., Methods: From 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time)., Results: A total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm 2 vs. 1,300 mGy×cm 2 , p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA ( p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35)., Conclusion: Using DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Achim, Szigethy, Olajos, Molnár, Papp, Bárczi, Kákonyi, Édes, Becker, Merkely, Van den Eynde and Ruzsa.)

Abstract: The thermal-oxidative resistances of seven soot and char samples from various combustion processes were tested with a chemothermal oxidation (CTO) method. The residues of each soot/char oxidized at different temperature conditions were quantified for the remaining organic carbon contents and their stable carbon isotope compositions. The results showed that the soot/char samples had distinctly different resistance to CTO, with half-temperature values of 380–409°C for diesel- and hexane-derived soots, 276–312°C for biomass- and coal-derived soots, and 257–323°C for the other two chars. The lower thermal resistance of the two biomass soots and coal soot suggested that they likely were formed at lower combustion temperatures and that they cannot be detected or quantified in environmental samples using the standard CTO-375 method. The stable carbon isotope data showed three different modes of δ13C shifts as the combustion temperature increased. Both diesel and hexane soots had no change of δ13C values during CTO treatment. The δ13C values of the coal soot shifted to more negative whereas the δ13C values of the other four biomass-derived soot/char samples became more positive. The data suggested that interpretation of δ13C data for residual BC materials after thermal treatment should be cautious. [Copyright &y& Elsevier]

Abstract: Calcium–titanium–oxygen precipitate (CTO) is well known for its notable electrorheological performance. The two main components of CTO particle are calcium oxalate dehydrate (COD) and titanium–oxygen precipitates (HTO). We systematically studied the wettability of these three compounds with silicon oil at different thermal treatment temperatures. We found that the wetting performance of the HTO decreases with increasing heating temperature, the same tendency as that of CTO particles. This discovery inferred that the wettability of CTO particles is dominated by HTO component. Thermal gravity analysis, X-ray diffraction, X-ray photoelectron spectroscopy as well as the wettability analysis were applied to demonstrate our proposition. The results revealed that HTO is decomposed into inorganic compounds like free carbon by thermal treatment, resulting in a decrease of the wettability of the CTO particles. [Copyright &y& Elsevier]

Cd2SnO4(CTO) thin film was made using RF magnetron sputtering and a single (CTO) target. Among various deposition variables, the effect of changes in plasma power on the electrical and optical properties of the film was investigated. It was observed, as plasma power grows, specific resistivity of the thin film increases while transmittance considerably decreases. It was found that such a phenomenon occurred because of the density of the thin film reduced by increased deposition speed. Another noteworthy result obtained through the X-ray photoelectron spectroscopy analysis is that Sn has metallic bond in the case of the thin film deposited under high power. It seems that existence of such metal was another cause of the reduced transmittance of the thin film. [ABSTRACT FROM PUBLISHER]

This paper assesses the impact of Chief Technology Officers (CTO) on firm performance using upper-echelon theory, human capital theory and social capital theory. The upper-echelon theory is used to investigate how CTO roles are realised within a company regardless of the individual who carries them out, i.e. through a formal CTO position or not. Human and social capital theories are employed to assess how certain features of CTO influences his/her effect on company performance. Thus, this explorative study investigates two questions: (1) do CTO roles affect a firm's performance?, and (2) which features of the senior manager in charge of technology influence performance? To answer these questions the study first develops a conceptual model and subsequently tests the model based on a survey of 49 firms in electronics and machinery industries in Turkey. Two findings emerge: (1) the fulfilment of CTO roles increases a firm's profitability and (2) the existence of a distinct managerial technology position further improves profitability. Moreover, the study clearly shows the role of social capital theory in explaining how the company performance is likely to increase when the CTO/CTO-proxy manager is placed on a higher rung on the organisational ladder. [ABSTRACT FROM AUTHOR]

