Publications

Tissue coverage and neointimal hyperplasia in overlap versus nonoverlap segments of drug-eluting stents 9 to 13 months after implantation: In vivo assessment with optical coherence tomography

Background Histologic experimental studies have reported incomplete neointimal healing in overlapping with respect to nonoverlapping segments in drug-eluting stents (DESs), but these observations have not been confirmed in human coronary arteries hitherto. On the contrary, angiographic and optical coherence tomography studies suggest that DES overlap elicits rather an exaggerated than an incomplete neointimal reaction. Methods Optical coherence tomography studies from 2 randomized trials including sirolimus-eluting, biolimus-eluting, everolimus-eluting, and zotarolimus-eluting stents were analyzed at 9- to 13-month follow-up. Coverage in overlapping segments was compared versus the corresponding nonoverlapping segments of the same stents, using statistical pooled analysis. Results Forty-two overlaps were found in 31 patients: 11 in sirolimus-eluting stents, 3 in biolimus-eluting stents, 17 in everolimus-eluting stents, and 11 in zotarolimus-eluting stents. The risk ratio of incomplete coverage was 2.35 (95% CI 1.86-2.98) in overlapping versus nonoverlapping segments. Thickness of coverage in overlaps was only 85% (95% CI 81%-90%) of the thickness in nonoverlaps. Significant heterogeneity of the effect was observed, especially pronounced in the comparison of thickness of coverage (I 2 = 90.31). Conclusions The effect of overlapping DES on neointimal inhibition is markedly heterogeneous: on average, DES overlap is associated with more incomplete and thinner coverage, but in some cases, the overlap elicits an exaggerated neointimal reaction, thicker than in the corresponding nonoverlapping segments. These results might help to understand why overlapping DES is associated with worse clinical outcomes, both in terms of thrombotic phenomena and in terms of restenosis and revascularization.

Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force

Deformation-based design of aluminium alloy beams

Determining the Relative Evolutionary Stages of Very Young Massive Star Formation Regions

We have recently completed an observing program with the Australia Telescope Compact Array towards massive star formation regions traced by 6.7 GHz methanol maser emission. We found the molecular cores could be separated into groups based on their association with/without methanol maser and 24 GHz continuum emission. Analysis of the molecular and ionised gas properties suggested the cores within the groups may be at different evolutionary stages. In this contribution we derive the column densities and temperatures of the cores from the NH3 emission and investigate if this can be used as an indicator of the relative evolutionary stages of cores in the sample. The majority of cores are well fit using single-temperature large velocity gradient models, and exhibit a range of temperatures from ~10 K to >200 K. Under the simple but reasonable assumption that molecular gas in the cores will heat up and become less quiescent with age due to feedback from the powering source(s), the molecular gas kinetic temperature combined with information of the core kinematics seems a promising probe of relative core age in the earliest evolutionary stages of massive star formation.

Interim prediction of two-year all-cause mortality in patients with de novo multivessel coronary artery disease undergoing intended multivessel PCI

