In JoVE (2)

Other Publications (138)

Articles by Stéphane Cook in JoVE

Other articles by Stéphane Cook on PubMed

Salmeterol for the Prevention of High-altitude Pulmonary Edema

The New England Journal of Medicine. May, 2002  |  Pubmed ID: 12023995

Pulmonary edema results from a persistent imbalance between forces that drive water into the air space and the physiologic mechanisms that remove it. Among the latter, the absorption of liquid driven by active alveolar transepithelial sodium transport has an important role; a defect of this mechanism may predispose patients to pulmonary edema. Beta-adrenergic agonists up-regulate the clearance of alveolar fluid and attenuate pulmonary edema in animal models.

Insulin Resistance, a New Target for Nitric Oxide-delivery Drugs

Fundamental & Clinical Pharmacology. Dec, 2002  |  Pubmed ID: 12685502

In the Western hemisphere, the incidence of insulin resistance and its complications has been growing rapidly and is reaching epidemic proportions. Over the past decade, evidence has accumulated, indicating that nitric oxide (NO) plays a key role in the regulation of metabolic and cardiovascular homeostasis. Defective endothelial nitric oxide synthase (eNOS) driven NO synthesis causes insulin resistance, arterial hypertension and dyslipidemia in mice, and characterizes insulin-resistant humans. On the other hand, stimulation of inducible nitric oxide synthase (iNOS) and NO overproduction in mice, may also cause metabolic insulin resistance, suggesting a Yin-Yang effect of NO in the regulation of glucose homeostasis. Here, we will review the evidence for this novel concept, and thereby provide the conceptual framework for the use of NO-delivery drugs and pharmacological agents that modulate the bioavailability of endogenously produced NO for the treatment of insulin resistance.

Clustering of Cardiovascular Risk Factors Mimicking the Human Metabolic Syndrome X in ENOS Null Mice

Swiss Medical Weekly. Jun, 2003  |  Pubmed ID: 12947532

The metabolic syndrome comprises a clustering of cardiovascular risk factors but the underlying mechanism is not known. Mice with targeted disruption of endothelial nitric oxide synthase (eNOS) are hypertensive and insulin resistant. We wondered, whether eNOS deficiency in mice is associated with a phenotype mimicking the human metabolic syndrome.

Partial Gene Deletion of Endothelial Nitric Oxide Synthase Predisposes to Exaggerated High-fat Diet-induced Insulin Resistance and Arterial Hypertension

Diabetes. Aug, 2004  |  Pubmed ID: 15277387

Nitric oxide (NO) plays a major role in the regulation of cardiovascular and metabolic homeostasis, as evidenced by insulin resistance and arterial hypertension in endothelial NO synthase (eNOS) null mice. Extrapolation of these findings to humans is difficult, however, because eNOS gene deficiency has not been reported. eNOS gene polymorphism and impaired NO synthesis, however, have been reported in several cardiovascular disease states and could predispose to insulin resistance. High-fat diet induces insulin resistance and arterial hypertension in normal mice. To test whether partial eNOS deficiency facilitates the development of insulin resistance and arterial hypertension during metabolic stress, we examined effects of an 8-week high-fat diet on insulin sensitivity (euglycemic clamp) and arterial pressure in eNOS(+/-) mice. When fed a normal diet, these mice had normal insulin sensitivity and were normotensive. When fed a high-fat diet, however, eNOS(+/-) mice developed exaggerated arterial hypertension and had fasting hyperinsulinemia and a 35% lower insulin-stimulated glucose utilization than control mice. The partial deletion of the eNOS gene does not alter insulin sensitivity or blood pressure in mice. When challenged with nutritional stress, however, partial eNOS deficiency facilitates the development of insulin resistance and arterial hypertension, providing further evidence for the importance of this gene in linking metabolic and cardiovascular disease.

Defective Respiratory Amiloride-sensitive Sodium Transport Predisposes to Pulmonary Oedema and Delays Its Resolution in Mice

The Journal of Physiology. Nov, 2004  |  Pubmed ID: 15308680

Pulmonary oedema results from an imbalance between the forces driving fluid into the airspace and the biological mechanisms for its removal. In mice lacking the alpha-subunit of the amiloride-sensitive sodium channel (alphaENaC(-/-)), impaired sodium transport-mediated lung liquid clearance at birth results in neonatal death. Transgenic expression of alphaENaC driven by a cytomegalovirus (CMV) promoter (alphaENaC(-/-)Tg+) rescues the lethal pulmonary phenotype, but only partially restores respiratory sodium transport in vitro. To test whether this may also be true in vivo, and to assess the functional consequences of this defect on experimental pulmonary oedema, we measured respiratory transepithelial potential difference (PD) and alveolar fluid clearance (AFC), and quantified pulmonary oedema during experimental acute lung injury in these mice. Both respiratory PD and AFC were roughly 50% lower (P < 0.01) in alphaENaC(-/-)Tg+ than in control mice. This impairment was associated with a significantly larger increase of the wet/dry lung weight ratio in alphaENaC(-/-)Tg+ than in control mice, both after exposure to hyperoxia and thiourea. Moreover, the rate of resolution of thiourea-induced pulmonary oedema was more than three times slower (P < 0.001) in alphaENaC(-/-)Tg+ mice. alphaENaC(-/-)Tg+ mice represent the first model of a constitutively impaired respiratory transepithelial sodium transport, and provide direct evidence that this impairment facilitates pulmonary oedema in conscious freely moving animals. These data in mice strengthen indirect evidence provided by clinical studies, suggesting that defective respiratory transepithelial sodium transport may also facilitate pulmonary oedema in humans.

[Nitric Oxide Donors, a New Treatment for Insulin Resistance, Metabolic Syndrome and Diabetes?]

Revue Medicale De La Suisse Romande. Oct, 2004  |  Pubmed ID: 15573511

Obesity/insulin resistance ("diabesity") and the associated long term complications are reaching epidemic proportions worldwide. Recent evidence in experimental animals and humans shows that nitric oxide (NO) plays a key role in glucose and cardiovascular homeostasis. Pharmaceutical drugs releasing small and physiological amounts of NO may represent potential new treatments for insulin resistance.

Sirolimus-eluting Stents Associated with Paradoxic Coronary Vasoconstriction

Journal of the American College of Cardiology. Jul, 2005  |  Pubmed ID: 16022947

The purpose of the present study was to assess coronary vasomotor response to exercise after sirolimus-eluting stent (SES) implantation.

The "zipper" Lesion: a Rare but Serious Guiding Catheter-induced Complication of a PCI Procedure

The Journal of Invasive Cardiology. Nov, 2005  |  Pubmed ID: 16264216

The 2002 European Registry of Cardiac Catheter Interventions

International Journal of Cardiology. Nov, 2006  |  Pubmed ID: 16371236

The tradition of yearly reports on cardiac catheter interventions in Europe has been initiated in 1992. This 11th report presents aggregated data on cardiac catheter procedures in 30 European countries in the year 2002.

Coronary Artery Disease, Nitric Oxide and Oxidative Stress: the "Yin-Yang" Effect--a Chinese Concept for a Worldwide Pandemic

Swiss Medical Weekly. Feb, 2006  |  Pubmed ID: 16633954

Prevention of coronary artery disease (CAD) and reduction of its mortality and morbidity remains a major public health challenge throughout the "Western world". Recent evidence supports the concept that the impairment of endothelial function, a hallmark of insulin resistance states, is an upstream event in the pathophysiology of insulin resistance and its main corollaries: atherosclerosis and myocardial infarction. Atherosclerosis is currently thought to be the consequence of a subtle imbalance between pro- and anti-oxidants that produces favourable conditions for lesion progression towards acute thrombotic complications and clinical events. Over the last decade, a remarkable burst of evidence has accumulated, offering the new perspective that bioavailable nitric oxide (NO) plays a pivotal role throughout the CAD-spectrum, from its genesis to the outcome after acute events. Vascular NO is a critical modulator of coronary blood flow by inhibiting smooth muscle contraction and platelet aggregation. It also acts in angiogenesis and cytoprotection. Defective endothelial nitric oxide synthase (eNOS) driven NO synthesis causes development of major cardiovascular risk factors (insulin resistance, arterial hypertension and dyslipidaemia) in mice, and characterises CAD-prone insulin-resistant humans. On the other hand, stimulation of inducible nitric oxide synthase (iNOS) and NO overproduction causes metabolic insulin resistance and characterises atherosclerosis, heart failure and cardiogenic shock in humans, suggesting a "Yin-Yang" effect of NO in the cardiovascular homeostasis. Here, we will present a concise overview of the evidence for this novel concept, providing the conceptual framework for developing a potential therapeutic strategy to prevent and treat CAD.

High Heart Rate: a Cardiovascular Risk Factor?

European Heart Journal. Oct, 2006  |  Pubmed ID: 17000632

Patent Foramen Ovale and High-altitude Pulmonary Edema

JAMA. Dec, 2006  |  Pubmed ID: 17190896

Individuals susceptible to high-altitude pulmonary edema (HAPE) are characterized by exaggerated pulmonary hypertension and arterial hypoxemia at high altitude, but the underlying mechanism is incompletely understood. Anecdotal evidence suggests that shunting across a patent foramen ovale (PFO) may exacerbate hypoxemia in HAPE.

Percutaneous Coronary Interventions in Europe 1992-2003

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Feb, 2006  |  Pubmed ID: 19755208

The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed.

Local Vascular Dysfunction After Coronary Paclitaxel-eluting Stent Implantation

International Journal of Cardiology. Aug, 2007  |  Pubmed ID: 17234280

Paclitaxel-eluting stents (PES) have been shown to reduce the rate of restenosis and the need for repeated revascularization procedures compared with bare metal stents. However, long-term effects of paclitaxel on vascular function are unknown. The purpose of the present study was to assess coronary vasomotor response to exercise after paclitaxel-eluting stent implantation.

Does the Beta-blocker Nebivolol Increase Coronary Flow Reserve?

Cardiovascular Drugs and Therapy. Apr, 2007  |  Pubmed ID: 17235472

Nebivolol, a highly selective beta1-adrenergic receptor-blocker, increases basal and stimulated endothelial nitric oxide (NO)-release. It is unknown, whether coronary perfusion is improved by the increase in NO availability. Therefore, we sought to evaluate the effect of nebivolol on coronary flow reserve (CFR) and collateral flow.

