WorldWideScience

Sample records for in-stent restenosis late

  1. Late In-Stent Restenosis of the Abdominal Aorta in a Patient with Takayasu's Arteritis and Related Pathology

    International Nuclear Information System (INIS)

    Ishibashi-Ueda, Hatsue; Yutani, Chikao; Kuribayashi, Sachio; Takamiya, Makoto; Imakita, Masami; Ando, Motomi

    1999-01-01

    This report describes an in-stent restenosis of the infrarenal aorta in a patient with Takayasu's arteritis in a nonactive state. A 10-mm-diameter Wallstent had been deployed 42 months previously. The stented restenosed segment was replaced by a surgical graft. Histopathological examination of the excised aortic segment showed a thin layer of fibrocellular neointima and massive organized and calcified thrombus. To our knowledge, this is the first histopathological report of a late in-stent restenosis of the abdominal aorta in Takayasu's arteritis. RID='''' ID='''' Correspondence to: H. Ishibashi-Ueda, M.D

  2. Modelling and simulating in-stent restenosis with complex automata

    NARCIS (Netherlands)

    Hoekstra, A.G.; Lawford, P.; Hose, R.

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling bulk flow, drug diffusion, and

  3. Colchicine reduces restenosis after balloon angioplasty treatment for in-stent restenosis.

    Science.gov (United States)

    Kong, Junying; Deng, Ying; Dong, Qiang; Liu, Wenhua; Lu, Ying

    2015-02-01

    Treatment of coronary in-stent restenosis (ISR) is hampered by a high incidence of recurrent ISR. Colchicine is an old drug with known anti-inflammatory and antiproliferative actions. We evaluated the strategy of colchicine combined with conventional balloon angioplasty for the treatment of ISR. Sixty coronary arteries of 60 mini-pigs underwent oversized bare-metal stent implantation to induce ISR. After 28 days, vessels with ISR (≥50% diameter stenosis) were randomly divided into three groups: control (conventional balloon angioplasty combined with placebo), colchicine (conventional balloon angioplasty combined with colchicine) and drug-eluting balloon (DEB). Restenosis and neointima formation were elevated with angiography and histological and morphometric analysis at 28 days after different interventions. Late lumen loss and percent area stenosis at follow-up were lower in colchicine group compared to control group but were similar to those of DEB group. There was no significant difference in proliferating cell nuclear antigen-positive vascular smooth muscle cells and inflammatory score between the colchicine group and the DEB group. The efficacy of colchicine combined with conventional balloon angioplasty for treatment of ISR was comparable to that of DEB. Treatment of ISR might not require a second stent implantation, and colchicine combined with conventional balloon angioplasty seemed to be another consideration. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

  4. Quantification of in-stent restenosis parameters in rabbits by micro-CT

    International Nuclear Information System (INIS)

    Langheinrich, A.C.; Zoerb, C.; Jajima, J.; Lommel, D.; Rau, W.S.; Walker, G.; Mueller, K.M.; Bohle, R.M.

    2005-01-01

    Purpose: The well-defined model of angioplasty and stent implantation in the rabbit aorta is useful in experimental studies of restenosis. This study was performed to evaluate the feasibility of Micro-CT for quantification of in-stent restenosis in a rabbit aortic in-stent restenosis model. Material and Methods: To induce in-stent restenosis seven female New Zealand rabbits underwent balloon dilation and denudation prior to stenting the abdominal aorta. After six weeks on atherogenic diet, animals were killed and the aorta was perfused with contrast agent. Micro-CT morphometric analysis of balloon and stent injured arteries obtained by 700 transverse sections (voxel size 10 μm) was compared to conventional histological analysis. Results: Intimal hyperplasia was present in stented and balloon injured arteries with a moderate intimal area assessed by Micro-CT and conventional histology (3.91±0.5 mm 2 vs. 4.18±0.42; r=0.9). High significant correlations between Micro-CT image analysis and conventional histomorphometry were obtained for lesion size, size of media, size of lumen and stent area (r=0.84 to 0.96). Conclusion: Micro-CT is feasible for quantitative information about restenosis following balloon angioplasty and stent implantation and has the potential to become a standard technique in many laboratories which will augment serial histology as the reference method for ex-vivo studies of restenosis. (orig.)

  5. Does nickel allergy play a role in the development of in-stent restenosis?

    Science.gov (United States)

    El-Mawardy, R; Fuad, H; Abdel-Salam, Z; Ghazy, M; Nammas, W

    2011-11-01

    It was suggested that coronary in-stent restenosis might be triggered by allergy to nickel and molybdenum ions released from stainless-steel stents. We sought to explore any possible relationship between nickel allergy and in-stent restenosis. 50 patients were studied, who underwent elective follow-up coronary angiography for recurrent symptoms after prior coronary stenting, at least 3 months following the index procedure. Consecutively, we enrolled 25 patients with > or = 50% in-stent restenosis (study group), and 25 others with nickel allergy was performed using 5% nickel sulphate solution in petroleum applied as a patch test to the interscapular region by the Finn chamber method. A positive test was defined as an inflammatory response with erythema, edema, papulovesicles, or infiltration after 48 or 72 hours. The mean age of the whole study cohort was 55.9 +/- 13.9 years, 44 (88%) being males. Two patients of the study group (8%) had a history of contact allergy to metals. However, both of them showed a negative patch test result. No patient in the control group had a history of metal allergy (p > 0.05). Only one patient in the study group (4%) had a positive patch test result for nickel contact allergy, whereas all patients in the control group had a negative result (p > 0.05). Based on the available evidence, a cause-effect relationship between nickel allergy and in-stent restenosis cannot be confirmed.

  6. From histology and imaging data to models for in-stent restenosis

    NARCIS (Netherlands)

    Amatruda, C.M.; Bona Casas, C.; Keller, B.K.; Tahir, H.; Dubini, G.; Hoekstra, A.; Hose, D.R.; Lawford, P.; Migliavacca, F.; Narracott, A.J.; Gunn, J.

    2014-01-01

    The implantation of stents has been used to treat coronary artery stenosis for several decades. Although stenting is successful in restoring the vessel lumen and is a minimally invasive approach, the long-term outcomes are often compromised by in-stent restenosis (ISR). Animal models have provided

  7. Technical options for treatment of in-stent restenosis after carotid artery stenting

    NARCIS (Netherlands)

    Pourier, Vanessa E C|info:eu-repo/dai/nl/413970310; de Borst, Gert J.|info:eu-repo/dai/nl/237108151

    2016-01-01

    Objective This review summarizes the available evidence and analyzes the current trends on treatments for carotid in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods An update of a 2010 review of the literature (which included 20 articles) was conducted using PubMed and Embase.

  8. Nickel and molybdenum contact allergies in patients with coronary in-stent restenosis.

    Science.gov (United States)

    Köster, R; Vieluf, D; Kiehn, M; Sommerauer, M; Kähler, J; Baldus, S; Meinertz, T; Hamm, C W

    2000-12-02

    Coronary in-stent restenosis might be triggered by contact allergy to nickel, chromate, or molybdenum ions released from stainless-steel stents. We investigated the association between allergic reactions to stent components and the occurrence of in-stent restenosis. Patients with coronary stainless-steel stents who underwent angiography for suspected restenosis were consecutively included in this study. Quantitative coronary angiography for analysis of percentage diameter stenosis was done on 131 patients (mean age 62 years [SD 9]) with 171 stents 6.1 months (2.7) after stent implantation. All patients underwent epicutaneous patch tests (Finn chamber method) for nickel, chromate, molybdenum, manganese, and small 316L stainless-steel plates. Patch tests were assessed by independent dermatologists after 48 h, 72 h, and when necessary 96 h of contact with the potential allergen. In-stent restenosis (> or =550% diameter stenosis) occurred in 89 patients. All ten patients with positive patch-test results had restenoses (p=0.03). Four male patients had positive reactions to molybdenum, and seven patients (four male, three female) had reactions to nickel. No patient with an allergic reaction to the standard test substances had a positive reaction to the stainless-steel plates. All patients with positive results had recurrent angina pectoris and needed target-vessel revascularisation. Patients with allergic patch-test reactions to nickel and molybdenum had a higher frequency of in-stent restenoses than patients without hypersensitivity. Allergic reactions to nickel and molybdenum released from stents may be one of the triggering mechanisms for in-stent restenosis.

  9. Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil

    Directory of Open Access Journals (Sweden)

    Fábio Sândoli de Brito Jr

    2001-09-01

    Full Text Available Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial. The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

  10. Bioresorbable vascular scaffold to treat malignant in-stent restenosis in a patient with nickel allergy.

    Science.gov (United States)

    Jurado-Román, Alfonso; López-Lluva, María T; Sánchez-Pérez, Ignacio; Piqueras-Flores, Jesús; Maseda, Ramón; Lozano-Ruíz-Poveda, Fernando

    2017-09-01

    Nickel is the most frequent allergen in patients with allergic contact dermatitis and nickel allergy has been associated with recurrent in-stent restenosis. However, it is often misdiagnosed because of a low suspicion threshold. It should be discarded in patients with recurrent in-stent restenosis, especially if their medical history reveals prior contact dermatitis. It is also noteworthy and rarely specified that even newer generation stents that use novel metal alloys also contain low amounts of nickel. To avoid the implantation of new stents containing this metal, when percutaneous coronary intervention is indicated, drug eluting balloons or bioresorbable vascular scaffolds associated with small doses of steroids could provide good alternatives of treatment. To the best of our knowledge, this is the first description of this therapeutic alternative in such an exceedingly rare clinical scenario. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Relation of Nickel Allergy with in-Stent Restenosis in Patients Treated with Cobalt Chromium Stents

    OpenAIRE

    Aliağaoğlu, Cihangir; Turan, Hakan; Erden, İsmail; Albayrak, Hülya; Özhan, Hakan; Başar, Cengiz; Gürlevik, Zehra; Alçelik, Ayşegül

    2012-01-01

    Background In-stent restenosis (ISR) is the major limitation of percutaneous coronary stenting procedure. The elements like nickel, chromate and molybdenum are known to cause contact allergy. Hypersensitivity reaction, against these metal ions, may be one of the reasons of ISR. Cobalt chromium coronary stents, which are increasingly being used in percutaneous coronary interventions, have more nickel amount than the stainless steel stents. Objective We aimed to investigate the association betw...

  12. In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

    International Nuclear Information System (INIS)

    Hussain, S.; Raza, A.; Ahmed, W.

    2011-01-01

    A lady with aortitis syndrome developed in-stent restenosis (ISR) of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty (PTA) with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting (CAS) in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels. (author)

  13. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    International Nuclear Information System (INIS)

    Ota, Hideaki; Mahmoudi, Michael; Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D.; Waksman, Ron

    2015-01-01

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis

  14. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-04-15

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.

  15. Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis. From western denmark heart registry

    DEFF Research Database (Denmark)

    Jensen, Jesper; Jensen, Lisette Okkels; Terkelsen, Christian Juhl

    2012-01-01

    There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis or resteno......There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis...

  16. Multiscale coupling of a Lattice Boltzmann simulation of blood flow to cell- and tissue-level processes: the case of in-stent restenosis

    NARCIS (Netherlands)

    Hoekstra, A.G.; Pereira, J.C.F.; Sequeira, A.; Pereira, J.M.C.

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling blood flow, drug diffusion, and

  17. Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

    Energy Technology Data Exchange (ETDEWEB)

    Arikawa, Ryo [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Yamaguchi, Hiroshi, E-mail: hyamaguchi@tsm.bbiq.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan)

    2015-01-15

    Background: Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate. Methods: We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns. Results: Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12). Conclusions: Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.

  18. The role of drug-coated balloons in in-stent restenosis.

    Science.gov (United States)

    Andrassy, Martin; Celik, Sultan; Andrassy, Joachim; Lichtenberg, Michael K; Brodmann, Marianne

    2017-08-01

    Despite a constantly expanding spectrum of therapeutic options for lower limb artery disease, there is not yet a well-defined consensus on the specific type of endovascular treatment that is best suited. Clinical data on patients with femoropopliteal disease treated with drug-coated balloons have not been elaborated sufficiently, especially in the case of in-stent restenosis. For this review a systematic research of the medical databases (Pubmed) has been conducted. Keywords such as "drug-coated balloons" (DCB), "drug-eluting balloons," "in-stent restenosis", "de novo stenosis", "angioplasty", "superficial femoral artery," "popliteal artery," "above the knee," "below the knee," "peripheral artery disease" (PAD) have been used. Furthermore, data from reviews, original contributions regarding randomized controlled studies, observational studies, registries and single center experiences have been included. Many trials have shown superiority for DCB- over percutaneous transluminal angioplasty-treatment alone in TASC IIA and TASC IIB femoropopliteal lesions. However, the currently available DCB systems are different in terms of efficacy and long-term outcomes depending on their mechanical and pharmacological features. Moreover, angiographic characteristics of femoropopliteal lesions classified by Tosaka seem to influence subsequent outcomes of DCB treatment. Lastly, there is still lack of reliable prospective long-term data regarding DCB technology.

  19. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

    Energy Technology Data Exchange (ETDEWEB)

    Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

    2010-11-15

    Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

  20. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis) : Angiographic Results and 1-Year Clinical Outcomes

    NARCIS (Netherlands)

    Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis; Erglis, Andrejs; Sondore, Dace; Agostoni, Pierfrancesco|info:eu-repo/dai/nl/34169276X; Cornelis, Kristoff; Janssens, Luc P F; Maeng, Michael; Slagboom, Ton; Amoroso, Giovanni; Jensen, Lisette Okkels; Granada, Juan F; Stella, Pieter|info:eu-repo/dai/nl/304814717

    2017-01-01

    Objectives The aim of this first-in-human study was to assess the safety and effectiveness of the Virtue sirolimus-eluting balloon in a cohort of patients with in-stent restenosis (ISR). Background Angioplasty balloons coated with the cytotoxic drug paclitaxel have been widely used for ISR

  1. A Comparison of Fully-Coupled 3D In-Stent Restenosis Simulations to In-vivo Data

    NARCIS (Netherlands)

    Zun, P.S.; Anikina, T.; Svitenkov, A.I.; Hoekstra, A.G.

    We describe our fully-coupled 3D multiscale model of in-stent restenosis, with blood flow simulations coupled to smooth muscle cell proliferation, and report results of numerical simulations performed with this model. This novel model is based on several previously reported 2D models. We study the

  2. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted

    2012-01-01

    as time-dependent variables. A total of 12,277 patients were treated with stent implantation. Stent thrombosis was observed in 111 (0.9%) patients and in-stent restenosis in 503 (4.1%) patients within 12 months after the index PCI. Occurrence of stent thrombosis was associated with an increased risk...

  3. Clinical results of Intracoronary Brachytherapy (ICBT) for multiple in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Stadler, P. [Dept. of Radiotherapy and Radiation Oncology, Univ. Hospital Regensburg (Germany); Praxis Muehleninsel, Landshut-Muehldorf-Dingolfing (Germany); Schaefer, C.; Chaber, S.; Putnik, K.; Treutwein, M.; Koelbl, O. [Dept. of Radiotherapy and Radiation Oncology, Univ. Hospital Regensburg (Germany); Muders, F. [Dept. of Cardiology, Univ. Hospital Regensburg (Germany)

    2006-06-15

    Background and purpose: treatment of in-stent restenosis (ISR) with percutaneous coronary intervention (PCI) alone is often followed by early re-restenosis. The present study focused on the effect of intracoronary brachytherapy (ICBT) on multiple in-stent restenosis (MISR) after repeated PCI. Patients and methods: 40 patients (27 male, 13 female, age: 66 {+-} 9 years) with MISR (two to six ISRs, median three ISRs) were retrospectively analyzed. All patients were treated by using the Novoste {sup registered} Beta-Cath trademark 3.5F System after PCI. The target vessel received 18.4-25.3 Gy of radiation at a depth of 2 mm from the center of the source. The restenosis-free survival and overall survival were calculated by Kaplan-Meier analysis (log-rank). The time interval between last PCI without ICBT and the consecutive recurrence was compared with the follow-up time after PCI with ICBT. Results: the 3-year overall survival rate after ICBT was 93%. The 0.5-, 1-, 2-, and 3-year ISR-free survival rates after PCI + ICBT were 81%, 72%, 52%, and 38%, respectively. After PCI alone, the 0.5-, 1-, and 2-year ISR-free survival rates were 30%, 13%, and 0%, respectively. This difference was highly significant (p < 0.0001). Patients with more than three ISRs before ICBT had a better outcome (3-year ISR-free survival: 80%) than patients with only two or three ISRs before ICBT (3-year ISR-free survival: 25%; p < 0.05). Conclusion: ICBT is highly effective and safe in patients with ISR. The results of this study are in accordance with the WRIST and BETA-WRIST data. After 6 months both studies revealed an ISR-free survival rate of 86% (WRIST) and 66% (BETA-WRIST), respectively. The ISR rates in the own control group (70%) were comparable to the placebo groups in WRIST (68%) and BETA-WRIST (72%). Interestingly, patients with more than three ISRs before ICBT had the lowest ISR rate after ICBT. (orig.)

  4. Clinical results of Intracoronary Brachytherapy (ICBT) for multiple in-stent restenosis

    International Nuclear Information System (INIS)

    Stadler, P.; Schaefer, C.; Chaber, S.; Putnik, K.; Treutwein, M.; Koelbl, O.; Muders, F.

    2006-01-01

    Background and purpose: treatment of in-stent restenosis (ISR) with percutaneous coronary intervention (PCI) alone is often followed by early re-restenosis. The present study focused on the effect of intracoronary brachytherapy (ICBT) on multiple in-stent restenosis (MISR) after repeated PCI. Patients and methods: 40 patients (27 male, 13 female, age: 66 ± 9 years) with MISR (two to six ISRs, median three ISRs) were retrospectively analyzed. All patients were treated by using the Novoste registered Beta-Cath trademark 3.5F System after PCI. The target vessel received 18.4-25.3 Gy of radiation at a depth of 2 mm from the center of the source. The restenosis-free survival and overall survival were calculated by Kaplan-Meier analysis (log-rank). The time interval between last PCI without ICBT and the consecutive recurrence was compared with the follow-up time after PCI with ICBT. Results: the 3-year overall survival rate after ICBT was 93%. The 0.5-, 1-, 2-, and 3-year ISR-free survival rates after PCI + ICBT were 81%, 72%, 52%, and 38%, respectively. After PCI alone, the 0.5-, 1-, and 2-year ISR-free survival rates were 30%, 13%, and 0%, respectively. This difference was highly significant (p < 0.0001). Patients with more than three ISRs before ICBT had a better outcome (3-year ISR-free survival: 80%) than patients with only two or three ISRs before ICBT (3-year ISR-free survival: 25%; p < 0.05). Conclusion: ICBT is highly effective and safe in patients with ISR. The results of this study are in accordance with the WRIST and BETA-WRIST data. After 6 months both studies revealed an ISR-free survival rate of 86% (WRIST) and 66% (BETA-WRIST), respectively. The ISR rates in the own control group (70%) were comparable to the placebo groups in WRIST (68%) and BETA-WRIST (72%). Interestingly, patients with more than three ISRs before ICBT had the lowest ISR rate after ICBT. (orig.)

  5. Bioresorbable vascular scaffold for coronary in-stent restenosis: A novel concept

    Directory of Open Access Journals (Sweden)

    Surender Deora

    2014-07-01

    Full Text Available The management of patients with significant in-stent restenosis (ISR with drug-eluting stent is still not well defined. Various treatment modalities include plain old balloon angioplasty (POBA, metallic stent, cutting or scoring balloon and drug-eluting balloon (DEB. Bioresorbable vascular scaffold (BVS is the latest technology for the treatment of de novo coronary artery lesions. The use of BVS in ISR is based on the rationale of local drug delivery as achieved by DEB without the permanent bi-layer of metal and also stabilizes dissection flaps and prevents acute recoil as provided by metallic stent. To the best of our knowledge this is the first case report of the use of BVS in patient with ISR.

  6. Novel Use of an Orbital Atherectomy Device for In-Stent Restenosis: Lessons Learned

    Directory of Open Access Journals (Sweden)

    K. Shaikh

    2016-01-01

    Full Text Available We present a case of a 67-year-old man with stage III chronic kidney disease, uncontrolled diabetes mellitus, coronary artery disease, and high surgical risk who presented with two episodes of acute coronary syndrome attributed to in-stent restenosis (ISR associated with heavily calcified lesions. In this case, we were able to improve luminal patency with orbital atherectomy system (OAS; however, withdrawal of the device resulted in a device/stent interaction, causing failure of the device. Given limitations in current evidence and therapies, managing ISR can be a technical and cognitive challenge. Balloon expansion of the affected region often provides unsatisfactory results, possibly related to significant calcium burden. OAS could be an efficacious way of reestablishing luminal patency in ISR lesions, as these lesions are often heavily calcified.

  7. Factors Associated with In-stent Restenosis in Patients Following Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Dedi Wihanda

    2015-07-01

    Full Text Available Aim: to determine factors associated with In-Stent Restenosis (ISR in patients following Percutaneous Coronary Intervention (PCI. Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS and drug-eluting stent (DES were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30, stent length (OR=3.71, 95% CI 1.99-6.90, bifurcation lesions (OR=2.43, 95% CI 1.16-5.10, smoking (OR=2.30, 95% CI 1.33-3.99, vascular diameter (OR=2.18, 95% CI 1.2-3.73, hypertension (OR=2.16, 95% CI 1.16-4.04 and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70. Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI. Key words: bare-metal stent; drug-eluting stent; in-stent restenosis.

  8. No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study

    DEFF Research Database (Denmark)

    Thyssen, Jacob P; Engkilde, Kåre; Menné, Torkil

    2011-01-01

    , and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. Objectives. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis...... restenosis. Conclusions. Nickel and/or chromium allergy in dermatitis patients does not appear to increase the overall risk of in-stent restenosis after PCI.......Background. Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum...

  9. Relation of Nickel Allergy with in-Stent Restenosis in Patients Treated with Cobalt Chromium Stents.

    Science.gov (United States)

    Aliağaoğlu, Cihangir; Turan, Hakan; Erden, Ismail; Albayrak, Hülya; Ozhan, Hakan; Başar, Cengiz; Gürlevik, Zehra; Alçelik, Ayşegül

    2012-11-01

    In-stent restenosis (ISR) is the major limitation of percutaneous coronary stenting procedure. The elements like nickel, chromate and molybdenum are known to cause contact allergy. Hypersensitivity reaction, against these metal ions, may be one of the reasons of ISR. Cobalt chromium coronary stents, which are increasingly being used in percutaneous coronary interventions, have more nickel amount than the stainless steel stents. We aimed to investigate the association between nickel hypersensitivity reaction and ISR in patients treated with cobalt chromium coronary stents. Epicutaneous patch tests for nickel were applied to 31 patients who had undergone elective cobalt chromium coronary stent implantation and had ISR in control angiogram. Thirty patients, without ISR, were included as the control group. Patch test results and other clinical variables were compared. There was no statistically significant difference of the mean age, sex, body mass index, rate of hypercholesterolemia, diabetes, hypertension and smoking between the patients with and without ISR. All other lesion characteristics were similar in the 2 groups. According to the patch test results, 7 patients had nickel contact allergy. All of these patients were in the ISR group, which was statistically significant (pnickel allergy than the control group. Nickel allergy may play role in restenosis pathophysiology.

  10. Clinical evaluation and stress test have limited value in the diagnosis of in-stent restenosis.

    Science.gov (United States)

    Andersen, Karl; Steinthórsdóttir, Sandra Dís; Haraldsdottir, Sigurdis; Gudnason, Thorarinn

    2009-12-01

    In-stent restenosis (ISR) is the main limitation of percutaneous coronary interventions (PCI), occurring in approximately 25% of cases. Although frequently asymptomatic, many PCI patients present with recurrent symptoms of chest pain at follow-up raising a clinical suspicion of ISR. The diagnosis of ISR can be challenging in these patients and difficult to rule out without repeat coronary angiography. We prospectively investigated the diagnostic accuracy of clinical evaluation and exercise stress testing to detect ISR as compared to coronary angiography, in a consecutive, unselected cohort of PCI patients. We studied 91 patients with a total of 143 stents. Clinical evaluation predicted ISR to be likely in 19% of cases and the exercise test was positive in 29%. The binary restenosis rate was 21%. Clinical evaluation had a positive predictive value of 29% and accuracy of 71%, while exercise stress testing had a positive predictive value of 19% and accuracy of 65%. In conclusion, we found the diagnostic accuracy of clinical evaluation to be low and not significantly improved by exercise stress testing when evaluating PCI patients for ISR.

  11. The initial course of in-stent restenosis influences the response to vascular brachytherapy

    International Nuclear Information System (INIS)

    Cheneau, Edouard; Leborgne, Laurent; Wolfram, Roswitha; Dilcher, Christian; Pakala, Rajbabu; Pichard, Augusto D.; Satler, Lowell F.; Canos, Daniel; Lindsay, Joseph; Waksman, Ron

    2002-01-01

    Background: Vascular brachytherapy (VBT) reduces the rate of recurrence of in-stent restenosis (ISR) by inhibiting intimal proliferation. However, the rate of cell proliferation, reflected by the speed of ISR development, is variable in ISR lesions and might influence the responsiveness of ISR to radiation. The aim of this study was to determine the influence of the initial ISR course on the clinical outcome of patients undergoing VBT. Methods: In 1165 patients treated for ISR with VBT in the WRIST studies, we determined the time for ISR (time between initial stent implantation and restenosis), the time for VBT treatment (time between stent implantation and VBT), and previous ISR treatment with conventional strategies. Target lesion revascularization (TLR) at 6 months was available in all patients. Results: Previous ISR treatment did not influence the result of VBT (TLR was 17% vs. 16% without previous angioplasty). Time to ISR influences the outcome of patients undergoing VBT; TLR decreased when ISR occurred later. TLR was 18.2%, 16.7%, and 11.1% when time to ISR was 270 days, respectively, P=.03. Early ISR (time for ISR <90 days) is a factor for radiation failure (OR=2.1, P<.05). In patients with early ISR, TLR is lower when VBT is delayed; TLR was 11% if performed 90 days after stent implantation as compared to 22% if VBT is performed early (<90 days), P<.05. Conclusion: The course of ISR development affects the long-term efficacy of VBT. Early restenosis remains a factor of treatment failure in the VBT era. Delaying VBT beyond 90 days after stent implantation reduces the rate of subsequent revascularization in these patients

  12. Which is currently the best strategy for treatment of SFA in-stent restenosis?

    Science.gov (United States)

    Elens, M; Verbist, J; Keirse, K; Van Den Eynde, W; Peeters, P

    2014-08-01

    Stents have been created to prevent vessel recoil after percutaneous transluminal angioplasty (PTA). Despite the evolution in stent design, intimal hyperplasia and stent fractures and the resulting in-stent restenosis (ISR) still occur. Different strategies to treat ISR have been described with variable results in patency rates in the short and the long-term. PTA only in the treatment of ISR showed high procedural success, but the mid and long-term patency rates were very disappointing. Atherectomy devices have showed same insufficient results. If stent fracture is the cause of the ISR, the fracture has to be overstent. The best two options are covered stents and drug eluting stents (DES). Drug eluting devices like DES and drug eluting balloons (DEBs) showed promising results, with patency rates up to over 90% after one year. DEBs have the advantage of leaving nothing behind. Combined treatment of ISR with atherectomy and DEB has a similar good result. Endovascular brachytherapy showed high patency rates after one year but this technique is limited due to the time-consuming nature of the procedure, complex radiation safety measurements, and staffing requirements. Overall drug-eluting devices are emerging as the best treatment of SFA ISR with patency rates over 90% after 2 years.

  13. CYP2C19⁎2 Polymorphism in Chilean Patients with In-Stent Restenosis Development and Controls

    Directory of Open Access Journals (Sweden)

    Jenny Ruedlinger

    2017-01-01

    Full Text Available Clopidogrel is an antiplatelet drug especially used in patients undergoing percutaneous coronary interventions (PCI. Polymorphisms within CYP2C19 can result in important interindividual variations regarding therapeutic efficacy. Therefore, we aimed to evaluate the impact of the CYP2C19⁎2 variant (rs4244285 on in-stent restenosis occurrence in Chilean patients who underwent PCI and received clopidogrel. A total of 77 cases with stenosis >50% in the angioplasty site (62.75 ± 9.8 years, 80.5% males and 86 controls (65.45 ± 9.8 years, 72.1% males were studied. The polymorphism was genotyped using TaqMan® Drug Metabolism Genotyping Assays. Overall, CYP2C19⁎2 allele frequency was 8.3%. Diabetes, chronic lesions, and bare metal stents (BMS were observed more often in cases than in controls (p = 0.05, p = 0.04, and p = 0.02, resp.. Genotypic frequencies did not differ significantly between the groups (p = 0.15. Nonetheless, the mutated allele was observed in a greater proportion in patients without in-stent restenosis (p = 0.055. There was no significant association between the rs4244285 variant and the occurrence of in-stent restenosis after PCI (OR = 0.44; 95% CI: 0.19 to 1.04; p = 0.06. In summary, no association was identified between the CYP2C19⁎2 variant and the development of coronary in-stent restenosis.

  14. Diagnostic accuracy of coronary in-stent restenosis using 320-row multidetector computed tomography

    International Nuclear Information System (INIS)

    Koeda, Tatsuhiko; Fusazaki, Tetsuya; Niinuma, Hiroyuki; Itoh, Tomonori; Tanaka, Ryoichi; Yoshioka, Kunihiro; Nakamura, Motoyuki

    2010-01-01

    Although a multidetector computed tomography (MDCT) was useful in assessing coronary artery disease, there were several limitations in detecting coronary in-stent restenosis (ISR). The aim of this study was to evaluate the diagnostic accuracy of coronary ISR using a 320-row MDCT (area detector computed tomography: ADCT) in patients after stent implantation. We performed ADCT in consecutive 102 patients (133 lesions) before coronary arteriography (CAG). In 133 lesions, 74 were treated with bare metal stents and 59 with drug eluting stents. The diagnostic accuracy of ADCT for coronary ISR was compared to the results of CAG. ISR was found in 18 cases with CAG analysis. To compare with CAG, sensitivity, specificity, positive predictive value, and negative predictive value to evaluate ISR by ADCT were 100%, 87.8%, 56.3% and 100% respectively. The ISR in a wide range of coronary artery disease was detected by ADCT with good diagnostic accuracy. ADCT may be a promising noninvasive diagnostic imaging modality to evaluate coronary ISR. (author)

  15. The value of matrix metalloproteinase in predicting the in-stent restenosis after percutaneous coronary intervention procedure

    International Nuclear Information System (INIS)

    Xu Zhaoyan; Yang Xili

    2011-01-01

    Objective: To discuss the relationship between the concentration of matrix metalloproteinase (MMP-1, MMP-9) and the in-stent restenosis after percutaneous coronary intervention procedure (PCI). Methods: During the period from June 2006 to June 2008, PCI procedure was carried out in 206 patients with coronary artery disease in authors' hospital. After the procedure, both coronary angiography and intravascular ultrasonography (IVUS) were conducted during follow-up period. Base on the angiographic findings, in-stent restenosis (ISR) was confirmed in 32 cases with a total of 38 lesions (ISR group), while no in-stent restenosis (non-ISR) was seen in 174 cases with a total of 229 lesions (non-ISR group). Before and after the treatment, the cross-sectional area of extra-elastic membrane, plaque area, minimal lumen area (MLA), and intima proliferation area were determined. The changes in MMP-1 and MMP-9 levels after PCI in each group were compared. Based on the MLA, the patients were divided into three groups: MLA > 5 mm 2 group, MLA (3∼5) mm 2 group and MLA 2 group. The MMP-1 and MMP-9 levels were compared among three groups. Results: Both the plaque area and intima proliferation area were significantly larger, while the MLA was significantly smaller, in ISR group than those in non-ISR group (P 5 mm 2 group, MLA (3∼5) mm 2 group and MLA 2 group was (1.45±0.32) ng/ml, (2.93±0.45) ng/ml and (3.09±0.65) ng/ml respectively, but no significant difference in MMP-9 concentration existed between MLA (3∼5) mm 2 group and MLA 2 group (P>0.05). Conclusion: After PCI the increase of MMP-9 concentration bears a close relationship to the degree of restenosis. (authors)

  16. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Barbara Campos Abreu Marino

    2015-05-01

    Full Text Available Background: Clinical in-stent restenosis (CISR is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI] and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males. Clinical presentations included acute coronary syndrome (ACS in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES in 36.4%, Bare Metal Stent (BMS in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5% deaths and 13 (11.8% AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009 and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001. Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001 and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019 emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

  17. Experimental study on effect of dexamethasone to the in-stent restenosis after vascular intervention

    International Nuclear Information System (INIS)

    Wang Jianbo; Yang Jianyong; Chen Wei; Zhuang Wenquan; Li Jiaping; Zhang Longjuan

    2007-01-01

    Objective: To evaluate the effect of dexamethasone to the cultured rat thoracic aortic smooth muscle cells (SMC) in vitro, and explore the role on it's prevention and cure for the in-stent restenosis after vascular intervention. Methods: The rat thoracic aortic SMC were harvested and cultured for six to ten passages. The cultured SMC were synchronized and then restimutated to enter the cell cycle, and treated with incremental concentrations of dexamethasone or without dexamethasone as control. The proliferative assay was performed with MTT method in the different time points after treatment. RT-PCR was performed to assay the level of proliferating cell nuclear antigen (PCNA) mRNA. Results: 1. Dexamethasone progressively inhibited rat aortic SMC proliferation in a concentration-dependent fashion. The A value was statistically significant for different concentrations (F=36.02, P -6 and 10 -5 mol/L (P=0.065) or between 10 -11 mol/L and control group (P 0.567). 2. RT-PCR suggested dexamethasone significantly decreased rat aortic SMC PCNA mRNA transcription in a concentration-dependent fashion. Statistical analysis indicated F=15.407 and P -9 or 10 -11 mol/L groups by post hoc analysis. Conclusions: Dexamethasone inhibits rat aortic SMC proliferation in a concentration- dependent fashion. The data suggest that effective action concentration is 10 -7 mol/L with persistent time up to 96 hours or more. Dexamethasone may play the inhibit role to SMC at lower concentration with prolonging action time. (authors)

  18. Management of drug eluting stent in-stent restenosis: A systematic review and meta-analysis.

    Science.gov (United States)

    Goel, Sachin S; Dilip Gajulapalli, Rama; Athappan, Ganesh; Philip, Femi; Gupta, Supriya; Murat Tuzcu, E; Ellis, Stephen G; Mishkel, Gregory; Kapadia, Samir R

    2016-05-01

    The optimal management for coronary drug eluting stent in-stent restenosis (DES ISR) is unclear. We performed a meta-analysis of observational and randomized studies to compare the outcomes of management of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty (BA). Eligible studies (25 single arm and 13 comparative, including 4 randomized studies with a total of 7,474 patients with DES ISR) were identified using MEDLINE search and proceedings of international meetings. Outcomes studied include major adverse cardiac events (MACE), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality. Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years). The rate of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55) groups compared to BA. Similarly, TVR rate was significantly lower in the DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups compared to BA. All other outcomes were similar between the DES/BA and DEB/BA comparisons. TLR was significantly lower in the DES group compared to BA for vessels  2.75 mm. Treatment of coronary DES ISR with DES or DEB is associated with a reduction in the risk of TLR and TVR compared to BA alone. The relative risk reduction for TLR with DES is similar to DEB. DEBs have a potential role in the treatment of DES ISR by avoiding placement of another layer of stent. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  19. The effect of stent structure changes on the hemodynamics and the formation of in-stent restenosis

    International Nuclear Information System (INIS)

    Wu Xia; Xu Ke; Xiao Liang; Zhang Xitong; Su Hongying; Feng Bo

    2009-01-01

    Objective: To investigate the effect of stent structure changes on the formation of in-stent restenosis by studying the influence of these changes on the shear force to the vascular wall, on the velocity of flow and on the flow pattern. Methods: Five stent models were established by using Pro/engineer wildfire 3.0. Model A was regarded as control structure. On the base structure of model A, transverse link component was added to form model B, and vertical link component was added to form model C. The thickness of model D was twice than that of model A, and the meshes density of model E was twice than that of model A. Fluid models were built up by importing these stent models into computational fluid dynamics (CFD) software ansys11.0-CFX, then, CFD analysis was proceeded to study the effect of stent structure on hemodynamics. Results: After the stents were implanted, the percentage of low wall shear stress on the surface of model A, B, C, D and E was 7.78%, 6.65%, 1.48%, 16.52% and 12.12%, respectively. The percentage of D and E was obviously larger than that of A, while the percentage of B was markedly smaller than that of A. The velocity vector on the cross-sectional planes showed that the low velocity and eddy areas in D and E were much larger than that in A, while this area in C was smaller than that in A. Conclusion: The stent structure changes can cause obvious changes in hemodynamics in the implanted vessels. The increase in the thickness and meshes density of the stent is the main factor that induces the formation of low wall shear stress, which will precipitate the development of in-stent restenosis. The added vertical link component will reduce the area of low wall shear stress as well as the occurrence of in-stent restenosis. (authors)

  20. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Kitabata, Hironori; Torguson, Rebecca; Chen, Fang; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-03-15

    Objectives: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). Background: The optimal treatment for drug-eluting in-stent restenosis remains controversial. Methods: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES = 14%, SES = 18%, POBA = 20%; p = 0.65), death (EES = 2.3%, SES = 6.2%, POBA = 6.1%; p = 0.61), MI (EES = 4.8%, SES = 2.1%, POBA = 2.5%; p = 0.69), TLR (EES = 11.9%, SES = 12.1%, POBA = 24%; p = 0.78), and TVR (EES = 11.9%, SES = 24.8%, POBA = 22.2%; p = 0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p = 0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. Conclusions: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

  1. Effect of pioglitazone on in-stent restenosis after coronary drug-eluting stent implantation: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Ming-duo Zhang

    Full Text Available In-stent restenosis (ISR remains a common life-threatening complication and some studies have shown that pioglitazone can reduce the incidence of ISR in patients with drug-eluting stents (DES implantation. We conducted a meta-analysis to assess the effect of pioglitazone in preventing ISR after DES implantation.Randomized controlled trials (RCTs investigating the effects of pioglitazone for ISR after DES implantation were identified by systematic searches of multiple online databases and manual searches of related reference lists of identified trials through May 2014. The primary endpoint was the rate of ISR. Secondary endpoints included minimum lumen diameter, percentage stenosis of stented vessels, late loss, in-stent neointimal volume, target vessel revascularization (TVR, target lesion revascularization, myocardial infarction, stent thrombosis and death.Five studies, comprising 255 pioglitazone-treated patients and 245 controls, were identified in the current meta-analysis. Pioglitazone did not significantly reduce the rate of ISR (P = 0.20 with low heterogeneity (I2 = 13.3%, P = 0.32. For the secondary outcomes, pioglitazone did not substantially affect the pooled estimates of these endpoints except late loss (P = 0.01 and TVR (P = 0.04.The limited evidence indicates that pioglitazone does not demonstrate markedly beneficial effect in patients subjected to coronary DES implantation. However, the results should be interpreted with care given the small sample size. Further large-scale RCTs are needed.

  2. [Prediction of in-stent restenosis by measurement of fractional flow reserve and the influence of diabetes mellitus].