Background/Introduction coronary revascularization in patients with de novo three-vessel coronary artery disease (3VD) without Left Main disease can be performed by either PCI or CABG after objective Heart Team consensus. In the ongoing Multivessel TALENT trial (NCT04390672)1, the intended multivessel PCI is performed using DES with ultrathin struts and biodegradable polymers under the guidance of quantitative flow ratio (QFR) and intracoronary imaging with IVUS or OCT. Purpose The Logistic Clinical SYNTAX score (logSYNTAX) to predict 2-year all-cause mortality after PCI was developed in 15,883 patients treated in the GLOBAL LEADERS trial and externally validated in 10,100 patients. This study aims to predict 2-year all-cause mortality after intended multivessel PCI in the currently enrolled trial population to identify patients who should be considered high risk. Methods and results We performed an interim analysis in the first consecutive 781 patients of the ongoing Multivessel TALENT Trial aimed to enrol 1550 patients. Thirteen clinical predictors are used in the logSYNTAX score: SYNTAX I-score, presence of 3VD and/or LM disease, age, creatinine clearance in mL/min, LVEF, BMI, serum hemoglobin level(g/dL), the White Blood Cell Count (WBC, in 109 cells/L) and the presence of COPD, PVD, diabetes mellitus, current smoking and/or a history of stroke. LVEF and BMI have additional squared terms to adjust for non-linear associations with all-cause mortality. The predicted mortality was estimated using the survival function developed in the GLOBAL LEADERS trial. We considered patients high-risk if the estimated risk was above the 3rd quartile. In 563 patients, all thirteen predictors necessary for 2-year mortality prediction were available. Median 2-year all-cause mortality of 1.9% (1.09-3.82; IQR2.73). 142 patients (25%) with an increased estimated 2-year mortality risk (>3.8%) due to higher prevalence of the aforementioned predictors; higher median age [75 (9.0) vs. 67 (12.0), p <0.001], a lower median LVEF [55% (20) vs. 94% (35.5), p <0.001] and a higher median SYNTAX score [26.0 (13.5) vs. 20.0(11.0), p <0.001]. A complete overview of predictors can be found in table 1. High age, an impaired LVEF, and an increased anatomical SYNTAX-I score were the main contributors to high mortality in this study cohort (see figure 1). Conclusion(s) In 563 patients, the median predicted 2-year all-cause mortality was 1.9%. Nevertheless, a non-neglectable amount of patients were estimated to be at increased risk for all-cause 2-year mortality. Accurate prediction by knowledge of aforementioned predictors is pivotal for appropriate mortality risk prediction to segregate high-risk patients with 3VD for individual decision-making on coronary revascularization, even if surgical revascularization is no option, and guide optimal treatment with use of intravascular imaging to achieve an optimal PCI result.Table 1Figure 1

IMPACT OF FINAL MINIMAL STENT AREA BY IVUS ON 3-YEAR OUTCOME AFTER PCI OF LEFT MAIN CORONARY ARTERY DISEASE: THE EXCEL TRIAL

No abstract is provided for this article.

Microstructure, mechanical properties and cross-sectional behaviour of additively manufactured stainless steel cylindrical shells

New drugs for asthma

Two years clinical outcomes with the state‐of‐the‐art PCI for the treatment of bifurcation lesions: A sub‐analysis of the SYNTAX II study

Background Bifurcation PCI is associated with a lower rate of procedural success, especially in multivessel disease patients. We aimed to determine the impact of bifurcation treatment on 2‐years clinical outcomes when a state‐of‐the‐art PCI strategy (heart team decision‐making using the SYNTAX score II, physiology guided coronary stenosis assessment, thin strut bioresorbable polymer drug‐eluting stent, and intravascular ultrasound guidance) is followed. Methods Three‐vessel disease patients enrolled in the SYNTAX II trial ( n = 454) were categorized in patients with (a) ≥1 treated bifurcation ( n = 126), and (b) without bifurcation ( n = 281). The primary endpoint was the occurrence of major adverse cardio and cerebrovascular events (MACCE—a composite of all‐cause death, stroke, any myocardial infarction, or any revascularization) at 2 years. Secondary endpoints were the occurrence of target lesion failure (TLF) defined as cardiac death, target‐vessel myocardial infarction and ischemia‐driven target lesion revascularization, and the individual components of the composite primary endpoint, as well as stent thrombosis. Results A total of 145 bifurcation were treated in 126 patients. At 2 years, MACCE occurred in 75/407 patients (20.7% for bifurcation versus 17.5% for nonbifurcation, hazard ratio [HR] of 1.28, CI95% 0.78–2.08, p = .32). TLF presented a trend toward higher occurrence in bifurcation (16.8% vs. 10.8%, HR 1.75, CI95% 0.99–3.09, p = .053). Definite stent thrombosis did not differ at 2‐year between groups (0.8% for the bifurcation vs. 0.7% for the nonbifurcation, p = .92). Conclusion Bifurcation treatment in patients with three‐vessel disease undergoing state‐of‐the‐art PCI had similar event rate of MACCE but was associated with a trend toward higher incidence of TLF compared with nonbifurcation lesions.