Very Late Restenosis of a Sirolimus-eluting Stent After Left Main Coronary Artery Stenting

The Canadian Journal of Cardiology. Jan, 2007  |  Pubmed ID: 17245486

Effect of Atorvastatin and Pravastatin on Platelet Inhibition by Aspirin and Clopidogrel Treatment in Patients with Coronary Stent Thrombosis

The American Journal of Cardiology. Feb, 2007  |  Pubmed ID: 17261397

We sought to determine a potential interaction between statins and antiplatelet therapy with aspirin and clopidogrel. Previous laboratory studies have shown a possible drug-drug interaction of statins metabolized by cytochrome P450 3A4 and clopidogrel (prodrug metabolized by cytochrome P450 3A4), resulting in an impaired inhibitory effect of clopidogrel on platelet aggregation. However, conclusive prospective data assessing this potentially relevant interaction are lacking. In 73 patients, 23 with previous coronary stent thrombosis (ST) (ST group) and 50 without coronary ST (control group), platelet aggregation was measured 3 times in monthly intervals using light transmission aggregometry (adenosine diphosphate [ADP] and arachidonic acid induction). Measurements were carried out with aspirin monotherapy (100 mg/day), dual antiplatelet therapy with aspirin plus clopidogrel (75 mg/day), and additional treatment of 20 mg/day of atorvastatin or 40 mg/day of pravastatin. ADP (5 and 20 micromol)-induced platelet aggregation was significantly decreased with clopidogrel (p <0.001) but remained stable under additional treatment with atorvastatin or pravastatin in the 2 groups. Patients with previous ST showed a higher ADP-induced aggregation level than control subjects. This difference was not influenced by clopidogrel or statin treatment. In conclusion, patients with previous ST show a higher aggregation level than control subjects independent of statin treatment. Atorvastatin and pravastatin do not interfere with the antiaggregatory effect of aspirin and clopidogrel. In conclusion, drug-drug interaction between dual antiplatelet therapy and atorvastatin or pravastatin seems not to be associated with ST.

Transseptal TandemHeart Implantation Through an Amplatzer Atrial Septal Occluder

The Journal of Invasive Cardiology. Apr, 2007  |  Pubmed ID: 17404408

Percutaneous Coronary Interventions in Europe: Prevalence, Numerical Estimates, and Projections Based on Data Up to 2004

Clinical Research in Cardiology : Official Journal of the German Cardiac Society. Jun, 2007  |  Pubmed ID: 17453137

A registry mandated by the European Society of Cardiology collects data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in new techniques and their distributions across Europe. We report the data through 2004 and give an overview of the development of coronary interventions since the first data collection in 1992.

Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-eluting Stent Implantation

Circulation. May, 2007  |  Pubmed ID: 17485593

Stent thrombosis may occur late after drug-eluting stent (DES) implantation, and its cause remains unknown. The present study investigated differences of the stented segment between patients with and without very late stent thrombosis with the use of intravascular ultrasound.

Beneficial Effect of Recruitable Collaterals: a 10-year Follow-up Study in Patients with Stable Coronary Artery Disease Undergoing Quantitative Collateral Measurements

Circulation. Aug, 2007  |  Pubmed ID: 17679611

The prognostic relevance of the collateral circulation is still controversial. The goal of this study was to assess the impact on survival of quantitatively obtained, recruitable coronary collateral flow in patients with stable coronary artery disease during 10 years of follow-up.

Impact of Vessel Size on Outcome After Implantation of Sirolimus-eluting and Paclitaxel-eluting Stents: a Subgroup Analysis of the SIRTAX Trial

Journal of the American College of Cardiology. Sep, 2007  |  Pubmed ID: 17868802

We assessed the impact of vessel size on angiographic and long-term clinical outcome after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) within a randomized trial (SIRTAX [Sirolimus-Eluting Stent Compared With Paclitaxel-Eluting Stent for Coronary Revascularization]).

Septal Myectomy: Cut, Coil, or Boil?

European Heart Journal. Feb, 2008  |  Pubmed ID: 18203703

Two-year Clinical Outcome After Implantation of Sirolimus-eluting and Paclitaxel-eluting Stents in Diabetic Patients

European Heart Journal. Mar, 2008  |  Pubmed ID: 18272504

Percutaneous coronary intervention (PCI) in diabetic patients is associated with an increased risk of restenosis and major adverse cardiac events (MACE). We assessed the impact of diabetes on long-term outcome after PCI with sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents.

Prognostic Value of Early Exercise Testing After Coronary Stent Implantation

The American Journal of Cardiology. Mar, 2008  |  Pubmed ID: 18328845

The clinical value of early exercise stress testing (EST) after coronary stenting to predict long-term clinical outcomes is unknown. Of 1,000 unselected patients who underwent coronary stenting, 446 random patients underwent early EST the day after intervention. Clinical long-term outcomes (41 +/- 20 months) were correlated with normal (n = 314 [70%]) or positive (n = 102 [23%]) EST results. Patients with inconclusive test results (n = 30 [7%]) were excluded from the analysis. Overall mortality was significantly higher in patients with positive EST results (9.3% vs 3.9%, p = 0.04). Major adverse cardiac events and cardiac mortality also tended to be higher in patients with positive stress test results (45.4% vs 35.4%, p = 0.08, and 4.1% vs 1.1%, p = 0.05, respectively). Patients with the combination of positive stress test results and incomplete revascularization appeared to be the group at highest risk for major adverse cardiac events (47.1% vs 33.3% for patients with normal stress test results and complete revascularization, p = NS). Negative stress test results reduced (odds ratio 0.329, 95% confidence interval 0.120 to 0.905, p = 0.031) and a lower ejection fraction increased (odds ratio 0.942, 95% confidence interval 0.897 to 0.989, p = 0.017) the risk for death. In conclusion, an early stress test after coronary stenting provides important prognostic information. Positive stress test results, especially in combination with incomplete revascularization, are associated with higher mortality, a trend toward more repeat revascularization procedures, and higher risk for major adverse cardiac events.

Coronary Aneurysm Formation in a Patient Early After Everolimus-eluting Stent Implantation

The Journal of Invasive Cardiology. May, 2008  |  Pubmed ID: 18460723

Coronary aneurysm formation after drug-eluting stent (DES) implantation is a rare complication with late stent thrombosis as a potentially fatal sequela. One possible mechanism involved in aneurysm formation is thought to be late-acquired stent malapposition due to a local inflammatory response to the polymer and/or the drug. Coronary aneurysm formation has been documented with sirolimus- and paclitaxel-eluting stents. We report a case of coronary aneurysm formation in a patient with an everolimus-eluting stent (EES; Xience(R) Abbott Vascular, Redwood City, California) relatively early (3 months) after stent implantation. This case illustrates that even with second-generation DES like the EES, which is thought to be highly biocompatible, there can be adverse reactions to the polymer and/or to the drug.

Hydrogel-based Engineered Skeletal Muscle Grafts Normalize Heart Function Early After Myocardial Infarction

Artificial Organs. Sep, 2008  |  Pubmed ID: 18684206

Tissue engineering represents an attractive approach for the treatment of congestive heart failure. The influence of the differentiation of myogenic graft for functional recovery is not defined. We engineered a biodegradable skeletal muscle graft (ESMG) tissue and investigated its functional effect after implantation on the epicardium of an infarcted heart segment. ESMGs were synthesized by mixing collagen (2 mg/mL), Matrigel (2 mg/mL), and rat skeletal muscle cells (10(6)). Qualitative and quantitative aspects of ESMGs were optimized. Two weeks following coronary ligation, the animals were randomized in three groups: ESMG glued to the epicardial surface with fibrin (ESMG, n = 7), fibrin alone (fibrin, n = 5), or sham operation (sham, n = 4). Echocardiography, histology, and immunostaining were performed 4 weeks later. A cohesive three-dimensional tissular structure formed in vitro within 1 week. Myoblasts differentiated into randomly oriented myotubes. Four weeks postimplantation, ESMGs were vascularized and invaded by granulation tissue. Mean fractional shortening (FS) was, however, significantly increased in the ESMG group as compared with preimplantation values (42 +/- 6 vs. 33 +/- 5%, P < 0.05) and reached the values of controlled noninfarcted animals (control, n = 5; 45 +/- 3%; not significant). Pre- and postimplantation FS did not change over these 4 weeks in the sham group and the fibrin-treated animals. This study showed that it is possible to improve systolic heart function following myocardial infarction through implantation of differentiated muscle fibers seeded on a gel-type scaffold despite a low rate of survival.

Percutaneous Ventricular Assist Devices for Cardiogenic Shock

Current Heart Failure Reports. Sep, 2008  |  Pubmed ID: 18752766

Cardiogenic shock complicates up to 7% of ST-segment elevation myocardial infarctions and 2.5% of non-ST-segment elevation myocardial infarctions, with an associated mortality of 50% to 70%. Primary cardiac pump failure is followed by secondary vital organ hypoperfusion and subsequent activation of various cascade pathways, resulting in a downward spiral leading to multiple organ failure and, ultimately, death. Immediate restoration of cardiac output by means of percutaneous ventricular assist devices restores hemodynamic -stability and is an important advance in the management of patients with severe left ventricular dysfunction and cardiogenic shock. This article reviews available evidence supporting the use of percutaneous ventricular assist devices in patients suffering from cardiogenic shock.

10-year Follow-up of a Prospective Randomized Trial Comparing Bare-metal Stenting with Internal Mammary Artery Grafting for Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis the SIMA (Stenting Versus Internal Mammary Artery Grafting) Trial

Journal of the American College of Cardiology. Sep, 2008  |  Pubmed ID: 18755343

This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery.

Elective Implantation of Sirolimus-eluting Stents for Bifurcated and Non-bifurcated Unprotected Left Main Coronary Artery Lesions: Clinical Outcomes at One Year

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Aug, 2008  |  Pubmed ID: 19110793

Recent studies of drug-eluting stents for unprotected left main coronary artery (LMCA) disease have been encouraging. We examined the performance of sirolimus-eluting stents (SES) for this indication.

Diabetic Patients Treated for Unprotected Left Main Coronary Artery Disease with Drug Eluting Stents: a 3-year Clinical Outcome Study. The Diabetes and Drug Eluting Stent for LeFT Main Registry (D-DELFT)

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. May, 2008  |  Pubmed ID: 19112783

Diabetes mellitus (DM) plays an important role in the development of coronary artery disease. Although previous studies have associated drug-eluting stent (DES) implantation in diabetic patients with favourable clinical and angiographic outcomes, the very long-term efficacy of these devices in diabetic patients undergoing PCI for significant unprotected left main coronary artery (ULMCA) disease has not been established yet.