    Science.gov (United States)

    Amaya, Kazutaka; Takazawa, Kenji; Tanaka, Nobuhiro; Yamashina, Akira

    2002-06-01

    This study tried to predict in-stent restenosis by the measurement of fractional flow reserve and to evaluate the effect of diabetes mellitus control on the relationship between in-stent restenosis and fractional flow reserve. Fractional flow reserve was measured in 62 patients (mean age 61 +/- 9 years, 32 with angina pectoris and 30 with myocardial infarction) after stent implantation. The patients were divided into three groups according to the value of HbA1c and fasting blood sugar (FBS): Group P (HbA1c > or = 6.5% or FBS > or = 126 mg/dl, n = 15), Group G (6.5% > HbA1c > or = 5.8% or 126 > FBS > or = 100 mg/dl, n = 12), and Group N (HbA1c or = 0.90), TLR rate was 60% in Group P, 0% in Group G and 0% in Group N. Fractional flow reserve after stent implantation is useful for the prediction of TLR in patients without diabetes mellitus. However, diabetic control in patients with diabetes mellitus might be attributable to TLR rather than fractional flow reserve.

  3. Brachytherapy using holmium-166 liquid balloon system for in-stent restenosis: 6 months clinical and angiographic follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M. H.; Kim, S. K.; Cha, K. S.; Kim, Y. D.; Lee, H. S.; Kang, D. Y. [Donga University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    In western country, 3 systems of brachytherapy using commercial radioactive source has been established. However, brachytherapy using holmium-166 liquid balloon system (HLBS) for the patient with stent restenosis has not been studied enough. 30 patients (male 23, mean age 58.9 7.7) were enrolled. Target dose was 15 Gy at 1 mm distance from the intimal surface. Clinical diagnoses of the study patients included stable angina 10 and unstable angina 20 patients. Target lesion included LAD 19, LCx 5 and RCA 6 arteries. Pre-brachytherapy treatment included cutting balloon angioplasty in 25, rotational atherectomy in 5 patients. Fractionation and stepping was done in 6 patients each. Follow-up angiography was done in 19 patients. Of them, 4 cases developed angiographic restenosis (21%) including 3 cases of total occlusion. 6 month MACE (major adverse cardiac event) occurred in 5 patients including one sudden cardiac death in a patient with 80 year-old, triple-vessel diseased patient. Vascular brachytherapy using HLBS is a safe and effective treatment modality for in-stent restenosis showing acceptable angiographic and clinical result.

  4. Intracoronary local paclitaxel delivery by X-ray contrast media for in-stent restenosis: a clinical pilot study to assess safety and tolerability.

    Science.gov (United States)

    Rutsch, W; Scheller, B; Borges, A C; Bräutigam, M; Clever, Y; Cremers, B; Dietz, U; Richter, W; Speck, U

    2012-08-01

    Non-stent-based immediate release formulations of paclitaxel have been shown to reduce in-stent restenosis in animal experiments and clinical trials. In the porcine overstretch model paclitaxel dissolved in the contrast medium iopromide inhibited neointimal proliferation in a dose-dependent manner after intracoronary injection and was well tolerated. As a first step entering clinical development, a phase I trial was performed using four ascending paclitaxel dose/concentration levels: samples of up to 100 mL of the contrast medium (iopromide) containing 10, 50, 100 or 200 µM paclitaxel or iopromide (controls) were randomly administered to patients assigned to bare metal stent implantation for single de novo coronary artery lesions. Safety variables, tolerability and angiographic parameters were assessed. Adverse events, ECG, systolic and diastolic blood pressure, left ventricular ejection fraction, leukocyte count, other hematological or clinical chemistry data did not reveal any trend which could be related to the study medication. Short-lasting serum paclitaxel concentrations remained significantly below those known from cancer therapy. Angiographic late lumen loss was 0.72±0.50 mm (N.=7) in controls versus 0.45±0.65 mm (N.=17) in all paclitaxel-treated patients; binary restenosis rate was 5/7(63%) versus 6/17 (35%) and target lesion revascularization rate was 4/8 (50%) versus 4/24 (17%). Intracoronary infusion of paclitaxel dissolved in an X-ray contrast medium was well tolerated. The results show restenosis inhibition, but the number of patients examined was too small to demonstrate a statistically significant inhibition.

  5. No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study.

    Science.gov (United States)

    Thyssen, Jacob P; Engkilde, Kåre; Menné, Torkil; Johansen, Jeanne D; Hansen, Peter Riis; Gislason, Gunnar H

    2011-03-01

    Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum, and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis with stainless steel stents. An individual-level linkage study was performed to identify dermatitis patients who had been patch tested with the European baseline series between 1979 and 2007 at Gentofte University Hospital (N = 18794) and who had also undergone PCI at some point in a Danish hospital. One hundred and forty-nine (0.8%) dermatitis patients who had undergone PCI with a metal stent were included. One hundred and forty-seven were patch-tested before undergoing PCI. Of the patients, 14.1% (21/149) had cardiac in-stent restenosis. Among patients with metal allergy, 2 (11.8%) had restenosis. Nickel and/or chromium allergy in dermatitis patients does not appear to increase the overall risk of in-stent restenosis after PCI. © 2011 John Wiley & Sons A/S.

  6. Dexamethasone-eluting stents for the prevention of in-stent restenosis: Evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients

    NARCIS (Netherlands)

    Hoeven, B.L. van der; Pires, N.M.M.; Warda, H.M.; Putter, H.; Quax, P.H.A.; Schalij, M.J.; Jukema, J.W.

    2008-01-01

    Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no

  7. Bioabsorbable drug-eluting vascular scaffold for the treatment of coronary in-stent restenosis: A two center registry

    International Nuclear Information System (INIS)

    Moscarella, Elisabetta; Varricchio, Attilio; Stabile, Eugenio; Franzone, Anna; Granata, Francesco; Rapacciuolo, Antonio; Galasso, Gennaro; Capozzolo, Claudia; Cirillo, Plinio

    2015-01-01

    Background/purpose: Coronary in-stent restenosis (ISR) is a clinical problem for which a satisfactory solution has not been found yet. Bioabsorbable drug eluting vascular scaffolds (BVSs) provide transient vessel scaffolding combined with prolonged drug delivery capability. The aim of this study was to investigate the safety of BVS for the treatment of coronary ISR. Methods/materials: Between January 2013 and June 2013, 27 patients (31 lesions), presenting with either stable or unstable angina due to coronary ISR, were enrolled in a single arm, prospective, open label registry. Primary end point was the occurrence of target vessel revascularization (TVR) at 12 months. Secondary end point was the composite of death, myocardial infarction and TVR at 12 months. Results: A diffuse ISR pattern was present in 70% of the lesions; mean lesion length was 34.6 ± 15. BVS was successfully implanted in all patients with no in hospital MACE. At twelve months of follow up, MACE rate was 18.5%. One patient died for non-cardiac reason, one patient died due to a possible stent thrombosis and TVR was necessary in 3 patients (11.1%). Conclusions: Our data suggest that BVS is safe and technically feasible for treatment of long and diffuse coronary ISR. These data could be considered hypothesis generator for a randomized clinical trial. - Highlights: • A safe therapeutic option for the treatment of diffuse ISR; • Technically feasible; • Associated to a low rate of restenosis recurrence at nine month.

  8. Bioabsorbable drug-eluting vascular scaffold for the treatment of coronary in-stent restenosis: A two center registry

    Energy Technology Data Exchange (ETDEWEB)

    Moscarella, Elisabetta [Division of Cardiology, Seconda Università degli studi di Napoli, AO Dei cColli, PO Monaldi (Italy); Varricchio, Attilio [Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Napoli (Italy); Stabile, Eugenio, E-mail: geko50@hotmail.com [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Franzone, Anna [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Granata, Francesco [Division of Cardiology, Seconda Università degli studi di Napoli, AO Dei cColli, PO Monaldi (Italy); Rapacciuolo, Antonio; Galasso, Gennaro [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Capozzolo, Claudia [Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Napoli (Italy); Cirillo, Plinio [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); and others

    2015-10-15

    Background/purpose: Coronary in-stent restenosis (ISR) is a clinical problem for which a satisfactory solution has not been found yet. Bioabsorbable drug eluting vascular scaffolds (BVSs) provide transient vessel scaffolding combined with prolonged drug delivery capability. The aim of this study was to investigate the safety of BVS for the treatment of coronary ISR. Methods/materials: Between January 2013 and June 2013, 27 patients (31 lesions), presenting with either stable or unstable angina due to coronary ISR, were enrolled in a single arm, prospective, open label registry. Primary end point was the occurrence of target vessel revascularization (TVR) at 12 months. Secondary end point was the composite of death, myocardial infarction and TVR at 12 months. Results: A diffuse ISR pattern was present in 70% of the lesions; mean lesion length was 34.6 ± 15. BVS was successfully implanted in all patients with no in hospital MACE. At twelve months of follow up, MACE rate was 18.5%. One patient died for non-cardiac reason, one patient died due to a possible stent thrombosis and TVR was necessary in 3 patients (11.1%). Conclusions: Our data suggest that BVS is safe and technically feasible for treatment of long and diffuse coronary ISR. These data could be considered hypothesis generator for a randomized clinical trial. - Highlights: • A safe therapeutic option for the treatment of diffuse ISR; • Technically feasible; • Associated to a low rate of restenosis recurrence at nine month.

  9. In-stent restenosis and multislice computed tomography: is the method ready to start?

    Science.gov (United States)

    Martuscelli, Eugenio; Razzini, Cinzia; D'Eliseo, Alessia; Di Luozzo, Marco; Mauro, Borzi; Romeo, Francesco

    2007-05-01

    We present two patients revascularized by coronary stents and evaluated by multislice computed tomography (CT). In first patient, angio-CT (16 slices/rotation scanner) detected a high-grade restenosis on the distal part of a drug-eluting stent; conventional coronary angiography confirmed the diagnosis. In second patient, angio-CT (64 slices/rotation) showed a tissue proliferation, non-flow-limiting, in the proximal part of a bare metal stent; conventional angiography confirmed the diagnosis. Blooming effects and partial volume averaging still limit the widespread application of this method. New scanners and the use of a special convolution kernel are likely to improve the accuracy of CT angiography in patients with stents.

  10. Influence of Vessel Size and Tortuosity on In-stent Restenosis After Stent Implantation in the Vertebral Artery Ostium

    International Nuclear Information System (INIS)

    Zhou Zhiming; Yin Qin; Xu Gelin; Yue Xuanye; Zhang Renliang; Zhu Wusheng; Fan Xiaobing; Ma Minmin; Liu Xinfeng

    2011-01-01

    Purpose: Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium. Methods: Sixty-one patients with 63 symptomatic lesions in vertebral artery ostium treated with stenting were enrolled onto this study. An average of 12.5 months’ clinical and angiographic follow-up results were analyzed retrospectively. The possible influential factors for ISR, including conventional risk factors of cerebrovascular diseases and morphological characteristics of target lesions, were evaluated by univariate and multivariate regression analysis. Results: Technical success was achieved in all 63 interventional procedures. Stenosis was reduced from (mean ± standard deviation) 75.5 ± 12% before to 1 ± 3.6% after the procedure. During the mean 12.5-month angiographic follow-up, ISR was detected in 17 treated vessels (27.0%), with 2 treated arteries (3.2%) resulting in occlusion, and a stent fracture in 1 case (1.6%). Multivariate Cox regression analysis showed that the tortuosity of V1 (hazard ratio 3.54, P = 0.01) and smaller diameter of the stent (hazard ratio 3.8, P = 0.04) were independent predictors of ISR. Conclusions: Angioplasty and stenting for symptomatic stenosis in the vertebral artery ostium stenosis seem to be feasible and effective. Tortuosity and smaller diameter may affect ISR after stent implantation.

  11. Risk factors for in-stent restenosis of vertebral artery origin after stent implantation: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Fang-fang HAO

    2018-01-01

    Full Text Available Objective To systematically review the risk factors for in-stent restenosis (ISR of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment. Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM, China National Knowledge Infrastructure (CNKI, Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS and Stata 12.0 software. Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440 and non-ISR group (N = 912. The ISR incidence rate of smokers was significantly higher than non-smokers (OR = 2.179, 95%CI: 1.373-3.458; P = 0.001. The differences of bare metal stents (BMS utilization rate (OR = 2.072, 95% CI: 1.560-2.753; P = 0.000 and drug-eluting stents (DES utilization rate (OR = 0.483, 95% CI: 0.363-0.641; P = 0.000 between ISR group and non-ISR group were statistically significant. Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004

  12. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis): Angiographic Results and 1-Year Clinical Outcomes.

    Science.gov (United States)

    Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis; Erglis, Andrejs; Sondore, Dace; Agostoni, Pierfrancesco; Cornelis, Kristoff; Janssens, Luc; Maeng, Michael; Slagboom, Ton; Amoroso, Giovanni; Jensen, Lisette Okkels; Granada, Juan F; Stella, Pieter

    2017-10-23

    The aim of this first-in-human study was to assess the safety and effectiveness of the Virtue sirolimus-eluting balloon in a cohort of patients with in-stent restenosis (ISR). Angioplasty balloons coated with the cytotoxic drug paclitaxel have been widely used for ISR treatment. The Virtue angioplasty balloon (Caliber Therapeutics, New Hope, Pennsylvania) delivers sirolimus in a nanoencapsulated liquid formulation. This clinical trial is the first to examine a sirolimus-eluting balloon for ISR. In this prospective, single-arm feasibility study at 9 European centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. Procedural success in the intention-to-treat population was 100%. The primary safety endpoint was target lesion failure (TLF) (cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization) assessed at 30 days (0%, n = 50). The primary performance endpoint was in-segment late lumen loss (LLL) at 6 months (0.31 ± 0.52 mm; n = 47). Secondary 6-month endpoints include binary restenosis (19.1%), diameter stenosis (30.3 ± 19.9%), and major adverse cardiac events (MACE) (10.2%, n = 49). In the 36-patient per-protocol population (excluding major protocol violations and previously stented ISR), LLL was 0.12 ± 0.33 mm at 6 months. Clinical outcomes at 1 year for the intention-to-treat group were 12.2% TLF and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes that warrant further evaluation in dedicated randomized studies. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Angiographic patterns of in-stent restenosis classified by computed tomography in patients with drug-eluting stents: correlation with invasive coronary angiography

    International Nuclear Information System (INIS)

    Pan, Jingwei; Lu, Zhigang; Wei, Meng; Zhang, Jiayin; Li, Minghua

    2013-01-01

    To evaluate the diagnostic accuracy of Mehran's in-stent restenosis (ISR) classification by coronary computed angiography (CCTA), with reference to invasive coronary angiography (ICA). Consecutive symptomatic patients, who had clinically suspected ISR and implanted stent diameter ≥ 3 mm, were prospectively enrolled in our study. Mehran's classification was employed by CCTA and ICA to classify ISR lesions into four subtypes: focal, diffuse intrastent, diffuse proliferative and total occlusion. CCTA and ICA measurement of lesion length was further compared. Sixty-one patients with 101 implanted stents were included in our study. The overall sensitivity, specificity, PPV and NPV of CCTA diagnosis of binary ISR, as shown by patient-based analysis (n = 61), were 100 % (49/49), 75 % (8/12), 92.45 % (49/53) and 100 % (8/8) respectively. Mehran's classification of CCTA correlated well with ICA findings. The diagnostic accuracy of CCTA for class I, class II, class III and class IV lesions was 92.5 %, 91.67 %, 100 % and 100 % respectively. Lesion length was assessed to be significantly longer with CCTA than with ICA (11.03 ± 5.89 mm versus 8.56 ± 4.99 mm, P < 0.001). Angiographic patterns of in-stent restenosis can be accurately classified by coronary computed angiography. The lesion length measured by CCTA is longer than that assessed by invasive coronary angiography. (orig.)

  14. Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Fujioka, Chikako; Kiguchi, Masao; Kohno, Shingo [Hiroshima University Hospital, Department of Clinical Radiology, Hiroshima (Japan); Yamamoto, Hideya; Kitagawa, Toshiro [Hiroshima University, Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan); Ito, Katsuhide [Hiroshima University, Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan)

    2009-10-15

    The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n=12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p=0.12-0.91). However, the visibility scores of in-stent restenosis were different (p<0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA. (orig.)

  15. Randomized comparison between intracoronary β-radiation brachytherapy and implantation of paclitaxel-eluting stents for the treatment of diffuse in-stent restenosis

    International Nuclear Information System (INIS)

    Schukro, Christoph; Syeda, Bonni; Kirisits, Christian; Schmid, Rainer; Pichler, Philipp; Pokrajac, Boris; Lang, Irene; Poetter, Richard; Glogar, Dietmar

    2007-01-01

    Background and purpose: Intracoronary brachytherapy was the primary therapeutic option for the treatment of in-stent restenosis (ISR) during the last years. Especially for the treatment of diffuse ISR (lesions >10 mm), β-source brachytherapy was significantly superior to singular balloon angioplasty. Despite lacking clinical database, the implantation of drug eluting stents recently became a common procedure for the treatment of ISR. This randomized trial aimed to compare the efficacy of β-brachytherapy with β-radioisotopes 90 Sr/ 90 Y and paclitaxel-eluting stent implantation for the treatment of diffuse ISR. Material and methods: Thirty-seven patients with diffuse ISR were randomly assigned to β-brachytherapy after balloon angioplasty (Beta-Cath TM in 17 patients) or paclitaxel-eluting stent implantation (Taxus-Express2 TM in 20 patients). Six-month clinical follow-up was obtained for all patients, while angiographic follow-up was available for 30 patients. Results: Binary ISR (restenosis >50%) within target segment was observed in three patients treated with Beta-Cath TM , of which one needed target segment revascularisation for recurrent ISR, whereas no significant restenosis occurred in the patients treated with Taxus-Express2 TM (P = 0.037). No further major adverse cardiac (target segment revascularisation, myocardial infarction, death) was found in either group (P = NS). Stent implantation was the more time-saving (31 ± 11 min versus 60 ± 23 min, P TM arm, we found no difference in clinical outcome after implantation of paclitaxel-eluting stents for the treatment of diffuse ISR when compared to β-brachytherapy

  16. Late in-stent thrombosis following carotid angioplasty and stenting.

    Science.gov (United States)

    Buhk, Jan-Hendrik; Wellmer, Andreas; Knauth, Michael

    2006-05-23

    Acute in-stent thrombosis is a well-known complication of carotid angioplasty and stenting (CAS) and often due to resistance to or inadequate treatment with platelet-inhibiting agents. The authors report three cases of a delayed in-stent thrombosis after more than a week but less than 3 months after CAS. In all cases, the postprocedural antiplatelet regimen was discontinued to enable the treatment of a relevant comorbidity.

  17. Neoatherosclerosis causing occlusive in-stent restenosis: Impact of intracoronary imaging in the intensity of lipid-lowering therapy

    Energy Technology Data Exchange (ETDEWEB)

    Martí, David, E-mail: docalcala@hotmail.com [Department of Cardiology, Hospital Central de la Defensa, Madrid (Spain); López, Edurne; Álvarez, Salvador; Palazuelos, Jorge; Rada, Ignacio [Department of Cardiology, Hospital Central de la Defensa, Madrid (Spain); Alfonso, Fernando [Department of Cardiology, Hospital Universitario de La Princesa, Madrid (Spain)

    2016-12-15

    The unique physical properties of optical coherence tomography (OCT) make it a useful technique in the study of restenosis mechanisms. In fact, OCT is able to differentiate between neointimal proliferation and neoatherosclerosis within the stent. We report a rare case of occlusive neoatherosclerosis presenting beyond one year after a successful drug-eluting stent implantation. The impact of OCT findings in the clinical decision making process is emphasized. - Highlights: • Optical coherence tomography (OCT) has the unique ability to detect lipid accumulation within the stent margins (i.e. neoatherosclerosis). • Lipid-rich tissues produce light absorption and therefore they typically attenuate backward signals. • Occlusive neoatherosclerosis may appear even in optimally implanted drug eluting stents. • OCT identification of restenosis mechanisms may have implications not only in the interventional strategy, but also in the long-term medical treatment.

  18. [Vertebral-subclavian bifurcation treatment. "The wedding ring technique" for a vertebral in-stent restenosis associated with stent fracture].

    Science.gov (United States)

    Damas-De Los Santos, Félix; Colombo, Federico; Zuffi, Andrea; Cremonesi, Alberto

    2015-01-01

    This report describes a solution for a restenosis and for the fracture of a stent in the vertebral artery in a patient suffering from vertebrobasilar symptoms. Angiography demonstrates restenosis of a vertebral stent as well as its fracture and migration into the subclavian artery. This complication was managed percutaneously by passing a guide wire through the fractured stent. Pre-dilatation and kissing balloon techniques were applied in both the vertebral and subclavian arteries to modify the stent's dimensions and shape it into the form of a "ring." Postprocedural angiography demonstrated an excellent final result with the assistance of StentBoost visualization. Control angiography at six months also utilized StentBoost imaging and confirmed the patency of the bifurcation and that the stent was not displaced.

  19. Drug-Coated Balloon Treatment for Femoropopliteal Artery Disease: The IN.PACT Global Study De Novo In-Stent Restenosis Imaging Cohort.

    Science.gov (United States)

    Brodmann, Marianne; Keirse, Koen; Scheinert, Dierk; Spak, Lubomir; Jaff, Michael R; Schmahl, Randy; Li, Pei; Zeller, Thomas

    2017-10-23

    This study sought to evaluate the safety and effectiveness of a paclitaxel-coated drug-coated balloon (DCB) for the treatment of patients with de novo in-stent restenosis (ISR). Treatment of patients with ISR remains a challenge. Current strategies are plagued by high rates of recurrent restenosis and need for reintervention. The best intervention for ISR remains to be elucidated. The IN.PACT Global study is an independently adjudicated multicenter, prospective, single-arm study that enrolled 1,535 subjects with symptomatic atherosclerotic disease of the superficial femoral and/or popliteal arteries, including de novo ISR lesions. Patients enrolled in the pre-specified ISR imaging cohort were evaluated for vessel patency and reintervention within the 12-month follow-up period. A total of 131 subjects with 149 ISR lesions were included for analysis. The mean age of the cohort was 67.8 years. Mean lesion length was 17.17 ± 10.47 cm, including 34.0% total occlusions and 59.1% calcified lesions. The 12-month Kaplan-Meier estimate of primary patency was 88.7%. The rate of clinically driven target lesion revascularization (CD TLR) at 12 months was 7.3%. The primary safety outcome, a composite of freedom from device- and procedure-related mortality through 30 days and freedom from major target limb amputation and CD TLR within 12 months, was 92.7%. There were no major target limb amputations, no deaths, and a low (0.8%) thrombosis rate. Results from the ISR imaging cohort demonstrate high patency and a low rate of CD TLR at 12 months. These data confirm the safety and effectiveness of the IN.PACT Admiral DCB (Medtronic, Dublin, Ireland) in complex femoropopliteal lesions, including this challenging subset. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Second-generation drug-eluting stents versus drug-coated balloons for the treatment of coronary in-stent restenosis: A systematic review and meta-analysis.

    Science.gov (United States)

    Kokkinidis, Damianos G; Prouse, Andrew F; Avner, Seth J; Lee, Joo Myung; Waldo, Stephen W; Armstrong, Ehrin J

    2017-10-10

    The benefit of drug-eluting stents (DES) versus drug-coated balloons (DCB) in coronary artery in-stent restenosis (ISR) for the prevention of target lesion revascularization (TLR), stent thrombosis, and mortality remains uncertain. Our aim was to synthesize the available evidence from randomized clinical trials (RCTs) and observational studies that directly compare second-generation drug-eluting stents (SG-DES) and DCB for the treatment of coronary ISR. Medline, Embase, and Cochrane Central were searched for RCTs or observational studies, published up to March 15, 2017. A random effects model meta-analysis investigating clinical and angiographic outcomes was conducted for RCTs and observational studies that compared SG-DES versus DCB for the treatment of ISR. Ten studies and 2,173 patients were included in this meta-analysis. The two treatment strategies were proven equal with regards to TLR, myocardial infarction, stent thrombosis, and cardiac mortality in both randomized and observational studies. No difference was found among RCTs for all-cause mortality, while in observational studies, patients who were treated with SG-DES had a lower mortality compared to DCB (OR: 0.47; 95% CI: 0.27-0.83). In the pooled analysis also (RCTs and observational studies), SG-DES were associated with lower all-cause mortality compared to DCB. Patients treated with SG-DES were also superior in terms of minimal lumen diameter (standardized mean difference: 0.39; 95% CI: 0.12-0.66). The two treatment strategies are equal for the treatment of ISR, while the difference in all-cause mortality might be potentially explained by baseline differences in the two groups among real-world studies. © 2017 Wiley Periodicals, Inc.

  1. Comparison of drug-eluting balloon versus drug-eluting stent treatment of drug-eluting stent in-stent restenosis: A meta-analysis of available evidence.

    Science.gov (United States)

    Bajraktari, Gani; Jashari, Haki; Ibrahimi, Pranvera; Alfonso, Fernando; Jashari, Fisnik; Ndrepepa, Gjin; Elezi, Shpend; Henein, Michael Y

    2016-09-01

    In-stent restenosis (ISR) remains an important concern despite the recent advances in the drug-eluting stent (DES) technology. The introduction of drug-eluting balloons (DEB) offers a good solution to such problem. We performed a meta-analysis to assess the clinical efficiency and safety of DEB compared with DES in patients with DES-ISR. A systematic search was conducted and all randomized and observational studies which compared DEB with DES in patients with DES-ISR were included. The primary outcome measure-major adverse cardiovascular events (MACE)-as well as individual events as target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), cardiac death (CD) and all-cause mortality, were analyzed. Three randomized and 4 observational studies were included with a total of 2052 patients. MACE (relative risk [RR]=1.00, 95% confidence interval (CI) 0.68 to 1.46, P=0.99), TLR (RR=1.15 [CI 0.79 to 1.68], P=0.44), ST (RR=0.37[0.10 to 1.34], P=0.13), MI (RR=0.97 [0.49 to 1.91], P=0.93) and CD (RR=0.73 [0.22 to 2.45], P=0.61) were not different between patients treated with DEB and with DES. However, all-cause mortality was lower in patients treated with DEB (RR=0.45 [0.23 to 0.87, P=0.019) and in particular when compared to only first generation DES (RR 0.33 [0.15-0.74], P=0.007). There was no statistical evidence for publication bias. The results of this meta-analysis showed that DEB and DES have similar efficacy and safety for the treatment of DES-ISR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Drug-eluting balloons versus drug-eluting stents for the management of in-stent restenosis: A meta-analysis of randomized and observational studies.

    Science.gov (United States)

    Wang, Yanwei; Lou, Xinmin; Xu, Xiaomin; Zhu, Jianhua; Shang, Yunpeng

    2017-11-01

    The aim of this study was to evaluate the efficacy of drug-eluting balloons (DEB) with drug-eluting stents (DES) in patients with in-stent restenosis (ISR). DES implantation and DEB were available strategies in percutaneous coronary intervention (PCI) for ISR, but the optimal management for ISR lesions remains controversial. Electronic databases were searched for randomized controlled trials and observational cohort studies which reported the clinical outcomes of using DEB comparing with DES implantation in patients with ISR. Clinical endpoints such as major adverse cardiovascular events (MACE), death, and myocardial infarction were assessed. Five randomized controlled trials and five observational cohort studies with 962 patients in the DEB group and 908 patients in the DES group met inclusion criteria. There was no significant difference between DEB and DES in major clinical outcomes, such as MACE (OR 1.01; 95% CI: 0.64-1.58; p=0.97; I 2 =0%), all-cause death (OR 1.04; 95% CI: 0.54-1.98; p=0.91; I 2 =0%), cardiovascular death (OR 1.44; 95% CI: 0.57-3.65; p=0.44; I 2 =0%), stent thrombosis (OR 0.61; 95% CI: 0.16-2.33; p=0.47; I 2 =0%), and myocardial infarction (OR 1.02; 95% CI: 0.53-1.94; p=0.96; I 2 =0%). DEB was associated with a significant increase in target lesion revascularization (OR 1.54; 95% CI: 1.10-2.15; p=0.01; I 2 =57%). Treatment of ISR using DEB led to comparable clinical outcomes with DES implantation. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  3. Evaluation of coronary in-stent restenosis by 64-slice computed tomography in patients with optimal heart rate control by systematic administration of beta-blocker drugs.

    Science.gov (United States)

    Martuscelli, Eugenio; Romagnoli, Andrea; D'eliseo, Alessia; Sperandio, Massimiliano; Di Luozzo, Marco; De Angelis, Barbara; Romeo, Francesco; Simonetti, Giovanni

    2010-06-01

    Imaging artifacts due to metallic stent struts can reduce the diagnostic accuracy of multislice computed tomography (MSCT) in the evaluation of in-stent restenosis (ISR). Our aim was to determine the accuracy of binary ISR exclusion using a 64-slice MSCT scanner and a systematic administration of beta-blockers having an aggressive heart rate (HR) control. We performed 64-slice MSCT in 218 consecutive patients revascularized by stenting. All patients were treated with oral/intravenous beta-blocker drugs in order to obtain a HR less than 65 beats/min in the prescan phase. Coronary stents were evaluated by two experienced observers in order to rule out the presence of significant (>50%) ISR. Quantitative conventional coronary angiography (CCA) served as a standard for reference. Five patients (2.3%) were excluded from the analysis; mean HR was 59 +/- 3 beats/min in the prescan phase and 62 +/- 5 beats/min during acquisition. In the 321 stented coronary segments, CCA found 27 significant ISRs. MSCT correctly diagnosed 26 significant ISRs, with two false-positive and one false-negative case. In a per-segment analysis, the sensitivity was 96%, specificity 99%, positive predictive value (PPV) 92.8%, and negative predictive value (NPV) 99%. In a per-patient analysis, the sensitivity was 100%, specificity 98.9%, PPV 92.8%, and NPV 100%. In our study, the evaluation of significant ISR by MSCT showed an excellent diagnostic accuracy with a PPV of 92.8% and a NPV of 99%. Selection criteria and radiation exposure can be considered a limitation of the method.

  4. Serum Level of Interleukin-18 to Interleukin-10 Ratio after Percutaneous Coronary Intervention: A New Predictor of In-Stent Restenosis

    Directory of Open Access Journals (Sweden)

    Nozar Givtaj

    2016-10-01

    Full Text Available Despite advanced techniques of stent placement which cause fewer traumas to the vessel walls; as well as introduction of drug-eluting stents which result in the least induction of immune response, in-stent restenosis (ISR is still one of the common and severe complications after PCI and stent placement. Intimal hyperplasia following immuno- inflammatory response of the arterial wall to balloon injury has been proposed as main mechanism of ISR. In a prospective study, we assessed the predictive role of Interleukin (IL-18 and tumor necrosis factor alpha (TNF-α as pro-inflammatory cytokines and IL-10 as anti-inflammatory cytokine and high sensitive C-reactive protein (hs-CRP for ISR. 128 patients (mean age=59±10.2, female/male: 41/87who underwent percutaneous coronary intervention (PCI and stent implantation. Venous blood samples were obtained before and 24 hours after PCI. IL-18, IL-10, TNF-αand hs-CRP levels were determined. We followed the patients for 24 months and measured the incidence of ISR via angiography. Results were compared between ISR and non-ISR patients. 20 patients (15.6% developed ISR. Serum level of IL-18, TNF-α and hs-CRP have been increased in all patients 24 hours after PCI. Serum level of IL-18 at 24-hours was not different between ISR and non-ISR patients (p=0.239, while serum level of IL-10 was significantly higher in non-ISR group (p<0.001. IL-18/IL-10 was significantly higher in ISR patients than in non-ISR patients (p<0.001. IL-18/IL-10 can be applied as predictive factors for ISR.

  5. Drug-Eluting Balloon versus New-Generation Drug-Eluting Stent for the Treatment of In-Stent Restenosis: An Updated Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Cui, Kong-Yong; Lyu, Shu-Zheng; Zhang, Min; Song, Xian-Tao; Yuan, Fei; Xu, Feng

    2018-03-05

    Currently, drug-eluting balloon (DEB) appears to be an attractive alternative option for the treatment of in-stent restenosis (ISR). Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent (DES). Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization (TLR) at the longest follow-up. Dichotomous variables were presented as risk ratios (RR s) with 95% confidence intervals (CI s), while the overall RR s were estimated using the Mantel-Haenszel random-effects model. Five randomized controlled trials (RCTs) and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms of TLR (RR = 1.24, 95% CI: 0.89-1.72, P = 0.21), cardiac death (RR = 1.55, 95% CI: 0.89-2.71, P = 0.12), major adverse cardiovascular event (RR = 1.21, 95% CI: 0.98-1.48, P = 0.07), myocardial infarction (RR = 1.12, 95% CI: 0.72-1.76, P = 0.62), and stent thrombosis (RR = 0.95, 95% CI: 0.38-2.42, P = 0.92). However, DEB was associated with higher risk of all-cause mortality than new-generation DES (RR = 1.65, 95% CI: 1.09-2.50, P = 0.02). This was especially true in the real-world observational studies (RR = 1.79, 95% CI: 1.12-2.88, P = 0.02). In RCTs, however, no significant difference was found between the two treatment strategies in the risk of all

  6. Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Cai, Jin-Zan; Zhu, Yong-Xiang; Wang, Xin-Yu; Bourantas, Christos V; Iqbal, Javaid; Zhu, Hao; Cummins, Paul; Dong, Sheng-Jie; Mathur, Anthony; Zhang, Yao-Jun

    2018-02-22

    The study sought to compare angiographic and clinical outcomes of new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB) in patients with coronary in-stent restenosis (ISR). Meta-analysis using data from randomised trial found by searches on PubMed, the Cochrane Library, ClinicalTrials.gov and websites of major cardiovascular congresses. Only randomised trials comparing DES with DCB were included. Patients with ISR in the included trials. New-generation DES versus DCB. The angiographic and clinical outcomes including cardiac death, all-cause death, myocardial infarction, target lesion revascularisation (TLR), target vessel revascularisation (TVR), major adverse cardiac events (MACE) and stent thrombosis were investigated. Five trials including 913 patients were eligible and included. Pooled analysis in angiographic results identified that new-generation DES were associated with higher acute luminal gain (-0.31 mm, 95% CI -0.42 to -0.20, PDES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28, P=0.01) compared with DCB; however, there was no statistical differences for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction (RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95% CI 0.60 to 5.39, P=0.29). Interventions with new-generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short-term follow-up, but had similar MACE, myocardial infarction and cardiac death for patients with coronary ISR compared with DCB. Appropriately powered studies with longer term follow-up are warranted to confirm these findings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Treatment of diffuse in-stent restenosis with rotational atherectomy followed by radiation therapy with a 188Re-MAG3-filled balloon: six-month clinical and angiographic results of R4 registry

    International Nuclear Information System (INIS)

    Moon, D. H.; Oh, S. J.; Park, S. W.; Hong, M. K.; Lee, C. H.; Kim, J. Z.; Park, S. J.; Lee, H. K.

    2000-01-01

    Intracoronary β-irradiation after rotational atherectomy may be a reasonable approach to prevent recurrent in-stent restenosis (ISR). This study was done to evaluate the feasibility and efficacy of β-radiation therapy with a 188 Re-MAG3-filled balloon following rotational atherectomy for ISR. Fifty consecutive patients with diffuse ISR (length >10 mm) in native coronary arteries underwent rotational atherectomy and adjunctive balloon angioplasty followed by β-irradiation using 188 Re-MAG3-filled balloon catheter. The radiation doses was 15 Gy at 1.0 mm deep into vessel wall. Mean length of the lesion and irradiated segment was 25.6±12.7 mm and 37.6±11.2 mm, respectively. The radiation was delivered successfully to all patients, with a mean irradiation time of 20.1±61 7 sec. No adverse event including myocardial infarction, death, or stent thrombosis occurred during the follow-up period (mean 10.3±3.7 mon) and non-target vessel revascularization was needed in one patient. Six-month binary angiographic restenosis rate was 10.4% (2 focal ISR and 3 edge restenosis) and loss index was 0.17±0.31. Irradiation using 188 Re-MAG3-filled balloon following rotational atherectomy for patients with diffuse ISR may improve the clinical and angiographic outcomes. Further prospective randomized trials are warranted to evaluate the synergistic effect of debulking and irradiation in patients with diffuse ISR

  8. Impact of Paclitaxel Dose on Tissue Pharmacokinetics and Vascular Healing: A Comparative Drug-Coated Balloon Study in the Familial Hypercholesterolemic Swine Model of Superficial Femoral In-Stent Restenosis.

    Science.gov (United States)

    Gongora, Carlos A; Shibuya, Masahiko; Wessler, Jeffrey D; McGregor, Jenn; Tellez, Armando; Cheng, Yanping; Conditt, Gerard B; Kaluza, Greg L; Granada, Juan F

    2015-07-01

    This study sought to compare the effect of paclitaxel-coated balloon (PCB) concentration on tissue levels and vascular healing using 3 different PCB technologies (In.Pact Pacific = 3 μg/mm(2), Lutonix = 2 μg/mm(2) and Ranger = 2 μg/mm(2)) in the experimental setting. The optimal therapeutic dose for PCB use has not been determined yet. Paclitaxel tissue levels were measured up to 60 days following PCB inflation (Ranger and In.Pact Pacific) in the superficial femoral artery of healthy swine (18 swine, 36 vessels). The familial hypercholesterolemic swine model of superficial femoral artery in-stent restenosis (6 swine, 24 vessels) was used in the efficacy study. Two weeks following bare-metal stent implantation, each in-stent restenosis site was randomly treated with a PCB or an uncoated control balloon (Sterling). Quantitative vascular analysis and histology evaluation was performed 28 days following PCB treatment. All PCB technologies displayed comparable paclitaxel tissue levels 4 h following balloon inflation. At 28 days, all PCB had achieved therapeutic tissue levels; however, the In.Pact PCB resulted in higher tissue concentrations than did the other PCB groups at all time points. Neointimal inhibition by histology was decreased in all PCB groups compared with the control group, with a greater decrease in the In.Pact group. However, the neointima was more mature and contained less peri-strut fibrin deposits in both 2-μg/mm(2) PCB groups. Compared with the clinically established PCB dose, lower-dose PCB technologies achieve lower long-term tissue levels but comparable degrees of neointimal inhibition and fewer fibrin deposits. The impact of these findings in restenosis reduction and clinical outcomes needs to be further investigated. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Mangold, Stefanie [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); De Cecco, Carlo N.; Yamada, Ricardo T.; Varga-Szemes, Akos; Stubenrauch, Andrew C.; Fuller, Stephen R. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Caruso, Damiano [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Vogl, Thomas J.; Wichmann, Julian L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Nikolaou, Konstantin [Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Todoran, Thomas M. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2016-12-15

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F{sub 0}.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F{sub 0}.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F{sub 0}.5 (16.9 ± 4.8; all p < 0.0463); luminal stent diameters were increased at ≥70 keV (5.41 ± 1.8-5.92 ± 1.7 vs. 5.27 ± 1.8, all p < 0.001) and diagnostic confidence was highest at 70-80 keV-VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F{sub 0}.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. (orig.)

  10. Distinctive effects of CD34- and CD133-specific antibody-coated stents on re-endothelialization and in-stent restenosis at the early phase of vascular injury

    DEFF Research Database (Denmark)

    Wu, Xue; Yin, Tieying; Tian, Jie

    2015-01-01

    It is not clear what effects of CD34- and CD133-specific antibody-coated stents have on re-endothelialization and in-stent restenosis (ISR) at the early phase of vascular injury. This study aims at determining the capabilities of different coatings on stents (e.g. gelatin, anti-CD133 and anti-CD34......-coated stents, the time of cells adhesion was longer and earlier present in the anti-CD133 antibody-coated stents and anti-CD133 antibody-coated stents have superiority in re-endothelialization and inhibition of ISR. In conclusion, this study demonstrated that anti-CD133 antibody as a stent coating...... for capturing EPCs is better than anti-CD34 antibody in promoting endothelialization and reducing ISR....

  11. On the Possible Interaction Mechanism between Collateral Vessels and Restenosis

    NARCIS (Netherlands)

    Zun, P.S.; Hoekstra, A.G.

