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A 68-year old lady present with left ventricular free wall rupture and cardiac arrest post-myocardial infarction. This article illustrates a strategy combining pericardiocentesis with autologous transfusion together with VA-ECMO as a bridge to definitive surgical repair.

Aim The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A 1c (HbA 1c ) target, but there is no consensus on the optimal HbA 1c level. The study aimed at examining the association between HbA 1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. Methods A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010–2011. The cumulative mean HbA 1c over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA 1c and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities. Results For patients with a DM duration of 1c and risk of CVD was identified, suggesting that there was no threshold HbA 1c level for CVD risk. For other diabetic patients, an HbA 1c level of 6.8–7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA 1c . The risk of CVD increased in patients with HbA 1c Conclusion Among Chinese primary care patients at the early ( 1c targets ( 1c levels may not necessarily better and can potentially be harmful.

Objectives The aim of this study was to evaluate 1-year clinical safety and efficacy of the dual-therapy COMBO stent in a large, all-comers patient-level pooled cohort. Background The COMBO stent (OrbusNeich Medical, Fort Lauderdale, Florida) is a novel stent with abluminal sirolimus elution from a biodegradable polymer and a luminal pro-healing anti-CD34+ antibody layer, which attracts circulating endothelial progenitor cells. These endothelial progenitor cells can quickly mature into normal endothelium, providing rapid endothelialization. Methods The MASCOT (Multinational Abluminal Sirolimus Coated biO-engineered stenT) (N = 2,614, 61 global sites) and REMEDEE (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimus coatED bio-Engineered StEnt Post Market Registry) (N = 1,000, 9 European sites) registries are 2 prospective, multicenter studies evaluating clinical outcomes after attempted COMBO stent placement in all-comer patients undergoing percutaneous coronary intervention. In this patient-level pooled analysis we analyzed 1-year target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Furthermore, we determined predictors of 1-year TLF. Results A total of 3,614 patients (63.5 ± 11.2 years of age; 23.8% women) were included in this analysis. The prevalence of diabetes mellitus was 29.3%, and 54.3% patients presented with acute coronary syndrome. The primary endpoint of 1-year TLF occurred in 140 (3.9%) patients, with incidence of cardiac death in 1.6%, target vessel myocardial infarction in 1.2%, clinically driven target lesion revascularization in 2.2%, and definite stent thrombosis in 0.5% patients. Insulin-treated diabetes mellitus, chronic renal failure, and American College of Cardiology/American Heart Association lesion type B2/C were independent predictors of 1-year TLF. Conclusions In this large patient-level pooled analysis of patients treated with the dual-therapy COMBO stent excellent results at 1-year were observed. (MASCOT - Post Marketing Registry [MASCOT]; NCT02183454; Prospective Registry to Assess the Long-term Safety and Performance of the COMBO Stent [REMEDEE Reg]; NCT01874002)

Aims To examine the association of patient volume with quality of diabetes care in the primary care setting. Methods We analyzed population-based data from Hospital Authority administrative database using a Hong Kong representative sample of 187,031 diabetic patients managed in 74 primary care general outpatient clinics between 04/2011 and 03/2012. We assessed the associations between annual clinic-based patient volume and quality of care in terms of adherence to care criteria of process (HbA1c test, renal function test, full lipid profile, urine protein analysis, diabetic retinopathy screening, and appropriate drug prescription) and clinical outcomes (HbA1c ⩽ 7%, BP ⩽ 130/80 mmHg, LDL-C ⩽ 2.6 mmol/L) of care criteria, with and without adjustment for patient and clinic characteristics. Results Patient volume was associated with three of seven process of care criteria; however, when compared to clinics in higher volume quartiles, those in lowest-volume quartile had more odds of HbA1c test (odds ratios (OR): 0.781, 0.655 and 0.646 for quartile from 2 to 4, respectively), renal function test (OR: 0.357, 0.367 and 0.590 for quartile from 2 to 4, respectively), and full lipid profile test (OR: 0.508, 0.612 and 0.793 for quartile from 2 to 4, respectively). There was no significant association between patient volume and the standards of achieving of HbA1c, BP and LDL-C outcome targets. Conclusions Disparities in volume and quality of diabetes care were observed in public primary care setting. Lower patient volumes at clinic level were associated with greater adherence to three process criteria but a volume–outcome association was not present.

Aims This epidemiological and longitudinal study aimed to confirm the association between BMI and CVD and determine the optimal BMI range for Chinese patients with T2DM. Method A retrospective cohort study was conducted on 113,194 Chinese adult primary care T2DM patients without prior CVD history at baseline, and had a documented BMI in 2008–2010. Using the average of the annual mean of BMI records (updated BMI) over a median follow-up of 4.2years, the risk of CVD associated with BMI by gender, age group, smoking status and presence of chronic kidney disease group was evaluated using multivariable Cox proportional hazard regression adjusted by socio-demographics and clinical characteristics. Results The updated BMI value and the incidence of CVD showed a J-shaped curvilinear relationship. Low ( 2 ) or high (≥25kg/m 2 ) BMI range was associated with higher risk of CVD and the optimal BMI range associated with the lowest likelihood of CVD was 20–22.9kg/m 2 in overall cohort and all selected groups. Conclusions There was no evidence of benefit of underweight or adiposity with regard to the risk of CVD and thus the maintenance of a normal weight should be emphasized as an integral part of preventive intervention in the diabetes management.

The cloud-point pressures and critical polymer concentration are measured for poly(ethylene-co-hexene-1)+propane solutions up to 180°C and 500 bar using a light-scattering probe. The measured cloud-point data agree with those calculated from SAFT1.