Have We Been Misled by the ESC DES Firestorm?

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Mar, 2008  |  Pubmed ID: 19608475

Percutaneous Coronary Interventions in Europe in 2005

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jan, 2008  |  Pubmed ID: 19736085

Since 1992, a registry has collected data on trends in interventional cardiology within Europe. This 14th report presents aggregated data on cardiac catheter procedures in 30 European countries in the year 2005.

Giant Coronary Artery Aneurysm: Imaging Findings Before and After Treatment with a Polytetrafluoroethylene-covered Stent

Circulation. Cardiovascular Interventions. Aug, 2008  |  Pubmed ID: 20031659

Transient Apical Ballooning Syndrome--clinical Characteristics, Ballooning Pattern, and Long-term Follow-up in a Swiss Population

International Journal of Cardiology. Jul, 2009  |  Pubmed ID: 18599137

Transient apical ballooning syndrome (TABS) or Takotsubo cardiomyopathy mimics acute ST-elevation myocardial infarction, but is considered to have a good prognosis with only moderate elevation of myocardial enzymes and full recovery of left ventricular function. Although it is increasingly reported, its exact incidence, clinical presentation, and prognosis in non-Asian populations remain largely unknown.

Early Stent Thrombosis: Past, Present, and Future

Circulation. Feb, 2009  |  Pubmed ID: 19204315

Surgical Versus Percutaneous Revascularization of Coronary Artery Disease in Diabetic Patients

Best Practice & Research. Clinical Endocrinology & Metabolism. Jun, 2009  |  Pubmed ID: 19520306

Morbidity and mortality related to coronary artery disease (CAD) remain a great challenge in patients with diabetes mellitus. Revascularization of CAD is an important therapeutic intervention owing to its impact on both symptoms and prognosis. The optimal revascularization strategy continues to evolve due to the advent of new technologies and improved peri-procedural outcome with both percutaneous coronary interventions and coronary artery bypass grafting. Although clinical outcome following coronary artery bypass is worse in diabetic as opposed to non-diabetic patients, surgical revascularization tends to be associated with better outcome in stable patients with multivessel disease and reduced left ventricular function. The advent of drug-eluting stents has challenged the supremacy of coronary artery bypass grafting and has become a valuable alternative to surgery. The safety and efficacy of drug-eluting stents in the treatment of patients with diabetes and multivessel disease is currently under investigation in several ongoing randomized controlled trials. Percutaneous coronary intervention is the therapy of choice in patients with acute coronary syndromes, particularly ST-elevation myocardial infarction. The focus of this review is to present the current evidence, define the role of percutaneous and surgical revascularization in the treatment of diabetic patients with CAD, and propose a tailored approach for clinical decision-making.

Correlation of Intravascular Ultrasound Findings with Histopathological Analysis of Thrombus Aspirates in Patients with Very Late Drug-eluting Stent Thrombosis

Circulation. Aug, 2009  |  Pubmed ID: 19620501

Intravascular ultrasound of drug-eluting stent (DES) thrombosis (ST) reveals a high incidence of incomplete stent apposition (ISA) and vessel remodeling. Autopsy specimens of DES ST show delayed healing and hypersensitivity reactions. The present study sought to correlate histopathology of thrombus aspirates with intravascular ultrasound findings in patients with very late DES ST.

Percutaneous Left Ventricular Assist Devices During Cardiogenic Shock and High-risk Percutaneous Coronary Interventions

Current Cardiology Reports. Sep, 2009  |  Pubmed ID: 19709497

Left ventricular assist devices were developed to support the function of a failing left ventricle. Owing to recent technological improvements, ventricular assist devices can be placed by percutaneous implantation techniques, which offer the advantage of fast implantation in the setting of acute left ventricular failure. This article reviews the growing evidence supporting the clinical use of left ventricular assist devices. Specifically, we discuss the use of left ventricular assist devices in patients with cardiogenic shock, in patients with acute ST-elevation myocardial infarction without shock, and during high-risk percutaneous coronary interventions.

Off-label Use and the Spectre of Drug-eluting Stent Thrombosis

Circulation. Cardiovascular Interventions. Aug, 2009  |  Pubmed ID: 20031728

Myocardial Injection of Skeletal Myoblasts Impairs Contractility of Host Cardiomyocytes

International Journal of Cardiology. Jan, 2010  |  Pubmed ID: 18809218

Mechanisms underlying improvement of myocardial contractile function after cell therapy as well as arrhythmic side effect remain poorly understood. We hypothesised that cell therapy might affect the mechanical properties of isolated host cardiomyocytes.

Coronary Collateral Growth by External Counterpulsation: a Randomised Controlled Trial

Heart (British Cardiac Society). Feb, 2010  |  Pubmed ID: 19897461

The efficacy of external counterpulsation (ECP) on coronary collateral growth has not been investigated in a randomised controlled study. Objective To test the hypothesis that ECP augments collateral function during a 1 min coronary balloon occlusion.

Resting Heart Rate and Cardiovascular Events: Time for a New Crusade?

European Heart Journal. Mar, 2010  |  Pubmed ID: 19933283

Impact of Stent Overlap on Angiographic and Long-term Clinical Outcome in Patients Undergoing Drug-eluting Stent Implantation

Journal of the American College of Cardiology. Mar, 2010  |  Pubmed ID: 20298923

We compared the angiographic and long-term clinical outcomes of patients with and without overlap of drug-eluting stents (DES).

Long-term Outcomes After Drug-eluting Stent Implantation: Get Your Feet Wet in the Real-world

Journal of Interventional Cardiology. Apr, 2010  |  Pubmed ID: 20337862

Dual Low Response to Acetylsalicylic Acid and Clopidogrel is Associated with Myonecrosis and Stent Thrombosis After Coronary Stent Implantation

American Heart Journal. May, 2010  |  Pubmed ID: 20435201

Impaired response to antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel (CLO) has been associated with an increased risk of stent thrombosis and ischemic events after coronary stent implantation. We sought to investigate whether patients with a low response (LR) to ASA or CLO are at increased risk for periprocedural and short-term ischemic events after coronary stent implantation.

Long-term Evaluation of Myoblast Seeded Patches Implanted on Infarcted Rat Hearts

Artificial Organs. Jun, 2010  |  Pubmed ID: 20482708

Cell transplantation presents great potential for treatment of patients with severe heart failure. However, its clinical application was revealed to be more challenging than initially expected in experimental studies. Further investigations need to be undertaken to define the optimal treatment conditions. We previously reported on the epicardial implantation of a bio-engineered construct of skeletal myoblast-seeded polyurethane and its preventive effect on progression toward heart failure. In the present study, we present a long-term evaluation of this functional outcome. Left anterior descending coronary ligation was performed in female Lewis rats. Two weeks later, animals were treated with either epicardial implantation of biograft, acellular scaffold, sham operation, or direct intramyocardial skeletal myoblast injection. Functional assessments were performed with serial echocardiographies every 3 months and end point left ventricle pressure was assessed. Hearts were then harvested for histological examinations. Myocardial infarction induced a slow and progressive reduction in fractional shortening after 3 months. Progression toward heart failure was significantly prevented for up to 6 months after injection of myoblasts and for up to 9 months following biograft implantation. Nevertheless, this effect vanished after 12 months, with immunohistological examinations revealing an absence of the transplanted myoblasts within the scaffold. We demonstrated that tissue therapy is superior to cell therapy for stabilization of heart function. However, beneficial effects are transient.

Percutaneous Coronary Interventions in Europe in 2006

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jun, 2010  |  Pubmed ID: 20562067

This registry has aimed to collect data on cardiac catheterisation procedures in Europe in 2006.

Iatrogenic Left Main Coronary Artery Dissection: Incidence, Classification, Management, and Long-term Follow-up

American Heart Journal. Jun, 2010  |  Pubmed ID: 20569732

Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection.

Impact of Arterial Injury on Neointimal Hyperplasia After Implantation of Drug-eluting Stents in Coronary Arteries: an Intravascular Ultrasound Study

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Sep, 2010  |  Pubmed ID: 20884434

We investigated the impact of arterial injury on neointimal hyperplasia following implantation of drug-eluting stents (DES).

[Acute Myocardial Infarction: Importance of the Networking in the Initial Management]

Revue Medicale Suisse. Nov, 2010  |  Pubmed ID: 21155290

Early reperfusion with prompt re-establishment of coronary blood flow improves survival in patients suffering from acute ST-elevation myocardial infarction (STEMI). Leaving systemic thrombolysis for primary percutaneous coronary intervention (PCI) is justified by clinical results in favor of PCI. Nevertheless, primary PCI necessitates additional transfer time and requires an efficient territorial networking. The present article summarizes the up-to-dated management of patients with acute STEMI and/or overt cardiogenic shock.

Sirolimus Versus Paclitaxel Coronary Stents in Clinical Practice

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. Jan, 2011  |  Pubmed ID: 20506333

We aimed at comparing the long term clinical outcome of SES and PES in routine clinical practice.

Figulla PFO Occluder Versus Amplatzer PFO Occluder for Percutaneous Closure of Patent Foramen Ovale

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. Apr, 2011  |  Pubmed ID: 20931665

Percutaneous closure of patent foramen ovale (PFO) has been shown safe and feasible using several devices. The Occlutech Figulla single layer PFO Occluder (FPO) constitutes an alternative to the Amplatzer PFO Occluder (APFO).

Coronary Collateral Function in the Transplanted Heart: Propensity Score Matching with Coronary Artery Disease

Heart (British Cardiac Society). Apr, 2011  |  Pubmed ID: 21270076

The function of the coronary collateral circulation in heart transplant patients has not been investigated in a controlled fashion. Since it partly belongs to the microcirculation, which is affected by transplant vasculopathy, the hypothesis was tested that the coronary collateral circulation in heart transplant recipients is less developed than in coronary artery disease (CAD) patients.

Long-term Comparison of Everolimus-eluting and Sirolimus-eluting Stents for Coronary Revascularization

Journal of the American College of Cardiology. May, 2011  |  Pubmed ID: 21596229

This study sought to compare the unrestricted use of everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention.

Five-year Clinical and Angiographic Outcomes of a Randomized Comparison of Sirolimus-eluting and Paclitaxel-eluting Stents: Results of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization LATE Trial

Circulation. Jun, 2011  |  Pubmed ID: 21646500

Long-term comparative data of first-generation drug-eluting stents are scarce. We investigated clinical and angiographic outcomes of sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) at 5 years as part of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) LATE study.