    2015-01-01

    Several clinical studies and their meta-analysis suggest that developed collateral vessels in the heart correlate to an increased risk of in-stent restenosis. The possible physiological interaction between the collateral development and in-stent restenosis is investigated in this study. Based on

  12. Evaluation of in-stent restenosis in the APPROACH trial (assessment on the prevention of progression by Rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history)

    NARCIS (Netherlands)

    H.M. Garcia-Garcia (Hector); S.A. Garg (Scot); S. Brugaletta (Salvatore); G. Morocutti (Giorgio); R.E. Ratner (Robert); N.S. Kolatkar (Nikheel); B.G. Kravitz (Barbara); D.M. Miller (Diane); C. Huang (Chunmei); R.W. Nesto (Richard); P.W.J.C. Serruys (Patrick); R.P. Aftring (R.); N.S. Kolatkar (Nikheel); B.G. Kravitz (Barbara); J. Wolstenholme (Jane); J. Saarinen (Jari); R. Fowler (R.); J. Hoffman (Jonathan); D. Steele-Norwood (D.); R. Russell (Robert); S. Young (S.); Y.F. Chou; S. McMorn (Steve); C. Kirsch (Courtney); B. Louridas (Bonnie); T. Olivieria (Teresa); D. Mattioli (Debra); D. Miller (D.); C. Huang (Chunmei); C. Nguyen (C.); K. Jahnke (Kristoph); G.S. Mintz (Gary); J. Lachin (J.); M. Abrahamson (M.); P. Carson (P.); P. Jones

    2012-01-01

    textabstractTo determine (1) the medium-term effect of rosiglitazone and glipizide on intra-stent neointima hyperplasia, (2) restenosis pattern as assessed by intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in patients with T2DM and coronary artery disease. A total of 462

  13. Incidence and classification of neointimal proliferation and in-stent restenosis in post-stenting patients at 1-year interval: Findings from non-invasive coronary computed tomography angiography

    International Nuclear Information System (INIS)

    Xu, Nan; Zhang, Jiayin; Li, Minghua; Pan, Jingwei; Lu, Zhigang

    2014-01-01

    Highlights: • The incidence of silent in-stent restenosis at 1-year as revealed by CT is 7.6%. • The incidence of neointimal proliferation at 1-year as revealed by CT is 12.6%. • Diabetes are associated with higher incidence of neointimal proliferation. - Abstract: Objectives: To evaluate the incidence of coronary in-stent restenosis (ISR) and neointimal proliferation by coronary CT angiography (CCTA) at 1-year follow-up in asymptomatic patients. Methods: 234 patients (mean age: 67 ± 10.2 years, range 39–88 years, 180 males and 54 females) with 379 stents were prospectively enrolled in this study. Binary ISR was classified by CCTA into 4 types using Mehran classification. Neointimal proliferation was similarly classified into focal and diffuse types. All patients with CCTA-revealed ISR or neointimal proliferation underwent further invasive coronary angiography (ICA) for validation. Fisher's exact test was used for comparison. Results: ICA revealed patent stents with neointimal proliferation in 39 patients (16.7%, 39/234) and binary ISR in 23 patients (9.8%, 23/234). Lesion-based analysis showed 12 type I ISR lesions, 4 type II ISR lesions, 1 type III ISR lesion and 7 type IV ISR lesions. Among cases with neointimal proliferation, 27 lesions were classified as focal type whereas 13 lesions were classified as diffuse type. Patients with diabetes mellitus were associated with higher incidence of CCTA-revealed neointimal proliferation (21/77 vs. 18/157, p = 0.002) as well as ISR (12/77 vs. 11/157, p = 0.038), compared to patients without diabetes. CCTA was found to have good diagnostic performance for neointimal proliferation and ISR detection as well as classification, with an overall accuracy of 84.4% (54/64). Conclusions: Silent ISR as well as neointimal proliferation is not uncommon findings in asymptomatic post-stenting patients at 1-year interval, as revealed by CCTA. Patients with diabetes are prone to have higher incidence of neointimal

  14. Incidence and classification of neointimal proliferation and in-stent restenosis in post-stenting patients at 1-year interval: Findings from non-invasive coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Nan, E-mail: southmuch@hotmail.com [Department of Radiology, East Hospital, Tongji University School of Medicine, No. 150, Jimo Road, Shanghai 200120 (China); Zhang, Jiayin, E-mail: andrewssmu@msn.com [Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Li, Minghua, E-mail: drliminghua@gmail.com [Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Pan, Jingwei, E-mail: drpanjingwei@gmail.com [Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Lu, Zhigang, E-mail: drluzhigang@gmail.com [Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China)

    2014-10-15

    Highlights: • The incidence of silent in-stent restenosis at 1-year as revealed by CT is 7.6%. • The incidence of neointimal proliferation at 1-year as revealed by CT is 12.6%. • Diabetes are associated with higher incidence of neointimal proliferation. - Abstract: Objectives: To evaluate the incidence of coronary in-stent restenosis (ISR) and neointimal proliferation by coronary CT angiography (CCTA) at 1-year follow-up in asymptomatic patients. Methods: 234 patients (mean age: 67 ± 10.2 years, range 39–88 years, 180 males and 54 females) with 379 stents were prospectively enrolled in this study. Binary ISR was classified by CCTA into 4 types using Mehran classification. Neointimal proliferation was similarly classified into focal and diffuse types. All patients with CCTA-revealed ISR or neointimal proliferation underwent further invasive coronary angiography (ICA) for validation. Fisher's exact test was used for comparison. Results: ICA revealed patent stents with neointimal proliferation in 39 patients (16.7%, 39/234) and binary ISR in 23 patients (9.8%, 23/234). Lesion-based analysis showed 12 type I ISR lesions, 4 type II ISR lesions, 1 type III ISR lesion and 7 type IV ISR lesions. Among cases with neointimal proliferation, 27 lesions were classified as focal type whereas 13 lesions were classified as diffuse type. Patients with diabetes mellitus were associated with higher incidence of CCTA-revealed neointimal proliferation (21/77 vs. 18/157, p = 0.002) as well as ISR (12/77 vs. 11/157, p = 0.038), compared to patients without diabetes. CCTA was found to have good diagnostic performance for neointimal proliferation and ISR detection as well as classification, with an overall accuracy of 84.4% (54/64). Conclusions: Silent ISR as well as neointimal proliferation is not uncommon findings in asymptomatic post-stenting patients at 1-year interval, as revealed by CCTA. Patients with diabetes are prone to have higher incidence of neointimal

  15. Impact of stent diameter and length on in-stent restenosis after DES vs BMS implantation in patients needing large coronary stents-A clinical and health-economic evaluation

    DEFF Research Database (Denmark)

    Zbinden, Rainer; von Felten, Stefanie; Wein, Bastian

    2017-01-01

    AIMS: The British National Institute of Clinical Excellence (NICE) guidelines recommend to use drug-eluting stents (DES) instead of bare-metal stents (BMS) only in lesions >15 mm in length or in vessels 3 mm in diameter. We analyzed the impact of stent length and stent diameter on in......-stent restenosis (ISR) in the BASKET-PROVE study population and evaluated the cost-effectiveness of DES compared to BMS. METHODS/RESULTS: The BASKET-PROVE trial compared DES vs BMS in large coronary arteries (≥3 mm). We calculated incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability...... of 10 000 CHF per TLR avoided, DES had a high probability of being cost-effective. CONCLUSION: In the BASKET-PROVE study population, the strongest predictor of ISR is the use of a BMS, even in patients in need of stents ≥3.0 mm and ≤15 mm lesion length and DES were cost-effective. This should prompt...

  16. Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina Intracoronary brachytherapy. Treatment of in-stent restenosis with the Beta-Cath system: initial experience in Latin America

    Directory of Open Access Journals (Sweden)

    Juan Simon Muñoz

    2004-07-01

    . METHODS: This study assessed 30 patients with ISR in native coronary arteries who underwent balloon catheter angioplasty followed by intracoronary beta radiation with the Beta-Cath systemTM (90Sr/Y. RESULTS: The study comprised complex, extensive (18.66±4.15 mm restenotic lesions, 77% of which were of the diffuse-proliferative type. Brachytherapy was successful in 100% of the cases. The mean radiation dose used was 20.7±2.3 Gy, released for a mean period of 3.8±2.1 minutes. On late follow-up, the in-stent minimum luminal diameter (MLD slightly decreased (from 1.98±0.30 mm to 1.84±0.39 mm at 6 months; P=0.13, with a late loss of 0.14±0.18 mm. The intrasegmentary MLD was significantly smaller than the in-stent diameter (1.55±0.40 mm vs 1.84±0.39 mm; P=0.008, and was associated with a more significant late loss (0.40±0.29 mm vs 0.14±0.18 mm; P=0.0001. On ICUS, a mild increase of 6.8±14.3 mm³ in the neointimal tissue was observed at 6 months (P=0.19, and the percentage of volumetric obstruction increased by 4.7±7.5%. Binary restenosis and revascularization of the target vessel recurred in 17% of the cases; late occlusion associated with myocardial infarction occurred in 1 case (3%. Event-free survival was 80%. CONCLUSION: The management of in-stent restenosis with intracoronary beta radiation proved to be a safe and effective procedure, with a high rate of immediate success, representing a therapeutic option for inhibiting neointimal hyperplasia.

  17. Predictive factors for in-stent late loss and coronary lesion progression in patients with type 2 diabetes mellitus randomized to rosiglitazone or placebo.

    Science.gov (United States)

    Finn, Aloke V; Oh, Jae S; Hendricks, Michael; Daher, Maureen; Cagliero, Enrico; Byrne, Raphael M; Nadelson, Jeffrey; Crimins, Johanna; Kastrati, Adnan; Schömig, Albert; Bruskina, Olga; Palacios, Igor; John, Michael C; Gold, Herman K

    2009-02-01

    Type 2 diabetics (DM2) are at increased risk for restenosis as well as nonculprit coronary artery lesion (NCCL) progression. Rosiglitazone (RSG) favorably modifies many of the altered biologic processes in DM2, although recent reports have questioned its safety. We conducted a double-blind randomized trial to assess the effects of RSG versus placebo on in-stent late lumen loss (LL) and angiographic progression of NCCL. A total of 65 DM2 were randomized to RSG (4 mg/d) (n = 32) or placebo (n = 33) at the time of stenting and underwent clinical and laboratory analysis at 1 and 4 months and 8-month angiography (n = 46 patients). Rapid angiographic progression (RAP) was defined as > or =20% diameter reduction of preexisting NCCL by quantitative coronary angiography, or a new narrowing > or =30%. Mean LL in RSG (n = 33 lesions) was not different from that of placebo (0.62 +/- 0.59 vs 0.70 +/- 0.67, P = NS). Seven (13.5%) of 52 NCCLs have RAP in RSG versus 9 (16.1%) of 56 in placebo (P = NS). High-sensitivity C-reactive protein (hs-CRP) was the only predictor of RAP. Patients with a 120-day hs-CRP > or =75th percentile had an OR of 7.35 (95% CI 2.35-23) for RAP versus those below. Although RSG treatment also lowered log (hs-CRP) at 4 months (RSG 0.10 +/- 0.37 vs placebo 0.26 +/- 0.49, P = .06), it did not decrease the likelihood of plaque progression while also raising LDL and N-terminal brain naturetic peptide. Rosiglitazone appears not to lower LL or reduce angiographic progression of NCCL in DM2 and had complex effects on markers of cardiac risk.

  18. Short- versus long-term duration of dual antiplatelet therapy in patients treated for in-stent restenosis: a PRODIGY trial substudy (Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia).

    Science.gov (United States)

    Campo, Gianluca; Tebaldi, Matteo; Vranckx, Pascal; Biscaglia, Simone; Tumscitz, Carlo; Ferrari, Roberto; Valgimigli, Marco

    2014-02-18

    This study sought to investigate the clinical outcome of patients treated with percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) randomized to short (6 months) versus long (24 months) dual antiplatelet therapy (DAPT) regimen. It is still unclear if patients treated for ISR may benefit from a long DAPT regimen. For the present purpose, we selected 224 patients undergoing the PCI procedure for ISR enrolled in the PRODIGY (Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia) trial and randomized to short (6 months) versus long (24 months) DAPT regimen. The primary objective was the cumulative incidence of death, nonfatal myocardial infarction (MI), or cerebrovascular accident at 24 months. Safety endpoints were moderate and major bleeding complications. Overall, 114 patients were allocated to short DAPT regimen, whereas 110 patients were allocated to long DAPT regimen. Twenty-seven patients reached the primary endpoint (19 in short DAPT regimen vs. 8 in long DAPT regimen; p = 0.02). The cumulative incidence of the primary endpoint at 24 months was 16.7% in the short DAPT regimen group compared with 7.3% in the long DAPT regimen group (p = 0.034). This is principally due to a lower occurrence of death and MI in the long DAPT regimen group as compared to the short DAPT regimen group (6.5% vs. 15.5%; p = 0.03). There was no difference in the occurrence of bleeding complications between long and short DAPT regimen. Our study offers preliminary evidence that patients receiving a new PCI procedure for ISR may benefit from long-term administration of aspirin plus clopidogrel. (Synergy Between Stent and Drugs to Avoid Ischemic Recurrences After Percutaneous Coronary Intervention [PRODIGY]; NCT00611286). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis: a network meta-analysis of 11 randomized, controlled trials.

    Science.gov (United States)

    Lee, Joo Myung; Park, Jonghanne; Kang, Jeehoon; Jeon, Ki-Hyun; Jung, Ji-Hyun; Lee, Sang Eun; Han, Jung-Kyu; Kim, Hack-Lyoung; Yang, Han-Mo; Park, Kyung Woo; Kang, Hyun-Jae; Koo, Bon-Kwon; Kim, Hyo-Soo

    2015-03-01

    A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). Optimal treatment options for ISR have not been well established. Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure. This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI. Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Is there a link between nickel allergy and coronary stent restenosis?

    Science.gov (United States)

    Norgaz, Tugrul; Hobikoglu, Gultekin; Serdar, Zehra Asiran; Aksu, Huseyin; Alper, Ahmet Taha; Ozer, Orhan; Narin, Ahmet

    2005-07-01

    Although many patients with coronary artery disease are being treated by coronary stents, in-stent restenosis is the major limitation of percutaneous coronary stenting procedures. Most stents are made of stainless steel, and that, allergic reactions to nickel ions released from coronary stainless-steel stents may be one of the triggering mechanisms for in-stent restenosis. We aimed to evaluate the relationship between in-stent restenosis and nickel allergy in a prospective study. For this purpose, we applied epicutaneous patch test for nickel in 43 patients who had undergone elective intracoronary stent placement for stable angina pectoris in the day following stent placement and evaluated the presence of nickel allergy. Control angiography was performed at 6 months to determine in-stent restenosis. Three (6.9%) patients had allergic reaction to nickel and 16 (37%) patients had developed in-stent restenosis. One of the 3 patients with nickel allergy had diffuse in-stent restenosis and the others not. The present study therefore does not support the proposed relationship between nickel allergy and development of in-stent restenosis in patients having stainless steel stents. Large scale studies are needed to reach a final conclusion.

  1. Association of morphologic characteristics on optical coherence tomography and angiographic progression patterns of late restenosis after drug-eluting stent implantation

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Hiroshi, E-mail: yhclinic@po5.synapse.ne.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima city, Kagoshima (Japan); Arikawa, Ryo; Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima city, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan); Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe (Japan)

    2015-01-15

    Objectives: To gain insight into the pathophysiology of late drug-eluting stent (DES) restenosis. Background: Restenosis of DES has a different time course from that of bare metal stents. Methods: Patients who underwent follow-up coronary angiography (CAG) twice (six to nine months and 18 to 24 months) after DES implantation were examined using optical coherence tomography (OCT). All lesions with target lesion revascularization at first follow-up were excluded. Late catch-up was defined as lesions that progressed from less than 50% diameter stenosis (DS) at the first CAG to more than 50% DS at the second CAG. Lesions with the late catch-up were further divided into two groups; lesions with jump-up (less than 25% DS at the first CAG) and lesions with gradual progression (25–50% DS at the first CAG). Results: Of the 25 patients who had late ISR, 23 patients (10 jump-up/13 gradual progression) were examined with OCT at late follow-up and enrolled in this study. In the qualitative OCT assessment, each ratio of homogeneous, layered, heterogeneous with or without attenuation tissue morphologies were in jump-up group, and gradual progression group were 0% and 15%, 0% and 23%, and 60% and 8%, and 40% and 54%, respectively. All of jump-up group showed heterogeneous restenotic tissue, while 62% of gradual progression group showed heterogeneous restenotic tissue (P = .04). Conclusions: These findings suggest different pathophysiology of the late catch-up after DES implantation between the jump-up and gradual progression groups.

  2. Intravascular ultrasound assessment of minimumlumen area and intimal hyperplasia in in-stent restenosis after drug-eluting or bare-metal stent implantation. The Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Vikman, Saila; Antonsen, Lisbeth

    2017-01-01

    Introduction: Drug-eluting stents (DES) reduce the risk of restenosis after percutaneous coronary intervention. The aim of the study was to evaluate, by intravascular ultrasound (IVUS), the minimum lumen area site in the stented segment and the distribution of intimal hyperplasia in patients...

  3. Coronary stent restenosis and the association with allergy to metal content of 316L stainless steel.

    Science.gov (United States)

    Slodownik, D; Danenberg, C; Merkin, D; Swaid, F; Moshe, S; Ingber, A; Lotan, H; Durst, R

    Most intra-coronary stents in use are made of 316 L stainless steel, which contains nickel, chromate and molybdenum. Whether inflammatory and allergic reactions to metals contribute to in-stent restenosis is still a matter of debate. The aim of this study was to ascertain the relationship between metal allergy and the occurrence of in-stent restenosis. Ninety-nine adult patients who underwent two cardiac catheterisations, up to two years apart, were included in the study. Seventy patients had patent stents at the second angiogram (patent stent group) and 29 were found to have in-stent restenosis (restenosis group). All patients underwent patch testing with the relevant metals and the 316L stainless steel plate. Twenty-eight (28.3%) patients were found to have an allergy to at least one metal. There was no significant difference in the prevalence of metal allergy between the patent stent group and the restenosis group (28.6 and 27.6%, respectively; p = 0.921). Our data do not support the theory that contact allergy plays a role in the pathogenesis of in-stent restenosis.

  4. Restenosis after stenting in symptomatic vertebral arterial orifice disease and considerations for better outcome

    Science.gov (United States)

    Chang, Jun Young; Park, Hyun; Kwon, Oki

    2017-01-01

    We have performed stenting in 11 patients with symptomatic vertebral arterial orifice stenosis refractory to medical treatment or impairment in anterior circulation. Three of the 11 patients experienced asymptomatic severe in-stent restenosis or occlusion. Bare metal stents were used in those three patients, two of whom received revascularization therapy. Development of sufficient cervical collateral channels reconstituting the distal vertebral artery was the common feature in patients with asymptomatic in-stent restenosis. In selecting appropriate stents, consideration of mechanical strength and drug-eluting properties of a stent according to characteristics of the target vessel is important to reduce the risk of in-stent restenosis. Any decision to perform revascularization should be based on the presence of abundant cervical collaterals as well as clinical symptoms of vertebrobasilar ischemia. PMID:28304206

  5. Endovascular brachytherapy to prevent restenosis after angioplasty; Endovaskulaere Brachytherapie in der Restenoseprophylaxe nach Angioplastie und Stentimplantation: Eine Uebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A.; Bohndorf, K. [Klinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

    2003-02-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [German] Die endovaskulaere Radiotherapie stellt das erste erfolgreiche Therapiekonzept in der Restenoseprophylaxe nach PTA und Stentimplantation dar. Am 3.11.2000 hat die amerikanische Food and Drug Administration erstmalig zwei Brachytherapiegeraete zur Restenoseprophylaxe nach Koronararterien-Stenting zugelassen. Grosse multizentrische, kontrollierte Studien wurden fuer das koronare Stromgebiet mit positiven Ergebnissen publiziert, die Datenlage im peripheren Stromgebiet ist noch ungenuegend. Beta-Strahler bieten Vorteile in der Anwendung, moeglicherweise auch in der Sicherheit, Gamma-Strahler dagegen sind besser klinisch evaluiert. Die primaere Indikation zur endovaskulaeren Brachytherapie

  6. Restenosis after coronary angioplasty.

    Science.gov (United States)

    Anderson, H V; Vignale, S J; Benedict, C R; Willerson, J T

    1993-09-01

    Coronary angioplasty is used to treat coronary atherosclerotic disease in many patients. One problem with coronary angioplasty is the phenomenon of restenosis. Restenosis appears to be a universal response to arterial wall injury. The biological events that underlie restenosis are characterized by: platelet adhesion and aggregation at sites of damaged endothelium, and within dissections into the medial layers, release of platelet derived growth-promoting substances, inflammation of the injured medial zone, transformation, migration, and proliferation of smooth muscle cells of the media following their activation by growth-promoting substances, secretion of copious amounts of extracellular matrix material, and finally, termination of the growth process following regrowth of endothelium over the damaged area. More than a decade of research work has helped identify clinical correlates of restenosis after coronary angioplasty. Patient-related correlates include male gender, unstable angina, diabetes, and continued smoking after angioplasty. Lesion-related correlates include multilesion and multivessel procedures, higher post-angioplasty residual stenosis, proximal vessel location, location in the left anterior descending coronary artery, location in a vein graft, long lesions, and total occlusions. However, for the purposes of individual patient care, clinical correlates are not particularly helpful. No group of variables has predicted complete freedom from restenosis, and conversely no group of variables has reliably indicated its presence. All patients undergoing angioplasty will require some form of follow-up evaluation. Symptom status by itself has not been found to be useful for predicting restenosis. However, when symptom status is combined with exercise thallium-201 scintigraphy, performed 4-6 months after angioplasty, it is less than ideal, but has a negative predictive value of over 90%. This means that over 90% of patients who are asymptomatic and have no

  7. Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

    Directory of Open Access Journals (Sweden)

    Jun-peng Liu

    2015-01-01

    Full Text Available Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study investigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that restenosis occurred in 30% (3/10 of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% (2/17 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% (1/23 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically significant (P > 0.05. Experimental findings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervical and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

  8. Radioactive stents delay but do not prevent in-stent neointimal hyperplasia

    NARCIS (Netherlands)

    I.P. Kay (Ian Patrick); A.J. Wardeh (Alexander); K. Kozuma (Ken); A.H.M. Knook (Marco); A. Thury (Attila); P.W.J.C. Serruys (Patrick); D.P. Foley (David); P.C. Levendag (Peter); W.J. van der Giessen (Wim); G. Sianos (Georgios)

    2001-01-01

    textabstractBACKGROUND: Restenosis after conventional stenting is almost exclusively caused by neointimal hyperplasia. Beta-particle-emitting radioactive stents decrease in-stent neointimal hyperplasia at 6-month follow-up. The purpose of this study was to evaluate the 1-year outcome of (32)P

  9. Comparison of plain balloon and cutting balloon angioplasty for the treatment of restenosis with drug-eluting stents vs bare metal stents.

    Science.gov (United States)

    Park, Seung-Jung; Kim, Kyung-Hee; Oh, Il-Young; Shin, Dong-Ho; Park, Kyung-Il; Seo, Myung-Ki; Chung, Jin-Wook; Park, Kyung Woo; Lee, Hae-Young; Kang, Hyun-Jae; Koo, Bon-Kwon; Youn, Tae-Jin; Kim, Hyo-Soo

    2010-09-01

    The efficacy of cutting or plain balloon angioplasty (CBA or PBA) has not been analyzed for the treatment of drug-eluting stent (DES) restenosis vs bare metal stent (BMS) restenosis. The 252 in-stent restenosis (ISR) lesions in 224 consecutive patients treated by CBA (n=167) or PBA (n=85) between July 2002 and December 2007 were analyzed. At 6-month angiographic and 12-month clinical follow-up, CBA and PBA showed similar efficacies: repeat-ISR (37.0% vs 37.8%, P=0.90), late loss (0.62+/-0.60 vs 0.61+/-0.47 mm, P=0.92), and target lesion revascularization (18.3% vs 22.4%, P=0.50). This comparable efficacy was maintained for treatment in the DES-ISR and BMS-ISR subgroups. However, target lesion-related myocardial infarction (n=9) occurred more frequently in the CBA than in the PBA arm (6.2% vs 0%, P=0.03), most of which developed early after ISR treatment (n=7; 54+/-26 days). Independent predictors of repeat-ISR were diffuse ISR and smaller pretreatment minimal lumen diameter, both of which might imply heavier plaque burden in the ISR group. Plain or cutting balloon angioplasty for ISR seems to be comparable, as the angiographic or clinical endpoints were not affected by initial stent type but by parameters related to the plaque burden of the ISR lesion. However, CBA might be associated with higher risk of myocardial infarction than PBA, suggesting more attention to dual-antiplatelet therapy after its use for ISR.

  10. Coated stents to prevent restenosis in coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2005-11-01

    Full Text Available Background: In-stent-restenosis (ISR is considered to be an essential limiting factor of stenting in coronary heart disease (CHD. The development of coated stents has raised expectations on substantial lowering restenosis after stenting with decreasing the rate of restenosis and a reduction in the rate of clinical events. Objectives: The present analysis addresses the questions on medical effectiveness and cost-effectiveness of the use of various coated stent types in CHD. Methods: The literature was searched in December 2004 in the most relevant medical and economic databases. The medical evaluation was conducted on the basis of published RCT. The data from the studies regarding various angiographic, sonographic and clinical endpoints were checked for methodical quality and summarised in meta-analyses. Within the scope of economic evaluation the primary studies were analysed and modelling was performed, applying clinical effect estimates from the meta-analyses of the medical evaluation and current estimates of German costs. Results: Medical evaluation: Ten different stenttypes were used in the included 26 RCT. The results for heparin, silicon-carbide, carbon and PTFE coated stenttypes could not reveal any significant differences between the medical effectiveness of coated and uncoated stents. The application of sirolimus, paclitaxel, everolimus and 7-hexanoyltaxol eluting stents showed a significant lower restenosis at 6-9 months with decrease in the rate of restenosis for polymer-based sirolimus, paclitaxel and 7-hexanoyltaxol eluting stents. In contrast, the use of gold-coated and actinomycin-D eluting stents was associated with a significantly higher restenosis. The polymer-based sirolimus and paclitaxel eluting stents also showed a significant and considerable reduction in the rate of repeated percutaneous revascularisations at 6-12 months (3.5% vs. 19.7%; p<0.0001, RR=0.19 [95%CI: 0.11; 0.33] and 3.5% vs. 12.2%; p<0.0001, RR=0.30 [95%CI: 0

  11. Restenosis: A Challenge to Angioplasty

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 6; Issue 4. Restenosis: A Challenge to Angioplasty. M S S Murthy. General Article Volume 6 Issue 4 April 2001 pp 52-61. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/006/04/0052-0061. Author Affiliations.

  12. One-year results of the CRISTAL Trial, a randomized comparison of cypher sirolimus-eluting coronary stents versus balloon angioplasty for restenosis of drug-eluting stents.

    Science.gov (United States)

    Chevalier, Bernard; Moulichon, Robert; Teiger, Emmanuel; Brunel, Philippe; Metzger, Jean-Philippe; Pansieri, Michel; Carrie, Didier; Stoll, Hans-Peter; Wittebols, Kristel; Spaulding, Christian; Fajadet, Jean

    2012-12-01

     We compared the efficacy of the Cypher Select (Cordis Corporation, Bridgewater, NJ, USA) sirolimus-eluting stent (SES) versus balloon angioplasty (BA) in in-stent restenosis (ISR) of Taxus or Taxus Liberté paclitaxel-eluting stents (PES; Boston Scientific, Natick, MA, USA) or Cypher/Cypher Select SES. Optimal treatment strategies have not been identified for drug-eluting stent (DES) ISR. Patients with a native coronary artery SES or PES ISR were randomized to SES or BA. In addition, a control group included BMS ISR treated with SES. Angiographic control was performed at 12 months. 281 patients were enrolled. Significant differences favoring SES over BA were noted in immediate and net gain (1.39 ± 0.51 vs. 0.97 ± 0.54 mm, P < 0.0001 and 1.07 ± 0.69 vs. 0.49 ± 0.67 mm, P < 0.0001), 12-month mean luminal diameter (MLD; 2.14 ± 0.62 vs. 1.71 ± 0.55 mm, P < 0.0001) and percent diameter stenosis (%DS; 21 ± 19.24 vs. 29.82 ± 18.47, P = 0.001). There was no significant difference at 12 months between SES and BA in the primary end-point late lumen loss (LLL; 0.37 ± 0.57 vs.0.41 ± 0.63, P = 0.73) and in in-stent binary restenosis (11.1% vs. 14%, P = 0.59). Target-lesion revascularization (TLR) was numerically lower in patients treated with SES (5.9% vs. 13.1%, P = 0.097). There was no difference according to the initial DES. In contrast, significantly higher immediate and net gains and MLD were noted in the BMS control group treated by SES. In this angiographic randomized trial comparing SES and BA in SES or PES restenosis, 12 month MLD, immediate and net gain, and %DS favored SES whereas no difference was noted in LLL. Condensed abstract optimal treatment strategies have not been identified for sirolimus-(SES) or paclitaxel-eluting stent (PES) in-stent restenosis (ISR). We randomized patients with a native coronary artery SES or PES ISR to SES or BA. In addition, a control group included BMS ISR treated with SES. There

  13. Novel A20-gene-eluting stent inhibits carotid artery restenosis in a porcine model

    Directory of Open Access Journals (Sweden)

    Zhou ZH

    2016-08-01

    Full Text Available Zhen-hua Zhou,1 Jing Peng,1 Zhao-you Meng,1 Lin Chen,1 Jia-Lu Huang,1 He-qing Huang,1 Li Li,2 Wen Zeng,2 Yong Wei,2 Chu-Hong Zhu,2 Kang-Ning Chen1 1Department of Neurology, Cerebrovascular Disease Research Institute, Southwest Hospital, 2Department of Anatomy, Key Laboratory for Biomechanics of Chongqing, Third Military Medical University, Chongqing, People’s Republic of China Background: Carotid artery stenosis is a major risk factor for ischemic stroke. Although carotid angioplasty and stenting using an embolic protection device has been introduced as a less invasive carotid revascularization approach, in-stent restenosis limits its long-term efficacy and safety. The objective of this study was to test the anti-restenosis effects of local stent-mediated delivery of the A20 gene in a porcine carotid artery model.Materials and methods: The pCDNA3.1EHA20 was firmly attached onto stents that had been collagen coated and treated with N-succinimidyl-3-(2-pyridyldithiolpropionate solution and anti-DNA immunoglobulin fixation. Anti-restenosis effects of modified vs control (the bare-metal stent and pCDNA3.1 void vector stents were assessed by Western blot and scanning electron microscopy, as well as by morphological and inflammatory reaction analyses.Results: Stent-delivered A20 gene was locally expressed in porcine carotids in association with significantly greater extent of re-endothelialization at day 14 and of neointimal hyperplasia inhibition at 3 months than stenting without A20 gene expression.Conclusion: The A20-gene-eluting stent inhibits neointimal hyperplasia while promoting re-endothelialization and therefore constitutes a novel potential alternative to prevent restenosis while minimizing complications. Keywords: restenosis, A20, gene therapy, stent, endothelialization

  14. Beta-radiation therapy for long lesions in native coronary vessels A matched comparison between de novo and in-stent restenotic lesions

    International Nuclear Information System (INIS)

    Stankovic, Goran; Orlic, Dejan; Di Mario, Carlo; Corvaja, Nicola; Airoldi, Flavio; Chieffo, Alaide; Amato, Antonio; Orecchia, Roberto; Colombo, Antonio

    2003-01-01

    Objective: The purpose of this study was to evaluate effectiveness and to compare clinical outcome of intracoronary beta-radiation to treat long lesions (>20 mm) in patients with de novo stenosis vs. patients with in-stent restenosis (ISR). Methods: A matched comparison of 44 patients with 63 de novo lesions and 48 patients with 63 ISR lesions (>20 mm) treated with intracoronary beta-radiation was performed. Results: Stents were implanted in 65.1% of de novo and 19% of ISR lesions (P=.001). Radiation doses delivered were 17.2±3.0 vs. 20.3±3.0 Gy at 2 mm from the source center for de novo and ISR lesions. There was no difference in the incidence of in-hospital events. Clinical follow-up at 16.4±6.7 months showed no difference in major adverse cardiac events (MACE) between de novo and ISR patients (27.3% vs. 25%, P=.8). Late total occlusions (LTOs) occurred in eight patients (four in each group) treated with stents at the time of radiation and after discontinuation of ticlopidine. By multivariate analysis, stent implantation was the only predictor of late occlusions (OR 8.25, 95% CI 1.73-38.46, P<.008). Restenosis rates were similar for de novo and ISR lesions (29.3% vs. 23.2%, P=.46), as well as target lesion revascularization (TLR) and target vessel revascularization (TVR) rates (22.7% vs. 22.9% and 29.5% vs. 29.2%, respectively). Conclusions: Intracoronary beta-radiation gives comparable results when used to treat de novo or ISR lesions provided new stent implantation can be avoided. Long-term combined antiplatelet therapy is mandatory for patients who receive new stents at the time of radiation treatment

  15. Left-main restenosis in the DES era-a call for action.

    Science.gov (United States)

    di Palma, Gaetano; Cortese, Bernardo

    2017-11-10

    Percutaneous treatment of the unprotected left main trunk (ULM), defined as a vessel without patent bypass graft either to the left circumflex (LCX) or left anterior descending (LAD) artery, has gained a precise role thanks to recent scientific evidence. Although new generation drug-eluting stents have already proven to be safer, there is still a consistent risk of restenosis and late adverse events. The optimal management of a ULM restenosis is still debated. Here we aim at presenting a review of the available data in literature and show our choice for treating it. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Predictors of 32P β brachytherapy failure in patients with high-risk in-s tent restenosis

    International Nuclear Information System (INIS)

    Ortolani, Paolo; Marzocchi, Antonio; Aquilina, Matteo; Gaiba, William; Bunkheila, Feisal; Neri, Stefano; Lombardo, Enzo; Marrozzini, Cinzia; Pini, Stefania; Taglieri, Nevio; Sbarzaglia, Paolo; Reggiani, Maria Letizia Bacchi; Barbieri, Enza; Branzi, Angelo

    2004-01-01

    Background: The effectiveness of coronary radiation therapy for the treatment of in-stent restenosis (ISR) has been established in several randomized clinical trials. The efficacy of this treatment in the general population is less well established. Methods and materials: We report our experience in 118 consecutive patients with nonselected high-risk ISR who had undergone successful percutaneous coronary intervention and brachytherapy with 32 P β-irradiation and who were prospectively enrolled in a quantitative angiographic and clinical follow-up protocol at 7 months after the index procedure. The aim of this study was to investigate the independent predictor of angiographic restenosis after 32 P brachytherapy treatment. Results: Of the patients, 28.8% were diabetics. The mean lesion and mean radiated lengths were, respectively, 30.1 ± 17.2 and 43.8 ± 16.9 mm. The ISR pattern was diffuse in 96% of the treated lesions; in particular, 22.1% presented an occlusive pattern and 37.1% a proliferative pattern. At follow-up angiographic, restenosis and major adverse cardiac events (MACE) rates were, respectively, 20.8% and 29.6%. The univariate predictors of angiographic restenosis were procedural geographic miss, pattern IV ISR, manual pullback maneuver of the radiation source, preprocedural lesion percentage stenosis and preprocedural lesion MLD. At logistic regression analysis, only geographic miss and pattern IV ISR were independent predictors of post intracoronary radiation therapy (IRT) angiographic restenosis. Conclusion: These data indicate that 7-month angiographic restenosis after 32 P IRT in complex patients with ISR is not a frequent event and is predicted mainly by an occlusive lesion at baseline and by procedural geographical miss

  17. Carotid stenting using tapered and nontapered stents: associated neurological complications and restenosis rates.

    Science.gov (United States)

    Brown, Katherine E; Usman, Asad; Kibbe, Melina R; Morasch, Mark D; Matsumura, Jon S; Pearce, William H; Amaranto, Daniel J; Eskandari, Mark K

    2009-01-01

    Self-expanding stent design systems for carotid artery stenting (CAS) have morphed from nontapered (NTS) to tapered (TS); however, the impact of this change is unknown. We reviewed the outcomes of CAS with these two broad categories of stents in a single-center retrospective review of 308 CAS procedures from May 2001 to July 2007. Nitinol self-expanding TS or NTS coupled with cerebral embolic protection devices were used to treat extracranial carotid occlusive disease. Data analysis included demographics, procedural records, duplex exams, and conventional arteriography. Mean follow-up was 18 months (range 1-69). Restenosis was defined as >or=80% in-stent carotid artery stenosis by angiography. The mean age of the entire cohort was 71.3 years (75% men, 25% women). Of the 308 cases, 233 were de novo lesions and 75 had a prior ipsilateral carotid endarterectomy (n = 44) or external beam radiation exposure (n = 31). Preprocedure neurological symptoms were present in 30% of patients. TS were used in 156 procedures and NTS in 152 procedures. The 30-day ipsilateral stroke and death rates were 1.3% and 0.3%, respectively. An additional three (1.0%) posterior circulation strokes occurred. There was no statistically significant difference in the 30-day total stroke rates between TS (3.2%, n = 5) and NTS (1.3%, n = 2) (p = 0.5). At midterm follow-up, restenosis or asymptomatic occlusion was detected in eight cases (2.6%). All occurred in arteries treated with NTS, and this was statistically different when compared to arteries treated with TS (p = 0.03). Furthermore, a post-hoc subgroup analysis revealed significant correlation (chi(2) = 0.02) for restenosis in "hostile necks" when separated by TS vs. NTS. Early CAS outcomes between TS and NTS are comparable. In contrast, self-expanding nitinol TS may have a lower incidence of significant restenosis or asymptomatic occlusion when compared to NTS.

  18. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis)

    DEFF Research Database (Denmark)

    Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis

    2017-01-01

    centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. RESULTS Procedural success in the intention-to-treat population was 100 The primary safety endpoint was target lesion failure (TLF) (cardiac death...... and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. CONCLUSIONS This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes...

