Publications

Coronary arterial findings after accidental death immediately after successful percutaneous transluminal coronary angioplasty

No abstract is provided for this article.

Three-Dimensional Intravascular Ultrasound Assessment of Noninjured Edges of β-Irradiated Coronary Segments

The "edge effect," late lumen loss at the margins of the treated segment, has become an important issue in the field of coronary brachytherapy. The aim of the present study was to assess the edge effect in noninjured margins adjacent to the irradiated segments after catheter-based intracoronary beta-irradiation.Fifty-three vessels were assessed by means of 3-dimensional intravascular ultrasound after the procedure and at 6- to 8-month follow-up. Fourteen vessels (placebo group) did not receive radiation (sham source), whereas 39 vessels were irradiated. In the irradiated group, 48 edges (5 mm in length) were identified as noninjured, whereas 18 noninjured edges were selected in the placebo group. We compared the volumetric intravascular ultrasound measurements of the noninjured edges of the irradiated vessels with the fully irradiated nonstented segments (IRS, n=27) (26-mm segments received the prescribed 100% isodose) and the noninjured edges of the vessels of the placebo patients. The lumen decreased (6 mm(3)) in the noninjured edges of the irradiated vessels at follow-up (P:=0. 001). We observed a similar increase in plaque volume in all segments: noninjured edges of the irradiated group (19.6%), noninjured edges of the placebo group (21.5%), and IRS (21.0%). The total vessel volume increased in the IRS in the 3 groups. No edge segment was subject to repeat revascularization.The edge effect occurs in the noninjured margins of radiation source train in both irradiated and placebo patients. Thus, low-dose radiation may not play an important role in this phenomenon, whereas nonmeasurable device injury may be considered a plausible alternative explanation.

TCTAP A-070 Non-Invasive Assessment of Microvascular Dysfunction After Optimal Coronary Artery Stent Deployment; Insight From Acetyl Salicylic Elimination Trial (Aset) Japan

No abstract is provided for this article.

Tumour Necrosis Factor α Causes Retention of Activated Glucocorticoid Receptor within the Cytoplasm of A549 Cells

TCT-314 Inpatient Versus Outpatient PCI in Patients With Left Main Disease: Analysis From the EXCEL Trial

No abstract is provided for this article.

A randomised comparison of an everolimus-eluting coronary stent with a paclitaxel-eluting coronary stent:the SPIRIT II trial.

Everolimus has been successfully tested in humans using both an erodable and a durable polymer in small previous studies.This single blind multi-centre non-inferiority randomised (3:1) controlled trial evaluated the safety and performance of the XIENCE V Everolimus Eluting Coronary Stent System (XIENCE V EECSS) versus the TAXUS Paclitaxel Eluting Coronary Stent System (TAXUS(R) PECSS) in the treatment of patients with a maximum of two de novo native coronary artery lesions located in two different epicardial vessels. Three hundred patients with evidence of myocardial ischaemia were allocated to stent implantation with an everolimus-eluting stent (n=223) or a paclitaxel-eluting stent (n=77). Suitable lesions had a diameter stenosis of <50-99%, a length of <28 mm, and a reference vessel diameter between 2.5 mm and 4.25 mm. The primary endpoint was in-stent late loss (LL) at 180 days. Percentage in-stent volume obstruction (%VO) was measured by intravascular ultrasound (IVUS) in a subset of 152 patients. Clinical secondary endpoints included ischaemia driven major adverse cardiac events (ID-MACE) at 180 days.At 6 months, the in-stent LL was 0.11+/-0.27 mm in the everolimus-eluting stent arm, as compared to 0.36+/-0.39 mm in the paclitaxel-eluting stent arm (p<0.0001). Percentage VO in the everolimus-eluting stent arm was 2.5+/-4.7% versus 7.4+/-7.0% in the paclitaxel-eluting stent arm (p<0.0001). Hierarchical MACE was 2.7% (6/222) in the everolimus-eluting stent arm vs. 6.5% (5/77) in the paclitaxel-eluting stent arm.This non-inferiority randomised trial not only met its primary endpoint, but also demonstrated the superiority of the everolimus-eluting stent over the paclitaxel-eluting stent in terms of in-stent late loss.