CTO (Cadmium Stannate) thin films, one of TCOs (Transparent Conducting Oxide) having a potential application for photovoltaic or display product, were prepared by using rf magnetron sputtering system. The lowest resistivity of CTO thin film deposited at room temperature was 6.6 × 10-4 ohm · cm with carrier mobility of 9.1 cm2/Vs and carrier concentration of 10.4 × 1020 cm-3. The average transmittance of CTO thin film was found to be over 80% regardless of deposition condition. The transmittance of the annealed CTO thin film at 600°C in air atmosphere, was found to increase upto more than 90%, but the film resistivity degraded by two order of magnitude due to the decreased carrier concentration with minor increase of carrier mobility. [ABSTRACT FROM AUTHOR]

Actually, the further development of surgical and interventional techniques enables the treatment of complex coronary artery disease of severely ill patients. Due to this development there is a growing spectrumof possible indications for the interventional technique. Since SYNTAX trial, the individual risk stratification and discussion of possible strategies in interdisciplinar meetings is of utmost importance again. Risk stratification should contain patients history, as well as objective findings like extent of coronary artery disease, left ventricular function, pathological stress tests and patients comorbidities. Today, controversial indications up until a short time ago were possible indications for interventional techniques like demonstrated in recent trials and registries. The most discussed controversial indications were interventions at multivessel-disease with drug-eluting stents (DES), left-main stem and chronic total occlusions. [ABSTRACT FROM AUTHOR]

To investigate the long-term outcome of Percutaneous transluminal intervention (PCI) for chronic total occlusion (CTO). The subjects were 606 patients (1,145 lesions) who were treated for CTO between January 1996 and December 2003 at our institution. Among them, 436 patients with early success and confirmed patency at the CTO by follow-up coronary angiography after 6 months were classified as the patent group (Group P), while 170 patients without early success or with occlusion on follow-up angiography were classified as the occluded group (Group O). In April 2006 (mean: 660 ± 602 days), the outcome of CTO was investigated and the major adverse cardiac events (MACE)-free rate was calculated. Multivariate analysis was performed to identify determinants of death. The early success rate was 76.4% before 2003 when Conquest guidewires were not available. However, it subsequently showed significant improvement to 89%. The cumulative survival rate was significantly higher for Group P (92%) than for Group O (64%) and the MACE-free rate (free from, death, bypass surgery, myocardial infarction, and revascularization) showed a similar trend. The cumulative survival rate of patients without myocardial viability in the territory of the vessel with CTO was significantly higher for Group P (88%) than for Group O (55%). The outcome was significantly worse for patients with occlusion of other vessels (90%) than for patients without additional occlusion (42%). It was significantly better when the left ventricular ejection fraction (LVEF) was ≥40% than when the LVEF was ≤40% (90 vs. 68%). Multivariate analysis identified occluded CTO, other vessel occlusion, low ejection fraction (EF), unimproved EF, and old age as determinants of death from CTO. If early success is obtained and patency is maintained, the long-term outcome after PCI for CTO is significantly better than when failure occurs Occluded CTO, other vessel occlusion, low EF, unimproved EF, and old age are important determinants of the outcome. [ABSTRACT FROM AUTHOR]

Abstract: The retrograde approach is an effective therapeutic strategy for chronic total occlusion (CTO) intervention. In CTO cases, the retrograde approach from the opposite coronary artery is not always applicable. In certain left anterior descending (LAD) CTO cases, the distal LAD is filled from the septal channel where it is supplied by the proximal septal route. We report two LAD CTO cases of percutaneous coronary intervention (PCI) conducted with a wire from the proximal septal branch to the distal septal channel using the retrograde approach. [Copyright &y& Elsevier]

The Chief Technology Officer position has been adopted by a wide variety of industries that are seeking to leverage technology within products and services. The position calls for an operational executive who can make important strategic decisions that impact the competitive position of the company. However, little research has been done to define the CTO's responsibilities, methods of evaluating the person's performance, and the skills that he or she should bring to the office. This paper identifies five dominant patterns of the CTO position, labeled the Genius, Administrator, Director, Executive, and Advocate. These patterns are useful in understanding the diversity within the position and in matching a CTO from a specific pattern to a business with unique issues to be addressed. [ABSTRACT FROM PUBLISHER]