  19. Diagnostic efficacy for coronary in-stent patency with parameters defined on Hounsfield CT value-spatial profile curves

    International Nuclear Information System (INIS)

    Yamazaki, Tadashi; Suzuki, Jun-ichi; Shimamoto, Ryoichi; Tsuji, Taeko; Ohmoto-Sekine, Yuki; Morita, Toshihiro; Yamashita, Hiroshi; Honye, Junko; Nagai, Ryozo; Komatsu, Shuhei; Akahane, Masaaki; Ohtomo, Kuni

    2008-01-01

    Purpose: Hounsfield CT values across coronary CT angiograms constitute CT value-spatial profile curves. These CT profile curves are independent of window settings, and therefore, parameters derived from the curves can be used for objective anatomic analyses. Applicability of parameters derived from the curves to quantification of coronary in-stent patency has not yet been evaluated. Methods: Twenty-five CT value-spatial profile curves were delineated from 10 consecutive coronary stents to test correlation between the curve derived parameter (i.e., the minimum extreme value normalized by dividing by the maximum value of the curves obtained at neighboring outside of stents) and three intravascular ultrasound (IVUS) parameters. Results: Correlation coefficients between normalized minimum extreme value of CT value-spatial profile curves and three IVUS parameters (such as patent cross-sectional in-stent area, the percentage of patent cross-sectional in-stent area, and coronary artery intra-stent diameter) were 0.65 (p < 0.01), 0.44 (p < 0.05) and 0.51 (p < 0.05), respectively. Conclusions: CT parameters defined on Hounsfield CT value-spatial profile curves correlated significantly with IVUS parameters for quantitative coronary in-stent patency. A new approach with CT coronary angiography is therefore indicated for the noninvasive assessment of in-stent re-stenosis

  20. Local drug delivery to prevent restenosis.

    Science.gov (United States)

    Seedial, Stephen M; Ghosh, Soumojit; Saunders, R Scott; Suwanabol, Pasithorn A; Shi, Xudong; Liu, Bo; Kent, K Craig

    2013-05-01

    Despite significant advances in vascular biology, bioengineering, and pharmacology, restenosis remains a limitation to the overall efficacy of vascular reconstructions, both percutaneous and open. Although the pathophysiology of intimal hyperplasia is complex, a number of drugs and molecular tools have been identified that can prevent restenosis. Moreover, the focal nature of this process lends itself to treatment with local drug administration. This article provides a broad overview of current and future techniques for local drug delivery that have been developed to prevent restenosis after vascular interventions. A systematic electronic literature search using PubMed was performed for all accessible published articles through September 2012. In an effort to remain current, additional searches were performed for abstracts presented at relevant societal meetings, filed patents, clinical trials, and funded National Institutes of Health awards. The efficacy of local drug delivery has been demonstrated in the coronary circulation with the current clinical use of drug-eluting stents. Until recently, however, drug-eluting stents were not found to be efficacious in the peripheral circulation. Further pursuit of intraluminal devices has led to the development of balloon-based technologies, with a recent surge in trials involving drug-eluting balloons. Early data appear encouraging, particularly for treatment of superficial femoral artery lesions, and several devices have recently received the Conformité Européene mark in Europe. Investigators have also explored the periadventitial application of biomaterials containing antirestenotic drugs, an approach that could be particularly useful for surgical bypass or endarterectomy. In the past, systemic drug delivery has been unsuccessful; however, there has been recent exploration of intravenous delivery of drugs designed specifically to target injured or reconstructed arteries. Our review revealed a multitude of additional

  1. Ultrasound thrombolysis in stent thrombosis.

    Science.gov (United States)

    Rassin, T; Desmet, W; Piessens, J; Rosenschein, U

    2000-11-01

    Recent refinement in stent implantation technique and peri-procedural pharmacological treatment has lowered the incidence of stent thrombosis significantly. Still, all stent thromboses are associated with major adverse events. In previous studies it has been suggested that intravascular ultrasound fibrinolysis is safe and effective. In this report, ultrasound successfully reperfused thrombotically occluded stents. These observations suggest that ultrasound may dissolve occlusive platelet-rich thrombus effectively and safely. Cathet. Cardiovasc. Intervent. 51:332-334, 2000. Copyright 2000 Wiley-Liss, Inc.

  2. Very late mesenteric bare metal stent thrombosis in the setting of cessation of antiplatelet agents.

    Science.gov (United States)

    Ait-Mokhtar, O; Bayet, G; Benamara, S; Brunet, J; Hager, F X; Sainsous, J

    2015-06-01

    We report a case of a 73 year-old man admitted for acute mesenteric ischaemia. Eight years before, he had a first mesenteric ischaemic event treated by left colectomy and angioplasty of both main coeliac artery (MCA) and superior mesenteric artery (SMA); the patient was discharged on lifelong clopidogrel and aspirin. One month before his admission for the index event, he had a major haematuria; clopidogrel was stopped first, then aspirin because of recurrent haematuria. Five days after withdrawal of both antiplatelet drugs, the patient presented with acute mesenteric ischaemia. Urgent aortography showed in-stent occlusion of SMA and in-stent restenosis of MCA; we performed ad hoc thrombus aspiration of SMA and balloon angioplasty of MCA. The patient was discharged seven days after, without complications. This case shows that very late stent thrombosis in digestive artery can occur in the setting of antiplatelet arrest and urgent endovascular intervention constitutes a seductive alternative for surgery when performed early after symptoms onset. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  3. Impact of cutting balloon angioplasty (CBA) prior to bare metal stenting on restenosis.

    Science.gov (United States)

    Ozaki, Yukio; Yamaguchi, Tetsu; Suzuki, Takahiko; Nakamura, Masato; Kitayama, Michihiko; Nishikawa, Hideo; Inoue, Teruo; Hara, Kazuhiro; Usuba, Fumihiko; Sakurada, Masami; Awano, Kojiro; Matsuo, Hitoshi; Ishiwata, Sugao; Yasukawa, Tatsuya; Ismail, Tevfik F; Hishida, Hitoshi; Kato, Osamu

    2007-01-01

    While stent restenosis and late thrombosis still occur even with drug-eluting-stents (DES), there remains a need to explore other strategies for preventing restenosis. Five hundred and twenty-one patients were randomized: 260 to cutting-balloon angioplasty (CBA) before bare-metal stent (CBA-BMS) and 261 to balloon-angioplasty (BA) before BMS (BA-BMS). Intravascular ultrasound (IVUS)-guided procedures were performed in 279 (54%) patients and angiographic guidance was used in the remainder. Minimal lumen diameter was significantly greater in CBA-BMS than BA-BMS (2.65+/-0.40 mm vs 2.52+/-0.4 mm, p<0.01) and % diameter stenosis (%DS)-post was less in CBA-BMS than BA-BMS (14.0+/-5.9% vs 16.3+/-6.8%, p<0.01). %DS-follow-up was subsequently less in CBA-BMS than BA-BMS (32.4+/-15.1% vs 35.4+/-15.3%, p<0.05) associated with lower rates of restenosis in CBA-BMS than BA-BMS (11.8% vs 19.6%, p<0.05) and less target lesion revascularization (TLR) in CBA-BMS than BA-BMS (9.6% vs 15.3%, p<0.05). Patients were divided into 4 groups based on the device used before stenting and IVUS use (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up IVUS-CBA-BMS had a significantly lower restenosis rate (6.6%) than Angio-CBA-BMS (17.9%), IVUS-BA-BMS (19.8%) and Angio-BA-BMS (18.2%, p<0.05). Restenosis and TLR were significantly lower in CBA-BMS than BA-BMS. This favorable outcome was achieved because of the lower restenosis rate conferred by the IVUS-guided-CBA-BMS strategy (6.6%). The restenosis rates obtained with this strategy were comparable to those achieved with DES.

  4. Exercise radionuclide ventriculography to detect restenosis following coronary angioplasty

    International Nuclear Information System (INIS)

    De Puey, E.G.; Leatherman, L.L.; Dear, W.E.; Leachman, R.D.; Massin, E.K.; Mathur, V.S.; Burdine, J.A.

    1984-01-01

    Forty one patients (pts) underwent semiupright exercise gated radionuclide ventriculography (EGRNV) before, within 3 d after single vessel transluminal coronary angioplasty (TCA), and 4 to 12 mos later, at which time follow-up cardiac catheterization was also performed. Prior to TCA 76% of pts had abnormal EGRNV, as defined by a failure to increase ejection fraction (EF) by 5 points or the development of a new regional wall motion abnormality. Stenosis was reduced from 90 +- 7% to 18 +- 17%. Early after TCA, exercise duration and maximum double product increased (p's 20% but <50%; Group III (n=8): ≥ 50%] Pts with abnormal EGRNV early after TCA were demonstrated to have a greater percent increase in stenosis at late follow-up than pts with normal EGRNV (41 +- 30% vs 19 +- 25%, p<.001). Early after TCA EGRNV was abnormal in 5% of Group I pts vs 75% in Group III (p<.01), and EF increased to a greater degree during exercise in Group I pts (+11.3 +- 7.5 vs +3.5 +- 6.5 points, p<.01). At 4-12 mos EGRNV was abnormal in 27% of Group I vs 88% of Group III (p<.01), and during exercise EF increased in Group I pts (+11.8 +- 7.8 points) but decreased in Group III (-1.9 +- 8.7 points) (p<.0005). The accuracy of abnormal EGRNV in predicting ≥ 50% restenosis was 73% early post-TCA and 77% at 4-12 mos. The authors conclude that EGRNV is a valuable test to verify the success of TCA and to detect subsequent restenosis

  5. Patterns of restenosis for the SFA: The second step on a long journey.

    Science.gov (United States)

    Ansel, Gary M

    2017-10-01

    Restenosis patterns required better definitions Defining restenosis patterns may help compare technologies better Further research with consistent restenosis pattern definition will help us define the most value-added treatments. © 2017 Wiley Periodicals, Inc.

  6. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Pomerantzeff Pablo Maria Alberto

    1999-01-01

    Full Text Available A forty eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR was implanted. The patient did well in the late follow-up and is now in NYHA Class I .

  7. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus.

    Science.gov (United States)

    Pomerantzeff, P M; Corrêa, J D; Brandão, C M; de Assis, R V; Jatene, A D

    1999-04-01

    A forty-eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE) had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR) was implanted. The patient did well in the late follow-up and is now in NYHA Class I.

  8. Restenosis in coronary bare metal stents. Importance of time to follow-up: a comparison of coronary angiograms 6 months and 4 years after implantation

    DEFF Research Database (Denmark)

    Jørgensen, Erik; Helqvist, Steffen; Kløvgaard, Lene

    2008-01-01

    Objectives. Angiographic late lumen loss measured 6 to 9 month after bare metal stent implantation in the coronary arteries is a validated restenosis parameter. Design. We performed a second angiographic follow-up after 4 years in event free survivors from the DANSTENT trial cohort. Results......-sectional vessel area and a 39% reduction of the binary restenosis rate over time. Conclusions. Instent late lumen loss in bare metal stents decreases spontaneously over time. Maturation of early hyperplastic tissue reaction after stent implantation with subsequent thinning of fibrotic tissue might explain...

  9. Do pre-procedural laboratory parameters predict drug-eluting stent restenosis?

    Science.gov (United States)

    Tanındı, Aslı; Ekici, Berkay; Töre, Hasan Fehmi

    2015-07-01

    Drug-eluting stents (DES) have considerably reduced the rates of in-stent restenosis (ISR). Several studies reported pre-procedural C-reactive protein (CRP), neutrophil to lymphocyte (N/L) ratio, red cell distribution width (RDW), serum uric acid (UA), and mean platelet volume (MPV) as independent predictors of ISR using bare metal stents. This study investigates whether any laboratory parameter obtained before the coronary stenting procedure is associated with ISR using DES in stable coronary artery disease. Three hundred fifteen stents were retrospectively analysed in 285 patients who had undergone coronary stenting and a control coronary angiography within one year of stenting, between January 2012 and April 2014. Pre-procedural complete blood count, biochemistry, and CRP were recorded. Off-line quantitative coronary angiography analysis was performed. Overall restenosis rate was 10.2%. When the stents were analysed with respect to the presence of ISR, the number of diabetics and smokers was higher in the ISR group. CRP levels were significantly higher in the ISR group, but there were no differences in N/L, monocytes, eosinophils, RDW, MPV, UA, and total bilirubin levels. In the univariate regression analysis, DM, CRP, stent length, stent diameter, pre-procedural diameter stenosis, pre-procedural minimal lumen diameter (MLD), post-procedural residual diameter stenosis, post-procedural reference vessel diameter, and post-procedural MLD were predictors of ISR. However, multivariate regression analysis identified only DM and post-procedural residual stenosis as independent predictors of ISR. Pre-procedural blood parameters do not independently predict ISR in DES, which is mainly determined by the presence of diabetes and post-procedural residual stenosis.

  10. External Beam Irradiation and Restenosis Following Femoral Stenting: Long-Term Results of a Prospective Randomized Study

    International Nuclear Information System (INIS)

    Zampakis, Petros; Karnabatidis, Dimitrios; Kalogeropoulou, Christina; Kardamakis, Dimitrios M.; Katsanos, Konstantinos; Skouras, Theodoros; Siablis, Dimitrios

    2007-01-01

    Purpose. To assess the long-term outcome of external beam irradiation (EBI) for the prevention of restenosis due to neointimal hyperplasia, following percutaneous transluminal angioplasty (PTA) and stenting of the superficial femoral artery. Methods. Sixty consecutive patients with peripheral arterial disease, who were treated with 'bail-out' stent implantation in the superficial femoral artery due to suboptimal PTA, were included in this study. Patients were randomly allocated into two groups, receiving either external beam irradiation (6 MV photons, total dose 24 Gy in a hypofractionated schedule) plus antiplatelet therapy (EBI group) or antiplatelet therapy alone (control group). Results. No procedure-related complications occurred, and all patients of the EBI group received the full dose of 24 Gy. During the long-term follow-up, an overall statistically significant difference was demonstrated in favor of the EBI group patients, regarding both the in-stent (log-rank test, p = 0.0072) and the in-segment binary restenosis (log-rank test, p = 0.0103). The primary patency rates were also significantly better in the EBI group at specific time-points, such as in the first (74.2% vs 46.5%, p = 0.019), second (62.5% vs 33.8%, p = 0.020), and third (54.6% vs 29.0%, p = 0.039) year, respectively. Moreover, the overall clinically driven reintervention rate was significantly lower among patients of the irradiated group (log-rank test, p = 0.038). Conclusion. Our long-term follow-up analysis revealed that EBI following femoral artery PTA and stenting significantly reduces restenosis and reintervention rates, while improving primary patency

  11. The sirolimus-eluting Cypher Select coronary stent for the treatment of bare-metal and drug-eluting stent restenosis: insights from the e-SELECT (Multicenter Post-Market Surveillance) registry.

    Science.gov (United States)

    Abizaid, Alexandre; Costa, J Ribamar; Banning, Adrian; Bartorelli, Antonio L; Dzavik, Vladimir; Ellis, Stephen; Gao, Runlin; Holmes, David R; Jeong, Muyng Ho; Legrand, Victor; Neumann, Franz-Josef; Nyakern, Maria; Orlick, Amy; Spaulding, Christian; Worthley, Stephen; Urban, Philip M

    2012-01-01

    This study sought to compare the 1-year safety and efficacy of Cypher Select or Cypher Select Plus (Cordis Corporation, Bridgewater, New Jersey) sirolimus-eluting stents (SES) with the treatment of bare-metal stents (BMS) and drug-eluting stent (DES) in-stent restenosis (ISR) in nonselected, real-world patients. There is paucity of consistent data on DES for the treatment of ISR, especially, DES ISR. The e-SELECT (Multicenter Post-Market Surveillance) registry is a Web-based, multicenter and international registry encompassing virtually all subsets of patients and lesions treated with at least 1 SES during the period from 2006 to 2008. We enrolled in this pre-specified subanalysis all patients with at least 1 clinically relevant BMS or DES ISR treated with SES. Primary endpoint was major adverse cardiac events and stent thrombosis rate at 1 year. Of 15,147 patients enrolled, 1,590 (10.5%) presented at least 1 ISR (BMS group, n = 1,235, DES group, n = 355). Patients with DES ISR had higher incidence of diabetes (39.4% vs. 26.9%, p target lesion revascularization and definite/probable late stent thrombosis were higher in patients with DES ISR (6.9% vs. 3.1%, p = 0.003, and 1.8% vs. 0.5%, p = 0.04, respectively). Use of SES for either BMS or DES ISR treatment is safe and associated with low target lesion revascularization recurrence and no apparent safety concern. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Endovascular brachytherapy prevents restenosis after femoropopliteal angioplasty: results of the Vienna-3 randomised multicenter study

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Poetter, Richard; Wolfram, Roswitha M.; Budinsky, Alexandra C.; Kirisits, Christian; Lileg, Brigitte; Mendel, Helmuth; Sabeti, Schila; Schmid, Rainer; Minar, Erich

    2005-01-01

    Background and purpose: The aim of the trial was to investigate the effect of Iridium-192 gamma endovascular brachytherapy on reduction of restenosis after femoropopliteal angioplasty. Patients and methods: Between Oct, 1998 and Jul, 2001 a total of 134 patients have been randomized after successful angioplasty to brachytherapy or sham irradiation in a prospective, randomized, multicenter, double blind controlled trial. Patients with de novo lesion of at least 5 cm or recurrent lesion of any length after prior angioplasty have been enrolled. Brachytherapy was performed with 7 F centering catheter. Mean lesion length was 9.1 cm (1.5-25 cm) and mean intervention length 13.6 cm (4-27.5 cm) in brachytherapy cohort. Results: In placebo cohort mean lesion length was 10.3 cm (2-25 cm) and mean intervention length 14.1 cm (2-29 cm). A dose of 18 Gy was prescribed 2 mm from the surface of centering balloons. Analyzed (based on angiography) on intention to treat basis the binary restenosis rate at 12 months was 41.7% (28/67) in brachytherapy cohort and 67.1% (45/67) in placebo cohort (χ 2 test, P 30% residual stenosis after angioplasty) have been 23.4% in the brachytherapy and 53.3% in the placebo group (P<0.05), respectively. The cumulative patency rates after 24 months on intention to treat analysis were 54% in the brachytherapy and 27% in the placebo group (P<0.005). Corresponding data for as treated analysis were 77% in the brachytherapy and 39% in the placebo group (P<0.001). Late thrombosis was not seen. Conclusions: Significant reduction of restenosis rate was obtained with endovascular gamma brachytherapy after femoropopliteal angioplasty

  13. Flow disturbances in stent-related coronary evaginations

    DEFF Research Database (Denmark)

    Radu, Maria D; Pfenniger, Aloïs; Räber, Lorenz

    2014-01-01

    Aims: Angiographic ectasias and aneurysms in stented segments have been associated with late stent thrombosis. Using optical coherence tomography (OCT), some stented segments show coronary evaginations reminiscent of ectasias. The purpose of this study was to explore, using computational fluid......-dynamic (CFD) simulations, whether OCT-detected coronary evaginations can induce local changes in blood flow. Methods and results: OCT-detected evaginations are defined as outward bulges in the luminal vessel contour between struts, with the depth of the bulge exceeding the actual strut thickness. Evaginations...... can be characterised cross ectionally by depth and along the stented segment by total length. Assuming an ellipsoid shape, we modelled 3-D evaginations with different sizes by varying the depth from 0.2-1.0 mm, and the length from 1-9 mm. For the flow simulation we used average flow velocity data from...

  14. Redefining the boundaries of drug-eluting stent utilization: from in-stent restenosis to acute myocardial infarction

    NARCIS (Netherlands)

    F. Saia (Francesco)

    2004-01-01

    textabstractPercutaneous Coronary Interventions Percutaneous coronary angioplasty was first introduced by Andreas Gruentzig in 1977 as a non surgical method for coronary artery revascularization. Although initially restricted to stable patients with single, discrete, concentric, noncalcified

  15. Evaluating the cost of therapy for restenosis: considerations for brachytherapy.

    Science.gov (United States)

    Weintraub, W S

    1996-11-01

    Costs have become increasingly important in medicine in recent years as demand for services has outstripped readily available resources. Clinical microeconomics offers an approach to understanding cost and outcomes in an environment of economic scarcity. In this article the types of costs and methods for determining cost are presented. In addition, methods for assessing outcome and outcome in relation to cost are developed. Restenosis after coronary angioplasty is a prime example of a clinical problem requiring economic evaluation. This is because it results in little serious morbidity except for recurrent chest pain, but it has serious economic consequences which occur some time after the original angioplasty. This makes the economic assessment of restenosis complicated. The application of health care microeconomic principles to brachytherapy for restenosis in the coronary arteries is presented.

  16. Evaluating the cost of therapy for restenosis: considerations for brachytherapy

    International Nuclear Information System (INIS)

    Weintraub, William S.

    1996-01-01

    Costs have become increasingly important in medicine in recent years as demand for services has outstripped readily available resources. Clinical microeconomics offers an approach to understanding cost and outcomes in an environment of economic scarcity. In this article the types of costs and methods for determining cost are presented. In addition, methods for assessing outcome and outcome in relation to cost are developed. Restenosis after coronary angioplasty is a prime example of a clinical problem requiring economic evaluation. This is because it results in little serious morbidity except for recurrent chest pain, but it has serious economic consequences which occur some time after the original angioplasty. This makes the economic assessment of restenosis complicated. The application of health care microeconomic principles to brachytherapy for restenosis in the coronary arteries is presented

  17. Late lumen loss and intima hyperplasia after sirolimus-eluting and zotarolimus-eluting stent implantation in diabetic patients: the diabetes and drug-eluting stent (DiabeDES III) angiography and intravascular ultrasound trial

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Maeng, Michael; Thayssen, Per

    2011-01-01

    Patients with diabetes mellitus have increased risk of in-stent restenosis after coronary stent implantation due to neointimal hyperplasia (NIH). The aim of this study was to use quantitative coronary angiography (QCA) and volumetric intravascular ultrasound (IVUS) to evaluate the effects...

  18. Re-examining minimal luminal diameter relocation and quantitative coronary angiography - Intravascular ultrasound correlations in stented saphenous vein grafts: Methodological insights from the randomised RRISC trial

    NARCIS (Netherlands)

    O. Semeraro (Oscar); P. Agostoni (Pierfrancesco); S. Verheye (Stefan); G.J.J. van Langenhove (Glenn); P.A. van den Heuvel (Paul); C. Convens (Carl); F. van den Branden (Frank); N. Bruining (Nico); P. Vermeersch (Paul)

    2009-01-01

    textabstractAims: Angiographic parameters (such as late luminal loss) are common endpoints in drug-eluting stent trials, but their correlation with the neointimal process and their reliability in predicting restenosis are debated. Methods and results: Using quantitative coronary angiography (QCA)

  19. Agreement of duplex ultrasonography vs. computed tomography angiography for evaluation of native and in-stent SFA re-stenosis--findings from a randomized controlled trial.

    Science.gov (United States)

    Langenberger, Herbert; Schillinger, Martin; Plank, Christina; Sabeti, Schila; Dick, Petra; Cejna, Manfred; Lammer, Johannes; Minar, Erich; Loewe, Christian

    2012-09-01

    Multidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required. Seventy randomized patients who underwent stent implantation (n=47) or balloon angioplasty (n=23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (>50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients. Binary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ=0.88, 95% CI: 0.80-0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ=0.82, 95% CI: 0.66-0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ=0.92, 95% CI: 0.84-1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ=0.65; 95% CI 0.54-0.76). Significant correlations (r=0.85, pSFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Hemodynamics in stented vertebral artery ostial stenosis based on computational fluid dynamics simulations.

    Science.gov (United States)

    Qiao, Aike; Dai, Xuan; Niu, Jing; Jiao, Liqun

    2016-01-01

    Hemodynamic factors may affect the potential occurrence of in-stent restenosis (ISR) after intervention procedure of vertebral artery ostial stenosis (VAOS). The purpose of the present study is to investigate the influence of stent protrusion length in implantation strategy on the local hemodynamics of the VAOS. CTA images of a 58-year-old female patient with posterior circulation transient ischemic attack were used to perform a 3D reconstruction of the vertebral artery. Five models of the vertebral artery before and after the stent implantation were established. Model 1 was without stent implantation, Model 2-5 was with stent protruding into the subclavian artery for 0, 1, 2, 3 mm, respectively. Computational fluid dynamics simulations based on finite element analysis were employed to mimic the blood flow in arteries and to assess hemodynamic conditions, particularly the blood flow velocity and wall shear stress (WSS). The WSS and the blood flow velocity at the vertebral artery ostium were reduced by 85.33 and 35.36% respectively after stents implantation. The phenomenon of helical flow disappeared. Hemodynamics comparison showed that stent struts that protruded 1 mm into the subclavian artery induced the least decrease in blood speed and WSS. The results suggest that stent implantation can improve the hemodynamics of VAOS, while stent struts that had protruded 1 mm into the subclavian artery would result in less thrombogenesis and neointimal hyperplasia and most likely decrease the risk of ISR.

  1. Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality.

    Science.gov (United States)

    Li, Yuehua; Yu, Mengmeng; Li, Wenbin; Lu, Zhigang; Wei, Meng; Zhang, Jiayin

    2018-01-18

    To investigate the diagnostic performance of low dose stent imaging in patients with large (≥ 3 mm) and small (source CT. Symptomatic patients suspected of having in-stent restenosis (ISR) were prospectively enrolled. Coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) were performed within 1 month for correlation. Binary ISR was defined as an in-stent neointimal proliferation with diameter stenosis ≥ 50%. The radiation dose and image quality of CCTA were also assessed. Sixty-nine patients with 140 stents were ultimately included for analysis. The mean total radiation dose of CCTA was 1.3 ± 0.72 mSv in all patients and 0.95 ± 0.17 mSv in patients with high pitch acquisition. The overall diagnostic accuracy of CCTA stent imaging of patient-based, lesion-based and stent-based analysis was 95.7%, 94.1% and 94.3%, respectively. Further, the diagnostic accuracy of CCTA in the small calibre stent group (diameter source CT enables accurate diagnosis of coronary ISR of both large and small calibre stents. Low radiation dose could be achieved with preserved image quality. • Third-generation DSCT enables accurate diagnosis of coronary ISR of all size stents. • Low radiation dose could be achieved with preserved image quality. • The diagnostic accuracy of CCTA of small calibre stents was 88.5%.

  2. Plasma levels of immunoinflammatory markers in De Novo coronary atherosclerosis and coronary restenosis postangioplasty

    Directory of Open Access Journals (Sweden)

    Alexandre Schaan de Quadros

    2001-05-01

    Full Text Available OBJECTIVE: To compare circulating plasma levels of immunoinflammatory markers in patients with known de novo coronary artery disease and patients with postangioplasty restenosis. METHODS: Using enzymatic immunoabsorbent assay, we measured plasma levels of soluble interleukin-2 receptosr, tumor necrosis factor alpha, and soluble tumor necrosis alpha receptors I and II in 11 patients with restenosis postcoronary angioplasty (restenosis group, in 10 patients with primary atherosclerosis (de novo group who were referred for coronary angiography because of stable or unstable angina, and in 9 healthy volunteers (control group. Levels of soluble interleukin-2 receptors were significantly higher in the de novo group compared with that in the restenosis and control groups. Levels were also higher in the restenosis group compared with that in the control group. Plasma levels of tumor necrosis alpha and receptor levels were significantly higher in the de novo group compared to with that in the restenosis and control groups, but levels in the restenosis group were not different from that in the controls. CONCLUSION: Coronary artery disease, either primary or secondary to restenosis, is associated with significant immunoinflammatory activity, which can be assessed by examining the extent of circulating plasma levels of inflammatory markers. Moreover, patients with de novo lesions appear to have increased inflammatory activity compared with patients with restenosis.

  3. Intraarterial 192Ir high-dose-rate brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2-trial radiotherapy parameters and risk factors analysis

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Poetter, Richard; Maca, Thomas; Fellner, Claudia; Mittlboeck, Martina; Ahmadi, Ramazanali; Seitz, Wolfgang; Minar, Erich

    2000-01-01

    Purpose: The aim of the Vienna-2-trial was to compare the restenosis rate of femoropopliteal arteries after percutaneous transluminal angioplasty (PTA) with or without intraarterial high-dose-rate (HDR) brachytherapy (BT) using an 192 Ir source. Materials and Methods: A prospective, randomized trial was conducted from 11/96 to 8/98. A total of 113 patients (63 men, 50 women), with a mean age of 71 years (range, 43-89 years) were included. Inclusion criteria were (1) claudication or critical limb ischemia, (2) de-novo stenosis of 5 cm or more, (3) restenosis after former PTA of any length, and (4) no stent implantation. Patients were randomized after successful PTA for BT vs. no further treatment. A well-balanced patient distribution was achieved for the criteria used for stratification, as there were 'de-novo stenosis vs. restenosis after former PTA', 'stenosis vs. occlusion', 'claudication vs. critical limb ischemia' and above these for 'diabetes vs. nondiabetes'. PTA length was not well balanced between the treatment arms: a PTA length of 4-10 cm was seen in 19 patients in the PTA alone group and in 11 patients in the PTA+BT group, whereas a PTA length of greater than10 cm was seen in 35 patients and 42 patients, respectively. A dose of 12 Gy was prescribed in 3-mm distance from the source axis. According to AAPM recommendations, the dose was 6.8 Gy in 5-mm distance (vessel radius + 2 mm). Primary endpoint of the study was femoropopliteal patency after 6 months. Results: PTA and additional BT were feasible and well tolerated by all 57 pts in this treatment arm. No acute, subacute, and late adverse side effects related to BT were seen after a mean follow up of 12 months (6-24 months) in 107 patients (PTA n = 54; PTA+ BT n = 53). Crude restenosis rate at 6 months was in the PTA arm 54% vs. 28% in the PTA + BT arm (χ 2 test; p 10 cm) showed significant decrease of the restenosis rate, if BT was added. Significant reduction was not achieved in diabetes patients

  4. The Relationships between Polymorphisms in Genes Encoding the Growth Factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A and the Restenosis Process in Patients with Stable Coronary Artery Disease Treated with Bare Metal Stent.

    Directory of Open Access Journals (Sweden)

    Tadeusz Osadnik

    Full Text Available Neointima forming after stent implantation consists of vascular smooth muscle cells (VSMCs in 90%. Growth factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A play an important role in VSMC proliferation and migration to the tunica intima after arterial wall injury. The aim of this paper was an analysis of functional polymorphisms in genes encoding TGF-β1, PDGFB, EGF, bFGF and VEGF-A in relation to in-stent restenosis (ISR.265 patients with a stable coronary artery disease (SCAD hospitalized in our center in the years 2007-2011 were included in the study. All patients underwent stent implantation at admission to the hospital and had another coronary angiography performed due to recurrence of the ailments or a positive result of the test assessing the coronary flow reserve. Angiographically significant ISR was defined as stenosis >50% in the stented coronary artery segment. The patients were divided into two groups-with angiographically significant ISR (n = 53 and without significant ISR (n = 212. Additionally, the assessment of late lumen loss (LLL in vessel was performed. EGF rs4444903 polymorphism was genotyped using the PCR-RFLP method whilst rs1800470 (TGFB1, rs2285094 (PDGFB rs308395 (bFGF and rs699947 (VEGF-A were determined using the TaqMan method.Angiographically significant ISR was significantly less frequently observed in the group of patients with the A/A genotype of rs1800470 polymorphism (TGFB1 versus patients with A/G and G/G genotypes. In the multivariable analysis, LLL was significantly lower in patients with the A/A genotype of rs1800470 (TGFB1 versus those with the A/G and G/G genotypes and higher in patients with the A/A genotype of the VEGF-A polymorphism versus the A/C and C/C genotypes. The C/C genotype of rs2285094 (PDGFB was associated with greater LLL compared to C/T heterozygotes and T/T homozygotes.The polymorphisms rs1800470, rs2285094 and rs6999447 of the TGFB1, PDGFB and VEGF-A genes, respectively, are associated with LLL

  5. Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

    NARCIS (Netherlands)

    D.R. Holmes Jr (David); J.R. Granett (Jeffrey); J.J. Popma (Jeffrey); P.J. Fitzgerald (Peter); D. Fischman (David); J.J. Ferguson (James); A.M. Lincoff (Michael); S. Goldberg (Sheldon); J.A. Brinker; R. Chan; B.R. Davis (Barry); M. Poland; A.M. Zeiher (Andreas); J.T. Willerson (James); S.B. King 3rd (Spencer); L.M. Shapiro; M. Savage (Michael); J.M. Lablanche (Jean Marc); J.E. Tcheng (James); L. Grip (Lars); P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral

  6. Interleukin 10: A new risk marker for the development of restenosis after percutaneous coronary intervention

    NARCIS (Netherlands)

    Monraats, P.S.; Kurreeman, F.A.S.; Pons, D.; Sewgobind, V.D.K.D.; Vries, F.R. de; Zwinderman, A.H.; Maat, M.P.M. de; Doevendans, P.A.; Winter, R.J. de; Tio, R.A.; Waltenberger, J.; Huizinga, T.W.J.; Eefting, D.; Quax, P.H.A.; Frants, R.R.; Laarse, A. van der; Wall, E.E. van der; Jukema, J.W.

    2007-01-01

    Genetic factors appear to be important in the process of restenosis after percutaneous coronary intervention (PCI), as well as in inflammation, a pivotal factor in restenosis. An important mediator in the inflammatory response is interleukin (IL)-10. Our aim was to study whether genetic variants in

  7. Engineering Radioactive Stents for the Prevention of Restenosis

    International Nuclear Information System (INIS)

    Bruce Thomadsen; Nickles, Robert J.; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

    2004-01-01

    Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year

  8. Engineering Radioactive Stents for the Prevention of Restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Bruce Thomadsen; Robert J. Nickles; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

    2004-09-10

    Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year.

  9. Detecting Restenosis after Percutaneous Coronary Intervention Using Exercise-Stress Electrocardiogram Findings Including QT Dispersion

    Directory of Open Access Journals (Sweden)

    Bonpei Takase, MD

    2006-01-01

    Full Text Available Despite the advent of drug-eluting stents in Japan, bare metal stents or conventional balloon angioplasty are still indicated in some patients needing elective percutaneous coronary intervention (PCI and in patients with acute coronary syndrome if these patients develop side effects while taking ticlopidine. In such patients, restenosis is a problem that is difficult to diagnose. To investigate the comparative diagnostic accuracy of the exercise-stress electrocardiogram (ECG for detecting restenosis after PCI, we measured conventional ST-segment changes and QT dispersion during exercise-stress testing in 173 patients with elective PCI (63 ± 10 years old. Exercise-stress testing was performed 3 to 6 months after successful PCI, and restenosis was confirmed by follow-up coronary angiogram. There were 98 patients with a prior myocardial infarction (prior MI group and 76 patients with no prior myocardial infarction (no MI group. Restenosis was found in 45 patients (46% in the prior MI group and 26 patients (34% in the no MI group. Conventional ST-segment depression (>1:0 mm, J 60 ms indicating exercise-induced myocardial ischemia had a sensitivity of around 50% and a specificity of around 70% for diagnosing restenosis in both groups. In the prior MI group, QT dispersion was increased by exercise-stress testing in both patients with and without restenosis, whereas in the no MI group, QT dispersion increased only in patients with restenosis. With a cut-off value of >60 ms, QT dispersion had a sensitivity of 54% and a specificity of 68% for detecting restenosis in the no MI group; these values were comparable to those seen with conventional ST-segment changes. In conclusion, due to its low cost, exercise-stress ECG remains useful for diagnosing restenosis following PCI if the clinician understands its limited sensitivity and specificity. The presence of a prior MI must be considered when QT dispersion during exercise-stress testing is used for

  10. Optimal conjugation of catechol group onto hyaluronic acid in coronary stent substrate coating for the prevention of restenosis.

    Science.gov (United States)

    Lih, Eugene; Choi, Seul Gi; Ahn, Dong June; Joung, Yoon Ki; Han, Dong Keun

    2016-01-01

    Although endovascular stenting has been used as an interventional therapy to treat cardio- and cerebro-vascular diseases, it is associated with recurrent vascular diseases following stent thrombosis and in-stent restenosis. In this study, a metallic stent was coated with dopamine-conjugated hyaluronic acid with different ratios of catechol group to improve hemocompatibility and re-endothelialization. Especially, we were interested in how much amount of catechol group is appropriate for the above-mentioned purposes. Therefore, a series of dopamine-conjugated hyaluronic acid conjugates with different ratios of catechol group were synthesized via a carbodiimide coupling reaction. Dopamine-conjugated hyaluronic acid conjugates were characterized with 1 H-nuclear magnetic resonance and Fourier transform infrared spectroscopy, and the amount of catechol group in dopamine-conjugated hyaluronic acid was measured by ultraviolet spectrometer. Co-Cr substrates were polished and coated with various dopamine-conjugated hyaluronic acid conjugates under pH 8.5. Dopamine-conjugated hyaluronic acid amounts on the substrate were quantified by micro-bicinchoninic acid assay. Surface characteristics of dopamine-conjugated hyaluronic-acid-coated Co-Cr were evaluated by water contact angle, scanning electron microscopy, and atomic force microscopy. The hemocompatibility of the surface-modified substrates was assessed by protein adsorption and platelet adhesion tests. Adhesion and activation of platelets were confirmed with scanning electron microscopy and lactate dehydrogenase assay. Human umbilical vein endothelial cells were cultured on the substrates, and the viability, adhesion, and proliferation were investigated through cell counting kit-8 assay and fluorescent images. Obtained results demonstrated that optimal amounts of catechol group (100 µmol) in the dopamine-conjugated hyaluronic acid existed in terms of various properties such as hemocompatibility and cellular responses.

  11. Fibrocellular tissue responses to endovascular and external beam irradiation in the porcine model of restenosis

    International Nuclear Information System (INIS)

    Marijianowski, Monique M.H.; Crocker, Ian R.; Styles, Terry; Forestner, Donna M.; Waksman, Ron; Cipolla, Gustavo D.; King, Spencer B.; Robinson, Keith A.

    1999-01-01

    Purpose: Endovascular radiation has reduced postangioplasty restenosis in preclinical and early clinical studies. External radiation treatment may have advantages over endovascular therapy. We examined vascular and perivascular tissue responses to endovascular and external irradiation in pig coronary arteries. Methods and Materials: Ninety-one animals received endovascular or external radiation following balloon injury and were sacrificed at 14, 30, or 180 days. Injured segments of coronary vessels including perivascular and myocardial tissues were evaluated with histochemistry. Results: Endovascular radiation was associated with delayed arterial wound healing as late as 6 months, evidenced by paucity of smooth muscle α-actin in neointimal cells compared to control. External treatment was associated with increased collagen in neointima and adventitia, and focal interstitial necrosis in adjacent myocardium. Conclusions: These investigations showed whole-heart 14 Gy external radiation treatment following coronary injury exacerbated certain aspects of arterial healing. In addition focal myocardial necrosis and fibrosis was observed following external but not endovascular irradiation. Endovascular radiation has some advantages over external irradiation; however the persistence of a synthetic smooth muscle cell phenotype in the neointima at 6 months suggests ionizing radiation in general may have profound effects on vessel architecture over the long term

  12. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

    NARCIS (Netherlands)

    W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

    1985-01-01

    textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

  13. Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2012-06-01

    Full Text Available Abstract Background The benefit of the coronary collateral circulation (natural bypass network on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis. Methods We searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011. Random effects models were used to calculate summary risk ratios (RR for restenosis. The primary endpoint was angiographic restenosis > 50%. Results A total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR 1.40 (95% CI 1.09 to 1.80; P = 0.009. This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83; P = 0.038 versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99; P = 0.049. For the subgroup of patients with stable coronary artery disease (CAD, the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35 compared to 'poor collaterals' (P = 0.008. For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69; P = 0.212. Conclusions The risk of restenosis after percutaneous coronary intervention (PCI is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol.

  14. Drug-Eluting Balloon versus New-Generation Drug-Eluting Stent for the Treatment of In-Stent Restenosis: An Updated Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Kong-Yong Cui

    2018-01-01

    Conclusions: The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.

  15. Usefulness of Eosinophil-Lymphocyte Ratio to Predict Stent Restenosis

    Directory of Open Access Journals (Sweden)

    Mehmet Zihni Bilik

    2016-06-01

    Full Text Available Objective: Stent restenosis (SR is an important compli­cation of percutaneous coronary intervention. There are many studies explored the relation of eosinophils with SR, however, there is no data about relationship between eo­sinophil-lymphocyte ratio (ELR and SR. In this study we aimed to investigate the relationship between the value of ELR on admission and SR. Methods: The study was included 314 patients who had been applied a coronary stent implantation and they were admitted to cardiology clinic with stabile angina and un­derwent repeat coronary angiography. The data obtained from patients were analyzed retrospectively. The patient group was consisted of 197 patients who were diagnosed as SR, and the control group was consisted of 117 pa­tients whose stents were patent angiographically. Results: The groups were similar in terms of age, gender, hypertension, diabetes mellitus, LDL-C, HDL-C, platelet count, platelet-lymphocyte ratio (PLR, hemoglobin and left ventricle ejection fraction (LVEF. White blood cell (WBC, neutrophil, eosinophil, C-reactive protein (CRP, ELR and neutrophil-lymphocyte ratio (NLR on admission were higher in the SR group compared to the controls. All patients were categorized into two groups according to ELR values and SR was more frequent in the high ELR group compared to low ELR group. An ELR value of ≥0.745 predicted SR with 64% sensitivity and 61% specif­ity. Conclusion: In this study ELR was found statistically higher in SR patients compared to the controls. Accord­ing to our data ELR as an inexpensive and easy method, may contribute to determination of high risk patients and increased ELR can be used as a predictor of SR.