Heart Failure in a Patient with Noonan Syndrome

Circulation. Jun, 2011  |  Pubmed ID: 21670236

Comparison of Titanium-nitride-oxide-coated Stents with Zotarolimus-eluting Stents for Coronary Revascularization a Randomized Controlled Trial

JACC. Cardiovascular Interventions. Jun, 2011  |  Pubmed ID: 21700254

This study sought to compare the efficacy of passive stent coating with titanium-nitride-oxide (TiNO) with drug-eluting stents releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota).

Determinants of Preformed Collateral Vessels in the Human Heart Without Coronary Artery Disease

Cardiology. 2011  |  Pubmed ID: 21701169

Coronary collaterals protect myocardium jeopardized by coronary artery disease (CAD). Promotion of collateral circulation is desirable before myocardial damage occurs. Therefore, determinants of collateral preformation in patients without CAD should be elucidated.

Clinical Use of Temporary Percutaneous Left Ventricular Assist Devices

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. Aug, 2011  |  Pubmed ID: 21766420

Temporary percutaneous left ventricular assist devices (TPLVAD) can be inserted and removed in awake patients. They substitute left ventricular function for a period of up to a few weeks and provide an excellent backup and bridge to recovery or decision.

Clinical Outcomes After PCI for Acute Coronary Syndrome in Unprotected Left Main Coronary Artery Disease: Insights from the Swiss Acute Left Main Coronary Vessel Percutaneous Management (SALVage) Study

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Oct, 2011  |  Pubmed ID: 21986328

Unprotected left main (ULM) coronary artery disease is encountered in 3%-10% of coronary angiograms and is associated with high mortality. The survival of patients with ULM disease presenting with acute coronary syndromes (ACS) depends on different variables and is lowest in those with cardiogenic shock (CS). The aim of the present study was to estimate the impact of baseline characteristics on the subsequent clinical outcome in patients treated by percutaneous coronary intervention (PCI) of ULM for ACS.

Patent Foramen Ovale: a Culpable Pathway for Myocardial Infarction

Journal of the American College of Cardiology. Oct, 2011  |  Pubmed ID: 22018303

Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

Minimally Invasive Surgery. 2011  |  Pubmed ID: 22091361

The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support.

Amplatzer Septal Occluder to Treat Iatrogenic Cardiac Perforations

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. Feb, 2012  |  Pubmed ID: 22131255

Iatrogenic free wall cardiac perforation is a rare but serious complication encountered during percutaneous cardiac procedures, which usually leads to tamponade and death. Septal occluder devices have been developed for sealing intracardiac shunts but may be also used in this emergency setting.

Impact of Incomplete Stent Apposition on Long-term Clinical Outcome After Drug-eluting Stent Implantation

European Heart Journal. Jun, 2012  |  Pubmed ID: 22285579

Late acquired incomplete stent apposition (ISA) is more common after drug-eluting stent (DES) than bare metal stent (BMS) implantation and has been associated with vascular hypersensitivity and stent thrombosis (ST). We investigated the impact of incidentally discovered ISA as assessed by intravascular ultrasound (IVUS) 8 months after DES implantation on the long-term clinical outcome.

Circadian Variations of Ischemic Burden Among Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

American Heart Journal. Feb, 2012  |  Pubmed ID: 22305838

Several parameters of cardiovascular physiology and pathophysiology exhibit circadian rhythms. Recently, a relation between infarct size and the time of day at which it occurs has been suggested in experimental models of myocardial infarction. The aim of this study is to investigate whether circadian rhythms could cause differences in ischemic burden in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).

Sealing Pseudo-aneurysms of the Femoral Artery with Saline Injection: a New Technique

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Feb, 2012  |  Pubmed ID: 22334319

Pseudo-aneurysm (PA) of the femoral artery is the most frequent complication after diagnostic or therapeutic catheterisation. PA may manifest with large and painful haematoma or compression of the adjacent nerve and vein. Among several therapeutic approaches, compression by injection of saline around the neck is a recent and promising method. To explore compression with saline as an alternative treatment for iatrogenic femoral artery PA was the aim of this study.

Contrast-induced Nephropathy in Invasive Cardiology

Swiss Medical Weekly. 2012  |  Pubmed ID: 22714555

Contrast-induced nephropathy (CIN) is an acute renal injury due to the renal toxicity of iodinated contrast media. It is classically defined as a relative (≥25%) or absolute (≥0.5 mg/dl; 44 μmol/l) increase in serum creatinine from baseline value. CIN accounts for 10 to 15% of hospital-acquired acute renal failure and may rarely lead to irreversible renal function loss. Following percutaneous coronary intervention, reported incidence of CIN varies between 0 to more than 20%, depending on the prevalence of risk factors and used definition. Nowadays, the diagnosis of CIN relays on serum creatinine monitoring, although it is a late marker of acute kidney injury. Given the expanding number of percutaneous coronary interventions made in outpatient settings and the morbidity and mortality associated with CIN, early detection of CIN is of utmost clinical relevance. Several plasmatic and urinary biomarkers have been studied in that view, with plasmatic cystatine-C and urinary NGAL being the most promising. As no treatment specifically targets CIN once it develops, the main goal for clinicians remains prevention, with hydration status optimisation being the only proven strategy to date. Here, we will review the recent evidence concerning CIN, its incidence, proposed early diagnostic biomarkers, as well as its treatment and prognostic implication.

Vascular Scaffolding to Seal Giant Aneurysms: a New Technique

Heart (British Cardiac Society). Jul, 2012  |  Pubmed ID: 22810852

Heart Rate, Coronary Artery Disease and Plaque Rupture - Myth, Hype, or Truth?

Swiss Medical Weekly. Aug, 2012  |  Pubmed ID: 22890390

Early Reperfusion Hemodynamics Predict Recovery in Rat Hearts: a Potential Approach Towards Evaluating Cardiac Grafts from Non-heart-beating Donors

PloS One. 2012  |  Pubmed ID: 22928009

Cardiac grafts from non-heartbeating donors (NHBDs) could significantly increase organ availability and reduce waiting-list mortality. Reluctance to exploit hearts from NHBDs arises from obligatory delays in procurement leading to periods of warm ischemia and possible subsequent contractile dysfunction. Means for early prediction of graft suitability prior to transplantation are thus required for development of heart transplantation programs with NHBDs.

Optical Coherence Tomography Findings in Renal Denervation

European Heart Journal. Dec, 2012  |  Pubmed ID: 23014864

A Randomized Comparison of Platelet Reactivity in Patients After Treatment with Various Commercial Clopidogrel Preparations: the CLO-CLO Trial

Archives of Cardiovascular Diseases. Nov, 2012  |  Pubmed ID: 23177487

The salt linked to the clopidogrel molecule in generic preparations is suspected to affect its clinical efficacy. There is a lack of information about inhibition of platelet reactivity by generic preparations.

[Left Ventricular Assist Devices in Cardiogenic Shock and Chronic Refractory Heart Failure]

Revue Medicale Suisse. Dec, 2012  |  Pubmed ID: 23346674

Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

Percutaneous Left-ventricular Support with the Impella-2.5-assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-registry

Circulation. Heart Failure. Jan, 2013  |  Pubmed ID: 23212552

Acute cardiogenic shock after myocardial infarction is associated with high in-hospital mortality attributable to persisting low-cardiac output. The Impella-EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5-percutaneous left-ventricular assist device in patients with cardiogenic shock after acute myocardial infarction.

A Modified Technique of Balloon Anchoring for Tricky Stent Delivery

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jan, 2013  |  Pubmed ID: 23339816

Percutaneous Coronary Intervention for Acute Coronary Syndromes in Eastern Nepal: a Preliminary Report

Swiss Medical Weekly. Feb, 2013  |  Pubmed ID: 23443879

Long-term Comparison of Everolimus-eluting and Biolimus-eluting Stents

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jul, 2013  |  Pubmed ID: 23482296

Second-generation everolimus-eluting stents (EES) are safer and more efficient than first-generation paclitaxel-eluting stents (PES). Third-generation biolimus-eluting stents (BES) have been found to be non-inferior to PES. To date, there is no available comparative study between EES and BES. We aimed to investigate the safety and efficacy of BES with biodegradable polymer compared to EES with durable polymer at a follow-up of two years in an unselected population of consecutively enrolled patients.

Quantitative Myocardial Contrast Echocardiography: a New Method for the Non-invasive Detection of Chronic Heart Transplant Rejection

European Heart Journal Cardiovascular Imaging. Dec, 2013  |  Pubmed ID: 23612502

Chronic heart transplant rejection, i.e. cardiac allograft vasculopathy (CAV) is a major adverse prognostic factor after heart transplantation (HTx). This study tested the hypothesis that the relative myocardial blood volume (rBV) as quantified by myocardial contrast echocardiography accurately detects severe CAV as defined by coronary intravascular ultrasound (IVUS).

How Should I Treat a Left Main Spontaneous Dissection Involving Left Anterior Descending Artery, Intermediate Branch Artery and Left Circumflex Artery?

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jun, 2013  |  Pubmed ID: 23793013

A 45-year-old woman presented to the emergency department with ST-segment elevation myocardial infarction (STEMI).

Acute Coronary Syndrome in Patients Younger Than 30 Years--aetiologies, Baseline Characteristics and Long-term Clinical Outcome

Swiss Medical Weekly. Jul, 2013  |  Pubmed ID: 23896944

Coronary atherosclerosis begins early in life, but acute coronary syndromes in adults aged <30 years are exceptional. We aimed to investigate the rate of occurrence, clinical and angiographic characteristics, and long-term clinical outcome of acute coronary syndrome (ACS) in young patients who were referred to two Swiss hospitals.

Urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) and Contrast-induced Acute Kidney Injury After Coronary Angiogram

Swiss Medical Weekly. Aug, 2013  |  Pubmed ID: 23986375

Diagnosis of acute kidney injury (AKI) relies on measurement of serum creatinine (SCr). SCr is a late marker of impaired renal function. Urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) has given encouraging results for an early and sensitive detection of AKI. This cohort study was conducted (1) to assess the value of uNGAL as early marker of contrast-induced AKI (CI-AKI) in unselected patients undergoing percutaneous coronary procedure (PCP) and (2) to investigate whether uNGAL levels correlate with the volume of contrast medium (CM) used during the procedure.