Shear resistance of elliptical hollow sections

Bradykinin–evoked sensitization of airway sensory nerves: A mechanism for ACE–inhibitor cough

Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent

The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging.Serial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported.In the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT).Luminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference -0.37 mm [95% confidence interval: -0.50 to -0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm2 vs. 7.15 ± 2.16 mm2, mean difference -1.04 mm2 [95% confidence interval: -1.66 to -0.42 mm2]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm2 vs. 1.86 ± 0.64 mm2, mean difference 0.24 mm2 [95% confidence interval: 0.06 to 0.43 mm2]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention.In this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284).

Murray law-based quantitative flow ratio for assessment of left main bifurcation derived from a single fluoroscopic angiographic view as compared to FFRCT

Background In patients with complex CAD, the presence of left main (LM) disease is an important prognostic factor in assessing the risk balance between PCI and CABG. Functional assessment has become standard of care to evaluate the significance of coronary stenosis and to justify the performance of PCI in the contemporary practice. FFRCT is a well-established method based on 3D reconstruction of coronary artery derived from CCTA. The Murray law-based quantitative flow reserve (μQFR) is a novel computational method of invasive angiography relying on a single angiographic view that takes into account side branches diameters to compute fractal flow division. The aim of the current analysis is to evaluate in patients with complex CAD the feasibility of μQFR in LM bifurcation and its diagnostic concordance with FFRCT. The impact of the optimal viewing angle defined by CCTA on the physiological assessment of the LM bifurcation using a single angiographic view was also evaluated. Methods In 299 consecutive patients with 3-vessel disease with or without LM coronary artery disease, up to 3 analyzable fluoroscopic projections per patient were analysed with μQFR retrospectively. FFRCT and μQFR were measured at 3 fiducial landmark points: i) point of LM bifurcation (POB); ii) proximal LAD 10 mm distal to POB; ii) proximal LCX 10 mm distal to POB. CCTA-based “optimal viewing angle” of LM bifurcation are computed by creating a 3-point closed spline involving the LM, LAD, and LCX at 5mm from the POB and subsequently by reconstructing the “en face” fluoroscopic viewing angle of the spline. The en face viewing angle provides an optimal assessment of the bifurcation geometry [1]. In terms of Rx gantry angulation, the closest angiographic projection to the optimal viewing angle derived from CCTA was defined as the “best fluoroscopic projection” for each patient. Results In 299 patients, 793 projections were analysed with μQFR and compared to FFRCT. Single view μQFR was analyzable in 100%. Correlation and agreement between μQFR and FFRCT for 793 projections in 299 patients are shown in Figure 1A, 2A. The Spearman's correlation coefficient showed moderate correlations at POB (r=0.481, p&amp;lt;0.001) and LCX (r=0.584, p&amp;lt;0.001), and strong correlation at LAD (r=0.642, p&amp;lt;0.001). Correlation and agreement between μQFR and FFRCT for best projections from each patient are shown in Figure 1B, 2B. Correlations were improved in the best projections with the following Spearman's correlation coefficient: at POB (r=0.522, p&amp;lt;0.001), LCX (r=0.622, p&amp;lt;0.001), and LAD (r=0.695, p&amp;lt;0.001). Conclusion Computation of μQFR from a single angiographic view has a high feasibility. Tailored optimal fluoroscopic view is essential for the physiological assessment of the LM bifurcation using a single angiographic view. Evaluation of diagnostic accuracy of μQFR warrants further analysis of the LMCAD after prospective planning of the optimal fluoroscopic view based on the selection of the best CCTA 3D view. Funding Acknowledgement Type of funding sources: None.

The great iFR vs. FFR debate: why sometimes “the wait and see approach” is the best tactic as the best pragmatic solution will always emerge and become established

No abstract is provided for this article.