  16. Study on the application of big cup membranate stent on restenosis after stenting for carcinoma of esophago cardia

    International Nuclear Information System (INIS)

    Wang Xiuping; Yao Zhongqiang; Liu Jian; Zhang Yan

    2007-01-01

    Objective: To evaluate the clinical value of self-designed big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia. Methods: 12 cases of restenosis after stenting for carcinoma of esophago-cardia were involved in the study. Self-designed big cup membranate stent made by Nanjing Weichuang Company (the length of the cup was 3.5 cm)was placed into the constricted stent under guidance of fluoroscopy. Clinical effect, restenosis, and complications were observed during followed up. Results: All the 12 cases of big cup membranat stent placement went along smoothly without indigitation of the cup of the stent. Follow-up of 1.5-8 months showed that 2 cases developed severe restenosis on the big cup of the stem, resulting in third grade difficult deglutition. Among them, one occurred 1 month after stenting, caused by hyperplasia of large amount of granulation tissue; another occurred 6 months after stenting, caused by growth of tumor tissue. 3 cases developed mild to moderate restenosis, 2.3-7 months (mean: 4.6 months) after stenting, with result of first grade difficult deglutition. The remaining 7 cases (mean 5.6 months follow-up) did not have difficulty during deglutition. Conclusions: Application of big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia can effectively prevent the stent from moving downwards and thus lower down the rate of restenosis, and postpone the occurrence of restenosis. (authors)

  17. Metabolic syndrome and risk of restenosis in patients undergoing percutaneous coronary intervention

    NARCIS (Netherlands)

    Wouterjukema, J; Monraats, PS; Zwinderman, AH; De Maat, MPM; Kastelein, JJP; Doevendans, PAF; De Winter, RJ; Tio, RA; Frants, RR; Van der Laarse, A; Van der Wall, EE; Jukema, JW

    OBJECTIVE - Patients with metabolic syndrome have increased risk of cardiovascular events. The number of patients With Metabolic syndrome is rapidly increasing, and these patients Often need revascularization. However, only limited data are available on the effect of metabolic syndrome on restenosis

  18. Drug-eluting stents studies in mice: do we need atherosclerosis to study restenosis?

    NARCIS (Netherlands)

    Pires, Nuno M. M.; Jukema, J. Wouter; Daemen, Mat J. A. P.; Quax, Paul H. A.

    2006-01-01

    In 2001, the first human study with drug-eluting stents (DES) was published showing a nearly complete abolition of restenosis by using a sirolimus-eluting stent. This success was very encouraging to test new compounds in combination with the DES platform. Nevertheless, several other anti-restenotic

  19. Platelet deposition at angioplasty sites and its relation to restenosis in human iliac and femoropopliteal arteries

    International Nuclear Information System (INIS)

    Minar, E.; Ehringer, H.; Ahmadi, R.; Dudczak, R.; Leitha, T.; Koppensteiner, R.; Jung, M.; Stuempflen, A.

    1989-01-01

    The amount and time course of platelet accumulation at angioplasty sites and influence of these platelets on restenosis after percutaneous transluminal angioplasty (PTA) in peripheral arteries were determined in 92 patients, who received either a high or low dose of aspirin. Platelet deposition was quantitated by means of dual-radiotracer scintigraphy and calculation of a platelet accumulation index (PAI). The PAI was higher (P less than .05) 4-6 hours after PTA compared with that on subsequent days. There was a trend toward greater platelet accumulation in vessels with extensive dissection. Platelet accumulation at the PTA site occurred with both doses of aspirin, with no differences between the two dosage groups. Twenty-one of 67 patients who underwent PTA in the femoropopliteal segment developed restenosis during a median follow-up of 14 months. The median PAI at 4-6 and 22-24 hours after PTA was significantly less in these 21 patients than in the 46 without restenosis. The data suggest that use of antiplatelet agents to prevent platelet deposition after PTA may not be useful for prevention of restenosis

  20. Models and Analysis of Atherosclerosis, Restenosis, and Aneurysm Formation in the Mouse

    NARCIS (Netherlands)

    de Waard, Vivian; Gijbels, Marion J. J.; Lutgens, Esther; de Winther, Menno P. J.; de Vries, Carlie J. M.

    2012-01-01

    Atherosclerosis is considered a chronic inflammatory condition of the vessel wall and involves a high chronic concentration of low-density lipoprotein (LDL) in blood. In humans, restenosis develops after intravascular interventions such as angioplasty and stent placement to treat atherosclerosis,

  1. Astro research fellowship: low dose radiation to prevent restenosis after angioplasty

    International Nuclear Information System (INIS)

    Rege, Sheila; Razavi, Mahmood; Fessenden, Kali; Ziegler, Werner; Gomez, Antoinette; Smathers, James; Withers, Rodney

    1997-01-01

    Purpose: To determine the optimal time to deliver a single dose of external radiation therapy (12 Gy) postoperatively following balloon angioplasty (on same day, day 2 or day 4) to prevent restenosis in a non-stented swine model. To model an endovascular radioactive source for prevention of restenosis in the same animal model. Materials and Methods: Both external iliac arteries in eleven red duroc swine were injured using balloon overdilation (3 inflations, 60 secs. each, 16 psi), and the first five were additionally injured using denudation. One artery in each animal was then irradiated using anteroposterior and posterioranterior fields using Co-60 with 12 Gy prescribed to the midplane, with the other artery serving as a control. Irradiation was delivered on the same day, day 2 or day 4. Animals were sacrificed 3 months following injury, and histomorphometric analysis was performed. Additionally, a prototype endovascular beta source was designed and manufactured for clinical testing, based on Monte Carlo estimations. Results: Neointima formation was noted in both radiated and control arteries. The mean neointimal thickness in the radiated and control arteries was 116 ± 39 μm and 131 ± 47 μm respectively. Time of radiation delivery did not have a significant effect in preventing restenosis. Physical measurements of the endovascular source are in progress using a water based phantom. Animal testing will commence on ten red duroc swine. Conclusion: External radiation at this low dose does not appear to prevent restenosis in an unstented animal model. We hope to begin animal experiments using an endovascular source to prevent restenosis

  2. Blood flow in stented coronary artery: numerical fluid dynamics analysis.

    Science.gov (United States)

    Bénard, N; Perrault, R; Coisne, D

    2004-01-01

    Recent generalization of stent implantation in interventional cardiology require full understanding of blood flow cartography. Interdepency between fluid stresses and in vivo cells covering lumen artery are regularly accused to be one of the instigator of neointimal proliferation (thickening of the inner layer of blood vessels) and mid-term restenosis. This study purpose to numericaly investigate the three dimensional flow in vicinity of an endoprothesis. We used a finite element method to simulate a steady flow of non-Newtonian fluid in a coronary artery using a rigid wall approximation. Results on the velocities, wall shear stress and wall shear stress gradients are presented. Theses simulations allow identification of stagnation site and low wall shear stress area that may be prone to clot formation and neointimal hyperplasia. Intra stent flow knowledge can potentially contribute to optimization of prothesis design and decreasing second intervention rate.

  3. Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

    International Nuclear Information System (INIS)

    Saguner, Ardan M.; Traupe, Tobias; Räber, Lorenz; Hess, Nina; Banz, Yara; Saguner, Arhan R.; Diehm, Nicolas; Hess, Otto M.

    2012-01-01

    Purpose: Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy. Methods: Ten uncoated NS and six TiNOX-coated NS (5–6 mm) were implanted randomly in the iliofemoral artery of six mini-pigs. After implantation, quantitative angiography (QA) was performed for calculation of artery and minimal luminal diameter. Follow-up was performed by QA and histomorphometry after 5 months. Results: Stent migration, stent fracture, or thrombus formation were not observed. All stents were patent at follow-up. Based on the location of the stent (iliac/femoral) and the stent-to-artery-ratio, stent segments were divided into “normal-sized” (stent-to-artery-ratio < 1.4, n = 12) and “oversized” (stent-to-artery-ratio ≥ 1.4, n = 9). All stent segments expanded to their near nominal diameter during follow-up. Normal-sized stent segments increased their diameter by 6% and oversized segments by 29%. A significant correlation between oversizing and restenosis by both angiography and histomorphometry was observed. Restenosis rates were similar for uncoated NS and TiNOX-coated NS. Conclusions: TiNOX-coated NS are as safe and effective as uncoated NS in the porcine iliofemoral artery. All stents further expand to near their nominal diameter during follow-up. Oversizing is linearly and positively correlated with neointimal proliferation and restenosis, which may not be reduced by TiNOX-coating.

  4. Optimization of cardiovascular stent against restenosis: factorial design-based statistical analysis of polymer coating conditions.

    Directory of Open Access Journals (Sweden)

    Gayathri Acharya

    Full Text Available The objective of this study was to optimize the physicodynamic conditions of polymeric system as a coating substrate for drug eluting stents against restenosis. As Nitric Oxide (NO has multifunctional activities, such as regulating blood flow and pressure, and influencing thrombus formation, a continuous and spatiotemporal delivery of NO loaded in the polymer based nanoparticles could be a viable option to reduce and prevent restenosis. To identify the most suitable carrier for S-Nitrosoglutathione (GSNO, a NO prodrug, stents were coated with various polymers, such as poly (lactic-co-glycolic acid (PLGA, polyethylene glycol (PEG and polycaprolactone (PCL, using solvent evaporation technique. Full factorial design was used to evaluate the effects of the formulation variables in polymer-based stent coatings on the GSNO release rate and weight loss rate. The least square regression model was used for data analysis in the optimization process. The polymer-coated stents were further assessed with Differential scanning calorimetry (DSC, Fourier transform infrared spectroscopy analysis (FTIR, Scanning electron microscopy (SEM images and platelet adhesion studies. Stents coated with PCL matrix displayed more sustained and controlled drug release profiles than those coated with PLGA and PEG. Stents coated with PCL matrix showed the least platelet adhesion rate. Subsequently, stents coated with PCL matrix were subjected to the further optimization processes for improvement of surface morphology and enhancement of the drug release duration. The results of this study demonstrated that PCL matrix containing GSNO is a promising system for stent surface coating against restenosis.

  5. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

    International Nuclear Information System (INIS)

    Tsumoto, T.; Miyamoto, T.; Shimizu, M.; Inui, Y.; Nakakita, K.; Hayashi, S.; Terada, T.

    2003-01-01

    We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little. (orig.)

  6. Angiographic Findings of the Multicenter Randomized Study With the Sirolimus-Eluting Bx Velocity Balloon-Expandable Stent (RAVEL) : Sirolimus-Eluting Stents Inhibit Restenosis Irrespective of the Vessel Size

    NARCIS (Netherlands)

    E.S. Regar (Eveline); M. Degertekin (Muzaffer); M-C. Morice (Marie-Claude); K. Tanabe (Kengo); E. Wülfert (Egon); C. Disco (Clemens); C. Holubarsch; J-L. Guermonprez (Jean-Leon); W. Wijns (William); A. Bartorelli (Antonio); P.W.J.C. Serruys (Patrick); C.H. Bode (Christoph); C. Constantini (Constantino)

    2002-01-01

    markdownabstractBACKGROUND: Restenosis remains the major limitation of coronary catheter-based intervention. In small vessels, the amount of neointimal tissue is disproportionately greater than the vessel caliber, resulting in higher restenosis rates. In the Randomized Study With the

  7. Zotarolimus-eluting stent for the treatment of recurrent, severe carotid artery in-stent stenosis in the TARGET-CAS population.

    Science.gov (United States)

    Tekieli, Lukasz; Pieniazek, Piotr; Musialek, Piotr; Kablak-Ziembicka, Anna; Przewlocki, Tadeusz; Trystula, Mariusz; Moczulski, Zbigniew; Dzierwa, Karolina; Paluszek, Piotr; Podolec, Piotr

    2012-06-01

    To evaluate the safety and efficacy of a balloon-mounted drug-eluting stent (DES) for recurrent carotid in-stent stenosis (ISS). As part of our targeted carotid artery stenting (TARGET-CAS) protocol, neurological and ultrasound evaluations have been performed at 3, 6, and 12 months and then annually since 2001 in all carotid stent patients. For angiographically-confirmed >70% ISS, balloon angioplasty was performed as a first-line treatment. Recurrent ISS was treated with a 4.0-mm zotarolimus-eluting coronary stent (ZES) that was postdilated according to intravascular ultrasound imaging. Among the 1350 neuroprotected CAS procedures performed between January 2001 and March 2011, there were 7 (0.52%) patients (5 men; ages 51-72 years), all neurologically asymptomatic, with >70% recurrent ISS that occurred at 5 to 11 months after the initial balloon angioplasty treatment for ISS. ZES implantation under distal embolic protection was technically successful and uncomplicated. Angiographic stenosis was reduced from 84.6%±7.5% to 10.7%±3.6% (p<0.01). In 5 patients with ZES implanted fully within the self-expanding carotid stent, duplex ultrasound follow-up (mean 17 months, range 6-36) revealed no evidence of restenosis or stent fracture/deformation. In the 2 other patients, the ZES had been implanted for distal edge ISS such that the ZES protruded beyond the original carotid stent. This protruding segment of the ZES demonstrated deformation/kinking in both; in one, this led to symptomatic stent occlusion. The use of coronary ZES in the treatment of recurrent carotid ISS is feasible and appears effective provided the ZES is placed entirely within the original stent. Placement of a coronary ZES outside the carotid stent scaffold should be avoided.

  8. Caracterización de la restenosis de stents coronarios convencionales y liberadores de medicamentos en pacientes incluidos en el registro DRug Eluting STent (DREST

    Directory of Open Access Journals (Sweden)

    Jorge A. Arroyave C., MD

    2012-05-01

    Conclusiones: las tasas de restenosis intrastent y las características relacionadas encontradas, son similares a lo publicado. La dislipidemia aparece como factor asociado significativo. La restenosis intrastent se manifestó como síndrome coronario agudo en 60% de los casos; no puede considerarse como un proceso benigno en esta población.

  9. Metabolic background determines the importance of NOS3 polymorphisms in restenosis after percutaneous coronary intervention: A study in patients with and without the metabolic syndrome

    NARCIS (Netherlands)

    Pons, D.; Monraats, P.S.; Zwinderman, A.H.; de Maat, M.P.M.; Doevendans, P.A.F.M.; de Winter, R.J.; Tio, R.A.; Waltenberger, J.; Jukema, J.W.

    2009-01-01

    Variation in the NOS3 gene has been related to the development of restenosis. The Glu298Asp polymorphism has previously been investigated for its effect on NO levels and the development of restenosis. However, the variability of findings gave rise to the hypothesis that the functional significance

  10. Photodynamic therapy of atherosclerosis and restenosis: a potentially exciting new treatment method

    Science.gov (United States)

    Vincent, G. Michael

    1994-07-01

    Photodynamic therapy (PDT) is the result of an interaction between light and a photoactive drug. The interaction produces cytotoxic oxygen radicals and radicals and microvascular collapse, resulting in tissue death. A number of photoactive drugs have been shown to accumulate in greater concentration in atherosclerotic plaque than in normal arterial wall and are potentially useful for PDT. The newer generation agents are safe and have brief skin phototoxicity as the only significant side effect. PDT in several animal models of atherosclerosis has shown plaque removal without damage to the artery wall if appropriate light energy is used, with no perforation, and no distal embolization or obstruction. In one such study we found that PDT using Photofrin and 630 nm laser light reduced the mean percent stenosis of 12 stenoses in 8 pigs from 63% to 40%, and in 7/12 of the segments from 63% to 16%, whereas in 2 untreated control lesions the mean stenosis progressed from 60% to 85%. PDT requires several days for tissue destruction, and immediate luminal enlargement by an adjunct angioplasty intervention may be appropriate. Animal studies suggest that PDT also inhibits the intimal hyperplasia process which follows vascular injury, and PDT may inhibit restenosis following clinical coronary angioplasty. The enthusiasm for PDT of atherosclerosis, therefore, stems from three important potential advantages of the technique: the apparent selectivity and safety of the process, the potential for effective debulking of plaque and the possibility of reduction or inhibition or restenosis.

  11. Bioresorbable scaffolds in the treatment of coronary artery disease

    OpenAIRE

    Zhang, Yaojun; Bourantas, Christos; Farooq, Vasim; Muramatsu, Takashi; Diletti, Roberto; Onuma, Yoshinobu; Garcia-Garcia, Hector; Serruys, Patrick

    2013-01-01

    textabstractDrug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of t...

  12. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis......-derived collateral flow index (CFI) was determined as (P(w)-P(cvp))/(P(a)-P(cvp)), where P(w) represents coronary wedge pressure, P(cvp) central venous pressure, and P(a) mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0.......65 +/- 0.20) correlated inversely with the CFI (0.18 +/- 0.11), r =- 0.356, P /=50% diameter stenosis) was seen in 29.1%. Compared to patients with poorly developed collaterals (CFI collaterals (CFI >/= 0...

  13. Two-dimensional fluorescence in-gel electrophoresis of coronary restenosis tissues in minipigs: increased adipocyte fatty acid binding protein induces reactive oxygen species-mediated growth and migration in smooth muscle cells.

    Science.gov (United States)

    Lu, Lin; Wang, Ya Nan; Sun, Wei Hua; Liu, Zhu Hui; Zhang, Qi; Pu, Li Jin; Yang, Ke; Wang, Ling Jie; Zhu, Zhen Bin; Meng, Hua; Yang, Ping; Du, Run; Chen, Qiu Jing; Wang, Li Shun; Yu, Hong; Shen, Wei Feng

    2013-03-01

    We aimed to uncover the protein changes of coronary artery in-stent restenosis (ISR) tissue in minipigs with and without streptozotocin-induced diabetes mellitus by quantitative 2-dimensional fluorescence in-gel electrophoresis (2D-DIGE), and to investigate the influences of crucial proteins identified, particularly adipocyte fatty acid binding protein (AFABP), in human arterial smooth muscle cells. Sirolimus-eluting stents were implanted in the coronary arteries of 15 diabetic and 26 nondiabetic minipigs, and angiography was repeated after 6 months. The intima tissue of significant ISR and non-ISR segments in both diabetic and nondiabetic minipigs was analyzed by 2D-DIGE and MALDI-TOF/TOF mass spectrometry. AFABP level was significantly increased in ISR tissue than in non-ISR tissue in both diabetic and nondiabetic minipigs, with level being higher in diabetic ISR than in nondiabetic ISR tissue. In human arterial smooth muscle cells, overexpression of AFABP significantly altered phenotype and promoted growth and migration, with effects more prominent in high-glucose than in low-glucose medium, whereas AFABP knockdown inhibited these effects. AFABP overexpression increased reactive oxygen species production by upregulating the expression of NADPH oxidase subunits Nox1, Nox4, and P22 through multiple pathways, with elevation of downstream gene cyclin D1, matrix metalloproteinase-2, and monocyte chemoattractant protein-1. However, AFABP-induced effects were inhibited by diphenyleneiodonium, pathway inhibitors, and small interfering RNA. In addition, the supernatant from AFABP-expressing human arterial smooth muscle cells and recombinant AFABP also promoted cellular growth and migration. This study has demonstrated that AFABP is significantly increased in coronary artery ISR segments of both diabetic and nondiabetic minipigs. Increased AFABP expression and secretory AFABP of human arterial smooth muscle cells promote growth and migration via reactive oxygen species

  14. Impact of 6-month angiographic restenosis inside bare-metal stents on long-term clinical outcome in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Chen Yunglung; Chen Miencheng; Wu Chiungjen

    2007-01-01

    This study enrolled 536 patients who underwent successful coronary stenting with bare-metal stents and 6-month angiographic follow-up examinations between 1998 and 2000. Baseline characteristics and angiographic and procedural parameters for these patients were obtained. Primary endpoints were all-cause mortality and nonfatal myocardial infarction. Patients were assigned to instent restenosis or non-instent restenosis groups based on 6-month angiographic follow-up results. Restenosis inside a bare-metal stent was defined as more than 50% stenosis at the intervention site. In total, 178 (33.2%) patients had restenosis inside bare-metal stents, while 358 (66.8%) patients were without. At mean follow-up of 56.8±20.3 months, 36 (6.7%) patients had a primary endpoint event while 500 (93.3%) patients had no primary endpoint event. Survival rates for patients free from primary endpoints in the instent restenosis and non-instent restenosis groups were 96.0 versus 99.4% at 1 year and 89.8% versus 94.8% at 5 years, respectively (P=0.0033). Survival rates for patients free of all-cause mortality in the instent restenosis and non-instent restenosis groups were 96.0% versus 99.4% at 1 year and 91.6% versus 96.3% at 5 years, respectively (P=0.0079). Multivariate Cox regression analysis showed that restenosis inside bare-metal stents was an independent predictor of primary endpoint events (odds ratio: 2.053; 95% CI: 1.048-4.022; P=0.036) and was a predictor of total mortality with borderline significance (odds ratio: 2.036; 95% CI: 0.936-4.431; P=0.073). In conclusion, in this study, restenosis inside bare-metal stents at 6-month angiographic follow-up was an independent predictor of long-term outcome-all-cause mortality and nonfatal myocardial infarction. Thus, this study provides clinical evidence that patients with restenosis inside bare-metal stents at 6-month angiographic follow-up likely warrant aggressive follow-up. (author)

  15. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

    Energy Technology Data Exchange (ETDEWEB)

    Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2016-02-15

    PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  16. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients.

    Science.gov (United States)

    Gary, Thomas; Prüller, Florian; Raggam, Reinhard; Mahla, Elisabeth; Eller, Philipp; Hafner, Franz; Brodmann, Marianne

    2016-02-01

    Although platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets. A prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated. Eight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04]. High residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  17. Incidence, Clinical Presentation, and Predictors of Clinical Restenosis in Coronary Bioresorbable Scaffolds.

    Science.gov (United States)

    Polimeni, Alberto; Weissner, Melissa; Schochlow, Katharina; Ullrich, Helen; Indolfi, Ciro; Dijkstra, Jouke; Anadol, Remzi; Münzel, Thomas; Gori, Tommaso

    2017-09-25

    The aim of this study was to describe the incidence and clinical characteristics, including intracoronary imaging features, of clinical restenosis in bioresorbable coronary scaffolds (BRS). Further, the authors searched for clinical and procedural predictors of scaffold restenosis (ScR) and report on the clinical outcomes after treatment of ScR in a cohort of consecutive all-comer patients. Data from randomized controlled trials demonstrate a higher rate of target lesion failure in patients treated with BRS as compared with those treated with metal drug-eluting stents. Although in-scaffold thrombosis has been thoroughly investigated, there are little data available on the incidence and characteristics of ScR. A total of 657 consecutive patients (age 63 ± 12 years, 79% men, 21% diabetics, 67% acute coronary syndrome) who received a total of 883 BRS for the treatment of coronary artery stenoses between May 2012 and January 2015 were enrolled in a retrospective registry. During the median follow-up of 1,076 days (interquartile range: 762 to 1,206 days), a total of 49 cases of ScR were found in 41 patients (Kaplan-Meier incidence: 2.4%, 6.0%, and 9.0% at 12-, 24-, and 36-month follow-up, respectively). ScR presented as stable angina or as incidental finding in 73% of the cases. The angiographic pattern was complex (type II to IV) in 55% of the ScR lesions. The neointima was homogeneous with high signal intensity in all but 3 cases at optical coherence tomography. Prior revascularization (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.5 to 5.1; p = 0.002), diabetes (HR: 2.9; 95%CI: 1.5 to 5.4; p = 0.001), lesion types B2 or C (HR: 2.8; 95% CI: 1.5 to 5.4; p = 0.002), and implantation technique (HR: 0.3; 95% CI: 0.1 to 0.6; p = 0.001) emerged as independent predictors of ScR. Oversizing (HR: 6.29; 95% CI: 2.4 to 16.4), undersizing (HR: 5.15; 95% CI: 1.99 to 13.30), and a residual stenosis >27% (HR: 8.9; 95% CI: 3.6 to 21.8) were associated with an

  18. In-stent thrombosis when switching ticagrelor to clopidogrel after percutaneous coronary intervention.

    Science.gov (United States)

    Brice, Aaron E; Hernandez, Gabriel A; Sanchez, Mariluz; Haynick, Marshall; Mendoza, Cesar E

    2017-05-01

    Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.

  19. A combined strategy to reduce restenosis for vascular tissue engineering applications.

    Science.gov (United States)

    Patel, Hemang J; Su, Shih-Horng; Patterson, Cam; Nguyen, Kytai T

    2006-01-01

    Biodegradable polymers including poly(l-lactic acid) (PLLA) have been used to develop cardiovascular prostheses such as vascular grafts and stents. However, implant-associated thrombosis, inflammation, and restenosis are still major obstacles for the utility of these devices. The lack of an endothelial cell (EC) lining (endothelialization) on the implants and the responses of the immune systems toward the implants have been associated with these complications. In our research strategy, we have combined the drug delivery principle with the strategies of tissue engineering, the controlled release of anti-inflammation drugs and enhanced endothelialization, to reduce the implant-associated adverse responses. We first integrated curcumin, an anti-inflammatory drug and anti-smooth muscle cell (SMC) proliferative drug, with PLLA. This curcumin-loaded PLLA material was then modified using adsorptive coating of adhesive proteins such as fibronectin, collagen-I, vitronectin, laminin, and matrigel to improve the endothelial cell (EC) adhesion and proliferation, and ECs were seeded on top of these modified surfaces. Our results showed steady drug release kinetics over the period of 50 days from curcumin-loaded PLLA materials. Additionally, integration of curcumin in PLLA increased the roughness of the scaffold at the nanometric scale using an atomic force microscopic analysis. Moreover, coating with fibronectin on curcumin-loaded PLLA surfaces gave the highest EC adhesion and proliferation compared to other adhesive proteins using PicoGreen DNA assays. The ability of our strategy to release the curcumin for producing anti-inflammation and anti-proliferation responses and to improve EC adhesion and growth after EC seeding suggests this strategy may reduce implant-associated adverse responses and be a better approach for vascular tissue engineering applications.

  20. Sulforaphane inhibits restenosis by suppressing inflammation and the proliferation of vascular smooth muscle cells.

    Science.gov (United States)

    Kwon, Jin-Sook; Joung, Hosouk; Kim, Yong Sook; Shim, Young-Sun; Ahn, Youngkeun; Jeong, Myung Ho; Kee, Hae Jin

    2012-11-01

    Sulforaphane, a naturally occurring organosulfur compound in broccoli, has chemopreventive properties in cancer. However, the effects of sulforaphane in vascular diseases have not been examined. We therefore aimed to investigate the effects of sulforaphane on vascular smooth muscle cell (VSMC) proliferation and neointimal formation and the related mechanisms. The expression of vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) was examined in VSMCs. The nuclear translocation of nuclear factor-κB (NF-κB) and GATA6 expression was examined in VSMCs and in a carotid artery injury model by Western blot and immunohistochemistry. We also investigated whether local delivery of sulforaphane affected neointimal formation. Sulforaphane inhibited the mRNA and protein expression of VCAM-1 induced by tumor necrosis factor (TNF)-α in VSMCs. Treatment of VSMCs with sulforaphane blocked TNF-α-induced IκBα degradation and NF-κB p65 and GATA6 expression. Furthermore, NF-κB p65 and GATA6 expression were reduced in sulforaphane-treated carotid injury sections. Notably, binding of GATA6 to the VCAM-1 promoter was dramatically reduced by sulforaphane. The MTT, BrdU incorporation, and in vitro scratch assays revealed that the proliferation and migration of VSMCs were reduced by sulforaphane. Furthermore, local administration of sulforaphane significantly reduced neointima formation 14 days after vascular injury in rats. Our results indicate that sulforaphane inhibits neointima formation via targeting of adhesion molecules through the suppression of NF-κB/GATA6. Furthermore, sulforaphane regulates migration and proliferation in VSMCs. Sulforaphane may be a potential therapeutic agent for preventing restenosis after vascular injury. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Late Budgets

    DEFF Research Database (Denmark)

    Andersen, Asger Lau; Lassen, David Dreyer; Nielsen, Lasse Holbøll Westh

    The budget forms the legal basis of government spending. If a budget is not in place at the beginning of the fiscal year, planning as well as current spending are jeopardized and government shutdown may result. This paper develops a continuous-time war-of-attrition model of budgeting...... in a presidential style-democracy to explain the duration of budget negotiations. We build our model around budget baselines as reference points for loss averse negotiators. We derive three testable hypotheses: there are more late budgets, and they are more late, when fiscal circumstances change; when such changes...... are negative rather than positive; and when there is divided government. We test the hypotheses of the model using a unique data set of late budgets for US state governments, based on dates of budget approval collected from news reports and a survey of state budget o¢ cers for the period 1988...

  2. Using oxidized low-density lipoprotein autoantibodies to predict restenosis after balloon angioplasty in patients with acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Ching-Hui Huang

    Full Text Available OBJECTIVES: Oxidized low-density lipoproteins (oxLDL and oxidized low-density lipoprotein autoantibodies (OLAB have been detected in human plasma and atherosclerotic lesions. OLAB appear to play a role in the clearance of oxLDL from circulation. Higher levels of OLAB appear to be associated with a reduced risk of a wide range of cardiovascular diseases. We investigated the prognostic value of plasma oxLDL and OLAB in patients undergoing primary coronary balloon angioplasty for acute ST-elevation myocardial infarction (STEMI. METHODS: Plasma oxLDL and OLAB concentrations were measured in 56 patients with acute STEMI before primary angioplasty, and then 3 days, 7 days and 1 month after the acute event. Follow-up angiography was repeated 6 months later to detect the presence of restensosis (defined as >50% luminal diameter stenosis. The thrombolysis in myocardial infarction (TIMI risk score was calculated to determine the relationship between OLAB/oxLDL ratio and TIMI risk scores. RESULTS: Of the 56 patients, 18 (31% had angiographic evidence of restenosis. Plasma OLAB concentrations were significantly lower in the restenosis group before angioplasty (181±114 vs. 335±257 U/L, p = 0.003, and at day 3 (155±92 vs. 277±185 U/L, p<0.001 and day 7 (177±110 vs. 352±279 U/L, p<0.001 after the acute event. There was no difference in oxLDL concentration between the two groups. The ratio of OLAB/oxLDL positively correlated with TIMI risk scores before angioplasty (p for trend analysis, p = 0.004, at day 3 (p = 0.008 and day 7 (p<0.001 after STEMI. SIGNIFICANCE: A relative deficit of OLAB, and hence likely impaired clearance of oxLDL, is associated with the risk of arterial restenosis after primary angioplasty for acute STEMI.

  3. Matrix Metalloproteinases 2 and 3 Gene Polymorphisms and the Risk of Target Vessel Revascularization after Percutaneous Coronary Intervention: Is There Still Room for Determining Genetic Variation of MMPs for Assessment of an Increased Risk of Restenosis?

    Directory of Open Access Journals (Sweden)

    J.J.W. Verschuren

    2010-01-01

    Full Text Available Objective: Mixed results have been reported of matrix metalloproteinases (MMP and their association with restenosis after percutaneous coronary intervention (PCI. The current study examines whether multiple single nucleotide polymorphisms (SNPs, covering the full genomic region of MMP2 and MMP3, were associated with restenosis in the GENDER study population.

  4. Detection of restenosis after successful coronary angioplasty: Improved clinical decision making with use of a logistic model combining procedural and follow-up variables

    International Nuclear Information System (INIS)

    Renkin, J.; Melin, J.; Robert, A.; Richelle, F.; Bachy, J.L.; Col, J.; Detry, J.M.; Wijns, W.

    1990-01-01

    A prospective study of 111 patients who underwent repeat coronary angiography and exercise thallium-201 scintigraphy 6 +/- 2 months after complete revascularization by percutaneous transluminal coronary angioplasty was performed to assess whether clinical, procedure-related and postangioplasty exercise variables yield independent information for the prediction of angiographic restenosis after angioplasty. Complete revascularization was defined as successful angioplasty of one or more vessels that resulted in no residual coronary lesion with greater than 50% diameter stenosis. Restenosis was defined as a residual stenosis at the time of repeat angiography of greater than 50% of luminal diameter. Restenosis occurred in 40% of the patients. The 111 patients were randomly subdivided into a learning group (n = 84) and a testing group (n = 27). A logistic discriminant analysis was performed in the learning group and the logistic model was used to estimate a logistic probability of restenosis. This probability of restenosis was validated in the testing group. In the learning group of 84 patients univariate analysis of 39 factors revealed 8 factors related to restenosis: recurrence of angina (p less than 0.0001), postangioplasty abnormal finding on exercise thallium-201 scintigram (p less than 0.0001), exercise thallium-201 scintigram score (p less than 0.0001), difference between exercise and rest ST segment depression (p less than 0.001), postangioplasty exercise ST segment depression (p less than 0.001), absolute postangioplasty stenosis diameter (p less than 0.003), postangioplasty exercise work load (p less than 0.03) and postangioplasty exercise heart rate (p less than 0.05)

  5. Use of Rhenium-188 Liquid-Filled Balloons for Inhibition of Coronary Restenosis After PTCA - A New Opportunity for Nuclear Medicine

    Energy Technology Data Exchange (ETDEWEB)

    Knapp, F.F., Jr.; Spencer, R.H.; Stabin, M.

    1999-05-13

    Although the use of ionizing radiation for the treatment of benign lesions such as keloids has been available for nearly one hundred years, only recently have the cost effective benefits of such technology for the inhibition of arterial restenosis following controlled vessel damage from balloon angioplasty been fully realized. In particular, the use of balloons filled with solutions of beta-emitting radioisotopes for vessel irradiation provide the benefit of uniform vessel irradiation. Use of such contained ("unsealed") sources is expected to represent a new opportunity for nuclear medicine physicians working in conjunction with interventional cardiologists to provide this new approach for restenosis therapy.

  6. Caracterización de la restenosis de stents coronarios convencionales y liberadores de medicamentos en pacientes incluidos en el registro DRug Eluting STent (DREST Characterization of conventional coronary stents restenosis and drug eluting stents in patients included in the Drug Eluting Stent Registry (DREST

    Directory of Open Access Journals (Sweden)

    Jorge A Arroyave C

    2012-06-01

    Full Text Available Introducción y objetivos: los stents convencionales presentan tasas de restenosis intrastent entre 10% y 60%, mientras los stents liberadores de fármacos alcanzan el 10%. Para Latinoamérica, no hay reportes de restenosis intrastent en comparación con los stents convencionales y los stents liberadores de fármacos. En este estudio se describen aspectos asociados a este evento en pacientes atendidos en un centro de alta complejidad en Colombia. Métodos: análisis retrospectivo de pacientes con restenosis intrastent incluidos en el registro DRug ELuting STent (DREST entre los años 1994 y 2011, en el que se compararon características basales, datos técnicos y supervivencia de los pacientes con stent convencional y stent liberador de fármacos. Resultados: se evidenció restenosis intrastent en 269 con stent convencional (11,5% y en 65 con stent liberador de fármacos (12,2%, sin diferencias significativas al comparar por género (p=0,983 o edad (p=0,55. La dislipidemia fue el factor de riesgo más significativo asociado a la restenosis intrastent de los stents liberadores de fármacos (pIntroduction and Objectives: Bare metal stents have stent restenosis rates between 10% and 60%, while drug-eluting stents reach 10%. In Latin America, there are no reports of stent restenosis between bare-metal stents and drug eluting stents. This study describes aspects associated with this event in patients treated at a center of high complexity in Colombia. Methods: Retrospective analysis of patients with stent restenosis included in the Drug Eluting Stent Registry (DREST between 1994 and 2011, which compared baseline characteristics, technical data and survival of patients with bare metal stents and drug eluting stents. Results: We found stent restenosis with bare metal stents in 269 patients (11.5% and in 65 with drug-eluting stent (12.2% without significant differences between gender (p = 0.983 or age (p = 0 , 55. Dyslipidemia was the most significant

  7. Increased Plasma Cathepsin S at the Time of Percutaneous Transluminal Angioplasty is Associated with 6-Months’ Restenosis of the Femoropopliteal Artery

    Directory of Open Access Journals (Sweden)

    Mijovski Mojca Bozic

    2018-01-01

    Full Text Available Background: We tested the hypothesis that increased levels of cathepsin S and decreased levels of cystatin C in plasma at the time of percutaneous transluminal angioplasty (PTA are associated with the occurrence of 6-months’ restenosis of the femoropopliteal artery (FPA. Methods: 20 patients with restenosis and 24 matched patients with patent FPA after a 6-months follow-up were in - cluded in this study. They all exhibited disabling claudication or critical limb ischemia and had undergone technically successful PTA. They were all receiving statins and ACE in hi - bitors (or angiotensin II receptor antagonist before the PTA and the therapy did not change throughout the observational period. Plasma concentrations of C-reactive protein were < 10 mg/L and of creatinine within the reference range at the time of the PTA. Plasma concentration and activity of cathepsin S, together with its potent inhibitor cystatin C, were measured the day before and the day after the PTA. Results: The increased plasma concentration and activity of cathepsin S at the time of PTA was associated with the occurrence of 6-months’ restenosis of FPA, independently of established risk factors (lesion complexity, infrapopliteal run-off vessels, type of PTA, age, gender, smoking, diabetes, lipids and of cystatin C. Plasma cystatin C concentration was not associated with restenosis and did not correlate with cathepsin S activity and concentration in the plasma. Conclusion: Increased level of plasma cathepsin S at the time of PTA is associated with 6-months’ restenosis of PTA, independently of established risk factors.

  8. Monocyte to HDL ratio in prediction of BMS restenosis in subjects with stable and unstable angina pectoris.

    Science.gov (United States)

    Tok, Derya; Turak, Osman; Yayla, Çağrı; Ozcan, Fırat; Tok, Duran; Çağlı, Kumral

    2016-08-01

    This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.

  9. Percutaneous mitral valvotomy in patients eighteen years old and younger. Immediate and late results

    Directory of Open Access Journals (Sweden)

    Mattos Cláudia

    1999-01-01

    Full Text Available OBJECTIVE - To analyze immediate and late results of percutaneous mitral valvotomy (PMV in patients <= 18 year. METHODS - Between August '87 and July '97, 48 procedures were performed on 40 patients. The mean age was 15.6 years; 68.7% were females four of whom were pregnant. RESULTS - Success was obtained in 91.7% of the procedures. Immediate complications were severe mitral regurgitation (6.3% and cardiac tamponade (2.0%. Late follow-up was obtained in 88.8% of the patients (mean value=43.2±33.9 months. NYHA functional class (FC I or II was observed in 96.2% of the patients and restenosis developed in five patients, at a mean follow-up of 29.7±11.9 months. Three patients presented with severe mitral insufficiency and underwent surgery. Two patients died. CONCLUSION - PMV represents a valid therapeutic option in young patients. In these patients, maybe because of subclinical rheumatic activity, restenosis may have a higher incidence and occur at an earlier stage than in others persons.

  10. Very late bare-metal stent thrombosis, rare but stormy!

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-08-01

    Recurrent in-stent thrombosis is rarely reported, with catastrophic clinical consequences of either acute coronary syndrome or death. We present a case of recurrent in-stent thrombosis with its outcome and a concise literature review.

  11. Preclinical study investigating the potential of low-dose-rate brachytherapy with32P stents for the prevention of restenosis of paranasal neo-ostia.