A Ruputured Left Cornual Pregnancy: a Case Report

Journal of Clinical and Diagnostic Research : JCDR. Jul, 2013  |  Pubmed ID: 23998092

A cornual gestation is one of the most hazardous types of ectopic gestations, which accounts for 2 - 4% of all the ectopic pregnancies and it has a mortality rate which is 6 - 7 times higher than that of the ectopics in general. The diagnosis and the treatment of such a pregnancy is challenging and it constitutes an urgent medical situation. Because of the myometrial stretch ability, they tend to present relatively late, at 7 - 12 weeks of gestation. A significant maternal haemorrhage which can lead to hypovolaemia and shock, can rapidly result from a cornual rupture. We are reporting a case of 28 year old woman who presented to the emergency obstetrical room in a state of hypovolaemic shock. The diagnosis of a ruptured ectopic pregnancy was confirmed in view of the history of 10 weeks of amenorrhoea, with a positive urine pregnancy test. She was shifted for emergency exploratory laparotomy. Intraoperatively, we encountered a left lateral wall ruptured uterus with a 10 week old foetus in the peritoneal cavity, which suggested a left cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully.

To Compare Standard Incision and Comma Shaped Incision and Its Influence on Post-operative Complications in Surgical Removal of Impacted Third Molars

Journal of Clinical and Diagnostic Research : JCDR. Jul, 2013  |  Pubmed ID: 23998110

Objectives: To compare standard incision and comma shaped incision and its influence on post operative complications in surgical removal of impacted third molar. Methods: This was a cross-over trial. Twenty subjects with bilateral impacted mandibular third molars were recruited for the study. A standard incision was made on one side of the lower jaw and a comma incision was made on the other side to reflect the mucoperiosteal flap, after which the common steps for removal of impacted third molars were followed. The post- operative parameters were recorded immediately on the post -operative days 1, 3 and 7 respectively. Results: The pain scores which were recorded on days 1, 3 and 7 in the surgical area with comma incisions were found to be significantly lower as compared to the pain scores in the area where standard incisions were made. Similarly, swelling was lesser with comma incisions than with standard incisions. There was a significant difference in mouth opening between the two incisions on day 1, but no significance was seen on days 3 and 7. All these findings showed significant statistical differences. Conclusion: The results of the study showed that the new incision design was preferable over the conventional method, considering the lesser degree of post-operative complications. The cross-over design of the study greatly enhanced its statistical power and validity.

Response to Letter Regarding Article, “percutaneous Left-ventricular Support with the Impella-2.5-assist Device in Acute Cardiogenic Shock Results of the Impella-EUROSHOCK Registry”

Circulation. Heart Failure. Jul, 2013  |  Pubmed ID: 24027780

Isolated Cutaneous Sarcoidosis: A New Insight into the Old Entity

Journal of Clinical and Diagnostic Research : JCDR. Aug, 2013  |  Pubmed ID: 24086892

Cutaneous lesions are a part of common manifestation in multi-systemic sarcoidosis and skin involvement occurs in 20% to 35% of the patients with systemic disease. An exclusive cutaneous involvement is rare and it is reported in about 4%-5% of the patients of sarcoidosis. These lesions have been classified into specific and non-specific, depending on the presence of non- caseating granulomas, on histopathologic studies. In the present study, we are reporting two cases of isolated cutaneous sarcoidosis without systemic manifestations, which is a rare presentation. Sarcoidosis will continue to challenge even the most experienced clinicians with respect to a high degree of suspicion and further investigations for diagnosing and treating this disorder.

Prevalence, Severity and Associated Factors of Dental Caries in 3-6 Year Old Children

Journal of Clinical and Diagnostic Research : JCDR. Aug, 2013  |  Pubmed ID: 24086915

Objectives: To determine the prevalence and the severity of dental caries in 3-6 year old children in Chennai and to elucidate the factors which affect the dental caries in 3-6 year old children. Methods: This study was a cross-sectional survey which was done on 527 children who were in the age group of 3 to 6 years, who were from 6 private and 6 corporation schools in Chennai, India. Two instruments were developed, pre-tested and validated for the study. One questionnaire which contained the various risk factors which had to be measured and the dental caries indices were used on children to collect the relevant data. A separate questionnaire was distributed to the parents to measure the socio economic status and to know the parents' educational levels. Results: The prevalence of dental caries was found to be 63.4% in the study samples. The association between dental caries and the associated factors was determined by calculating the Odd`s ratio. Logistic regression was performed to test the magnitude of the association between dental caries and the factors which were associated with it, and linear regression was done for the continuous variables. There was a statistically significant high association between the oral hygiene practice, the eating habits of the children, the economic status and the parents' literacy levels and the caries prevalence in this study. Conclusion: This study showed that preventive efforts should be focused on young children, as the benefits are cumulative. The oral health promotion should particularly be targeted to the areas of need, to redress the inequalities.

Chronic Inflammatory Gingival Overgrowths: Laser Gingivectomy & Gingivoplasty

Journal of International Oral Health : JIOH. Feb, 2013  |  Pubmed ID: 24155582

It is quite common to note chronic inflammatory Gingival overgrowths during and/or post orthodontic treatment. Sometimes the overgrowths may even potentially complicate and/or interrupt orthodontic treatment. With the introduction of soft tissue lasers these problems can now be addressed more easily. Amongst many LASERS now available in Dentistry DIODE LASERS seem to be most ideal for orthodontic soft tissue applications. As newer treatments herald into minimally invasive techniques, DIODE LASERS are becoming more promising both in patient satisfaction and dentist satisfaction. How to cite this article: Shankar BS, Ramadevi T, Neetha M S, Reddy P S K, Saritha G, Reddy J M. Chronic Inflammatory Gingival Overgrowths: Laser Gingivectomy & Gingivoplasty. J Int Oral Health 2013; 5(1):83-87.

A Novel Mutation C.1048A>T at Codon 350(Lys>Stop) in PROC Gene Causing Neonatal Purpura Fulminans

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. Dec, 2013  |  Pubmed ID: 24158118

Purpura fulminans in the neonatal period due to severe congenital protein C deficiency (protein C activity <1 IU/dl) is a rare autosomal recessive disorder. If untreated, it is fatal. Early identification of such patients may be lifesaving. Acquired deficiency of protein C caused by increased consumption as overt disseminated intravascular coagulation (DIC) and severe infection creates a diagnostic dilemma. Mutation analysis plays a critical role in confirming the diagnosis of the disease and offering prenatal diagnosis. In this report, we describe a newborn who presented with purpura fulminans and DIC, molecular analysis showed a novel c.1048A>T transversion in a homozygous state at codon 350 (Lys>Stop) of protein C (PROC) gene. Prenatal diagnosis in subsequent pregnancy was done which revealed the affected fetus had the same mutation in homozygous form.

Liver Function Tests in Viremic and Nonviremic Chronic Hepatitis B Virus-infected Pregnant Women: Importance of Alanine Aminotransferase/sodium Ratio

Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. Nov-Dec, 2013  |  Pubmed ID: 24304526

The major risk factor of perinatal transmission of Hepatitis B virus (HBV) infection is the level of maternal HBV-deoxyribonucleic acid (DNA) during the third trimester of pregnancy. The primary aim of this study was to evaluate the hematological and biochemical status in Hepatitis B e-antigen (HBeAg)-negative chronic HBV-infected pregnant women and to correlate the findings with the presence or absence of viremia. Ninety-five consecutive chronic HBV-infected pregnant women were evaluated between the 28th and 32nd week of gestation. Viral load was determined by using the COBAS TaqMan HBV test. Sixty-nine women were evaluated and 14 of them exhibited HBV-DNA levels higher than 2000 IU·ml. In this study, viremic women exhibited significantly higher alanine aminotransferase (ALT), creatinine, and uric acid values as well as significantly lower white blood cell count compared with nonviremic women. There was also a significant statistical difference concerning ALT/sodium ratio between viremic and nonviremic women (0.20 ± 0.22 vs. 0.10 ± 0.09, respectively, p= .024). The optimal cutoff points discriminating those women with a high probability to have detectable serum HBV-DNA were 0.092 for ALT/sodium ratio (sensitivity = 73.0%, specificity = 61.5%, area under the receiver operating characteristic curve [AUC] = 71.05%) and 12.8 IU/L for ALT (sensitivity = 73.0%, specificity = 63.0%, AUC = 72.2%). Chronic HBV-infected pregnant women with ALT/sodium ratio ≥ 0.11 had the higher probability of having serum HBV-DNA levels higher than 2000 IU/ml (sensitivity = 76.92%, specificity = 58%, AUC = 62.38%). Presence of HBV-DNA in maternal blood during the third trimester of pregnancy is significantly associated with maternal serum ALT levels in HBeAg-negative chronic HBV-infected pregnant women. Women with an ALT/sodium ratio greater than 0.092 have the higher probability of HBV-DNA presence in maternal blood whereas an ALT/sodium ratio greater than 0.11 could discriminate those women with HBV-DNA levels higher than 2000 IU/ml.

Diabetic Foot Ulcer Due to Scedosporium Apiospermum

Journal of Clinical and Diagnostic Research : JCDR. Nov, 2013  |  Pubmed ID: 24392407

We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity.

Immunohistochemical Expression of PCNA in Epithelial Linings of Selected Odontogenic Lesions

Journal of Clinical and Diagnostic Research : JCDR. Nov, 2013  |  Pubmed ID: 24392421

Aim: Though odontogenic lesions have in common origin from the primitive odontogenic epithelium , there is a diversity in their initiation behavior and growth. The aggressive nature of odontogenic keratocyst similar to ameloblastoma in comparision with the other common odontogenic (dentigerous and radicular) cyst could be due to possible differences in their epithelial linings. PCNA (Proliferating cell nuclear antigen) is a cell cycle related antigen, used in the study of cell kinetics of these epithelial linings, to corelate the biological behaviour among these common odontogenic lesions. Objectives: This paper has intended to study the cell kinetics of 4 selected odontogenic lesions (dentigerous cyst, radicular cyst,odontogenic keratocyst and ameloblastoma) to demonstrate differences in their epithelial linings. Material and Methods: Sixty samples of paraffin embedded tissue specimens (archival tissues) were included (15 radicularcysts, 15 odontogenic keratocysts; 15 dentigerous cysts and15 Ameloblastoma. Results: Among cyst OKC had higher values than DC and RC. When staining results of all the cyst were compared individually with ameloblastoma ,the staining results of OKC was similar to ameloblastoma ,and ameloblastoma presented higher values than OKC (p=0.000). Conclusion: The results of this study show 1) Though OKC and DC are developmental in origin and radicular cyst is inflammatory, OKC has intrinsic growth potential among these cyst 2). Ameloblastoma has similar proliferative potential as OKC and hence it has been reinforced as KCOT(Keratocystic odontogenic tumour) in the recent classification.

