Background Long-term outcome in patients with chronic total occlusions (CTO) depends on the target vessel and proximity of the lesion.Aims To investigate of the target vessel was associated with procedural efficacy and safety in patients with proximal CTO lesions.Methods Patients treated for a CTO lesion in the European CTO registry (ERCTO) between January 1, 2021, and December 31, 2023, were included in the study. Patients were categorized based on the treated vessel and the proximity of the lesion. The outcome was compared between proximal lesions in the three native vessels. The co-primary endpoints were procedural success and 30-day safety. Procedural success was defined as technical success without in-hospital major adverse cardiac events.Results A total of 14,744 patients were screened, and 7128 were included in the analysis of proximal CTO PCI. Technical success rates proximal in the three native vessel territories were 91.0% (left anterior descending [LAD]), 92.1% (left circumflex [LCX]), and 88.5% (right coronary artery [RCA]). In the adjusted analysis, the probability of procedural success was higher for LCX compared to RCA, but not for the LAD (OR (95% CI): LCX: 1.35, (1.05-1.75); LAD: 1.06 [0.86-1.31]). The adjusted 30-day safety was better in the LAD, but not LCX, compared with RCA (LAD: OR 0.69, 95% CI: 0.50; 0.94, LCX: OR 0.77, 95% CI 0.54; 1.09).Conclusions Modern CTO PCI for proximal lesions generally yields a very high success rate. The procedure tends to be more successful in the LAD and LCX territories compared to the RCA, with LAD lesion treatment being the safest option.
Die Schockraumversorgung von schwer verletzen und polytraumatisierten Patienten hat sich als Modell auch für die Behandlung nichttraumatologischer akut-vital bedrohter Patienten etabliert. Für die Behandlung von Traumapatienten wird deshalb spezifisch der Begriff Traumateam verwendet. In diesem Beitrag werden die evidenzbasierten Anforderungen an den Traumaschockraum dargestellt. Im Weiteren werden die Grundlagen und Gründe erörtert, weshalb ein Traumateam das Outcome verbessert. Die Zusammensetzung eines Traumateams hängt partiell von den organisatorischen Regelungen der einzelnen Krankenhäuser, aber auch von deren Versorgungsstufe ab. Dies ist für die Zertifizierung als Traumazentrum von Relevanz. Die Kriterien für die Traumateamaktivierung sind ein entscheidendes Kriterium für die Qualität der Versorgung und für einen Ressourcen-schonenden Einsatz. Zur Qualitätskontrolle und Reduzierung von Über- und Untertriage wird dargestellt, anhand welcher Parameter beurteilt werden kann, wann eine Traumateamaktivierung angemessen war.
This study examines long-term auditory, psychological, social and educational outcomes in adults who received a cochlear implant (CI) in early childhood. It aims to identify predictors of quality of life (QoL) in adulthood, with particular emphasis on the impact of prolonged CI use. Thirty-one adults (mean age 25 ± 4.6 years) who had received a unilateral or bilateral CI before the age of 10 (mean implantation age 3.37 ± 2.31 years) participated in this cross-sectional study. Auditory performance was evaluated using pure-tone audiometry (PTA-4), Freiburg speech test (ESV 65 dB SPL, mEV), and the Oldenburg sentence test (OLSA) in background noise. Psychological assessment included disease-specific and general QoL (NCIQ, WHOQoL-Bref), depression (DESC-I), resilience (RS-13), self-esteem (MSWS), and personality traits (NEO-FFI-30). The average period of CI use was 21.6 ± 3.6 years. Average PTA-4 was 25.79 dB, and mean mEV was 73.33
BackgroundOptimal mesh selection in complex abdominal wall reconstruction remains controversial, particularly in contaminated fields or in patients with extensive tissue loss. Reinforced tissue matrix (RTM) meshes combine biologic material with permanent synthetic reinforcement and may represent a potential option in selected cases. This study aimed to analyze clinical use patterns of RTM meshes and identify potential indication niches through structured expert consensus.MethodsA multicenter expert panel collected cases of abdominal wall reconstruction using RTM mesh (OviTex). Patient characteristics, hernia features, operative strategies, and postoperative outcomes were recorded in a standardized database. Cases were evaluated according to established complexity criteria. Seven abdominal wall surgeons independently rated the appropriateness of RTM use. Consensus was defined as ≥70% agreement, and interrater reliability was assessed using Fleiss’ kappa.ResultsSeventy-four patients were included (mean age 63.9 ± 12.0 years; median BMI 30.2 kg/m2). Most patients presented with incisional hernias and large fascial defects. Contaminated or potentially contaminated operative fields were present in approximately one-third of cases. Surgical site infection occurred in 20.3%, mesh infection in 7.8%, and hernia recurrence in 12.3%. Expert consensus supporting RTM implantation was reached in 50% of cases, particularly in scenarios combining contamination with large fascial defects. Interrater agreement was fair (κ = 0.34).ConclusionRoutine use of RTM meshes in abdominal wall reconstruction is not supported. However, RTM may represent a potential option in selected high-complexity scenarios involving contamination and large fascial defects where permanent synthetic meshes may be unsuitable. These findings are exploratory and hypothesis-generating and may support future Delphi-based indication consensus development.