    Science.gov (United States)

    Oestreicher, Elmar; Bartsch, Harald; Mayr, Doris; Schubert, Mario; Weber, Barbara; Kneschaurek, Peter; Assmann, Walter; Sroka, Ronald; Betz, Christian Stephan

    Ostial restenosis is a common cause of failures in paranasal sinus surgery. The aim of the current study was to investigate the use of low-dose-rate brachytherapy to prevent neo-ostial restenosis in an animal model. In 14 rabbits, maxillary neo-ostia were created and measured. One side each was stented with a regular silicone stent, the other side was either not stented (n = 7) or stented with a phosphorous-32 implanted stent depositing a low-dose radiation of 15 Gy (n = 7) within 1 week, after which all stents were removed. After a period of additional 12 weeks of recovery, the animals were sacrificed, the neo-ostia were again measured, and the areas and histopathologic changes compared in between the groups. After 15-Gy stenting, the mean ostial areas were even slightly enlarged by 5.1% compared to the area at stent removal, whereas a significant reduction in area, indicating a process of restenosis, by 56.1% or 54.0% was seen in the control groups with no stent and normal stent, respectively. Furthermore, no indication for adverse histopathologic radiation effects was seen in the 15-Gy group. Low-dose-rate brachytherapy with phosphorous-32 doped silicone stents showed promising results in the prevention of neo-ostium restenosis in this proof-of-concept study, indicating that further preclinical and clinical testing may be warranted. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  12. Comparison of the very long term (>1 year) outcomes of drug-eluting stents for the treatment of bare-metal and drug-eluting stent restenosis.

    Science.gov (United States)

    Ribamar Costa, Jose; Sousa, Amanda G M R; Moreira, Adriana; Alves da Costa, Ricardo; Cano, Manuel N; Maldonado, Galo; Campos Neto, Cantídio; Jardim, César; Pavanello, Ricardo; Sousa, Jose Eduardo

    2009-09-01

    Drug-eluting stents (DES) have become the first choice to treat BMS restenosis (ISR), replacing brachytherapy and all other available percutaneous approaches. Although markedly reduced, DES ISR still occurs and has been frequently treated with another DES, despite the lack of robust data supporting the safety and efficacy of this approach. We sought to compare the long term clinical outcomes of patients with BMS and DES ISR treated with another DES deployment. Between May 2002 and January 2008 a total of 158 patients with BMS restenosis and 58 patients with DES restenosis were treated with a DES and enrolled in this registry. Primary endpoint included the cumulative occurrence of major adverse cardiac events (MACE=cardiac death, myocardial infarction and target-vessel revascularisation) and stent thrombosis. Baseline clinical aspects did not significantly differ between the groups. There was a trend toward a higher incidence of DM in the DES cohort (36.1% vs. 32.9%, p=0.1). Mean time between first procedure and restenosis was significant longer in the DES population (178+/-61 days vs. 140+/-38 days, p=0.02). At the end of the follow-up period, 92.6% of the patients with BMS-ISR and 86.3% of those with DES-ISR were free of MACE (p<0.001). Patients with DES ISR had significant more recurrence of ISR but equivalent rates of cardiac death, MI and stent thrombosis. Percutaneous treatment of BMS or DES ISR with the implant of a DES represents a simple and safe approach with sustained long term results. However, the relatively high rate of ISR recurrence among patients with prior DES ISR demand the developing of more effective strategies for that subset of individuals.

  13. Delivery of TFPI-2 using SonoVue and adenovirus results in the suppression of thrombosis and arterial re-stenosis.

    Science.gov (United States)

    Wang, Yuxue; Zhou, Jie; Zhang, Yanrong; Wang, Ximing; Chen, Juan

    2010-09-01

    Genes could be used to treat atherosclerosis. The key problem is how to target a gene through the walls of arteries in free-flowing blood. TFPI-2 has been shown to suppress thrombosis and arterial re-stenosis, which indicates its potential function in gene therapy for atherosclerosis. The microbubble ultrasound contrast agent is widely applied in diagnostic imaging, and could be used for transferring genes into arteries. By transfecting TFPI-2 into arteries using SonoVue (a kind of microbubble ultrasound contrast agent), we identified TFPI-2 as an available factor for inhibiting the proliferation of vascular endothelial cells in vivo. Compared with adenovirus, SonoVue showed similar gene transfection efficiency, but the latter showed stronger inhibition of thrombosis and arterial re-stenosis with a high expression of TFPI-2 protein in vitro and in vivo. SonoVue was less damaging when transfecting genes into the arterial wall. These data indicate that transfecting human TFPI-2 into the arterial wall may suppress thrombosis and arterial re-stenosis, and reduce atherosclerosis.

  14. Beyond Oncogenesis: The Role of S-Phase Kinase-Associated Protein-2 (SKP2 In Vascular Restenosis

    Directory of Open Access Journals (Sweden)

    Yih-Jer Wu

    2008-12-01

    Full Text Available The clinical benefits of percutaneous coronary intervention, the most prevalent procedure nowadays for the treatment of symptomatic coronary artery disease, are frequently offset by the occurrence of vascular restenosis. Although the introduction of drug-eluting stents has significantly reduced restenotic rates, the rare, but potentially fatal, delayed thrombosis remains a clinical threat. Further refinement of the drug-eluting stent based on a better understanding of cell cycle regulation between the vascular smooth muscle cell (VSMC and endothelial cell (EC is required. In this review, we discuss the role of S-phase kinase-associated protein-2 (Skp2, previously known as an oncoprotein, in the regulation of VSMC proliferation and its signaling axis. The currently available evidence suggests that the Rac1-Skp2-p27Kip1 signaling axis acts as a common final pathway for many factors that regulate VSMC proliferation, such as growth factors, extracellular matrices and cyclic nucleotides. Importantly, although EC proliferation is also shown to be regulated by the same axis, cAMP seems to regulate this axis differentially between VSMC and EC, rendering the underlying mechanism of this differential regulation a promising target for the development of a new generation of drug-eluting stent.

  15. Inhibition effect of tacrolimus and platelet-derived growth factor-BB on restenosis after vascular intimal injury.

    Science.gov (United States)

    Ma, Xu; Jiang, Chunyu; Li, Yuehua; Feng, Lishuai; Liu, Jingjing; Wang, Jianbo

    2017-09-01

    Excessive proliferation and migration of vascular smooth muscle cells(VSMCs) and delayed proliferation and migration of endothelial cells(ECs) were the main cause of restenosis after endovascular interventional therapy. Since tacrolimus has proved to be more sensitive to inhibiting VSMCs' proliferation,and platelet-derived growth factor-BB(PDGF-BB) benefitted ECs' and VSMCs' proliferation, this study was aimed to identify combined effect of tacrolimus and PDGF-BB, investigate any mechanisms underneath and demonstrate combined effect of two drugs in vivo. As the results showed we confirmed differential effect of PDGF-BB and tacrolimus on ECs and VSMCs. On the concentration level of 2-5μg/ml tacrolimus plus 10ng/ml PDGF-BB, combination of drugs could effectively promote ECs proliferation and migration, and meanwhile inhibit VSMCs proliferation and migration, and the inhibition of p-mTOR's expression within VSMCs played an important role in this differentiated effect. Raising concentration level of PDGF-BB would weaken inhibitory effect of tacrolimus on both kinds of cell. For injured intima, the mix solution of two drugs could promote intima healing and suppress excessive intimal hyperplasia. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Mechanical behavior of polymer-based vs. metallic-based bioresorbable stents

    OpenAIRE

    Ang, Hui Ying; Huang, Ying Ying; Lim, Soo Teik; Wong, Philip; Joner, Michael; Foin, Nicolas

    2017-01-01

    Bioresorbable scaffolds (BRS) were developed to overcome the drawbacks of current metallic drug-eluting stents (DES), such as late in-stent restenosis and caging of the vessel permanently. The concept of the BRS is to provide transient support to the vessel during healing before being degraded and resorbed by the body, freeing the vessel and restoring vasomotion. The mechanical properties of the BRS are influenced by the choice of the material and processing methods. Due to insufficient radia...

  17. Effects of abciximab on key pattern of human coronary restenosis in vitro: impact of the SI/MPL-ratio

    Directory of Open Access Journals (Sweden)

    Baur Regine

    2006-04-01

    Full Text Available Abstract Background The significant reduction of angiographic restenosis rates in the ISAR-SWEET study (intracoronary stenting and antithrombotic regimen: is abciximab a superior way to eliminate elevated thrombotic risk in diabetes raises the question of whether abciximab acts on clopidogrel-independent mechanisms in suppressing neointimal hyperplasia. The current study investigates the direct effect of abciximab on ICAM-1 expression, migration and proliferation. Methods ICAM-1: Part I of the study investigates in cytoflow studies the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on TNF-α induced expression of intercellular adhesion molecule 1 (ICAM-1. Migration: Part II of the study explored the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on migration of HCMSMC over a period of 24 h. Proliferation: Part III of the study investigated the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on proliferation of HUVEC, HCAEC, and HCMSMC after an incubation period of 5 days. Results ICAM-1: In human venous endothelial cells (HUVEC, human coronary endothelial cells (HCAEC and human coronary medial smooth muscle cells (HCMSMC no inhibitory or stimulatory effect on expression of ICAM-1 was detected. Migration: After incubation of HCMSMC with abciximab in concentrations of 0.0002 – 2 μg/ml a stimulatory effect on cell migration was detected, statistical significance was achieved after incubation with 0.002 μg/ml (p 1. Conclusion Thus, the anti-restenotic effects of systemically administered abciximab reported in the ISAR-SWEET-study were not caused by a direct inhibitory effect on ICAM-1 expression, migration or proliferation.

  18. The Impact of Blood Rheology on Drug Transport in Stented Arteries: Steady Simulations

    Science.gov (United States)

    Vijayaratnam, Pujith R. S.; O’Brien, Caroline C.; Reizes, John A.; Barber, Tracie J.; Edelman, Elazer R.

    2015-01-01

    Background and Methods It is important to ensure that blood flow is modelled accurately in numerical studies of arteries featuring drug-eluting stents due to the significant proportion of drug transport from the stent into the arterial wall which is flow-mediated. Modelling blood is complicated, however, by variations in blood rheological behaviour between individuals, blood’s complex near-wall behaviour, and the large number of rheological models which have been proposed. In this study, a series of steady-state computational fluid dynamics analyses were performed in which the traditional Newtonian model was compared against a range of non-Newtonian models. The impact of these rheological models was elucidated through comparisons of haemodynamic flow details and drug transport behaviour at various blood flow rates. Results Recirculation lengths were found to reduce by as much as 24% with the inclusion of a non-Newtonian rheological model. Another model possessing the viscosity and density of blood plasma was also implemented to account for near-wall red blood cell losses and yielded recirculation length increases of up to 59%. However, the deviation from the average drug concentration in the tissue obtained with the Newtonian model was observed to be less than 5% in all cases except one. Despite the small sensitivity to the effects of viscosity variations, the spatial distribution of drug matter in the tissue was found to be significantly affected by rheological model selection. Conclusions/Significance These results may be used to guide blood rheological model selection in future numerical studies. The clinical significance of these results is that they convey that the magnitude of drug uptake in stent-based drug delivery is relatively insensitive to individual variations in blood rheology. Furthermore, the finding that flow separation regions formed downstream of the stent struts diminish drug uptake may be of interest to device designers. PMID:26066041

  19. Asymptotic analysis of blood flow in stented arteries: time dependency and direct simulations***

    Directory of Open Access Journals (Sweden)

    Pichon Gostaf Kirill

    2010-12-01

    Full Text Available This work aims to extend in two distinct directions results recently obtained in [10]. In a first step we focus on the possible extension of our results to the time dependent case. Whereas in the second part some preliminary numerical simulations aim to give orders of magnitudes in terms of numerical costs of direct 3D simulations. We consider, in the first part, the time dependent rough problem for a simplified heat equation in a straight channel that mimics the axial velocity under an oscillating pressure gradient. We derive first order approximations with respect to ϵ, the size of the roughness. In order to understand the problem and set up correct boundary layer approximations, we perform a time periodic fourier analysis and check that no frequency can interact with the roughness. We show rigorously on this toy problem that the boundary layers remain stationary in time (independent on the frequency number. Finally we perform numerical tests validating our theoretical approach. In the second part, we determine actual limits, when running three-dimensional blood flow simulations of the non-homogenized stented arteries. We solve the stationary Stokes equations for an artery containing a saccular aneurysm. Consecutive levels of uniform mesh refinement, serve to relate spatial resolution, problem scale, and required computation time. Test computations are presented for femoral side aneurysm, where a simplified ten-wire stent model was placed across the aneurysm throat. We advocate the proposed stent homogenization model, by concluding that an actual computation power is not sufficient to run accurate, direct simulations of a pulsatile flow in stented vessels.

  20. Stent graft treatment for infra-inguinal arterial disease for either instent-restenosis and denovo lesions associated with very high rates of failure.

    Science.gov (United States)

    Golla, Maheswara S; Acharji, Subasit; Paul, Timir K; Madapathi, Praveena; Garcia, Lawrence A

    2017-12-07

    FDA approved the Gore Viabahn (WL Gore, Flagstaff, AZ, USA) stent for both femoro-popliteal arterial denovo and instent restenosis (ISRS) lesions. To date there is little data on Viabahn stent graft outcomes in ISRS arterial disease. Between 2007 and 2014 we identified 734 patients who underwent 1573 endovascular interventions in our institution for infra-inguinal revascularization. Among these, 48 patients had 143 Viabahn stents placed. Of these, 26 patients had 94 stents placed for ISRS and 22 patients had 49 stents placed for denovo lesions. The patients in the ISRS group were younger and more likely to have hypertension, hyperlipidemia, coronary artery disease, compared to the patients in the denovo group. Stents were placed principally for femoro-popliteal lesions, with mean length of 21 ± 12.5 cm (19.2 ± 14, ISRS vs. 22.1 ± 11, denovo; P = 0.2). Both groups had low primary patency rates during one year follow up (54% vs. 33%, OR = 2.3 (0.9-2.2). Target lesion revascularization (TLR) (57% vs. 27%, P ISRS group than in the denovo group. Amputation rate (17% vs. 31%, OR 0.7, CI = 0.2-1), cumulative blockage (defined as ISRS and thrombosis) (62% vs. 47%, P = 0.09, OR = 1.8, CI = 0.9-3.6), and Restenosis (40% vs. 31%, OR 1.5, CI = 0.7-3.2) were not statistically different between the two groups. Mean duration of follow-up was 12.8 ± 13 months. Stent graft treatment using the Gore Viabahn for denovo and ISRS in femoro-popliteal arterial obstructive disease have high restenosis and failure rates, of both stent patency and limb outcomes, which is consistent with existed literature. © 2017 Wiley Periodicals, Inc.

  1. [Coronary angioplasty in patients with restenosis. Characterization of clinical and angiographic profiles, hospital clinical course, and implications for the selection of patients].

    Science.gov (United States)

    Nunes, G L; Centemero, M P; Feres, F; Pinto, I M; Chaves, A; Mattos, L A; Tanajura, L F; Maldonado, G; Cano, M; Sousa, A G

    1995-09-01

    To define the clinical and angiographic profile of patients undergoing to a 2nd or a 3rd coronary angioplaty (PTCA) for the treatment of restenosis, and assess the safety and efficacy of redilatation. Patients submitted to PTCA for a 1st (1stRE) or a 2nd (2ndRE) restenosis, from Jan/1980 through Dec/1993, were retrospectively identified, and compared to those undergoing to PTCA for de novo lesions (DN). A total of 5,736 underwent to dilatation of primary lesions, 610 of a 1stRE, and 64 of a 2ndRE. Patients with restenotic lesions had a higher prevalence of diabetes, smoking, history of prior infarction (1stRE e 2ndRE) and hyperlipidemia (2ndRE) as compared with primary lesions (p < 0.05). Besides patients with a 2ndRE had a higher incidence of left ventricular dysfunction, as compared to those with DN or a 1stRE (31.3% with EF < 45% in group 2ndRE, vs 19.8% and 23.1% in groups 1stRE and DN, respectively, p < 0.05). Primary success, infarct rate and mortality were similar in all groups, but emergency bypass surgery was significantly higher in the DN (2.1% vs 0.8% in 1stRE and 0% in 2ndRE, p < 0.05). Restenosis can be effectively treated by redilatation. Patients with clinical and angiographic features predisposing to further recurrence can be better treated with other interventions (i.e., coronary stents, bypass surgery).

  2. Tratamento endovascular da reestenose carotídea: resultados em curto prazo Endovascular treatment of carotid artery restenosis: short term results

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Carvalho Lujan

    2011-03-01

    Full Text Available CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS no tratamento da reestenose carotídea (REC no intraoperatório e no pós-operatório recente (80%, enquanto quatro (21% eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias. CONCLUSÃO: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazoCONTEXT: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. OBJECTIVE: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting - CAS for the treatment of carotid artery restenosis, in the intraoperative and early (80%, whereas 4 (21% were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days. CONCLUSION: Endovascular treatment of

  3. Exploring Late Globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    The purpose of this viewpoint paper is to motivate a program of research on late globalization, a program that could eventually lead to one or more significant theories of late globalization. The paper explores the phenomenon of late globalization as well as the idea of “late” by drawing on sparse...

  4. Multi-drug-resistant hypertension caused by severe aortic coarctation presenting in late adulthood.

    Science.gov (United States)

    Meller, Stephanie M; Fahey, John T; Setaro, John F; Forrest, John K

    2015-04-01

    Aortic coarctation, a congenital narrowing in the region of the ligamentum arteriosium, is a rare etiology for multi-drug-resistant hypertension in adulthood; however, advances in stenting modalities may offer long-term improvements in morbidity and possibly even cure. We report on a female patient in her late 50s presenting with refractory hypertension and severely elevated renin levels, ultimately diagnosed with aortic coarctation and treated with percutaneous stent implantation, which resulted in successful blood pressure control with verapamil monotherapy. This case highlights the efficacy of endovascular stent implantation for the treatment of coarctation and the need for clinicians to consider this disease entity in the differential diagnosis of refractory hypertension even in late adulthood. © 2015 Wiley Periodicals, Inc.

  5. HVJ-AVE liposome-mediated Tissue Factor Pathway Inhibitor (TFPI) gene transfer with recombinant TFPI (rTFPI) irrigation attenuates restenosis in atherosclerotic arteries.

    Science.gov (United States)

    Yin, Xinhua; Fu, Yu; Yutani, Chikao; Ikeda, Yoshihiko; Enjyoji, Keiichi; Kato, Hisao

    2009-06-26

    In this study, we investigate whether the combination of HVJ-AVE liposome-mediated TFPI gene transfer and recombinant TFPI (rTFPI) irrigation would reduce restenosis safely and more effectively. The results indicated that at 4 weeks after angioplasty, the MLD, EELA, IELA and LA of TFPI group and rTFPI group were markedly greater than those of the control groups, and those in the combination group were even greater. The mean IA, I/M, and the percentage of stenosis in TFPI gene group and rTFPI group were significantly reduced compared with control groups, and those in the combination group were even further reduced. Thrombosis in the TFPI gene group, rTFPI group and combination group was significantly reduced compared with the other control groups. The systemic coagulation status of treated animals was not significantly changed and no toxicity was observed in each group. So combination of TFPI gene transfer using HVJ-AVE liposomes and rTFPI irrigation could inhibit thrombosis and neointimal hyperplasia, and attenuate vascular remodeling and luminal stenosis more effectively than using each method alone. The combination method may be a more effective and safe strategy for the prevention of restenosis after angioplasty in humans.

  6. Matrix metalloproteinases 2 and 3 gene polymorphisms and the risk of target vessel revascularization after percutaneous coronary intervention: Is there still room for determining genetic variation of MMPs for assessment of an increased risk of restenosis?

    NARCIS (Netherlands)

    Verschuren, J. J. W.; Sampietro, M. L.; Pons, D.; Trompet, S.; Ewing, M. M.; Quax, P. H. A.; de Knijff, P.; Zwinderman, A. H.; de Winter, R. J.; Tio, R. A.; de Maat, M. P.; Doevendans, P. A. F. M.; Jukema, J. W.

    2010-01-01

    Objective: Mixed results have been reported of matrix metalloproteinases (MMP) and their association with restenosis after percutaneous coronary intervention (PCI). The current study examines whether multiple single nucleotide polymorphisms (SNPs), covering the full genomic region of MMP2 and MMP3,

  7. Nuclear Receptor Nurr1 Is Expressed In and Is Associated With Human Restenosis and Inhibits Vascular Lesion Formation In Mice Involving Inhibition of Smooth Muscle Cell Proliferation and Inflammation

    NARCIS (Netherlands)

    Bonta, Peter I.; Pols, Thijs W. H.; van Tiel, Claudia M.; Vos, Mariska; Arkenbout, E. Karin; Rohlena, Jakub; Koch, Karel T.; de Maat, Moniek P. M.; Tanck, Michael W. T.; de Winter, Robbert J.; Pannekoek, Hans; Biessen, Erik A. L.; Bot, Ilze; de Vries, Carlie J. M.

    2010-01-01

    Background-Restenosis is the major drawback of percutaneous coronary interventions involving excessive activation and proliferation of vascular smooth muscle cells (SMCs). The nuclear receptor Nurr1 is an early response gene known mainly for its critical role in the development of dopamine neurons.

  8. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Bonati, Leo H

    2009-10-01

    In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS.

  9. Bile viscosity in patients with biliary drainage. Effect of co-trimoxazole and N-acetylcysteine and role in stent clogging

    NARCIS (Netherlands)

    Coene, P. P.; Groen, A. K.; Davids, P. H.; Hardeman, M.; Tytgat, G. N.; Huibregtse, K.

    1994-01-01

    The main disadvantage of endoscopic insertion of an endoprosthesis is the tendency of the stent to clog after a few months. In this study we determined the role of bile viscosity in stent clogging. Sixty patients were stented with 10 Fr 11-cm stents. The stents were electively removed after 2

  10. Sirolimus-eluting stents suppress neointimal formation irrespective of metallic allergy.

    Science.gov (United States)

    Nakazawa, Gaku; Tanabe, Kengo; Aoki, Jiro; Onuma, Yoshinobu; Higashikuni, Yasutomi; Yamamoto, Hirosada; Ohtsuki, Shuji; Yachi, Sen; Yagishita, Atsuhiko; Nakajima, Hiroyoshi; Hara, Kazuhiro

    2008-06-01

    Metallic allergy is associated with restenosis following bare metal stent implantation, but the impact of metallic allergy on the outcome after implantation of drug-eluting stents (DES) has not been investigated. The present study group consisted of 88 consecutive patients (109 lesions) who underwent percutaneous coronary intervention with sirolimus-eluting stents (SES). Follow-up angiography was obtained at 8 months in all patients. At that time, the patients underwent epicutaneous patch tests for nickel, chromate, molybdenum, manganese, and titanium, which were evaluated after 48 h of contact. The patch test was positive in 14 patients (16%) (5 for manganese, 3 for nickel, 1 for chromate, 1 for Nickel and manganese, and 4 for manganese and chromate). The binary restenosis rate in the patients with a positive patch test was similar to those with negative patch test (6.3% vs 6.5%, p=0.98). Serial quantitative coronary angiography analyses identified no significant differences in late lumen loss of in-stent segments between patients with positive patch test and those with negative patch test (0.19+/-0.49 mm vs 0.12+/-0.48 mm, p=0.55). SES prevent restenosis irrespective of metallic allergy. The classic relationship between metallic allergy and in-stent restenosis, seen with bare metal stents, does not appear to arise with DES, possibly because of the immunosuppressive effect of sirolimus.

  11. Intravascular ultrasound assessment of expansion of the sirolimus-eluting (Cypher Select) and paclitaxel-eluting (Taxus Express-2) stent in patients with diabetes mellitus

    DEFF Research Database (Denmark)

    Jensen, L.O.; Maeng, M.; Mintz, G.S.

    2008-01-01

    Patients with diabetes have a higher risk for in-stent restenosis after coronary stent implantation. Drug-eluting stents (DES) are highly effective in reducing in-stent restenosis. Once neointimal hyperplasia is suppressed with DES, the impact of stent underexpansion becomes magnified. The aim of...

  12. Investigation on the potential of thulium-fibre-laser irradiation for in-stent tissue ablation (Conference Presentation)

    Science.gov (United States)

    Sroka, Ronald; Frank, Johannes; Reichenberger, Frank; Behr, J.; Gesierich, Wolfgang

    2017-04-01

    Granulation and tumor regrowth in the area of bronchi stent implants may result in restenosis. It had been shown that by means of Thulium-Fibre-Laser (TFL) a controlled ablation and reduction of the tissue within the stent could be performed. When using Nd:YAG irradiation there is risk for explosive flames, burns of fibre and stent, ruptures of stent meshes as well as perforation of stent and cover. Therefore it was the aim to investigate the safety margin when using TFL. Four different types of clinical used stents (with/without cover) were fixed to pig trachea tissue. Irradiation was performed by fibre assisted TFL-1940nm-laser irradiation while laser power, light application duration and distance, as well as oxygen percentage and contamination were varied. In case of Nitinol-stents rupture were observed at power levels >=7W or distances of =5 mm and the power level should be <=6W. Furthermore the oxygen conc. should not exceed 30% and short term continuous irradiation of less than 15s exposition should be considered. In case of Silicon-stents light application on contaminated area should be avoided.

  13. Evolution process of the Late Silurian–Late Devonian tectonic ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Earth System Science; Volume 124; Issue 1. Evolution process of ... Keywords. Tectonic evolution; zircon U–Pb dating; geochemistry; granitoid; Late Silurian–Late Devonian; Qimantagh. ... We obtained 5 zircon U–Pb ages from the Late Silurian–Late Devonian granitoids in the Qimantagh area.

  14. Clinical outcomes of secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction.

    Science.gov (United States)

    Park, Jun Chul; Park, Jae Jun; Cheoi, Kungseok; Chung, Hyunsoo; Lee, Hyuk; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2012-12-01

    Although a substantial number of patients require secondary stents insertion due to primary stent malfunction in malignant gastric outlet obstruction, data on the outcomes of secondary self-expanding metal stents are sparse. To investigate clinical outcomes and factors related with secondary stent malfunction in patients with malignant gastric outlet obstruction given secondary stent-in-stent self-expanding metal stent insertion. For this retrospective study, a total 77 patients who underwent secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction were enrolled. We compared the effectiveness and complications of secondary covered and uncovered stents and explored the predictive factors for stent malfunction. Stent-in-stent self-expanding metal stent placements were technically successful in all patients. Both groups also had comparable clinical success rates (covered stent, 87.2% and uncovered stent, 90.0%, P = 1.000). Stent malfunction rates (31.9% and 36.7% respectively, P = 0.805) and median patency time of stent (165 [95% confidence interval: 112-218] and 165 [95% confidence interval: 126-204] days, respectively, P = 0.358) were similar between secondary covered and uncovered stents. Longer patients' survival time (≥ 100 days) was associated with increased risk of stent malfunction (odds ratio: 4.598; 95% confidence interval: 1.473-14.355; P = 0.009). Secondary stent-in-stent self-expanding metal stent placement is feasible and effective treatment for primary stent malfunctions in malignant gastric outlet obstruction. Covered and uncovered stent are equally acceptable in terms of stent-related complications and stent patency, regardless of primary stent type. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  15. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

    2005-04-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

  16. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    International Nuclear Information System (INIS)

    Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

    2005-01-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

  17. Late-Onset Asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2017-01-01

    the risk of systemic effects. However, most recommendations are based on extrapolation from findings in younger patients. Comorbidities are very common in patients with late-onset asthma and need to be taken into account in the management of the disease. In conclusion, late-onset asthma is poorly......Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case...... history and spirometry), it is important to acknowledge that elderly individuals are likely to have diminished bronchodilator reversibility and some degree of fixed airflow obstruction. Elderly individuals, therefore, often require further objective tests, including bronchial challenge testing...

  18. Lateness to School Remediation Game

    Science.gov (United States)

    Ugwuegbulam, Charles N.; Ibrahim, Haj. Naheed

    2015-01-01

    Primary and secondary school in Nigeria encourage punctuality to school yet a good number of the learners came late to school. This is especially true in the case of day students. Learners who come late to school are usually punished in one way or the other yet the lateness to school phenomenon still persist. Lateness to school behaviour affects…

  19. Big Java late objects

    CERN Document Server

    Horstmann, Cay S

    2012-01-01

    Big Java: Late Objects is a comprehensive introduction to Java and computer programming, which focuses on the principles of programming, software engineering, and effective learning. It is designed for a two-semester first course in programming for computer science students.

  20. Mengapa Late Childhood Merokok?

    Directory of Open Access Journals (Sweden)

    Apriyani Taryaka

    2011-04-01

    Full Text Available This research is set to determine the cause of late childhood smoking and whether the factor behind late child hood smoking is the same with teenagers. The background of this research are the findings of Tobacco Control Support Center that 3 out of 10 students are found to be smoking before reaching the age of 10. This research uses qualitative case study research through observation and in-depth direct interview towards 3 male subjects aged 11 who smokes every day. Results show that the 3 subjects smoke due to personal factor, friends, family and cigarette advertisements. Most of the factor behind the smoking behavior are found to be in the sociogenic motive category. Therefore, it could be concluded that the smoking behavior of the 3 subjects is not purely from the personal factor, but more of the environmental factor having big part in creating smoking behavior in the 3 subjects. Factors behind smoking behavior of the three late childhood subjects and teenagers have a lot in common. Friend factor is the first driving factor of smoking behavior on both late childhood and teenager. 

  1. Loneliness among Late Adolescents.

    Science.gov (United States)

    Roscoe, Bruce; Skomski, Grant G.

    1989-01-01

    Assessed extent of loneliness among late adolescent college students (N=559). Findings suggest that, although moderate loneliness was reported by most participants, number of respondents evidenced high degree of loneliness. Comparison of lonely and nonlonely adolescents yielded relatively few significant differences. Lonely and nonlonely…

  2. Late Embryogenesis Abundant Proteins

    NARCIS (Netherlands)

    Shih, M.D.; Hoekstra, F.A.; Hsing, Y.I.C.

    2008-01-01

    During the late maturation stage of seed development, water content decreases greatly. One of the most striking characteristics of mature orthodox seeds is their ability to withstand severe desiccation. Mechanisms of plant drought/desiccation tolerance have been studied by numerous groups, and a

  3. p21-Activated Kinase 4 Promotes Intimal Hyperplasia and Vascular Smooth Muscle Cells Proliferation during Superficial Femoral Artery Restenosis after Angioplasty

    Directory of Open Access Journals (Sweden)

    Liangxi Yuan

    2017-01-01

    Full Text Available The aim of this study is to explore the function of p21-activated kinase 4 (PAK4 in intimal hyperplasia (IH and vascular smooth muscle cells (VSMCs proliferation. We choose vascular samples from patients undergoing angioplasty in superficial femoral artery (SFA as the experimental group and vascular samples from donors without clinical SFA restenosis as the control group, respectively. We draw from the results that both levels of mRNA and protein of PAK4 in the experimental group increased dramatically compared with the control group. IH arose from angioplasty of SFA. Moreover, overexpression of PAK4 dramatically contributed to cell proliferation of VSMCs and promoted cell cycle progression from G0/G1 phase (71.12±0.69% versus 58.77±0.77%, P<0.001 into S phase (23.99±0.21% versus 31.35±0.33%, P<0.001. Besides, PAK4 downregulated the level of p21 and enhanced the activity of Akt as well. And we conclude that PAK4 acts as a regulator of cell cycle progression of VSMC by mediating Akt signaling and controlling p21 levels, which further modulate IH and VSMCs’ proliferation.

  4. Late Babylonian Astrology

    Science.gov (United States)

    Steele, John M.

    The last five centuries BC saw the development of several new forms of astrology in Babylonia. Key to these new astrological techniques was the invention of the zodiac in about 400 BC. These new forms of astrology include personal horoscopes, astral medicine, and the exploitation of geometrical relationships between the position of heavenly bodies. Several Late Babylonian astrological doctrines were later adopted within Greek astrology.

  5. Late somatic effects

    International Nuclear Information System (INIS)

    Gilbert, E.S.

    1989-01-01

    Late effects are by definition effects that occur at least one year, and in most cases decades, after the time of exposure. The late effects considered in this chapter are limited to latent cancer incidence and mortality, and benign thyroid disease. A model is provided for estimating risks of late effects resulting from the radiation exposure likely to be received in the event of a nuclear power plant accident. It is assumed that exposure to high-LET radiation would be negligible in such an accident, and thus only risks from low-LET exposure are evaluated. Separate estimates are provided for risks of leukemia, bone cancer, lung cancer, gastrointestinal cancers, thyroid cancer, skin cancer, and the residual group of all other cancers; estimates of leukemia and other cancers due to in utero exposure are also provided. Risks are expressed in absolute terms as the number of cancer deaths (or cases) per million persons exposed to a particular dose. Because the time of death is also important in assessing the impact of an accident, and because the quality of life after the occurrence of cancer will often be reduced, the number of years of life lost and the number of years of life lived after the occurrence of cancer are also estimated

  6. Coping – Late Side Effects

    Science.gov (United States)

    Cancer treatment can cause late side effects that may not show up for months or years after treatment. These late effects may include heart and lung problems, bone loss, eye and hearing changes, lymphedema, and other problems

  7. Late induced abortion.

    Science.gov (United States)

    Savage, W

    1990-09-01

    In the UK in 1988, 13.3% of abortions were performed at 13 weeks' gestation or later. Reasons for this delay, in addition to the diagnosis through amniocentesis of a fetal abnormality, include late recognition of pregnancy, a change of mind about completing the pregnancy, a failure of primary care physicians to entertain the diagnosis of pregnancy, travel or financial problems, and referral difficulties and scheduling delays. Women with little education and very young women are most likely to present for late abortions. From 13-16 weeks, dilatation and evacuation is the safest method of pregnancy termination. The procedure can be made easier through preparation of the cervix with a prostaglandin pessary or Foley catheter. After 16 weeks, an instillation method is recommended; prostaglandin administration can be intro- or extra-amniotic. Complication rates at 13-19 weeks are 14.5/1000 for vaginal methods of abortion and 7.2/1000 for prostaglandin methods. The risk of complications is 3 times higher for women who have 2nd-trimester abortions through the National Health Service. Although it is not realistic to expect that late abortions ever can be eliminated, improved sex education and contraceptive reliability as well as reforms in the National Health Service could reduce the number substantially. To reduce delay, it is suggested that the National Health Service set up satellite day care units and 1-2 central units in each region to deal quickly with midtrimester abortions. Delays would be further reduced by legislation to allow abortion on request in at least the 1st trimester of pregnancy.

  8. Solving the Issue of Restenosis After Stenting of Intracranial Stenoses: Experience with Two Thin-Strut Drug-Eluting Stents (DES)—Taxus Element™ and Resolute Integrity™

    Energy Technology Data Exchange (ETDEWEB)

    Kurre, Wiebke, E-mail: wiebke.kurre@gmx.de; Aguilar-Pérez, Marta [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany); Fischer, Sebastian [Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin (Germany); Arnold, Guy [Klinikverbund Südwest, Klinikum Sindelfingen, Klinik für Neurologie (Germany); Schmid, Elisabeth; Bäzner, Hansjörg [Klinikum Stuttgart, Klinik für Neurologie (Germany); Henkes, Hans [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany)

    2015-06-15

    PurposeThin-strut, flexible DES are suitable for intracranial stenting and may improve long-term vessel patency. The purpose of this study was to report our experience with two new-generation DES for the treatment of intracranial atherosclerotic disease.Patients and MethodsWe retrospectively reviewed all patients treated with Taxus Element™ or Resolute Integrity™ stent for an intracranial atherosclerotic stenosis between March 2011 and August 2013. Technical success was defined as the ability to deploy the device at the desired location and reduce the degree of stenosis below 50 %. All procedure-related strokes were recorded. Control angiography was scheduled after 6 weeks, 3, 6, and 12 months and yearly thereafter. A luminal narrowing ≥50 % was regarded as a restenosis. Stroke recurrence in the territory of the treated artery was reported.ResultsIn the defined period we treated 101 patients harboring 117 intracranial stenoses. The procedure was successful in 100 (85.5 %) lesions. Procedure-related strokes occurred in 10 (9.9 %) patients with a permanent morbidity in 3 (3.0 %). Follow-up angiography was available for 83 of 100 (83.0 %) successfully treated lesions with an average of 355 days (IQR 153–482 days). Three (3.6 %) asymptomatic restenoses were detected. All occurred after treatment with Resolute Integrity™, none after Taxus Element™ (p = 0.059). New strokes in the territory of the treated artery were encountered in 2 (2.6 %) occasions.ConclusionThin-strut DES improve long-term patency and reduce the risk of subsequent stroke. Differences between devices may exist. Feasibility is comparable to bare-metal balloon-mounted stents and procedure-related strokes occurred within the expected range.

  9. Late Washing efficiency

    International Nuclear Information System (INIS)

    Morrissey, M.F.

    1992-01-01

    Interim Waste Technology has demonstrated the Late Washing concept on the Experimental Laboratory Filter (ELF) at TNX. In two tests, washing reduced the [NO 2 - ] from 0.08 M to approximately 0.01 M on slurries with 2 year equivalent radiation exposures and 9.5 wt. % solids. For both washes, the [NO 2 - ] decreased at rates near theoretical for a constant volume stirred vessel, indicating approximately l00% washing efficiency. Permeate flux was greater than 0.05 gpm/ft 2 for both washes at a transmembrane pressure of 50 psi and flow velocity of 9 ft/sec

  10. Late-Modern Symbolism

    DEFF Research Database (Denmark)

    Andersen, Bjørn Schiermer

    2015-01-01

    Through analysis of key texts, I seek to demonstrate the explanative potential of Durkheim’s sociology of religion in the present context. I critically readdress the idea, found in his early work, that modernity is characterized by a rupture with pre-modern forms of solidarity. First, I investiga...... of “mechanical” solidarity is to be found behind the “symbolist” template crystalizing in Durkheim’s late work. Third, I develop this template for a modern context by critically addressing and removing other obstacles and prejudices on Durkheim’s part....

  11. Comparison of Recanalization and In-Stent Stenosis Between the Low-Profile Visualized Intraluminal Support Stent and Enterprise Stent-Assisted Coiling for 254 Intracranial Aneurysms.

    Science.gov (United States)

    Feng, Xin; Qian, Zenghui; Liu, Peng; Zhang, Baorui; Wang, Luyao; Guo, Erkang; Wen, Xiaolong; Xu, Wenjuan; Jiang, Chuhan; Wu, Zhongxue; Li, Youxiang; Liu, Aihua

    2018-01-01

    To compare the rates of recanalization and in-stent stenosis between the Enterprise (EP) and low-profile visualized intraluminal support (LVIS) stent deployments for intracranial aneurysms (IAs), and the factors associated therein. Between June 2014 and July 2016, 142 patients with a total of 161 IAs were treated by LVIS stent-assisted coiling and 111 patients with a total of 142 IAs were treated by EP stent-assisted coiling at our institution. Procedure-related complications, angiographic follow-up results, and clinical outcomes were analyzed statistically. The rates of initially complete and near-complete IA occlusion immediately after the procedure were similar in the LVIS and EP groups (94.3% vs. 89.9%; P = 0.275). On follow-up, complete and near-complete occlusion rates and recanalization rates were also similar in the 2 groups (96.6% vs. 92.1%; P =0.330 and 8.0% vs. 13.5%; P = 0.245, respectively). On logistic regression analysis, a higher size ratio (SR) was significantly associated with the recanalization of aneurysms in the EP group, but not in the LVIS group. The rate of moderate to severe in-stent stenosis was lower in the LVIS group (10.2%) than in the EP group (16.8%), but the difference was not statistically significant (P = 0.198). Our data show acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. LVIS stents were associated with lower rates of recanalization and in-stent stenosis, but the difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with EP stents, but not in those treated with LVIS stents. Copyright © 2017. Published by Elsevier Inc.