Friday 24 March 2017

For the last 40 years the use of Computed Tomography "CT" in Medical Imaging has been increasing dramatically.Yearly CT scans done in US have risen from less than 3 million in 1980 to currently being more than 80 million a year. 1 Last year in Australia, Medicare has paid for 3 million CT examinations 2 that does not include Hospital inpatients, private insurance and workers compensation and Motor vehicle accident patients.CT technology went through a phenomenal progress with Image quality and excelled to become the ultimate diagnostic tool in medicine.The only missing pieces from the puzzle were Radiobiology and the mutagenic impact of ionising radiation on humans.Three from every 10 thousand patients exposed to ionising radiation will die from cancer.The grey zone is the neurological and immune system disorders that are developed even if cancer is not developed. 3 It has also been estimated that in the USA, 29 000 future cancers (approximately 2% of the cancers diagnosed annually in the United States) could be related to CT performed in the United States in 2007. 4 An Australian study that looked at more than 680 000 people who had CT scans as children compared with some 10 million children who did not have a CT scan had a 24 percent increased cancer risk.Each additional scan boosted the risk of increased cancer by 16 percent.Is that ethically sound?We need our diagnostic tools.If Ionising Radiation is not the answer where do we go from here?Five minutes MR Screening is the new paradigm.Come along to understand the BMDH concept, see the images and prepare yourself to move away at warps speed in 2020.Dual energy vs FLASH CTPA: which results in more indeterminate reports?

Comparison of long-term outcomes in STEMI and NSTE-ACS after coronary stent placement: an analysis in a real world BMS and DES population

Background/Objectives The prognostic difference between STEMI and NSTE-ACS after coronary stent placement remains unclear. We aimed to compare the short- and long-term event rates in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents (DES). Methods Between 2000 and 2005 a total of 1749 STEMI and 1921 NSTE-ACS patients received either a BMS or DES in consecutive real world cohorts. Descriptive statistics and multivariate survival analyses were applied to compare the event rates in STEMI and NSTE-ACS during 4years follow-up. Results NSTE-ACS patients had significantly higher clinical and angiographic risk profiles at baseline and were treated with less optimal medical therapy during follow-up. At 4years follow-up, all-cause mortality was significantly higher in STEMI compared to NSTE-ACS after coronary stent placement (17.4% vs. 14.3%; HR 1.60, 95% CI 1.24–2.07). In a landmark analysis no difference was seen in all-cause mortality among STEMI en NSTE-ACS between 1month and 4years follow-up (HR 1.10, 95% CI 0.81–1.51). Cardiac death was more prevalent in STEMI patients, while the 4-year cumulative incidences of any myocardial infarction, any coronary revascularization, target lesion revascularization and definite stent thrombosis were similar in both ACS groups. Conclusions Patients presenting with STEMI have a worse long-term prognosis compared to NSTE-ACS after coronary stent placement, due to higher short-term death rates. However, after the first month STEMI and NSTE-ACS patients have a comparable long-term survival.