Some organizations particularly companies that create new technologies may have a CTO and a CIO. In that case, the CTO is generally responsible for overseeing the technologies that the company creates, and the CIO is responsible for applying information technologies to the organization. The priorities of the position can be somewhat defined by the organizational unit to which they report. The reporting line is between the CIO and the CFO, it can be because the CIO function is viewed as a cost that needs to be managed and controlled. As a result, it is important to a CIO to have people in the IT organization who are both competent and comfortable to express their opinion about what should be done [ABSTRACT FROM PUBLISHER]

Abstract: A simple model of the microstructure of a sensor as a network of three resistors, representing the surface, the bulk and the particle boundary, is combined with a simple model of sensor response in order to understand the effects of sintering temperature on response of a ceramic gas-sensitive resistor. This description accurately fitted the response of chromium titanium oxide to carbon monoxide over a range of four orders of magnitude in gas concentration. The parameters representing the microstructure are found to vary with sintering temperature according to predictions made from microscopy of the structures. The parameter representing chemistry also varied with sintering temperature: understandable because titanium segregation, which is the major determinant of the charge carrier distribution, varies with sintering temperature. [Copyright &y& Elsevier]

The low temperature sol-gel synthesis of chromium titanate (CTO) is reported. Crystalline CTO powders have been obtained at temperature as low as 400 °C. CTO thin films deposited by LPD on alumina substrates were tested regarding their humidity sensing properties. They were found sensitive to water vapor at room temperature showing fast response time. The humidity sensing mechanism on these thin films has been investigated and discussed on the basis of the film porosity and water–CTO surface interaction. [Copyright &y& Elsevier]

: ObjectivesWe sought to investigate the success rate and the acute and 12-month clinical outcome of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in the contemporary era.: BackgroundThe technique of PCI involving CTO has improved over time. However, limited data on acute and follow-up results in patients treated with PCI on CTO in recent years are available.: MethodsFour hundred nineteen consecutive patients scheduled for PCI of CTO of ≥30 days of duration were enrolled in 29 centers; 390 CTOs were confirmed in 376 patients in an independent core laboratory. The end points were technical and procedural success, in-hospital and 12-month major adverse cardiac events (MACE) occurrence, and 12-month symptomatic status.: ResultsTechnical and procedural success was obtained in 77.2% and 73.3% of lesions, respectively. In-hospital major adverse cardiac events occurred in 5.1% of patients. Multivariate analysis identified CTO length >15 mm or not measurable, moderate to severe calcifications, duration ≥180 days, and multivessel disease as significant predictors of PCI failure. At 12 months, patients with a successful procedure experienced a lower incidence of cardiac deaths or myocardial infarction (1.05% vs. 7.23%, p = 0.005), a reduced need for coronary artery bypass surgery (2.45% vs. 15.7%, p < 0.0001), and were more frequently free of angina (88.7% vs. 75.0%, p = 0.008) compared with patients who had an unsuccessful procedure.: ConclusionsSuccessful PCI was achieved in a high percentage of CTOs with a low incidence of complications. At one-year follow-up, patients with successful PCI of a CTO had a significantly better clinical outcome than those whose PCI was unsuccessful. [Copyright &y& Elsevier]

: ObjectivesWe sought to evaluate the safety and efficacy of percutaneous transmyocardial revascularization (PTMR) in patients with refractory angina caused by one or more chronic total occlusions (CTOs) of a native coronary artery.: BackgroundPrevious unblinded, randomized trials of PTMR in patients with end-stage coronary artery disease and refractory angina have demonstrated significant relief of angina and increased exercise duration. Whether such benefits would be realized in blinded patients with less extensive coronary artery disease is unknown.: MethodsA total of 141 consecutive patients with class III or IV angina caused by one or more chronically occluded native coronary arteries in which a percutaneous coronary intervention (PCI) had failed were prospectively randomized, at 17 medical centers, in the same procedure, to PTMR plus maximal medical therapy (MMT) (n = 71) or MMT only (n = 70). Blinding was achieved through heavy sedation, dark goggles and the concurrent performance of PCI in all patients.: ResultsBaseline characteristics were similar between the two groups. A median number of 20 laser channels were created in patients randomized to PTMR. At six months, the anginal class improved by two or more classes in 49% of patients assigned to PTMR and in 37% of those assigned to MMT (p = 0.33). The median increase in exercise duration from baseline to six months was 64 s with PTMR versus 52 s with MMT (p = 0.73). There were no differences in the six-month rates of death (8.6% vs. 8.8%), myocardial infarction (4.3% vs. 2.9%) or any revascularization (4.3% vs. 5.9%) in the PTMR and MMT groups, respectively (p = NS for all).: ConclusionsIn patients with class III or IV angina caused by nonrecanalizable CTOs, the performance of PTMR does not result in a greater reduction in angina, improvement in exercise duration or survival free of adverse cardiac events, as compared with MMT only. [Copyright &y& Elsevier]