  12. Bioresorbable vascular scaffold (BVS) for in-stent chronic total occlusion: Antegrade recanalization and IVUS-guided BVS implantation by radial access

    Energy Technology Data Exchange (ETDEWEB)

    Medda, Massimo [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Casilli, Francesco, E-mail: frcasill@tin.it [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Bande, Marta [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Latini, Maria Giulia [Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese, Milano (Italy); Ghommidh, Mehdi [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Del Furia, Francesca [Unità Operativa di Cardiologia, Azienda Ospedaliera di Melegnano, Milano (Italy); Inglese, Luigi [Interventistica Cardiovascolare, Gruppo Sanitario Policlinico di Monza, Milano (Italy)

    2016-01-15

    The completely absorbable stents represent one of the latest innovations in the field of interventional cardiology, prospecting the possibility of “vascular repair”. In the published trials (ABSORB Cohort A and B, ABSORB EXTEND, and ABSORB II, III and IV) chronic total occlusions (CTOs) were considered an exclusion criteria. More recently the CTO-ABSORB pilot study demonstrated the safety and feasibility of bioresorbable vascular scaffold (BVS) use in case of CTO recanalization. We present the first case, to our knowledge, of in-stent occlusion successfully treated with an everolimus-eluting BVS and discuss its potential advantages in such kind of lesions.

  13. Late somatic effects

    International Nuclear Information System (INIS)

    Gilbert, E.

    1985-01-01

    A model is provided for estimating risks of late effects resulting from low-LET radiation exposure likely to be received in the event of a nuclear power plant accident. Separate estimates are provided for risks of leukemia, cancers of the bones, lungs, gastrointestinal tract, thyroid, skin, and the residual group of all other cancers; estimates of leukemia and other cancers due to in utero exposure are also provided. Risks are expressed in absolute terms as the number of cancer deaths (or cases) per million persons exposed to a particular dose. In addition, the number of years of life lost and the number of years of life lived after the occurrence of cancer are also estimated. The model used in the earlier Reactor Safety Study has been modified to reflect additional epidemiological data and these changes are described in detail. 37 references, 1 figure, 13 tables

  14. Better late than never

    DEFF Research Database (Denmark)

    Womack, Molly C; Christensen-Dalsgaard, Jakob; Hoke, Kim L

    2016-01-01

    in the final stages of ear maturation. Thus, juvenile toads are at a hearing disadvantage, at least in the high-frequency range, throughout much of their development, because late forming ear elements are critical to middle ear function at these frequencies. We discuss the potential fitness consequences......Most vertebrates have evolved a tympanic middle ear that enables effective hearing of airborne sound on land. Although inner ears develop during the tadpole stages of toads, tympanic middle ear structures are not complete until months after metamorphosis, potentially limiting the sensitivity...... of post-metamorphic juveniles to sounds in their environment. We tested the hearing of five species of toads to determine how delayed ear development impairs airborne auditory sensitivity. We performed auditory brainstem recordings to test the hearing of the toads and used micro-CT and histology to relate...

  15. Bioresorbable scaffolds in the treatment of coronary artery disease.

    Science.gov (United States)

    Zhang, Yaojun; Bourantas, Christos V; Farooq, Vasim; Muramatsu, Takashi; Diletti, Roberto; Onuma, Yoshinobu; Garcia-Garcia, Hector M; Serruys, Patrick W

    2013-01-01

    Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.

  16. Successful stent-in-stent insertion of an expandable metallic stent covered with polyuretane placed to obliterate a large bronchial fistula after chemoradiotherapy for inoperable lung cancer

    International Nuclear Information System (INIS)

    Minami, Hiroya; Tsubota, Noriaki; Miyamoto, Yoshifumi; Yoshimura, Masahiro; Obayashi, Kayoko; Takada, Yoshiki

    1999-01-01

    Bronchial fistulas in cases of inoperable lung cancer caused by radiochemotherapy are quite refractory and generally cannot be surgically closed. A 45-year-old man with squamous cell carcinoma in the right lung underwent two courses of induction chemotherapy (135 mg CDDP, 5 mg VDS, 13.5 mg MMC) and radiation therapy (2 Gy x 22 times) for invasion of the right main bronchus, the pulmonary artery and superior vena cava. Just before the end of the second course, the empyem second to the bronchial fistula caused by tumor necrosis developed in the right upper bronchus, and fenestration was performed. After the operation, his condition improved remarkably, however the fistula enlarged into the right main bronchus and the purulent discharge flowed into the left lung. An expandable metallic stent (EMS) covered with polyuretane was inserted in the trachea and the left main bronchus to break aspiration pneumonia. As the covered EMS was too unstable to be fixed, a bare EMS was inserted in a stent-in-stent fashion. After the procedure he was followed at the O.P.D. and lived a relatively comfortable life for 9 months until his death due to tumor. We inserted the covered EMS in a stent-in-stent fashion to successfully obliterate a large bronchial fistula. (author)

  17. Radiation protection review in nuclear medicine and analysis of new medical techniques. ACDOS-5-P-3 project. Final report, part 2

    International Nuclear Information System (INIS)

    Di Trano, Jose L.; Rojo, Ana M.; Kunst, Juan J.

    2003-01-01

    The intravascular brachytherapy (IVB) is a new application of ionizing radiation in the interventional cardiology and radioncology and medical physics field. The source is temporarily or permanently placed inside the vessel to prevent the restenosis. The restenosis is the re-narrowing of the lumen of the artery up to 50 % in the primary site of the treatment. Its incidence is 30 to 50 % following percutaneous transluminal coronary angioplasty (PTCA), and 20 % after stenting. The IVB is apply to prevent peripheric and coronary restenosis. The radiation is delivered through a catheter placed across the lesion, or by implanting a radioactive stent into a targeted lesion. Both beta and gamma radiation is used depending on the depth of penetration required. There isn't a definitive conclusion regarding the advantage of each one. The experience and the knowledge about the effects of ionizing radiation reveals that the cells in high rate division are the main target. It determines the selection of this type of radiation to prevent and treat the main component of restenosis: the neo intimal hyperplasia. Recently, several clinical trials have been approved in multicenter studies to assess the effectiveness and safety of IVB in reducing the restenosis rate. During the year 2000, Cordis's Checkmate System and Novoste's Beth-Cath System received Food and Drug Administration (FDA) approval to treat patients with in-stent restenosis. This approval marks a significant achievement for U.S. clinicians/researchers, who have devoted more than four years of clinical study to evaluate the effects and intricacies of vascular brachytherapy. The approval mechanism anticipates a follow up of the cases for an evaluation of the conditions of the definitive authorization. The IVB showed to be useful in the treatment of neo intimal hyperplasia post angioplasty injury and in-stent restenosis. Nevertheless there are uncertainties to be studied before the routine clinical application. These

  18. Erythropoietin prevention trial of coronary restenosis and cardiac remodeling after ST-elevated acute myocardial infarction (EPOC-AMI): a pilot, randomized, placebo-controlled study.

    Science.gov (United States)

    Taniguchi, Norimasa; Nakamura, Takeshi; Sawada, Takahisa; Matsubara, Kinya; Furukawa, Keizo; Hadase, Mitsuyoshi; Nakahara, Yoshifumi; Nakamura, Takashi; Matsubara, Hiroaki

    2010-11-01

    Erythropoietin (EPO) enhances re-endothelialization and anti-apoptotic action. Larger clinical studies to examine the effects of high-dose EPO are in progress in patients with acute myocardial infarction (AMI). The aim of this multi-center pilot study was to investigate the effect of `low-dose EPO' (6,000 IU during percutaneous coronary intervention (PCI), 24 h and 48 h) in 35 patients with a first ST-elevated AMI undergoing PCI who was randomly assigned to EPO or placebo (saline) treatment. Neointimal volume, cardiac function and infarct size were examined in the acute phase and 6 months later (ClinicalTrials.gov identifier: NCT00423020). No significant regression in in-stent neointimal volume was observed, whereas left ventricular (LV) ejection fraction was significantly improved (49.2% to 55.7%, P=0.003) and LV end-systolic volume was decreased in the EPO group (47.7 ml to 39.0 ml, P=0.036). LV end-diastolic volume tended to be reduced from 90.2% to 84.5% (P=0.159), whereas in the control group it was inversely increased (91.7% to 93.7%, P=0.385). Infarction sizes were significantly reduced by 38.5% (P=0.003) but not in the control group (23.7%, P=0.051). Hemoglobin, peak creatine kinase values, and CD34(+)/CD133(+)/CD45(dim) endothelial progenitors showed no significant changes. No adverse events were observed during study periods. This is a first study demonstrating that short-term `low-dose' EPO to PCI-treated AMI patients did not prevent neointimal hyperplasia but rather improved cardiac function and infarct size without any clinical adverse effects.

  19. Incidence and predictors of very late (>or=4 years) major cardiac adverse events in the DESIRE (Drug-Eluting Stents in the Real World)-Late registry.

    Science.gov (United States)

    Costa, J Ribamar; Sousa, Amanda; Moreira, Adriana C; Costa, Ricardo A; Cano, Manuel; Maldonado, Galo; Campos, Cantídio; Carballo, Mariana; Pavanello, Ricardo; Sousa, J Eduardo

    2010-01-01

    Our aim was to access the incidence of late major adverse cardiac events (MACE) and stent thrombosis (ST) in nonselected, complex patients followed for a period >/=4 years. Despite the efficacy of drug-eluting stents (DES) in reducing repeated target lesion revascularization, concerns regarding the occurrence of late and very late ST have partially obscured the benefits of this novel technology. All consecutive patients treated solely with DES between May 2002 and January 2005 were enrolled into this prospective, nonrandomized, single-center registry. The primary end point was long-term occurrence of MACE up to 7 years. Independent predictors of MACE, cardiac death, target lesion revascularization, and ST were obtained by a multivariate Cox proportional hazards regression model. A total of 1,010 patients were enrolled. Most of them were men (77%) with a mean age of 63.7 years. Stent/patient rate was 1.4. Patients were kept in dual antiplatelet therapy for 3 and 6 months after Cypher (Cordis, Johnson & Johnson, Miami Lakes, Florida) and Taxus (Boston Scientific Corp., Natick, Massachusetts) stent implantation, respectively. Follow-up was obtained in 98.2% of the cohort (median 5.01 years). Survival free of MACE and cumulative incidence of definite/probable ST were 84.6% and 1.7%, respectively. Independent predictors of ST were percutaneous coronary intervention in the setting of acute myocardial infarction, DES overlapping, treatment of multivessel disease, presence of moderate-to-severe calcification at lesion site, and in-stent residual stenosis. The deployment of DES in complex, real-world patients resulted in a low rate of very long-term MACE and ST. However, ST still occurs very long after the index procedure. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Evolution process of the Late Silurian–Late Devonian tectonic ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Earth System Science; Volume 124; Issue 1. Evolution process of the Late Silurian–Late Devonian tectonic environment in Qimantagh in the western portion of east Kunlun, China: Evidence from the geochronology and geochemistry of granitoids. Nana Hao Wanming Yuan Aikui Zhang Yunlei ...

  1. Sirolimus inhibits key events of restenosis in vitro/ex vivo: evaluation of the clinical relevance of the data by SI/MPL- and SI/DES-ratio's

    Directory of Open Access Journals (Sweden)

    Kountides Margaratis

    2007-05-01

    Full Text Available Abstract Background Sirolimus (SRL, Rapamycin has been used successfully to inhibit restenosis both in drug eluting stents (DES and after systemic application. The current study reports on the effects of SRL in various human in vitro/ex vivo models and evaluates the theoretical clinical relevance of the data by SI/MPL- and SI/DES-ratio's. Methods Definition of the SI/MPL-ratio: relation between significant inhibitory effects in vitro/ex vivo and the maximal plasma level after systemic administration in vivo (6.4 ng/ml for SRL. Definition of the SI/DES-ratio: relation between significant inhibitory effects in vitro/ex vivo and the drug concentration in DES (7.5 mg/ml in the ISAR drug-eluting stent platform. Part I of the study investigated in cytoflow studies the effect of SRL (0.01–1000 ng/ml on TNF-α induced expression of intercellular adhesion molecule 1 (ICAM-1 in human coronary endothelial cells (HCAEC and human coronary smooth muscle cells (HCMSMC. Part II of the study analysed the effect of SRL (0.01–1000 ng/ml on cell migration of HCMSMC. In part III, IV, and V of the study ex vivo angioplasty (9 bar was carried out in a human organ culture model (HOC-model. SRL (50 ng/ml was added for a period of 21 days, after 21 and 56 days cell proliferation, apoptosis, and neointimal hyperplasia was studied. Results Expression of ICAM-1 was significantly inhibited both in HCAEC (SRL ≥ 0.01 ng/ml and HCMSMC (SRL ≥ 10 ng/ml. SRL in concentrations ≥ 0.1 ng/ml significantly inhibited migration of HCMSMC. Cell proliferation and neointimal hyperplasia was inhibited at day 21 and day 56, significance (p Conclusion SI/MPL-ratio's ≤ 1 (ICAM-1 expression, cell migration characterize inhibitory effects of SRL that can be theoretically expected both after systemic and local high dose administration, a SI/MPL-ratio of 7.81 (cell proliferation represents an effect that was achieved with drug concentrations 7.81-times the MPL. SI/DES-ratio's between 10

  2. The late administration of surfactant

    African Journals Online (AJOL)

    HMD and 4 as having congenital pneumonia. Overall there was a significant and sustained improvement ... 3 infants weighing> 2 400 g with congenital pneumonia responded to a single delayed dose of SRT. Late SRT is ..... pneumonia and meconium aspiration syndrome.' It does not appear that late SRT compromised the ...

  3. Recent casualties of late globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    In this essay I will expand my thoughts on universities as ‘late globalizers’ and the impact ‘being late’ has on university internationalization or globalization activities. In my earlier essay I viewed universities as ‘late globalizers’ and briefly introduced the impact of being ‘late’, e...

  4. Restenosis: A Challenge to Angioplasty

    Indian Academy of Sciences (India)

    fluoroscopy, as it moves down the artery. Wherever the flow is blocked, it clearly shows up as .... animals were sacrificed at various intervals of time (weeks to months) and their arteries examined for the efficacy ... Alterna- tively, a stent implanted with a small amount of radioactive material is placed permanently at the site of ...

  5. Restenosis: A Challenge to Angioplasty

    Indian Academy of Sciences (India)

    biology. He occasionally writes popular science articles in both English and Kannada. He was also the Editor of Journal of. Medical Physics. M S S Murthy. Fatty deposits clog the coronary arteries blocking .... Unlike bone, the arteries, the blood, and the atherosclerotic plaque are transparent to X-rays and do not show up on ...

  6. Helping the Habitually Late Student.

    Science.gov (United States)

    Bergman, Jerry

    1978-01-01

    The author gives three major reasons for a student being habitually late to class: resistance, disorganization, or unavoidable schedule conflicts. He makes specific suggestions to teachers for dealing with the disorganized and resistant latecomers. (SJL)

  7. Late prematurity: a systematic review

    Directory of Open Access Journals (Sweden)

    Luís Carlos Machado Júnior

    2014-06-01

    Full Text Available Objective: this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation in its several aspects. Sources: the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. Data synthesis: numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. Conclusions: numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed.

  8. Late prematurity: a systematic review.

    Science.gov (United States)

    Machado Júnior, Luís Carlos; Passini Júnior, Renato; Rodrigues Machado Rosa, Izilda

    2014-01-01

    this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects. the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  9. Late effects from hadron therapy

    Energy Technology Data Exchange (ETDEWEB)

    Blakely, Eleanor A.; Chang, Polly Y.

    2004-06-01

    Successful cancer patient survival and local tumor control from hadron radiotherapy warrant a discussion of potential secondary late effects from the radiation. The study of late-appearing clinical effects from particle beams of protons, carbon, or heavier ions is a relatively new field with few data. However, new clinical information is available from pioneer hadron radiotherapy programs in the USA, Japan, Germany and Switzerland. This paper will review available data on late tissue effects from particle radiation exposures, and discuss its importance to the future of hadron therapy. Potential late radiation effects are associated with irradiated normal tissue volumes at risk that in many cases can be reduced with hadron therapy. However, normal tissues present within hadron treatment volumes can demonstrate enhanced responses compared to conventional modes of therapy. Late endpoints of concern include induction of secondary cancers, cataract, fibrosis, neurodegeneration, vascular damage, and immunological, endocrine and hereditary effects. Low-dose tissue effects at tumor margins need further study, and there is need for more acute molecular studies underlying late effects of hadron therapy.

  10. Therapy and prophylaxis of acute and late radiation-induced sequelae of the esophagus

    Energy Technology Data Exchange (ETDEWEB)

    Zimmermann, F.B.; Geinitz, H.; Feldmann, H.J. [Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, Muenchen (Germany)

    1998-11-01

    Background: Radiation-induced esophagitis is a frequent acute side effect in curative and palliative radiotherapy of thoracal and cervical tumors. Late reactions are rare but might be severe. Methods: A resarch for reports on prophylactic and supportive therapies of radiation-induced esophagitis was performed (Medline, Cancerlit, and others). Results: Nutrition must be ensured and symptomatic relief of sequelae is important, especially in the case of dysphagia. The latter can be improved by topic or systemic analgetics. If esophageal spasm occurs, calcium antagonists might help. In case of gastro-esophageal reflux proton pump inhibitors should be used. There is no effective prophylactic measure for radiation esophagitis. Late side effects with clinical relevance are rare in conventional radiotherapy. Chronic ulcera, fistula or stenosis may develop. Before any treatment, a tumor infiltration of the esophagus should be excluded by biopsy. This can lead more often to late complications than radiation therapy itself. Nutrition should be ensured by endoscopic dilation, stent-implantation, or endoscopic percutaneous gastrostomy. Local injection of steroids might be used to avoid an early restenosis. Conclusions: An intensive symptomatic therapy of acute esophagitis is reasonable. Effective prophylaxis do not exist. Late radiation induced sequelae is rare. Therefore, a tumor recurrenc e should be excluded in cases of dysphagia. Securing nutrition by PEG, stent, or port is well in the fore. (orig.) [Deutsch] Hintergrund: Die radiogene Oesophagitis ist eine haeufige akute Nebenwirkung bei kurativen wie palliativen Bestrahlungen thorakaler und zervikaler Tumoren. Spaete Gewebereaktionen sind selten, koennen aber schwerwiegend sein. Methode: Es wurde eine Literaturrecherche nach prophylaktischen und supportiven Therapien der radiogen verursachten Oesophagitis durchgefuehrt (Medline, Cancerlit und andere). Ergebnisse: Therapeutisch stehen die Sicherung der Ernaehrung und die

  11. Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis.

    Science.gov (United States)

    Zhang, Bu Chun; Tu, Sheng Xian; Karanasos, Antonios; van Geuns, Robert-Jan; de Jaegere, Peter; Zijlstra, Felix; Regar, Evelyn

    2018-02-05

    The relationship between vessel angulation and large changes in vessel geometry after stent implantation and the occurrence of stent failure still remains unclear. We sought to investigate the association of the change in the coronary bending angle after stenting and the risk for late stent failure by three-dimensional quantitative coronary angiography (3D QCA). The bending angle in coronary lesions that presented with late stent failure and those without stent failure was computed during the cardiac cycle, before and after stenting using a recently developed 3D QCA software. A total of 40 lesions with stent failure (cases) were successfully matched to 47 lesions without stent failure (controls).The mean duration to follow-up coronary angiography was 1,011 days in cases and 1,109 days in the control group (P = 0.14). In stent failure, the systolic bending angle after stenting was smaller (14.45° [12.18, 17.68] versus 18.20° [14.00, 20.30], P = 0.01), while the stent-induced change in systolic bending angle was significantly larger (4.15° [1.13, 7.20] versus 1.80° [-1.90, 4.40], P = 0.004). Multivariable logistic regression analysis suggested that systolic bending angle after stenting (odds ratio: 0.88; 95% CI: 0.79-0.99; P = 0.03), and decrease in systolic bending angle after stenting (odds ratio: 1.13; 95% CI: 1.02-1.26; P = 0.03) were predictors of stent failure. Our study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure. © 2018 Wiley Periodicals, Inc.

  12. Investigating late-onset ADHD

    DEFF Research Database (Denmark)

    Cooper, Miriam; Hammerton, Gemma; Collishaw, Stephan

    2018-01-01

    BACKGROUND: Adult ADHD has been assumed to be a continuation of childhood-onset ADHD. However, recent studies have identified individuals with ADHD in adulthood who have not had ADHD in childhood. Whether or not these individuals have a 'typical' neurodevelopmental profile is not clear. METHODS: We...... tested two explanations for the emergence of apparent late-onset ADHD symptomatology using the ALSPAC epidemiological cohort, by grouping individuals according to their scores on the Strengths and Difficulties Questionnaire (SDQ) hyperactivity subscale at ages 12 and 17 years. First, we tested whether...... some of those with apparent late-onset ADHD symptoms had been potentially misclassified on the basis of earlier SDQ hyperactivity scores (ages 7, 8 and 9 years) or of subthreshold symptoms at age 12 years. Second, we investigated the possibility that those with 'genuine' late-onset ADHD symptoms had...

  13. Inhibition of neointima formation by local delivery of estrogen receptor alpha and beta specific agonists

    NARCIS (Netherlands)

    Krom, Y.D.; Pires, N.M.M.; Jukema, J.W.; Vries, M.R. de; Frants, R.R.; Havekes, L.M.; Dijk, K.W. van; Quax, P.H.A.

    2007-01-01

    Objective: Neointima formation is the underlying mechanism of (in-stent) restenosis. 17β-Estradiol (E2) is known to inhibit injury-induced neointima formation and post-angioplasty restenosis. Estrogen receptor alpha (ERα) has been demonstrated to mediate E2 anti-restenotic properties. However, the

  14. Late Carboniferous to Late Permian carbon isotope stratigraphy

    DEFF Research Database (Denmark)

    Buggisch, Werner; Krainer, Karl; Schaffhauser, Maria

    2015-01-01

     analyses. The carbon isotope record of diagenetically unaltered samples from the Carnic Alps (Austria) and Karavanke Mountains (Slovenia) shows generally high δ13C values, but Late Carboniferous and Early Permian successions are affected by a diagenetic alteration as consequence of glacio-eustatic sea level changes...

  15. Microvascular denudation of the femoral artery of the mouse as a model for restenosis; Mikrovaskulaere Denudation der Arteria femoralis der Maus - ein Restenosemodell fuer die Experimentelle Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Feuls, R.; Bantleon, R.; Henning, E.B.; Tepe, G.; Khorchidi, S.; Reis, E.D.; Duda, S.H. [Eberhard-Karls-Univ. Tuebingen, Abteilung fuer Radiologische Diagnostik (Germany); Chereshnev, I. [Mount Sinai School of Medicine, Department of Surgery, New York City (United States)

    2003-07-01

    Objective: To present technique and results of a microvascular denudation of the common femoral artery of the mouse as a model for inducing intimal hyperplasia in interventional radiology. Materials and methods: Under general anesthesia introduced by intraperitoneal injection, 14 B6129F1 hybrid mice (7 females and 7 males) at a mean age of 12.1{+-}1.8 weeks and a mean weight of 28{+-}2.8 grams had a groin incision of the vascular bundle directly distal to the inguinal ligament in preparation of placing a vascular clamp. Thereafter, the femoral artery was dissected distal to the origin of the epigastric artery and a loop prepared for a ligation proximal to the planned arteriotomy. Through an arteriotomy performed free-hand with a pair of micro scissors, a 0.010'' (=0.25 mm) guidewire was introduced into the vessel and advanced to the aortic bifurcation. The guidewire was moved back and forth three times. The same procedure was performed on the other side as sham-operation, i.e., without introduction and passage of a guidewire. The resulting changes of the vessel wall were evaluated by histology and morphometry. Results: Four weeks after intervention, the mean intima-to-media-ratio (IMR) was 1.80{+-}0.28. A significant difference was observed between the sexes, with an IMR of 1.41{+-}0.29 in females and an IMR of 2.24{+-}0.45 in males (p=0.0173). The neointima led to an overall luminal loss of 50.2%{+-}8.3% without significant sex difference (p=0.09), but the average lumina loss was still more severe in females, amounting to 43.9% in comparison to 56.1% in males. This technique induces a significant neointima formation in a reproducible manner. The internal elastic membrane was preserved in all vessels. Conclusion: This technique is an excellent model to examine the differences between genetically modified mice to clarify the role of putative key molecules in the pathophysiology of restenosis. (orig.) [German] Ziel: Wir moechten Technik und Ergebnisse der

  16. TIMP-2 gene transfer by positively charged PEG-lated monosized polycationic carrier to smooth muscle cells

    Energy Technology Data Exchange (ETDEWEB)

    Lacin, Nelisa, E-mail: melisalacin@yahoo.com [Mersin University, Advanced Technology Education, Research and Application Center (Turkey); Utkan, Gueldem [TUBITAK MAM, Enzyme and Fermentation Technology Laboratory, Genetic Engineering and Biotechnology Institute (Turkey); Kutsal, Tuelin [Hacettepe University, Chemical Engineering Department and Bioengineering Division (Turkey); Dedeoglu, Bala Guer; Yulug, Is Latin-Small-Letter-Dotless-I k G. [Bilkent University, Department of Molecular Biology and Genetics, Faculty of Science (Turkey); Piskin, Erhan [Hacettepe University, Chemical Engineering Department and Bioengineering Division and Center for Bioengineering-Biyomedtek (Turkey)

    2012-02-15

    Remodeling of the extracellular matrix resulting from increased secretion of metalloproteinase enzymes is implicated in restenosis following balloon angioplasty. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases play an essential role in both normal and pathological extracellular matrix degradation. Tissue inhibitor of matrix metalloproteinase-2 is the most extensively studied tissue inhibitor of metalloproteinases in myocardial tissue in animal models and clinical examples of cardiac disease; therefore it is selected for this study. Gene transfer of tissue inhibitor of matrix metalloproteinase-2 may have a therapeutic potential by inhibition of matrix metalloproteinase activity. We have used PEG-lated nanoparticles poly(St/PEG-EEM/DMAPM) which were synthesized previously in our laboratory. The nanoparticles, with an average size of 77.6 {+-} 2.05 nm with a zeta potential of +64. 4 {+-} 1.14 mV and 201.9 {+-} 1.83 nm with +54.2 {+-} 0.77 mV were used in the transfection studies. Zeta Potential values and size of polyplex were appropriate for an effective transfection. TIMP-2 expression was detected by western blotting. Increased protein level in smooth muscle cells according to non-transfected smooth muscle cells confirms the successful delivery and expression of the tissue inhibitor of matrix metalloproteinase-2 gene with the non-viral vector transfection approach.

  17. TIMP-2 gene transfer by positively charged PEG-lated monosized polycationic carrier to smooth muscle cells

    Science.gov (United States)

    Laçin, Nelisa; Utkan, Güldem; Kutsal, Tülin; Dedeoğlu, Bala Gür; Yuluğ, Işık G.; Pişkin, Erhan

    2012-02-01

    Remodeling of the extracellular matrix resulting from increased secretion of metalloproteinase enzymes is implicated in restenosis following balloon angioplasty. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases play an essential role in both normal and pathological extracellular matrix degradation. Tissue inhibitor of matrix metalloproteinase-2 is the most extensively studied tissue inhibitor of metalloproteinases in myocardial tissue in animal models and clinical examples of cardiac disease; therefore it is selected for this study. Gene transfer of tissue inhibitor of matrix metalloproteinase-2 may have a therapeutic potential by inhibition of matrix metalloproteinase activity. We have used PEG-lated nanoparticles poly(St/PEG-EEM/DMAPM) which were synthesized previously in our laboratory. The nanoparticles, with an average size of 77.6 ± 2.05 nm with a zeta potential of +64. 4 ± 1.14 mV and 201.9 ± 1.83 nm with +54.2 ± 0.77 mV were used in the transfection studies. Zeta Potential values and size of polyplex were appropriate for an effective transfection. TIMP-2 expression was detected by western blotting. Increased protein level in smooth muscle cells according to non-transfected smooth muscle cells confirms the successful delivery and expression of the tissue inhibitor of matrix metalloproteinase-2 gene with the non-viral vector transfection approach.

  18. First-in-man randomised comparison of the BuMA Supreme biodegradable polymer sirolimus-eluting stent versus a durable polymer zotarolimus-eluting coronary stent: the PIONEER trial.

    Science.gov (United States)

    von Birgelen, Clemens; Asano, Taku; Amoroso, Giovanni; Aminian, Adel; Brugaletta, Salvatore; Vrolix, Mathias; Hernandez-Antolín, Rosana; van de Harst, Pim; Iñiguez, Andres; Janssens, Luc; Smits, Pieter C; Wykrzykowska, Joanna J; Ribeiro, Vasco Gama; Pereira, Hélder; da Silva, Pedro Canas; Piek, Jan J; Onuma, Yoshinobu; Serruys, Patrick W; Sabaté, Manel

    2018-04-20

    A second iteration of a sirolimus-eluting stent (SES) that has a biodegradable PLGA polymer coating with an electrografting base layer on a thin-strut (80 µm) cobalt-chromium platform (BuMA Supreme; SINOMED, Tianjin, China) has been developed. This first-in-man trial aimed to assess the efficacy and safety of the novel device. This randomised, multicentre, single-blinded, non-inferiority trial compared the BuMA Supreme SES versus a contemporary durable polymer zotarolimus-eluting stent (ZES) in terms of angiographic in-stent late lumen loss (LLL) at nine-month follow-up as the primary endpoint. A total of 170 patients were randomly allocated to treatment with either SES (n=83) or ZES (n=87). At nine-month angiographic follow-up, in-stent LLL was 0.29±0.33 mm in the SES group and 0.14±0.37 mm in the ZES group (pnon-inferiority=0.45). The in-stent percent diameter stenosis and the binary restenosis rate of the two treatment arms were similar (19.2±12.0% vs. 16.1±12.6%, p=0.09, and 3.3% vs. 4.4%, p=1.00, respectively). At 12-month clinical follow-up, there was no difference between treatment arms with regard to the device-oriented composite clinical endpoint (4.9% vs. 5.7%; p=0.72). The PIONEER trial did not meet its primary endpoint in terms of in-stent LLL at nine-month follow-up. However, this result did not translate into any increase in restenosis rate or impairment in 12-month clinical outcomes.

  19. Zotarolimus- and paclitaxel-eluting stents in an all-comer population in China: the RESOLUTE China randomized controlled trial.

    Science.gov (United States)

    Xu, Bo; Yang, Yuejin; Yuan, Zuyi; Du, Zhimin; Wong, S Chiu; Généreux, Philippe; Lu, Shuzheng

    2013-07-01

    This study sought to compare clinical outcomes and angiographic findings using the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Santa Rosa, California) versus the Taxus Liberte paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) in an all-comer Chinese population. Concerns regarding restenosis risk led to new-generation drug-eluting stents (DES) designed for use in patients with complex clinical or lesion characteristics. In-stent late lumen loss (LLL) is a measure of restenosis risk. Patients with an indication for treatment with a DES were randomized in a 1:1 ratio to placement of at least 1 R-ZES or PES with minimal exclusions. The primary endpoint was angiographic in-stent LLL at 9 months post-procedure. Clinical endpoints at 12 months are compared between the 2 stents. A total of 198 patients received a R-ZES, and 202 patients received a PES. Most patients were male; 25.8% and 29.2% of R-ZES and PES patients, respectively, had diabetes. Over 70% of lesions in both cohorts were American College of Cardiology/American Heart Association lesion classification Type B2 and C (B2/C). In-stent LLL was 0.16 ± 0.38 mm for R-ZES and 0.33 ± 0.52 mm for PES at 9 months (p comers Chinese population, 9-month in-stent LLL was significantly less with R-ZES compared with PES, which was reflected in lower revascularization rates at 12 months for the R-ZES patients. Results are consistent with previous clinical trials of the R-ZES in all-comer populations. (Resolute Zotarolimus-Eluting Stent Versus the Taxus Liberte Paclitaxel-Eluting Stent for Percutaneous Coronary Intervention in China [R-China RCT]; NCT01334268). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Late onset globoid cell leukodystrophy.

    OpenAIRE

    Grewal, R P; Petronas, N; Barton, N W

    1991-01-01

    A 29 year old male with onset of globoid cell leukodystrophy at age 14 is described. This is the first case of enzymatically confirmed globoid cell leukodystrophy with onset of symptoms after the age of ten. This patient is unique because of the late onset and slow progression and extends the clinical spectrum of globoid cell leukodystrophy.

  1. Late onset globoid cell leukodystrophy.

    Science.gov (United States)

    Grewal, R P; Petronas, N; Barton, N W

    1991-11-01

    A 29 year old male with onset of globoid cell leukodystrophy at age 14 is described. This is the first case of enzymatically confirmed globoid cell leukodystrophy with onset of symptoms after the age of ten. This patient is unique because of the late onset and slow progression and extends the clinical spectrum of globoid cell leukodystrophy.

  2. Late onset startle induced tics

    NARCIS (Netherlands)

    Tijssen, M. A.; Brown, P.; Morris, H. R.; Lees, A.

    1999-01-01

    Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor tics were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The tics developed after physical trauma or a period of undue emotional stress. Reflex tics may occur in

  3. Late onset startle induced tics

    NARCIS (Netherlands)

    Tijssen, MAJ; Brown, P; Morris, HR; Lees, A

    1999-01-01

    Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor ties were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The ties developed after physical trauma or a period of undue emotional stress. Reflex ties may occur in

  4. and late onset Alzheimer's disease

    African Journals Online (AJOL)

    Yomi

    2012-03-15

    Mar 15, 2012 ... Alzheimer's disease (AD) is a prevalent disorder and the most common cause of dementia in elderly populations. Genetic and environmental factors together play a role in developing late onset. Alzheimer's disease (LOAD). According to the recent published papers, ACE is one of the candidate.

  5. Late abortions and the law.

    Science.gov (United States)

    Smith, T

    1988-02-13

    The Abortion (Amendment) Bill in the British House of Commons would lower the maximum limit for termination of pregnancy from 28 to 18 weeks. Supporters of the bill assert that Britain allows termination of pregnancy later than any other European country, and that in Britain over 90% of all late abortions are of fetuses without phisical abnormality. The 28-week limit is considered anachronoistic by doctors since neonatal care has made possible survival at 24 weeks. A similar bill in the House of Lords would reduce the limit to 24 weeks. Making early abortions more easily available would help reduce late abortions. Statistics indicate that women who have abortions late in their pregnancies tend to be young. In 1986, 172,286 abortions were performed in England and Wales. Of these, 144,857, or 84%, were performed before the 13th week. A total of 8276 (5%) were performed after 18 weeks. Of these, 3688 (45% of late abortions) were on nonresidents who traveled to Britain because of legal restrictions in their own country. This means that 4594 late abortions were performed on residents of England and Wales in 1986. This was 3% of the total, with 14% of this number on grounds of fetal abnormality. About 40% of the rest were in women under the age of 20, with 6% (239) on girls under 16. A 1984 study concluded that more counseling and information should be provided for young women. Education in contraception for young women is less than ideal and likely to become less available as economic restraints reduce the number of family planning clinics. Postcoital contraception should be taught more as an emergency proceedure. Prompt, dispassionate physician counseling, wider provision of National Health Service facilities, and uniform service in all districts would also be beneficial.

  6. Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction.

    Science.gov (United States)

    Sasaki, Takashi; Isayama, Hiroyuki; Nakai, Yousuke; Takahara, Naminatsu; Hamada, Tsuyoshi; Mizuno, Suguru; Mohri, Dai; Yagioka, Hiroshi; Kogure, Hirofumi; Arizumi, Toshihiko; Togawa, Osamu; Matsubara, Saburo; Ito, Yukiko; Yamamoto, Natsuyo; Sasahira, Naoki; Hirano, Kenji; Toda, Nobuo; Tada, Minoru; Koike, Kazuhiko

    2015-01-01

    To evaluate the efficacy and safety of secondary gastroduodenal stent placement after first stent dysfunction for malignant gastric outlet obstruction. We conducted a retrospective analysis to investigate the efficacy and safety of secondary stent-in-stent gastroduodenal stent placement. Among 260 patients who had been treated with first gastroduodenal stent placement for malignant gastric outlet obstruction, 29 patients (11.2%) were treated with secondary gastroduodenal stent placement because of first stent dysfunction. Pancreatic cancer was the major primary cancer (55.2%). A WallFlex duodenal stent was the most frequently inserted stent both as a first stent (75.9%) and as a secondary stent (62.1%). There were 22 patients (75.9%) that received gastroduodenal stents at the bending site (supraduodenal angle or infraduodenal angle). Technical and clinical success rates were 100% and 86.2%, respectively. Median eating period was 3.0 months, and median survival time was 3.5 months. As for related complications, gastrointestinal perforation, insufficient stent expansion, tumor ingrowth, tumor overgrowth, and cholangitis were experienced in 13.8% (four cases), 6.9% (two cases), 6.9% (two cases), 3.4% (one case), and 3.4% (one case), respectively. Secondary gastroduodenal stent placement might be effective for managing first stent dysfunction in malignant gastric outlet obstruction. However, gastrointestinal perforation was the major complication. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  7. Reliability of mechanical and phased-array designs for serial intravascular ultrasound examinations--animal and clinical studies in stented and non-stented coronary arteries.

    Science.gov (United States)

    Tardif, J C; Bertrand, O F; Mongrain, R; Lespérance, J; Grégoire, J; Paiement, P; Bonan, R

    2000-10-01

    Both mechanical and multi-element intravascular ultrasound designs have potential advantages and limitations that may impact on their value for clinical and research purposes. Determination of the reproducibility of measurements is critical before a given system can be used in studies such as regression of atherosclerosis trials. We performed serial intravascular ultrasound imaging with catheters using mechanical and phased-array designs in stented and non-stented coronary arteries in dogs and in patients. Both systems correlated well for areas (r > or = 0.90, p or = 0.84. p mechanical designs for measurements of area (mean difference in dogs and in patients: -0.24 and 0.96 mm2, p mechanical system (r > or = 0.96 for all measurements). The differences in absolute and relative variability between the mechanical and phased-array designs, both for reanalysis of same frames and serial pullbacks, were very small. Although multi-element and mechanical intravascular ultrasound designs are not strictly interchangeable, their similar reproducibility and the small differences in measurements demonstrate that both designs are acceptable alternatives for trials of regression of atherosclerosis. Determination of the variability for serial pullbacks of both designs was also important to assess the statistical power of such trials.

  8. Stents Eluting 6-Mercaptopurine Reduce Neointima Formation and Inflammation while Enhancing Strut Coverage in Rabbits.

    Directory of Open Access Journals (Sweden)

    Matthijs S Ruiter

    Full Text Available The introduction of drug-eluting stents (DES has dramatically reduced restenosis rates compared with bare metal stents, but in-stent thrombosis remains a safety concern, necessitating prolonged dual anti-platelet therapy. The drug 6-Mercaptopurine (6-MP has been shown to have beneficial effects in a cell-specific fashion on smooth muscle cells (SMC, endothelial cells and macrophages. We generated and analyzed a novel bioresorbable polymer coated DES, releasing 6-MP into the vessel wall, to reduce restenosis by inhibiting SMC proliferation and decreasing inflammation, without negatively affecting endothelialization of the stent surface.Stents spray-coated with a bioresorbable polymer containing 0, 30 or 300 μg 6-MP were implanted in the iliac arteries of 17 male New Zealand White rabbits. Animals were euthanized for stent harvest 1 week after implantation for evaluation of cellular stent coverage and after 4 weeks for morphometric analyses of the lesions.Four weeks after implantation, the high dose of 6-MP attenuated restenosis with 16% compared to controls. Reduced neointima formation could at least partly be explained by an almost 2-fold induction of the cell cycle inhibiting kinase p27Kip1. Additionally, inflammation score, the quantification of RAM11-positive cells in the vessel wall, was significantly reduced in the high dose group with 23% compared to the control group. Evaluation with scanning electron microscopy showed 6-MP did not inhibit strut coverage 1 week after implantation.We demonstrate that novel stents coated with a bioresorbable polymer coating eluting 6-MP inhibit restenosis and attenuate inflammation, while stimulating endothelial coverage. The 6-MP-eluting stents demonstrate that inhibition of restenosis without leaving uncovered metal is feasible, bringing stents without risk of late thrombosis one step closer to the patient.