Relationship Between Time of Day and Periprocedural Myocardial Infarction After Elective Angioplasty

Chronobiology International. Mar, 2014  |  Pubmed ID: 24152063

To test if the time of day significantly influences the occurrence of type 4A myocardial infarction in elective patients undergoing percutaneous coronary intervention (PCI).

Comparison of Everolimus-eluting and Biolimus-eluting Coronary Stents with Everolimus-eluting Bioresorbable Scaffold: Study Protocol of the Randomized Controlled EVERBIO II Trial

Trials. Jan, 2014  |  Pubmed ID: 24398143

Second-generation everolimus-eluting stents (EES) and third generation biolimus-eluting stents (BES) have been shown to be superior to first-generation paclitaxel-eluting stents (PES) and second-generation sirolimus-eluting stents (SES). However, neointimal proliferation and very late stent thrombosis is still an unresolved issue of drug-eluting stent (DES) implantation overall. The Absorb™ (Abbott Vascular, Abbott Park, IL, USA) is the first CE approved DES with a bioresorbable vascular scaffold (BVS) thought to reduce long-term complication rates. The EVERBIO II trial was set up to compare the BVS safety and efficacy with both EES and BES in all patients viable for inclusion.

Interaction of NPSR1 Genotypes and Probiotics in the Manifestation of Atopic Eczema in Early Childhood

Allergologia Et Immunopathologia. Jan, 2014  |  Pubmed ID: 24439655

Neuropeptide S Receptor (NPSR1) gene has been associated with multiple allergic phenotypes in several patient populations.

Survey of Ethical Issues Reported by Indian Medical Students: Basis for Design of a New Curriculum

Indian Journal of Medical Ethics. Jan-Mar, 2014  |  Pubmed ID: 24509105

Education in ethics is now a formal part of the undergraduate medical curriculum. However, most courses are structured around principles and case studies more appropriate to western countries. The cultures and practices of countries like India differ from those of western countries. It is, therefore, essential that our teaching should address the issues which are the most relevant to our setting. An anonymised, questionnaire-based, cross-sectional survey of medical students was carried out to get a picture of the ethical problems faced by students in India. The data were categorised into issues related to professional behaviour and ethical dilemmas. Unprofessional behaviour was among the issues reported as a matter of concern by a majority of the medical students. The survey highlights the need to design the curriculum in a way that reflects the structure of medical education in India, where patients are not always considered socio-culturally equal by students or the medical staff. This perspective must underpin any further efforts to address education in ethics in India.

The Economic Cost of Nonepileptic Attack Disorder in Ireland

Epilepsy & Behavior : E&B. Apr, 2014  |  Pubmed ID: 24632352

The present study endeavored to calculate a conservative estimate of both incidence- and prevalence-based costs of nonepileptic attack disorder (NEAD) in Ireland by applying previously identified prevalence figures to Irish population figures. Variables related to the economic cost of NEAD were identified based on a retrospective chart review of patients diagnosed with NEAD at Beaumont Hospital, Dublin. The annual cost per patient of undiagnosed NEAD was calculated as €20,995.30. The combined cost of diagnosis and psychological treatment of NEAD was estimated at €8728. Although it is difficult to determine precise economic costings, early diagnosis and intervention would result in a significant economic saving to the exchequer, a reduction in hospital waiting-list times, and a better prognosis for patients.

Transcatheter Renal Denervation for the Treatment of Resistant Arterial Hypertension: the Swiss Expert Consensus

Swiss Medical Weekly. Mar, 2014  |  Pubmed ID: 24652665

Transcatheter (or percutaneous) renal denervation is a novel technique developed for the treatment of resistant hypertension. So far, only one randomised controlled trial has been published, which has shown a reduction of office blood pressure. The Swiss Society of Hypertension, the Swiss Society of Cardiology, The Swiss Society of Angiology and the Swiss Society of Interventional Radiology decided to establish recommendations to practicing physicians and specialists for good clinical practice. The eligibility of patients for transcatheter renal denervation needs (1.) confirmation of truly resistant hypertension, (2.) exclusion of secondary forms of hypertension, (3.) a multidisciplinary decision confirming the eligibility, (4.) facilities that guarantee procedural safety and (5.) a long-term follow-up of the patients, if possible in cooperation with a hypertension specialist. These steps are essential until long-term data on safety and efficacy are available.

Primary Hyperparathyroidism in Young People. When Should We Perform Genetic Testing for Multiple Endocrine Neoplasia 1 (MEN-1)?

The Journal of Clinical Endocrinology and Metabolism. Apr, 2014  |  Pubmed ID: 24731012

Context: Multiple endocrine neoplasia (MEN-1) is a rare, autosomal dominant inherited disorder. Primary hyperparathyroidism (pHPT) is the most frequent and usually the earliest expression of MEN-1, with typical age of onset at 20-25 years. Early detection of the disease and correct treatment are therefore of great importance. Case presentation: A 31-year-old woman, with osteogenesis imperfecta was incidentally found also to have hypercalcaemia and elevated parathyroid hormone (pHPT). Exploratory neck surgery showed multiglandular parathyroid affection and she turned out to have MEN-1, but she was diagnosed 7 years after her debut of pHPT. Objective and methods: The aim was to search literature on indications for performing mutational analysis in young patients with pHPT and no family history of MEN-1. Pubmed was searched for English-language articles and words used were: MEN1 OR MEN-1 OR MEN type 1 OR multiple endocrine neoplasia 1 OR multiple endocrine neoplasia type 1 AND Mutational analysis OR genetic testing OR testing OR Hyperparathyroidism, primary [majr]. 625 articles reviewed. Results and discussion: Whether to perform screening of patients with pHPT under the age of 30, 35 or 40 years is controversial. According to international guidelines from 2001, genetic testing is indicated only in patients with pHPT below the age of 30 years. However, in updated guidelines from 2012 it is suggested to perform genetic testing in patients with pHPT below the age of 30 years, but at any age in patients presenting with multigland parathyroid disease. Conclusions: The reviewed literature and the presented case illustrates the importance of this change in international guidelines, but also raises concern for a potential underdiagnosing of patients before year 2012.

Hidden Regularity and Universal Classification of Fast Side Chain Motions in Proteins

Journal of the American Chemical Society. May, 2014  |  Pubmed ID: 24844417

Proteins display characteristic dynamical signatures that appear to be universal across all proteins regardless of topology and size. Here, we systematically characterize the universal features of fast side chain motions in proteins by examining the conformational energy surfaces of individual residues obtained using enhanced sampling molecular dynamics simulation(618 free energy surfaces from 0.94 microsecond MD simulation). The side chain conformational free energy surfaces obtained using the adaptive biasing force (ABF) method for a set of five proteins with different molecular weights and secondary structures are used to determine the methyl axial NMR order parameters (O(2)axis), populations of side chain rotamer states (ρ), conformational entropies, probability fluxes, and activation energies for side chain inter-rotameric transitions. The free energy barriers separating side chain rotamer states range from 0.3 to 12 kcal/mol in all proteins and follow a trimodal distribution with an intense peak at ~5 kcal/mol and two shoulders at ~3 and ~7.5 kcal/mol indicating that some barriers are more favored than others by proteins to maintain a balance between their conformational stability and flexibility. The origin and the influences of trimodal barrier distribution on the distribution of O(2)axis and the side chain conformational entropy are discussed. A hierarchical grading of rotamer states based on the conformational free energy barriers, entropy, and probability flux reveals three distinct classes of side chain in proteins. A unique non-linear correlation is established between O(2)axis and the side chain rotamer populations (ρ). The apparent universality in O(2)axis versus ρ correlation, trimodal barrier distribution, and distinct characteristics of three classes of side chain observed among all proteins indicates a hidden regularity (or commonality) in the dynamical heterogeneity of fast side chain motions in proteins.

Ten-year Clinical Follow-up After Sirolimus-eluting Stent Implantation

American Heart Journal. Jun, 2014  |  Pubmed ID: 24890540

Little is known on the "very" long-term incidence of major adverse cardiac events (MACE), target-lesion revascularization (TLR), target-vessel revascularization and stent thrombosis after sirolimus-eluting stent (SES) implantation. We present the first study to provide a 10-year clinical follow-up in an unselected patient population who underwent SES implantation.

Self Care and Medication Adherence Among Type 2 Diabetics in Puducherry, Southern India: A Hospital Based Study

Journal of Clinical and Diagnostic Research : JCDR. Apr, 2014  |  Pubmed ID: 24959496

Micro and macro-vascular complications of Type 2 Diabetes mellitus (DM) could be decreased by maintaining a good glycaemic control, which is dependent on adherence to medication and self care.

[Influence of Circadian Rhythms on Myocardial Infarction]

Revue Medicale Suisse. May, 2014  |  Pubmed ID: 24964530

Myocardial infarction is one of the most important causes of mortality and its incidence exhibits a significant circadian pattern with a peak of maximum frequency between 10 am and 11 am. Furthermore, myocardial infarction size and related mortality rate also undergo a variation over 24 hours. Recent publications have shown greatest myocardial injury when symptoms onsets are around midnight and this was independent of ischemic time and quality of care. These data were corroborated by studies using experimental models that unravel correlation between myocardial infarction's size and genes involved in circadian rhythm the link between circadian biology and pathophysiology of ischemia provides a new era of cardiovascular research and in addition new potential therapeutic targets to prevent myocardial ischemic burden.

Unicystic Ameloblastoma of the Mandible- Report of Two Cases with Review of Literature

Journal of Clinical and Diagnostic Research : JCDR. May, 2014  |  Pubmed ID: 24995253

Ameloblastoma is classified into solid/multicystic, extraosseous/peripheral, desmoplastic and unicystic types based on the clinical appearance by WHO (2003). Unicystic ameloblastoma is the 2(nd) and far less frequent growth pattern seen in intra-osseous ameloblastoma. It tends to occur in younger population and constitutes approximately 6% of ameloblastomas with no sexual or racial predilection. Here in, reporting 2 cases of cystic ameloblastoma in the mandible, in varying age groups.