Background: Percutaneous coronary interventions (PCI) with intravascular ultrasound (IVUS) guidance have been associated with better long-term outcomes, but adoption remains limited. There are limited data on the impact of IVUS on chronic total occlusion (CTO)-PCI., Objectives: To examine the impact of IVUS guidance on the outcomes of CTO-PCI., Methods: We performed a systematic review and study-level meta-analysis of IVUS vs angiography-guided CTO-PCI. Electronic databases were systematically searched for all pertinent studies from inception through January 2021. Randomized controlled trials (RCT), registry data, and abstracts published in peer-reviewed indexed journals were included. We examined the following in-hospital and long-term outcomes: major adverse cardiac events; all-cause mortality; cardiovascular mortality; myocardial infarction (MI); target-vessel revascularization (TVR); target-lesion revascularization (TLR); and stent thrombosis (ST). We also evaluated the following procedural metrics: procedure time; fluoroscopy time; contrast volume; total stent length; and total number of stents. Random-effects models were used to pool individual study results., Results: Four (2 observational, 2 randomized) studies including 1975 patients (IVUS-guided PCI, 861 patients; angiography-guided PCI, 1114 patients) were included in the analysis. IVUS-guided CTO-PCI had similar all-cause mortality, major adverse cardiac events, cardiovascular mortality, MI, TVR, and TLR compared with angiography-guided CTO-PCI, but lower risk of stent thrombosis (odds ratio, 0.24; 95% confidence interval, 0.08-0.76; P=.02; I²=0%), shorter procedure time (P<.001; I²=88%), shorter fluoroscopy time (P<.001; I²=63%), and less contrast volume use (P<.001; I²=59%). Total stent length (P<.001; I²=39%) and total number of stents (P<.001; I²=72%) were lower with IVUS-guided CTO-PCI., Conclusion: IVUS-guided CTO-PCI is associated with lower risk of ST.

Background: Coronary vascular function of a chronic coronary total occlusion (CTO) immediately after recanalization is known to be poor and to be partially improved by pre-treatment with loading dose of ticagrelor vs. clopidogrel. It is unknown if this vascular dysfunction is maintained at long-term follow-up and may be improved by 1-year dual antiplatelet therapy (DAPT)., Methods: The TIGER is a prospective, open-label, two parallel-group controlled clinical trial, which 1:1 randomized 50 CTO patients to pre-PCI loading dose and subsequent 1-year DAPT with ticagrelor vs. clopidogrel. Coronary blood flow (CBF) under stepwise adenosine infusion was assessed after drug loading dose and at follow-up and compared between the two drug groups, adjusting for time of follow-up., Results: Out of 50 patients with index CBF evaluation, 38 (76%) patients underwent angiographic follow-up (23 and 15 at 1 and 3-year, respectively) and Doppler data was available in 35 (70%). A high CBF area under the curve (AUC), already observed after loading dose in ticagrelor vs. clopidogrel group (p = 0.027), was maintained at follow-up (AUC 34815.22 ± 24,206.06 vs. AUC 22712.47 ± 13,768.95; p = 0.071). Specifically, whereas high ticagrelor loading dose-related CBF was sustained at follow-up (p = 0.933), clopidogrel loading dose-related CBF increased at follow-up (p = 0.039)., Conclusion: The TIGER trial showed that DAPT with ticagrelor maintained a non-significantly higher CBF in a recanalized CTO as compared to clopidogrel, whose treated patients exhibit a lower CBF immediately after PCI with a significant increase at follow-up. The clinical value of such sustained high coronary flow should be evaluated in a larger group of patients., Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02211066 (ClinicalTrials.gov number NCT02211066)., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)