Effects of bronchodilator particle size in asthmatic patients using monodisperse aerosols

Aerosol particle size influences airway drug deposition. Current inhaler devices are inefficient, delivering a heterodisperse distribution of drug particle sizes where, at best, 20% reaches the lungs. Monodisperse aerosols are the appropriate research tools to investigate basic aerosol science concepts within the human airways. We hypothesized that engineering such aerosols of albuterol would identify the ideal bronchodilator particle size, thereby optimizing inhaled therapeutic drug delivery. Eighteen stable mildly to moderately asthmatic patients [mean forced expiratory volume in 1 s (FEV 1 ) 74.3% of predicted] participated in a randomized, double-blind, crossover study design. A spinning-top aerosol generator was used to produce monodisperse albuterol aerosols that were 1.5, 3, and 6 μm in size, and also a placebo, which were inhaled at cumulative doses of 10, 20, 40, and 100 μg. Lung function changes and tolerability effects were determined. The larger particles, 6 and 3 μm, were significantly more potent bronchodilators than the 1.5-μm and placebo aerosols for FEV 1 and for the forced expiratory flow between exhalation of 25 and 75% of forced vital capacity. A 20-μg dose of the 6- and 3-μm aerosols produced FEV 1 bronchodilation comparable to that produced by 200 μg from a metered-dose inhaler. No adverse effects were observed in heart rate and plasma potassium. The data suggest that in mildly to moderately asthmatic patients there is more than one optimal β 2 -agonist bronchodilator particle size and that these are larger particles in the higher part of the respirable range. Aerosols delivered in monodisperse form can enable large reductions of the inhaled dose without loss of clinical efficacy.

TCT-242 Prospective Validation of the ARC-HBR, PRECISE-DAPT, and PARIS Risk Prediction Model in the All-Comer PIONEER IV Trial

No abstract is provided for this article.

Quantitative Digital Angiographic Techniques

No abstract is provided for this article.

Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions

Objectives To compare visual estimation with different quantitative coronary angiography (QCA) methods (single‐vessel versus bifurcation software) to assess coronary bifurcation lesions. Background QCA has been developed to overcome the limitations of visual estimation. Conventional QCA however, developed in “straight vessels,” has proved to be inaccurate in bifurcation lesions. Therefore, bifurcation QCA was developed. However, the impact of these different modalities on bifurcation lesion severity classification is yet unknown Methods From a randomized controlled trial investigating a novel bifurcation stent (Clinicaltrials.gov NCT01258972), patients with baseline assessment of lesion severity by means of visual estimation, single‐vessel QCA, 2D bifurcation QCA and 3D bifurcation QCA were included. We included 113 bifurcations lesions in which all 5 modalities were assessed. The primary end‐point was to evaluate how the different modalities affected the classification of bifurcation lesion severity and extent of disease. Results On visual estimation, 100% of lesions had side‐branch diameter stenosis (%DS) &gt;50%, whereas in 83% with single‐vessel QCA, 27% with 2D bifurcation QCA and 26% with 3D bifurcation QCA a side‐branch %DS &gt;50% was found ( P &lt; 0.0001). With regard to the percentage of “true” bifurcation lesions, there was a significant difference between visual estimate (100%), single‐vessel QCA (75%) and bifurcation QCA (17% with 2D bifurcation software and 13% with 3D bifurcation software, P &lt; 0.0001). Conclusions Our study showed that bifurcation lesion complexity was significantly affected when more advanced bifurcation QCA software were used. “True” bifurcation lesion rate was 100% on visual estimation, but as low as 13% when analyzed with dedicated bifurcation QCA software.

Performance of concrete-filled stainless steel tubular (CFSST) columns after exposure to fire

Fly Ash and Silica in Expanded Polystyrene Concrete: Finding the Research Gap

Gender, Task Scenarios and Children's Computer‐based Problem Solving

Abstract Gender differences in response to computers have been widely reported. This paper addresses the question of how far superficial aspects of the software in use can affect the performance of girls and boys on computer‐based problem‐solving tasks. A first study compared girls’ and boys’ performance on two versions of a route‐planning task which differed in terms of the scenario within which the task was framed. The participants were 52 11‐ and 12‐year‐olds. There was a significant gender by software interaction, the girls’ performance being markedly influenced by which version of the software they encountered. Following refinement of the software to tighten the comparison still further, a replication study was conducted with another 48 children of similar age, and the same result was obtained. The findings suggest that gender differences in children's responses to computers are relatively labile and highly context sensitive. Implications and possible explanations for these findings are discussed.