Localized Multiple Cemental Excrescences: a Rare Presentation of Hypercementosis

Journal of Clinical and Diagnostic Research : JCDR. May, 2014  |  Pubmed ID: 24995256

Hypercementosis is an abnormal thickening of cementum which may be generalized or localized. Localized hypercementosis is usually characterized by nodular enlargement of apical third of root. Hypercementosis in the form of multiple cemental spikes distributed throughout the entire length of root is a very rare finding. In this article, we report such a rare manifestation of localized hypercementosis affecting right maxillary third molar in a 24-year-old male. This finding was an accidental observation following a difficult extraction procedure as the spikes were not evident in the orthopantamogram. It is imperative that every dental practitioner be aware of several presentations of hypercementosis and ensure that such an entity is considered in the differential diagnosis of difficult extraction procedures as an Intraoral Periapical (IOPA) radiograph or even an Orthopantamogram (OPG) could not differentiate the root morphology.

Phylogenetic Clustering of Hepatitis C Virus Among People Who Inject Drugs in Vancouver, Canada

Hepatology (Baltimore, Md.). Jul, 2014  |  Pubmed ID: 25042607

Little is known about factors associated with HCV transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n=313), G1b: 6% (n=41), G2a: 3% (n=20), G2b: 7% (n=46), G3a: 33% (n=213), G4a: <1% (n=4), G6a: 1% (n=8), G6e: <1% (n=1) and unclassifiable: 1% (n=9). The mean age was 36 years, 162 (25%) were female and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n=156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (vs. age ≥40, adjusted odds ratio [AOR] = 1.64; 95% CI 1.03, 2.63), HIV infection (AOR = 1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR = 3.05; 95% CI 1.40, 6.66) and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36). Conclusion: In this sample of PWID, one-third demonstrated phylogenetic clustering. Factors independently associated with phylogenetic clustering included younger age, recent HCV seroconversion, prevalent HIV infection, and recent syringe borrowing. Strategies to enhance the delivery of prevention and/or treatment strategies to those with HIV and recent HCV seroconversion should be explored, given an increased likelihood of HCV transmission in these sub-populations. 3 (Hepatology 2014;).

Analysis of Thrombotic Deposits in Extracorporeal Membrane Oxygenators by Multidetector Computed Tomography

ASAIO Journal (American Society for Artificial Internal Organs : 1992). Aug, 2014  |  Pubmed ID: 25158889

Oxygenator thrombosis is a serious complication in extracorporeal membrane oxygenation (ECMO) and may necessitate a system exchange. Coagulation and fibrinolysis parameters, flow dynamics and gas transfer performance are currently used to evaluate the degree of oxygenator thrombosis, but there is no technical approach for direct visualization and quantification of thrombotic deposits within the membrane oxygenator (MO).We used multidetector computed tomography (MDCT) with 3D post-processing to assess the incidence of oxygenator thrombosis, to quantify thrombus extent, and to localize clot distribution. Twenty heparin-coated MOs after successful weaning were analyzed. Mean ECMO support time was 7 ± 4 days, mean activated partial thromboplastin time (aPTT) during ECMO was 59 ± 20 seconds. Thrombotic deposits were detected in all MOs. The mean clot volume was 51.7 ± 22.3 cm³. All thrombotic deposits were located in the venous, i.e. inlet part of the device, without apparent evidence of embolization in patients. There was no correlation between clot volume and ECMO support time or aPTT.Clot formation within the MO is a common finding in ECMO despite adequate systemic anticoagulation. The clinical significance of thrombus formation and its influence on gas exchange capacity and hemostatic complications have to be addressed in further studies.

Genome Wide Association Study of Cholesterol and Poly- and Monounsaturated Fatty Acids, Protein, and Mineral Content of Beef from Crossbred Cattle

Meat Science. Dec, 2014  |  Pubmed ID: 25170816

The objectives were to determine the variation explained by the BovineSNP50v2 BeadChip for cholesterol (CH), polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), protein, and minerals in beef cattle, and to identify chromosomal regions that harbor major allelic variants underlying the variation of these traits. Crossbred steers and heifers (n=236) segregating at the inactive myostatin allele on BTA2 were harvested and steaks were sampled from the M. semitendinosus and the M. longissimus thoracis et lumborum for nutrient analysis. A Bayes C algorithm was employed in genome-wide association analysis. The resulting posterior heritability (SD) estimates ranged from 0.43 (0.10) to 0.71 (0.08) for lipid traits and 0.05 (0.08) to 0.75 (0.06) for mineral traits. Across cuts, correlations between genomic estimated breeding values (GEBV) were similar for CH, MUFA and PUFA. The top 0.5% 1-Mb windows for all traits explained up to 9.93% of the SNP variance. Slight differences did exist between cuts and between different measurement scales of fatty acids.

Randomized Comparison of Biodegradable Polymer Sirolimus-eluting Stents Versus Durable Polymer Everolimus-eluting Stents for Percutaneous Coronary Revascularization: Rationale and Design of the BIOSCIENCE Trial

American Heart Journal. Sep, 2014  |  Pubmed ID: 25173535

Biodegradable polymers for release of antiproliferative drugs from metallic drug-eluting stents aim to improve long-term vascular healing and efficacy. We designed a large scale clinical trial to compare a novel thin strut, cobalt-chromium drug-eluting stent with silicon carbide-coating releasing sirolimus from a biodegradable polymer (O-SES, Orsiro; Biotronik, Bülach, Switzerland) with the durable polymer-based Xience Prime/Xpedition everolimus-eluting stent (EES) (Xience Prime/Xpedition stent, Abbott Vascular, IL) in an all-comers patient population.

Ultrathin Strut Biodegradable Polymer Sirolimus-eluting Stent Versus Durable Polymer Everolimus-eluting Stent for Percutaneous Coronary Revascularisation (BIOSCIENCE): a Randomised, Single-blind, Non-inferiority Trial

Lancet (London, England). Dec, 2014  |  Pubmed ID: 25189359

Refinements in stent design affecting strut thickness, surface polymer, and drug release have improved clinical outcomes of drug-eluting stents. We aimed to compare the safety and efficacy of a novel, ultrathin strut cobalt-chromium stent releasing sirolimus from a biodegradable polymer with a thin strut durable polymer everolimus-eluting stent.

A Propensity Score-matched Comparison Between Cardia and Amplatzer PFO Closure Devices - Insights from the SOLUTION Registry (Swiss PercutaneOus Patent Foramen Ovale CLosUre in Recurrent Clinical Events PrevenTION)

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jun, 2015  |  Pubmed ID: 24830681

To compare clinical outcome of Amplatzer PFO (APFO) to Cardia PFO (CPFO) occluder. Percutaneous patent foramen ovale (PFO) closure prevents stroke recurrence in stroke due to paradoxical embolism.

Five-year Results of a Randomised Comparison of Titanium-nitride-oxide-coated Stents with Zotarolimus-eluting Stents for Coronary Revascularisation

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Mar, 2015  |  Pubmed ID: 25572026

Stents with a passive coating of titanium-nitride-oxide (TiNO) have been compared with Endeavor® zotarolimus-eluting stents (E-ZES) with regard to the primary endpoint of in-stent late lumen loss at six to eight months. The objective of the present analysis was to compare the long-term outcomes of TiNO stents with E-ZES up to five years of clinical follow-up.

Comparison of a Novel Biodegradable Polymer Sirolimus-eluting Stent with a Durable Polymer Everolimus-eluting Stent: Results of the Randomized BIOFLOW-II Trial

Circulation. Cardiovascular Interventions. Feb, 2015  |  Pubmed ID: 25634905

Biodegradable polymers for release of antiproliferative drugs from drug-eluting stents aim to improve vascular healing. We assessed noninferiority of a novel ultrathin strut drug-eluting stent releasing sirolimus from a biodegradable polymer (Orsiro, O-SES) compared with the durable polymer Xience Prime everolimus-eluting stent (X-EES) in terms of the primary end point in-stent late lumen loss at 9 months.

Comparison of Everolimus- and Biolimus-eluting Coronary Stents With everolimus-eluting Bioresorbable Vascular Scaffolds

Journal of the American College of Cardiology. Mar, 2015  |  Pubmed ID: 25720622

The first CE-approved bioresorbable vascular scaffold (BVS) is effective at treating simple lesions and stable coronary artery disease, but it has yet to be assessed versus the best-in-class drug-eluting stents (DES).

Clinical Outcomes According to Diabetic Status in Patients Treated with Biodegradable Polymer Sirolimus-eluting Stents Versus Durable Polymer Everolimus-eluting Stents: Prespecified Subgroup Analysis of the BIOSCIENCE Trial

Circulation. Cardiovascular Interventions. Jun, 2015  |  Pubmed ID: 26043895

Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) proved noninferior to durable polymer everolimus-eluting stents (DP-EES) for a composite clinical end point in a population with minimal exclusion criteria. We performed a prespecified subgroup analysis of the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation (BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in patients with diabetes mellitus.

Subsurface Ablation of Atherosclerotic Plaque Using Ultrafast Laser Pulses

Biomedical Optics Express. Jul, 2015  |  Pubmed ID: 26203381

We perform subsurface ablation of atherosclerotic plaque using ultrafast pulses. Excised mouse aortas containing atherosclerotic plaque were ablated with ultrafast near-infrared (NIR) laser pulses. Optical coherence tomography (OCT) was used to observe the ablation result, while the physical damage was inspected in histological sections. We characterize the effects of incident pulse energy on surface damage, ablation hole size, and filament propagation. We find that it is possible to ablate plaque just below the surface without causing surface damage, which motivates further investigation of ultrafast ablation for subsurface atherosclerotic plaque removal.

Optical Coherence Tomography Findings in Bioresorbable Vascular Scaffolds Thrombosis

Circulation. Cardiovascular Interventions. Oct, 2015  |  Pubmed ID: 26399265

Everolimus-eluting bioresorbable vascular scaffolds have been developed to improve late outcomes after coronary interventions. However, recent registries raised concerns regarding an increased incidence of scaffold thrombosis (ScT). The mechanism of ScT remains unknown.

Prognostic Value of Troponin I for Infarct Size to Improve Preclinical Myocardial Infarction Small Animal Models

Frontiers in Physiology. 2015  |  Pubmed ID: 26640441

Coronary artery ligations to induce myocardial infarction (MI) in mice and rats are widely used in preclinical investigation. However, myocardial ischemic damage and subsequent infarct size are highly variable. The lack of standardization of the model impairs the probability of effective translation to the clinic. Cardiac Troponin I (cTnI) is a major clinically relevant biomarker.