Role of Cyclooxygenase and 5-Lipoxygenase Metabolites, Platelet-Activating Factor and 5-Hydroxytryptamine in Allergen-Induced Airway Responses in the Brown Norway Rat

We determined the effects of selective inhibition of arachidonic acid metabolism via the cyclooxygenase and 5′-lipoxygenase pathways using flurbiprofen and BWA4C, respectively, of 5-hydroxytryptamine (5-HT) using methysergide and of platelet-activating factor (PAF) using WEB 2086 on the airway responses to ovalbumin (OA) aerosol in OA-sensitized Brown Norway rats. Twenty-one days after intraperitoneal injection of OA, rats were exposed to a 1% OA or saline aerosol. Only methysergide (10 mg/kg i.p.; 3 doses over 24 h) provided significant protection of the immediate response to OA. The increase in airway responsiveness to acetylcholine after OA exposure was not significantly altered by methysergide, flurbiprofen (10 mg/kg i.p.), BWA4C (50 mg/kg i.p.) and WEB 2086 (50 mg/kg i.p.) all given over 24 h prior to OA challenge. In addition, there was no effect on the increased recovery of eosinophils and lymphocytes in bronchoalveolar lavage fluid at 24 h. We conclude that 5-HT is an important mediator of the acute response to OA, but that 5-HT, lipoxygenase and cyclooxygenase products and PAF are unlikely to be involved in OA-induced airway hyperresponsiveness and inflammation in the Brown Norway rat.

An Activator Of AMP Activated Kinase (AMPK) Restores Nrf2 Protein Levels Decreased By Chronic Cigarette Smoke Exposure

Mid-term outcomes of the Absorb BVS versus second-generation DES: A systematic review and meta-analysis

Background Bioresorbable Vascular Scaffolds (BVS) were introduced to overcome some of the limitations of drug-eluting stent (DES) for PCI. Data regarding the clinical outcomes of the BVS versus DES beyond 2 years are emerging. Objective To study mid-term outcomes. Methods We searched online databases (PubMed/Medline, Embase, CENTRAL), several websites, meeting presentations and scientific session abstracts until August 8th, 2017 for studies comparing Absorb BVS with second-generation DES. The primary outcome was target lesion failure (TLF). Secondary outcomes were all-cause mortality, myocardial infarction, target lesion revascularization (TLR) and definite/probable device thrombosis. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived using a random effects model. Results Ten studies, seven randomized controlled trials and three propensity-matched observational studies, with a total of 7320 patients (BVS n = 4007; DES n = 3313) and a median follow-up duration of 30.5 months, were included. Risk of TLF was increased for BVS-treated patients (OR 1.34 [95% CI: 1.12–1.60], p = 0.001, I2 = 0%). This was also the case for all myocardial infarction (1.58 [95% CI: 1.27–1.96], p<0.001, I2 = 0%), TLR (1.48 [95% CI: 1.19–1.85], p<0.001, I2 = 0%) and definite/probable device thrombosis (of 2.82 (95% CI: 1.86–3.89], p<0.001 and I2 = 40.3%). This did not result in a difference in all-cause mortality (0.78 [95% CI: 0.58–1.04], p = 0.09, I2 = 0%). OR for very late (>1 year) device thrombosis was 6.10 [95% CI: 1.40–26.65], p = 0.02). Conclusion At mid-term follow-up, BVS was associated with an increased risk of TLF, MI, TLR and definite/probable device thrombosis, but this did not result in an increased risk of all-cause mortality.

Plaque Compositional Syntax Score

No abstract is provided for this article.

Early development of bioresorbable scaffold

This chapter reflects on the fact whether it could be possible to scaffold a vessel without using a permanent metallic implant to keep the vessel largely patent. Scaffold was the word used by Ulrich Sigwart to describe the stenting process since at that time the word "stent" was not even mentioned in any dictionary of the English language. Back in the Netherlands, Wim van der Giessen and the author kept working on the concept of developing a stent with a biostable polymer with the major Dutch corporation AkzoNobel. The results of this scaffold implantation in the coronaries of the pig model were very satisfactory and were published in the Journal of Interventional Cardiology in 1992. They created a working group to test a family of bioresorbable polymers and biostable polymers, all attached on the external surface of a Wictor stent.

Bioresorbable Polymeric Vascular Scaffolds

No abstract is provided for this article.

Effect of tachykinins on secretory event rate in cultured guinea-pig tracheal epithelial cells