Biodegradable Polymer Sirolimus-eluting Stents Versus Durable Polymer Everolimus-eluting Stents for Primary Percutaneous Coronary Revascularisation of Acute Myocardial Infarction

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Dec, 2015  |  Pubmed ID: 26690319

Our aim was to compare the safety and efficacy of a novel, ultrathin strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin strut, durable polymer everolimus-eluting stent (DP-EES) in a pre-specified subgroup of patients with acute ST-segment elevation myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial.

Coronary Healing After Stenting: Wounds, Faith, and the Quest for the Perfect Stent

European Heart Journal Cardiovascular Imaging. Jan, 2016  |  Pubmed ID: 26377906

Comparison of Endothelium-dependent and -independent Vasomotor Response After Abluminal Biodegradable Polymer Biolimus-eluting Stent and Persistent Polymer Everolimus-eluting Stent Implantation (COMPARE-IT)

International Journal of Cardiology. Jan, 2016  |  Pubmed ID: 26440470

Drug-eluting stents (DES) have been associated with local endothelial dysfunction in the segments proximal and distal to the stent (peristent segments) and increased thrombotic risk in long term follow-up. Little data exists on endothelial function post-implantation of new DES with biodegradable polymer. The aim of our study was to compare the local endothelial function assessed by exercise induced coronary vasomotion after implantation of a biolimus A9-eluting stent with biodegradable polymer (BES) with an everolimus-eluting stent with durable polymer (EES).

Coronary Evaginations and Peri-scaffold Aneurysms Following Implantation of Bioresorbable Scaffolds: Incidence, Outcome, and Optical Coherence Tomography Analysis of Possible Mechanisms

European Heart Journal. Jul, 2016  |  Pubmed ID: 26543048

Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS).

Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

Circulation. Feb, 2016  |  Pubmed ID: 26762519

The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography, we investigated potential causes of this adverse event.

Vascular Response to Everolimus- and Biolimus-eluting Coronary Stents Versus Everolimus-eluting Bioresorbable Scaffolds--an Optical Coherence Tomography Substudy of the EVERBIO II Trial

Swiss Medical Weekly. 2016  |  Pubmed ID: 26766027

Head-to-head optical coherence tomography (OCT) data comparing metallic stents with bioresorbable vascular scaffolds (BVS) are lacking. This study assessed vascular healing at 9-month follow-up after implantation of everolimus- and biolimus-eluting stents (EES; BES) and everolimus-eluting BVS.

Heart Rate Never Lies: Interventional Cardiologist and Braude's Quote Revised

Open Heart. 2016  |  Pubmed ID: 26835145

Interventional cardiologists may be immune to stress, allowing them to perform complex percutaneous interventions under pressure.

Bioresorbable Coronary Scaffold Thrombosis: Multicenter Comprehensive Analysis of Clinical Presentation, Mechanisms, and Predictors

Journal of the American College of Cardiology. Mar, 2016  |  Pubmed ID: 26916481

Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]).

Mechanisms of Late and Very Late Bioresorbable Vascular Scaffold Thrombosis: Is It Only About Flow?

Journal of the American College of Cardiology. Mar, 2016  |  Pubmed ID: 26965551

Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable-Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularization: 2-Year Results of the BIOSCIENCE Trial

Journal of the American Heart Association. Mar, 2016  |  Pubmed ID: 26979080

No data are available on the long-term performance of ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES). We reported 2-year clinical outcomes of the BIOSCIENCE (Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation) trial, which compared BP-SES with durable-polymer everolimus-eluting stents (DP-EES) in patients undergoing percutaneous coronary intervention.

Biodegradable-Polymer Sirolimus-Eluting Stents Versus Durable-Polymer Everolimus-Eluting Stents in Patients With Acute ST-Segment Elevation Myocardial Infarction: Insights From the 2-Year Follow-Up of the BIOSCIENCE Trial

JACC. Cardiovascular Interventions. May, 2016  |  Pubmed ID: 27151616

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

The American Journal of Cardiology. Jul, 2016  |  Pubmed ID: 27239022

We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). Because of an increased incidence of long-term malignancy in interventional cardiologists, operator radiation exposure is of rising concern. This prospective study included all consecutive patients who underwent elective or emergency CA ± PCI from September 2014 to March 2015. The primary end point was operator radiation exposure, quantified as the ratio of operator cumulative dose (CD) and patient radiation reported as dose-area product (DAP) (CD/DAP). Secondary end points included CD, DAP, and fluoroscopy time (FT). Overall 830 procedures (457 CA [55%] and 373 PCI [45%]) were performed, 455 (55%) through RFA, 272 (33%) through RRA, and 103 (12%) through LRA. The CD/DAP was lower in RFA (0.09 μSv/Gycm(2) [0.02 to 0.20]) compared with RRA (0.47 μSv/Gycm(2) [0.25 to 0.75], p <0.001). The LRA showed lower CD/DAP compared with RRA (p <0.001). CD was significantly lower in RFA (3 μSv [1 to 7]) compared with RRA (12 μSv [6 to 29], p <0.001). The LRA showed lower CD compared with RRA (p <0.001). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 ± 7, RRA 5 ± 5, LRA 6 ± 5 minutes, RFA vs RRA: p = 1, RFA vs LRA: p = 0.16, RRA vs LRA: p = 0.52). In conclusion, the use of RFA during CA ± PCI is associated with significantly lower operator radiation exposure compared with RRA. LRA is associated with significantly lower operator radiation exposure compared with RRA.

Bioresorbable Vascular Scaffolds-time to Vanish?

Journal of Thoracic Disease. Jun, 2016  |  Pubmed ID: 27293872

The fully bioabsorbable vascular scaffold (BVS) has been developed to reduce late adverse events after coronary stenting such as device thrombosis. The device consists of polylactic acid, which is gradually absorbed within the first few years after its implantation. The initial experience with the device in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of the device in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of early device thrombosis. The performance of the device largely depends on an optimal implantation technique, which differs from that employed with metallic drug-eluting stents due to the device's distinct physical propensity. Mid-term outcomes in large-scale randomized clinical trial were disappointing. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation. However, the BVS's putative advantages are expected to manifest themselves at long-term, that is 3 to 5 years after the device has been implanted. Evidence pertaining to these long-term outcomes is eagerly awaited.

Reply: Bioresorbable Scaffold Thrombosis: Why BRS Size Matters

Journal of the American College of Cardiology. Aug, 2016  |  Pubmed ID: 27470463

Angiographic Complexity of Coronary Artery Disease According to SYNTAX Score and Clinical Outcomes After Revascularisation with Newer-generation Drug-eluting Stents: a Substudy of the BIOSCIENCE Trial

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Aug, 2016  |  Pubmed ID: 27497359

We sought to assess the performance of drug-eluting stents combining an ultrathin cobalt-chromium platform with a biodegradable polymer across categories of increasing SYNTAX score (SS).

Will ABSORB III Change My Practice? Everolimus-eluting Bioresorbable Scaffolds for Coronary Artery Disease

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Aug, 2016  |  Pubmed ID: 27542795

Intra-Arterial Drug and Light Delivery for Photodynamic Therapy Using Visudyne®: Implication for Atherosclerotic Plaque Treatment

Frontiers in Physiology. 2016  |  Pubmed ID: 27672369

Photodynamic therapy (PDT), which is based on the activation of photosensitizers with light, can be used to reduce plaque burden. We hypothesized that intra-arterial photosensitizer administration and photo-activation will lead to high and rapid accumulation within the plaque with reduced systemic adverse effects. Thus, this "intra-arterial" PDT would be expected to have less side effects and due to the short time involved would be compatible with percutaneous coronary interventions.

Bioresorbable Vascular Scaffold: Promises and the Fallen Child-as-king?

Open Heart. 2016  |  Pubmed ID: 27843570

Photodynamic Therapy for the Treatment of Atherosclerotic Plaque: Lost in Translation?

Cardiovascular Therapeutics. Nov, 2016  |  Pubmed ID: 27893195

Acute coronary syndromeis a life-threatening condition of utmost clinical importance, which, despite recent progress in the field, is still associated with high morbidity and mortality. Acute coronary syndrome results from a rupture or erosion of vulnerable atherosclerotic plaque with secondary platelet activation and thrombus formation, which leads to partial or complete luminal obstruction of a coronary artery. During the last decade, scientific evidence demonstrated that, when an acute coronary event occurs, several non-culprit plaques are in a "vulnerable" state. Among the promising approaches, several investigations provided evidence of photodynamic therapy (PDT) induced stabilisation and regression of atherosclerotic plaque. Significant development of PDT strategies improved its therapeutic outcome. This review addresses PDT's pertinence and major problems/challenges toward its translation to a clinical reality. This article is protected by copyright. All rights reserved.

Impact of Patient and Lesion Complexity on Long-Term Outcomes Following Coronary Revascularization With New-Generation Drug-Eluting Stents

The American Journal of Cardiology. Nov, 2016  |  Pubmed ID: 27923461

Long-term clinical outcomes of new-generation drug-eluting stents in complex anatomic and clinical settings are not well defined. This study assessed the impact of patient and lesion complexity on 2-year outcomes after coronary revascularization with ultrathin strut biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified analysis of the BIOSCIENCE randomized trial (NCT01443104), complex patients (911 of 2,119; 43%) were defined by the presence of acute ST-elevation myocardial infarction (MI); left ventricular ejection fraction ≤30%; renal dysfunction; insulin-treated diabetes; treatment of ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel intervention. The primary end point was target lesion failure (TLF), a composite of cardiac death, target vessel MI, and clinically indicated target lesion revascularization. At 2 years, complex compared with simple patients had a greater risk of TLF (14.5% vs 7.4%, risk ratio 2.05, 95% confidence interval 1.56 to 2.69; p <0.001). The difference was sustained beyond 1 year on landmark analysis. Complex patients had higher rates of the patient-oriented composite end point of death, any MI, or any revascularization (23% vs 14.4%; p <0.001) as well as definite stent thrombosis (1.6% vs 0.4%, p = 0.006). There were no differences in TLF and patient-oriented composite end point between the BP-SES versus DP-EES, consistently among simple and complex patients. In conclusion, patient and lesion complexity had a durable adverse impact on clinical outcomes throughout 2 years of follow-up in this all-comers randomized trial. Safety and efficacy of new-generation BP-SES and DP-EES were comparable, irrespective of complexity status.

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