  9. Clerical Exile in Late Antiquity

    DEFF Research Database (Denmark)

    Engberg, Jakob

    2016-01-01

    This volume results from the international research project ‘The Migration of Faith: Clerical Exile in Late Antiquity (325‒c.600)’. The project is a collaboration between the Department of History at the University of Sheffield, the Seminar für Kirchengeschichte at the University of Halle......, and the Department of Culture and Society at Aarhus University. Ten chapters of the volume are revised versions of papers delivered at the XVII International Conference on Patristic Studies held in Oxford in 2015. The three chapters of the first part of the volume discuss the question of “Clerical Exile and Social...... Control”. The second part offers five selected case studies from the 3rd to the 6th centuries. The final part deals with discourses, memories and legacies of clerical exile in late antiquity....

  10. Clerical Exile in Late Antiquity

    DEFF Research Database (Denmark)

    This volume results from the international research project ‘The Migration of Faith: Clerical Exile in Late Antiquity (325‒c.600)’. The project is a collaboration between the Department of History at the University of Sheffield, the Seminar für Kirchengeschichte at the University of Halle......, and the Department of Culture and Society at Aarhus University. Ten chapters of the volume are revised versions of papers delivered at the XVII International Conference on Patristic Studies held in Oxford in 2015. The three chapters of the first part of the volume discuss the question of “Clerical Exile and Social...... Control”. The second part offers five selected case studies from the 3rd to the 6th centuries. The final part deals with discourses, memories and legacies of clerical exile in late antiquity....

  11. Late abortion meeting, Paris / France.

    Science.gov (United States)

    Spinelli, A

    1989-01-01

    On January 27 and 28, 1989 a workshop and a meeting were organized in Paris by Mouvement Francais pour le Planning Familial (MFPF/France) and the IPPF Europe Region. The workshop was held on the first day. 24 staff and volunteers from Planned Parenthood Associations of 15 countries attended, reviewing abortion laws, the definition of therapeutic abortion, and the incidence and problems of second trimester abortion. Second trimester abortion is available in only a few European countries. Second trimester abortions are rare in France (about 2000 per annum), and in 1986 1717 French women travelled to England in order to seek an abortion. All late abortions are performed for serious reasons. Older women may mistake signs of pregnancy for the onset of the menopause; and women fearful of social or familial punishment, especially teenagers, may be reluctant to consult a doctor. The experiences of Denmark and Sweden, where the problem is partially solved, suggest some strategies: optimize accessibility of contraceptive services, particularly for women at higher risk of late abortion; diminish the taboo surrounding abortion, so that women are less frightened to seek help at an early stage of pregnancy; make abortion services available in all regions of the country; avert time-consuming enforced waiting periods or consent for minors; and stimulate public information campaigns on the importance of seeking help early. On January 28 a meeting involving about 200 participants took place at the Universite Paris Dauphine, Salle Raymond Aron. Speakers at the meeting discussed the issue of late abortion in Europe, the difficulties of obtaining late abortions, counseling, medical problems, the woman's point of view, and possible solutions. At the close of the meeting, the MFPF called on the French government to modify some of the articles in the Penal Code that restrict women's access to safe and legal abortion.

  12. The late-M dwarfs

    International Nuclear Information System (INIS)

    Bessell, M.S.

    1991-01-01

    Far-red spectra and VRIJHK photometry have been obtained for a sample of late-M dwarfs selected on the basis of large reduced red magnitudes from the LHS Catalog. Half of the stars in the three faintest 1 mag bins are late-M stars, the other red stars are metallic-hydride subdwarfs. Relations between various colors for the late-M dwarfs are investigated. Of all the colors I - K most reliably correlates with spectral type. FeH bands near 9900 A are clearly seen in the spectra of all dwarf stars later than M5. Two stars cooler than VB10, and similar in temperature to LHS2924 have been identified; both have H-alpha in emission and appear variable in magnitude and R - I color; one is a flare star. The other stars are of earlier spectral type and resemble W359 and VB8. The observed MI, I - K main sequence is in good agreement with the IG theoretical main sequence of Stringfellow, and the faintest stars could be about 0.09 solar mass red dwarfs or lower mass brown dwarfs. 65 refs

  13. Late Effects of Polio: An Overview

    Science.gov (United States)

    ... Polio Wellness Retreats For Health Professionals The Late Effects of Polio: An Overview FRENCH | GERMAN | PORTUGUESE POLIOMYELITIS ( ... largest and most inclusive category is called Late Effects of Polio or Polio Sequelae and is defined ...

  14. Are we ready to predict late effects?

    DEFF Research Database (Denmark)

    Salz, Talya; Baxi, Shrujal S; Raghunathan, Nirupa

    2015-01-01

    to patient characteristics, late effects, the prediction model and model evaluation. DATA SYNTHESIS: Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy...

  15. 24 CFR 241.1105 - Late charges.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Late charges. 241.1105 Section 241...-Eligibility Requirements § 241.1105 Late charges. The note and security instrument may provide for the lender's collection of a late charge, not to exceed 2 cents for each dollar of each payment to interest or...

  16. 50 CFR 600.1015 - Late charges.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Late charges. 600.1015 Section 600.1015... charges. The late charge to fish buyers for fee payment, collection, deposit, and/or disbursement shall be..., deposited, and/or disbursed. The full late charge shall apply to the fee for each month or portion of a...

  17. 12 CFR 560.33 - Late charges.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Late charges. 560.33 Section 560.33 Banks and... Investment Powers for Federal Savings Associations § 560.33 Late charges. A Federal savings association may include in a home loan contract a provision authorizing the imposition of a late charge with respect to...

  18. Causes for Late onset Alcohol Use Disorder

    DEFF Research Database (Denmark)

    Emiliussen, Jakob; Nielsen, Anette Søgaard; Andersen, Kjeld

    Introduction One subgroup among elderly with AUD is the “late-onset” abusers. Late-onset (60+ years) AUD seems to be a milder, more narrowly defined psychiatric problem, than early or midlife onset AUD. This review seeks to expand the description and understanding of late-onset AUD by reviewing t...

  19. Nine-month Angiographic and Two-year Clinical Follow-up of Novel Biodegradable-polymer Arsenic Trioxide-eluting Stent Versus Durable-polymer Sirolimus-eluting Stent For Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Li Shen

    2015-01-01

    Full Text Available Background: Despite great reduction of in-stent restenosis, first-generation drug-eluting stents (DESs have increased the risk of late stent thrombosis due to delayed endothelialization. Arsenic trioxide, a natural substance that could inhibit cell proliferation and induce cell apoptosis, seems to be a promising surrogate of sirolimus to improve DES performance. This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES, compared with traditional sirolimus-eluting stent (SES. Methods: Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group. The primary endpoint was target vessel failure (TVF, and the second endpoint includes rates of all-cause death, cardiac death or myocardial infarction, target lesion revascularization (TLR by telephone visit and late luminal loss (LLL at 9-month by angiographic follow-up. Results: From July 2007 to 2009, 212 patients were enrolled and randomized 1:1 to receive either AES or SES. At 2 years of follow-up, TVF rate was similar between AES and SES group (6.67% vs. 5.83%, P = 0.980. Frequency of all-cause death was significantly lower in AES group (0 vs. 4.85%, P = 0.028. There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis, but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs. 0.10 ± 0.25 mm, P = 0.008. Conclusions: After 2 years of follow-up, AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.

  20. Clerical Exile in Late Antiquity

    OpenAIRE

    2016-01-01

    This volume results from the international research project ‘The Migration of Faith: Clerical Exile in Late Antiquity (325‒c.600)’. The project is a collaboration between the Department of History at the University of Sheffield, the Seminar für Kirchengeschichte at the University of Halle, and the Department of Culture and Society at Aarhus University. Ten chapters of the volume are revised versions of papers delivered at the XVII International Conference on Patristic Studies held in Oxford i...

  1. Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study.

    Science.gov (United States)

    Perisinakis, K; Manousaki, E; Zourari, K; Tsetis, D; Tzedakis, A; Papadakis, A; Karantanas, A; Damilakis, J

    2011-03-01

    We investigated the potential of low-dose CT angiography for accurate assessment of in-stent restenoses (ISRs) of the iliac artery. A Rando anthropomorphic phantom (Alderson Research Labs, Stanford, CA), custom-made wax simulating hyperplastic tissue and a nitinol stent were used to simulate a patient with clinically relevant iliac artery ISRs. The cylindrical lumen was filled with a solution of iodine contrast medium diluted in saline, representing a patient's blood during CT angiography. The phantom was subjected to standard- and low-dose angiographic exposures using a modern multidetector (MD) CT scanner. The percentage of ISR was determined using the profile along a line normal to the lumen axis on reconstructed images of 2 and 5 mm slice thickness. Percentage ISRs derived using the standard- and low-dose protocols were compared. In a preliminary study, seven patients with stents were subjected to standard- and low-dose MDCT angiography during follow-up. The resulting images were assessed and compared by two experienced radiologists. The accuracy in measuring the percentage ISR was found to be better than 12% for all simulated stenoses. The differences between percentage ISRs measured on images obtained at 120 kVp/160 mAs and 80 kVp/80 mAs were below 6%. Patient image sets acquired using low-exposure factors were judged to be of satisfactory diagnostic quality. The assessment of ISR did not differ significantly between image sets acquired using the standard factors and those acquired using the low-exposure factors, although the mean reduction in patient effective dose was 48%. A reduction in exposure factors during MDCT angiography of the iliac artery is possible without affecting the accuracy in the determination of ISRs.

  2. Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

    International Nuclear Information System (INIS)

    Vajda, Zsolt; Güthe, Thomas; Perez, Marta Aguilar; Kurre, Wiebke; Schmid, Elisabeth; Bäzner, Hansjörg; Henkes, Hans

    2013-01-01

    Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54–86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

  3. Dual role of circulating endothelial progenitor cells in stent struts endothelialisation and neointimal regrowth: A substudy of the IN-PACT CORO trial

    Energy Technology Data Exchange (ETDEWEB)

    De Maria, Giovanni Luigi [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Porto, Italo, E-mail: italo.porto@gmail.com [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Interventional Cardiology Unit, San Donato Hospital, Arezzo (Italy); Burzotta, Francesco; Brancati, Marta Francesca; Trani, Carlo; Pirozzolo, Giancarlo; Leone, Antonio Maria; Niccoli, Giampaolo [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Prati, Francesco [Department of Interventional Cardiology, San Giovanni Hospital, Rome (Italy); Crea, Filippo [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy)

    2015-01-15

    higher neointimal volume and a lower rate of uncovered struts at six months of follow up are significantly associated to higher baseline levels of endothelial progenitor cells (EPC) • Baseline EPC level is an independent predictor of neointimal volume and struts coverage rate at six months of follow up. • At the same, the detection of higher neointimal volume in those patients with persistent high EPC levels at follow up suggests the possible involvement of these elements in an exaggerated healing answer to stent-related injury leading to instent restenosis.

  4. Late veneer and late accretion to the terrestrial planets

    Science.gov (United States)

    Brasser, R.; Mojzsis, S. J.; Werner, S. C.; Matsumura, S.; Ida, S.

    2016-12-01

    It is generally accepted that silicate-metal ('rocky') planet formation relies on coagulation from a mixture of sub-Mars sized planetary embryos and (smaller) planetesimals that dynamically emerge from the evolving circum-solar disc in the first few million years of our Solar System. Once the planets have, for the most part, assembled after a giant impact phase, they continue to be bombarded by a multitude of planetesimals left over from accretion. Here we place limits on the mass and evolution of these planetesimals based on constraints from the highly siderophile element (HSE) budget of the Moon. Outcomes from a combination of N-body and Monte Carlo simulations of planet formation lead us to four key conclusions about the nature of this early epoch. First, matching the terrestrial to lunar HSE ratio requires either that the late veneer on Earth consisted of a single lunar-size impactor striking the Earth before 4.45 Ga, or that it originated from the impact that created the Moon. An added complication is that analysis of lunar samples indicates the Moon does not preserve convincing evidence for a late veneer like Earth. Second, the expected chondritic veneer component on Mars is 0.06 weight percent. Third, the flux of terrestrial impactors must have been low (≲10-6 M⊕ Myr-1) to avoid wholesale melting of Earth's crust after 4.4 Ga, and to simultaneously match the number of observed lunar basins. This conclusion leads to an Hadean eon which is more clement than assumed previously. Last, after the terrestrial planets had fully formed, the mass in remnant planetesimals was ∼10-3 M⊕, lower by at least an order of magnitude than most previous models suggest. Our dynamically and geochemically self-consistent scenario requires that future N-body simulations of rocky planet formation either directly incorporate collisional grinding or rely on pebble accretion.

  5. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  6. Antibiotics in late clinical development.

    Science.gov (United States)

    Fernandes, Prabhavathi; Martens, Evan

    2017-06-01

    Most pharmaceutical companies have stopped or have severely limited investments to discover and develop new antibiotics to treat the increasing prevalence of infections caused by multi-drug resistant bacteria, because the return on investment has been mostly negative for antibiotics that received marketing approved in the last few decades. In contrast, a few small companies have taken on this challenge and are developing new antibiotics. This review describes those antibiotics in late-stage clinical development. Most of them belong to existing antibiotic classes and a few with a narrow spectrum of activity are novel compounds directed against novel targets. The reasons for some of the past failures to find new molecules and a path forward to help attract investments to fund discovery of new antibiotics are described. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Congenital chloride diarrhea: late presentation

    Directory of Open Access Journals (Sweden)

    Al Bishi L

    2011-04-01

    Full Text Available Laila Al Bishi1, Mustafa Al Toonisi2Pediatric Department, North West Armed Forces Hospital, Tabuk, Kingdom of Saudi ArabiaAbstract: We report the case of a male infant who presented with diarrhea at 6 months of age. He was failing to thrive, and biochemical investigation revealed hypokalemic hypochloremic metabolic alkalosis. Diagnosis of congenital chloride diarrhea was suspected and confirmed by the stool chloride result. He was started on high-dose sodium chloride and potassium chloride to control the electrolyte imbalance. The disease was difficult to control for a year after diagnosis. Late presentation is associated with severe chronic electrolyte disturbances and high-dose replacement therapy.Keywords: congenital chloride diarrhea, hypokalemic hypochloremic metabolic alkalosis, high stool chloride

  8. [Threatened late miscarriage. French guidelines].

    Science.gov (United States)

    Carcopino, X; Barde, K; Petrovic, M; Beucher, G; Capmas, P; Huchon, C; Deffieux, X; d'Ercole, C; Bretelle, F

    2014-12-01

    To define guidelines for the management of women diagnosed with threatened late miscarriage (TLM). A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies. Management of women diagnosed with threatened LM requires a complete history-taking searching for a previous history of LM and/or of premature delivery (Grade B). Speculum examination is required to diagnose membrane prolapse (Grade B) and vaginal ultrasound scan is recommended to measure the cervical length (Grade B). Finally, initial management should allow to rule out chorioamniotitis (Grade B). Vaginal progesterone therapy (90-200mg daily) is recommended for women diagnosed with a sole shortened cervix (Mc Donald technique) associated with systematic tocolytic therapy (indometacine) and antibiotics are to be recommended in women diagnosed with TLM with dilated cervical os eventually associated with membrane prolapse (GradeC). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Late hemodynamic failure following percutaneous transluminal angioplasty for long and multifocal femoropopliteal stenoses

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Holstein, P

    1991-01-01

    separate segments were dilated. Following 98% initial technical success, 3-year patency was 68% for single short stenoses, as opposed to 20% for long and multifocal stenoses (p = 0.05, logrank test). Antiplatelet therapy with acetylsalicyclic acid was not found to influence occurrence of restenosis...

  10. Late complications of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masaki, Norie [Osaka Prefectural Center for Adult Diseases (Japan)

    1998-03-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  11. Late complications of radiation therapy

    International Nuclear Information System (INIS)

    Masaki, Norie

    1998-01-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  12. Severe Anaemia during Late Pregnancy

    Directory of Open Access Journals (Sweden)

    Mahenaz Akhtar

    2012-01-01

    Full Text Available Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

  13. Cycads: Fossil evidence of late paleozoic origin

    Science.gov (United States)

    Mamay, S.H.

    1969-01-01

    Plant fossils from Lower Permian strata of the southwestern United States have been interpreted as cycadalean megasporophylls. They are evidently descended from spermopterid elements of the Pennsylvanian Taeniopteris complex; thus the known fossil history of the cycads is extended from the Late Triassic into the late Paleozoic. Possible implications of the Permian fossils toward evolution of the angiosperm carpel are considered.

  14. 16 CFR 444.4 - Late charges.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Late charges. 444.4 Section 444.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES CREDIT PRACTICES § 444.4 Late charges. (a) In... any deliquency charge on a payment, which payment is otherwise a full payment for the applicable...

  15. Childhood abuse in late-life depression

    NARCIS (Netherlands)

    Comijs, Hannie C; van Exel, Eric; van der Mast, Roos C; Paauw, Anna; Oude Voshaar, Richard; Stek, Max L

    Background: Little is known about the role of childhood abuse in late-life depression. The aim of the study is therefore to study whether childhood abuse is associated with late-life depression according to its onset, and which clinical characteristics play a role in this association. Methods: Data

  16. Consequential late effects in normal tissues.

    Science.gov (United States)

    Dörr, W; Hendry, J H

    2001-12-01

    Unconventional, more aggressive irradiation protocols are usually associated with aggravation of acute reactions. In recent clinical studies, this has resulted in modulation of late effects in the same organ. This phenomenon has been termed consequential late effect (CLE). Correlations between acute and late effects have been reported in a number of tissues. Moreover, some radiobiological parameters may be used to differentiate between consequential and generic late effects: Dose fractionation and overall treatment time have a similar effect on acute and consequential responses, but opposing effects on generic late effects. Modulation of acute effects will affect the consequential component of late sequelae. Similarly, it will be influenced by the irradiated volume if a volume effect exists for the acute response. Moreover, markers for the acute response should be predictive for consequential effects. The present review gives preclinical and clinical evidence for CLE. These are predominantly found in organ systems where the acute response (of the epithelial lining) is associated with an impairment of the barrier against mechanical or chemical stress, which may cause additional trauma to the underlying tissues. Therefore, CLE are mainly found in the urinary and intestinal system, in mucosa and, to some extent, in skin. In these tissues with a consequential component of the late sequelae, amelioration of the acute response to irradiation may be a useful approach to minimize late side effects of effective radiation therapy.

  17. Early restenose in a polymer-free Biolimus A9-coated stent (BioFreedom): A case report based on optical coherence tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ellert, Julia, E-mail: jellert55@gmail.com; Antonsen, Lisbeth; Jensen, Lisette Okkels

    2017-04-15

    An 81-year-old male patient with a severe de novo coronary artery stenosis in the proximal left anterior descending artery was treated with a BioFreedom stent (3.5 × 11 mm), three months later, the patient was re-admitted with chest pain and slightly increased troponin. The angiogram showed a significant in-stent restenosis in the recently treated lesion. Optical coherence tomography revealed a fully expanded stent without areas of incomplete stent apposition. Severe immature neointimal hyperplasia without formation of thrombosis was visualized, causing a severe in-stent restenosis. An underlying plaque rupture within the mid-proximal part of the in-stent restenosis was evident. - Highlights: • OCT images revealed an expanded stent without areas of incomplete stent apposition. • Severe immature neointimal hyperplasia caused a severe in-stent restenosis. • No formation of thrombosis was visualized. • A plaque rupture within the mid-proximal part of the in-stent restenosis was evident.

  18. Late Abortion: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Sheng Chiang

    2005-12-01

    Full Text Available Late termination of pregnancy (LTOP is defined as an abortion carried out beyond 24 gestational weeks, when the fetus has arguably attained viability. In Taiwan, the current abortion law, bearing a eugenic title, allows LTOP on certain medical grounds. However, the fetal and maternal conditions that constitute medical grounds are not clarified and remain legally untested. Professional debate on the abortion issue is also lacking in academia in Taiwan, despite societal concerns. With the advent of technology to detect fetal abnormalities, obstetricians are now confronted more frequently with acute dilemmas regarding LTOP. Quite often, they sail in an uncharted sea with no clinical guidelines from their professional societies or affiliated hospitals. Recently, LTOP at 35 gestational weeks for a fetus with Down syndrome, complicated with polyhydramnios and tetralogy of Fallot, triggered media scrutiny and aroused much public attention. Although the clinical decision making for pregnancies with fetal abnormalities entails increasingly balanced information and consideration in terms of the medical, ethical, legal, psychologic, and societal aspects, society at large is unaware of the complexity and intertwined nature of various abortion issues, especially LTOP. Obstetricians are now in a vulnerable position in Taiwanese society, where litigations relevant to the practice of early abortions are not rare. Therefore, a global and in-depth look into abortion issues from legal and ethical dimensions is indispensable for modern obstetric practice. This review considers the core issues in LTOP, including what conditions constitute a “serious” fetal abnormality to justify LTOP, the incidence of LTOP, legislation regarding LTOP in Western countries, and recent research on ambivalent fetal pain. It will also present procedures, some under the auspices of the ethical committee of a Presbyterian hospital in Taiwan, for clinical decision making, particularly

  19. Educating Citizens in Late Modern Societies

    DEFF Research Database (Denmark)

    Christensen, Torben Spanget

    2011-01-01

    One way or the other democratic states need to take on the task of educating its rising generation in governmental affairs, societal matters and citizenship in order to sustain the democracy itself. This article presents a model for analysing civic education in late modern, globalised world....... The model is based on the fundamental belief that the overall aim of civic education in democratic, late modern and global societies is empowerment of the citizen in order to establish a self governing citizen who simultaneous is capable of managing and keeping together partly contradictory citizens tasks......, which applies to all western democratic and late modern countries....

  20. Late washing filter cleaning cycle demonstration

    International Nuclear Information System (INIS)

    Meyer, M.L.; McCabe, D.J.

    1992-01-01

    The DWPF Late Washing Facility will filter cesium and potassium tetraphenyl borate (TPB) solids using a Mott sintered metal filter, identical to the filter now used in the In-tank Precipitation Facility. The purpose of the late wash step is primarily to remove the nitrite salts from the slurry prior to delivery to DWPF. Periodic chemical cleaning of the filter will be required, presumably after each batch although the actual required frequency could not be determined on the lab-scale. Minimization of chemical cleaning solution volumes is key to maximizing the attainment of the Late Wash facility. This report summarizes work completed in experiments designed to identify minimum cleaning solution requirements

  1. Frontier and Periphery in Late Antique Palestine

    Directory of Open Access Journals (Sweden)

    Doron Bar

    2010-11-01

    Full Text Available Recent archaeological work has revealed in late antique Palestine extensive development of previously unused land, and a prosperous and enterprising population of new settlers moving from the older developed zones.

  2. 12 CFR 535.4 - Late charges.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Late charges. 535.4 Section 535.4 Banks and.... until 7-1-2010) § 535.4 Late charges. (a) In connection with collecting a debt arising out of an... delinquency charge on a payment, which payment is otherwise a full payment for the applicable period and is...

  3. 12 CFR 706.4 - Late charges.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Late charges. 706.4 Section 706.4 Banks and.... until 7-1-10) § 706.4 Late charges. (a) In connection with collecting a debt arising out of an extension... indirectly, to levy or collect any delinquency charge on a payment, which payment is otherwise a full payment...

  4. Late Ordovician brachiopods from eastern North Greenland

    DEFF Research Database (Denmark)

    Mac Ørum Rasmussen, Christian

    2013-01-01

    Late Ordovician rhynchonelliformean brachiopods, typical of the North American Red River fauna, are found sporadically in the BOrglum River Formation of the Centrum SO area, Kronprins Christian Land, eastern North Greenland. The geographical distribution of this characteristic brachiopod fauna...... invasion of migrants from Baltica that arrived later during the Hirnantian. The offshore migration of this atypical Hiscobeccus fauna likely demonstrates the path of warm-water currents as the Centrum SO locality was located at the equator during the Late Ordovician....

  5. Transcription of the T4 late genes

    Directory of Open Access Journals (Sweden)

    Kassavetis George A

    2010-10-01

    Full Text Available Abstract This article reviews the current state of understanding of the regulated transcription of the bacteriophage T4 late genes, with a focus on the underlying biochemical mechanisms, which turn out to be unique to the T4-related family of phages or significantly different from other bacterial systems. The activator of T4 late transcription is the gene 45 protein (gp45, the sliding clamp of the T4 replisome. Gp45 becomes topologically linked to DNA through the action of its clamp-loader, but it is not site-specifically DNA-bound, as other transcriptional activators are. Gp45 facilitates RNA polymerase recruitment to late promoters by interacting with two phage-encoded polymerase subunits: gp33, the co-activator of T4 late transcription; and gp55, the T4 late promoter recognition protein. The emphasis of this account is on the sites and mechanisms of actions of these three proteins, and on their roles in the formation of transcription-ready open T4 late promoter complexes.

  6. Quantification of late complications after radiation therapy

    International Nuclear Information System (INIS)

    Jung, Horst; Beck-Bornholdt, Hans-Peter; Svoboda, Vladimir; Alberti, Winfried; Herrmann, Thomas

    2001-01-01

    Background: An increasing number of patients survive cancer after having received radiation therapy. Therefore, the occurrence of late normal tissue complications among long-term survivors is of particular concern. Methods: Sixty-three patients treated by radical surgery and irradiation for rectal carcinoma were subjected to an unconventional sandwich therapy. Preoperative irradiation was given in four fractions of 5 Gy each applied within 2 or 3 days; postoperative irradiation consisted mostly of 15x2 Gy (range, 20-40 Gy). A considerable proportion of these patients developed severe late complications (Radiother Oncol 53 (1999) 177). The data allowed a detailed analysis of complication kinetics, leading to a new model which was tested using data from the literature. Results: Data on late complications were obtained for eight different organs with a follow-up of up to 10 years. For the various organs, the percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by exponential regression. From the fit, the parameter p a was obtained, which is the percentage of patients at risk in a given year of developing a complication in a given organ during that year. The rate p a remained about constant with time. Following sandwich therapy, the annual incidence of complications in the bladder, ileum, lymphatic and soft tissue, and ureters was about the same (p a =10-14%/year), whereas complications in bone or dermis occurred at lower rates (4.7 or 7.5%/year, respectively). Discussion: Numerous data sets collected from published reports were analyzed in the same way. Many of the data sets studied were from patients in a series where there was a high incidence of late effects. Three types of kinetics for the occurrence of late effects after radiotherapy were identified: Type 1, purely exponential kinetics; Type 2, exponential kinetics, the slope of which decreased exponentially with time

  7. Are drug-eluting stents the future of SFA treatment?

    Science.gov (United States)

    Bosiers, M; Deloose, K; Keirse, K; Verbist, J; Peeters, P

    2010-02-01

    Drug-eluting stent (DES) technology was developed to prevent early thrombosis and late luminal loss to potentially improve long-term patency rates. Although favorable DES results have recently become available with the Zilver PTX and STRIDES studies, the high price of DES is a major drawback for this technology to become the golden standard for peripheral endovascular therapy in de novo femoro-popliteal (FP) lesions. Nevertheless, DES has the potential to make the difference and to establish itself as an important treatment option in patients presenting with TASC C&D FP lesions who are at high-risk for surgery and for the treatment of in-stent restenosis, where until now, no valuable treatment option has proven to be beneficial.

  8. Biomimicry, vascular restenosis and coronary stents.

    Science.gov (United States)

    Schwartz, R S; van der Giessen, W J; Holmes, D R

    1998-01-01

    Biomimicry is in its earliest stages and is being considered in the realm of tissue engineering. If arterial implants are to limit neointimal thickening, purely passive structures cannot succeed. Bioactivity must be present, either by pharmacologic intervention or by fabricating a 'living stent' that contains active cellular material. As tissue engineering evolves, useful solutions will emerge from applying this knowledge directly to vascular biologic problems resulting from angioplasty, stenting, and vascular prosthesis research.

  9. A Mixed Blessing : Radioactivity Against Restenosis

    NARCIS (Netherlands)

    Clarijs, M.; Van Eijk, C.; Van Den Berg, R.

    2001-01-01

    Since their discovery a little over a century ago, X-rays and radioactivity have been used in numerous applications, from medical care to the process industry.We have also become acutely aware of the damaging effects both can have on the human body. This is the reason for the never-ending research

  10. Endovascular photodynamic therapy to prevent arterial restenosis

    NARCIS (Netherlands)

    E.E.E. Gabeler

    2003-01-01

    markdownabstract__Abstract__ Since their existence, man has appreciated the benefits of sunlight and described some of its medicinal effects known as heliotherapy. Herodotus in the 6th century BC noticed that sunlight had beneficial effects on bone growth. Hippocrates in 460-375 BC advocated

  11. Dosimetry implant for treating restenosis and hyperplasia

    Science.gov (United States)

    Srivastava, Suresh; Gonzales, Gilbert R; Howell, Roger W; Bolch, Wesley E; Adzic, Radoslav

    2014-09-16

    The present invention discloses a method of selectively providing radiation dosimetry to a subject in need of such treatment. The radiation is applied by an implant comprising a body member and .sup.117mSn electroplated at selected locations of the body member, emitting conversion electrons absorbed immediately adjacent selected locations while not affecting surrounding tissue outside of the immediately adjacent area.

  12. LATE TRIASSIC (LATE NORIAN-RHAETIAN RADIOLARIANS FROM THE ANTALYA NAPPES, CENTRAL TAURIDES, SOUTHERN TURKEY

    Directory of Open Access Journals (Sweden)

    UGUR KAGAN TEKIN

    2002-11-01

    Full Text Available The Hocaköy section measured from the Alakirçay Nappe (middle nappe of the Antalya Nappes contain rich radiolarian fauna ranging from late Norian (Late Triassic to middle-late Cenomanian (mid Cretaceous. At the basal part of the section, the Late Triassic (late Norian-Rhaetian Gökdere Formation is characterized by gray to beige cherty limestone at the base and pinkish red chert- gray to beige limestone alternation at the top, with moderately to well-preserved radiolarians in the red chert beds. The overlying Jurassic - Middle Cretaceous Hocaköy Radiolarite is mainly represented by chert-mudstone alternations with some limestone interlayers. Radiolarians of the Gökdere Formation can be well correlated with that of the fauna from the Mino Terrane, central Japan and the fauna from the Queen Charlotte Islands, British Columbia, Canada. Four radiolarian zones from central Japan are recognized in the fauna obtained from Gökdere Formation such as “Praemesosaturnalis multidentatus Lowest Occurrence Zone (TR8A” (late Norian, “Praemesosaturnalis pseudokahleri Lowest Occurrence Zone (TR8B” (late Norian, ? “ Skirt F lowest Occurrence Zone (TR8C” (late Norian-Rhaetian and partly “Haeckelicyrtium breviora Taxon Range Zone (TR8D” (Rhaetian. In comparison with the Queen Charlotte fauna, the two zones “Betraccium deweveri Zone” (late Norian and “Proparvicingula moniliformis Zone” (early Rhaetian are also encountered in the Gökdere Formation. Radiolarians of the uppermost part of the Gökdere Formation indicate that “Globolaxtorum tozeri Zone” defined in Queen Charlotte Islands corresponding to the late Rhaetian, is not present in the section. Five new taxa, Capnuchosphaera okayi, Bistarkum rhaeticum, Praemesosaturnalis heilongjiangensis aksekiensis, P. nobleae, Veghicyclia sanfilippoae were determined within the late Norian-Rhaetian radiolarian fauna of the Gökdere Formation in Hocaköy section.   

  13. The polyimage poetics in Ibsen's late plays

    Directory of Open Access Journals (Sweden)

    Wang Yuli

    2015-02-01

    Full Text Available The unique poetics of polyimage implied in Ibsen’s late plays can be excavated with aesthetic reading. The term polyimage is coined to describe Ibsen’s original design in aesthetic form and ingenious realm in aesthetic reaction in his late plays; that is, beyond an imagery realm, another imagery realm exists, which construct a deep vision of significance. In each of the excellent late plays, what Ibsen creates is one or more veiled holistic imagery realms in addition to an ordinary entire imagery realm perceived by most audiences. The “layers of imagery realm” result from Ibsen’s “double self-examinations”, including self-examination of soul and of art. It is these “double self-examinations” that make polyimage possible in his late plays and generates the attribute of “meta-art” in these works. Compared with polyphony in Dostoevsky’s novels, the polyimage in Ibsen’s late plays contains a unique modernity, which is of great significance to modern artistic creation.

  14. Precursors and Correlates of Anxiety Trajectories from Late Childhood to Late Adolescence

    Science.gov (United States)

    Letcher, Primrose; Sanson, Ann; Smart, Diana; Toumbourou, John W.

    2012-01-01

    The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed…

  15. Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging.

    Science.gov (United States)

    Amabile, Nicolas; Souteyrand, Géraud; Ghostine, Said; Combaret, Nicolas; Slama, Michel S; Barber-Chamoux, Nicolas; Motreff, Pascal; Caussin, Christophe

    2014-01-01

    Recent data have reported that neoatherosclerosis could develop long after stent implantation and lead to subsequent rupture and acute coronary syndrome (ACS). We sought to identify the presence of in-stent neoatheroma (ISNA) in patients with very late stent thrombosis (VLST) using optical coherence tomography (OCT). All patients from two catheterization centres who presented with ACS related to VLST underwent a standard coronary angiography and intra-coronary OCT. ISNA was defined as the combination of diffuse neointimal proliferation, lipid-laden intima with plaque organization, and fibrous cap rupture with no evidence of an uncovered strut. Out of 2139 ACS patients, 20 presented with definite VLST, including 10 with evidence of ISNA lesions, detected using OCT. The mean delay between initial percutaneous coronary intervention and VLST was longer in the ISNA patients compared with non-ISNA patients (10.5 ± 1.6 vs. 4.0 ± 0.6 years, P = 0.003). The mean LDL-cholesterol tended to be higher in ISNA patients compared with non-ISNA patients. OCT analysis revealed significantly thicker neointimal coverage as well as a lower number of uncovered struts in ISNA lesions compared with the other patients. LDL-cholesterol levels were correlated with the average neointima thickness (Spearman's rho = 0.46, P = 0.04). All the ISNA lesions were treated through initial thrombectomy followed by redo stenting in nine patients. Our data show that ISNA is frequent in patients with VLST. These results suggest that OCT imaging is helpful in identifying the underlying mechanisms of VLST and, therefore, in the clinical decision-making process.

  16. Mobile ICT Acceptance in Late Adopter Countries

    DEFF Research Database (Denmark)

    Gimpel, Gregory; Sudzina, Frantisek; Petrovcikova, Katarina

    2014-01-01

    Despite the rapid global diffusion of the smartphone, some countries have experienced much slower uptake of the technology. The low smartphone penetration within Slovakia provides the opportunity to explore what drives smartphone use in late majority countries. Slovakia is a central European nation...... and part of the Eurozone. It has advanced telecommunications infrastructure and is subject to the same telecommunications regulations as other EU members. While neighbours have high smartphone penetration, Slovakia is a late majority adopter. This study uses Triandis’ theory of interpersonal behavior...... to investigate the question: What drives the use of smartphones in late majority countries? By studying the differences between current and potential smartphone users, the study revisits Karahanna et al.’s research question: Do potential adopters and users of IT hold the same behavioral and normative beliefs...

  17. Late effects of thoracic irradiation in children

    Energy Technology Data Exchange (ETDEWEB)

    Boelling, T.; Koenemann, S.; Ernst, I.; Willich, N. [Dept. of Radiotherapy, Univ. Hospital of Muenster (Germany)

    2008-06-15

    Purpose: to summarize the literature regarding the late effects of radiotherapy to the thorax in childhood and adolescence with special emphasis on cardiac and pulmonary impairment. Material und methods: the literature was critically reviewed using the PubMed {sup registered} database with the key words 'late effects', 'late sequelae', 'child', 'childhood', 'adolescence', 'radiation', 'radiotherapy', 'thorax', 'lung', 'heart', and 'pulmonary'. Results: 17 publications dealing with radiation-induced pulmonary and cardiac late sequelae in children could be identified and were analyzed in detail. 29 further publications with additional information were also included in the analysis. Pulmonary function impairment after mediastinal irradiation arose in one third of all pediatric patients, even when treatment was performed with normofractionated lower doses (15-25 Gy). Whole lung irradiation was regularly followed by pulmonary function impairment with differing rates in several reports. However, clinically symptomatic function impairment like dyspnea was less frequent. Irradiation of up to 25 Gy (single doses {<=} 2 Gy) to the heart showed little or no cardiac toxicity in analyses of irradiated children (median follow-up 1.3-14.3 years). Doses of > 25 Gy (single doses {<=} 2-3.3 Gy) led to several cardiac dysfunctions. However, new data from adults with longer follow-up may indicate threshold doses as low as 1 Gy. Impairment of skeletal growth, breast hypoplasia, and secondary malignancy were further potential late sequelae. Conclusion: several retrospective reports described radiation-associated late sequelae in children. However, there is still a lack of sufficient data regarding the characterization of dose-volume effects. (orig.)

  18. Late preterm birth and neurocognitive performance in late adulthood: a birth cohort study.

    Science.gov (United States)

    Heinonen, Kati; Eriksson, Johan G; Lahti, Jari; Kajantie, Eero; Pesonen, Anu-Katriina; Tuovinen, Soile; Osmond, Clive; Raikkonen, Katri

    2015-04-01

    We studied if late preterm birth (34 weeks 0 days-36 weeks 6 days of gestation) is associated with performance on the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) in late adulthood and if maximum attained lifetime education moderated these associations. Participants were 919 Finnish men and women born between 1934 and 1944, who participated in the Helsinki Birth Cohort Study. They underwent the CERAD-NB at a mean age of 68.1 years. Data regarding gestational age (late preterm versus term) were extracted from hospital birth records, and educational attainment data were gathered from Statistics Finland. After adjustment for major confounders, those born late preterm scored lower on word list recognition (mean difference: -0.33 SD; P = .03) than those born at term. Among those who had attained a basic or upper secondary education, late preterm birth was associated with lower scores on word list recognition, constructional praxis, constructional praxis recall, clock drawing, Mini-Mental State Examination, and memory total and CERAD total 2 compound scores (mean differences: >0.40 SD; P values late preterm birth was not associated with CERAD-NB scores. Our findings offer new insight into the lifelong consequences of late preterm birth, and they add late preterm birth as a novel risk factor to the list of neurocognitive impairment in late adulthood. Our findings also suggest that attained lifetime education may mitigate aging-related neurocognitive impairment, especially among those born late preterm. Copyright © 2015 by the American Academy of Pediatrics.

  19. Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease

    OpenAIRE

    Dave, Bhargav

    2016-01-01

    Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex...

  20. Transcription of the T4 late genes

    OpenAIRE

    Geiduschek, E Peter; Kassavetis, George A

    2010-01-01

    Abstract This article reviews the current state of understanding of the regulated transcription of the bacteriophage T4 late genes, with a focus on the underlying biochemical mechanisms, which turn out to be unique to the T4-related family of phages or significantly different from other bacterial systems. The activator of T4 late transcription is the gene 45 protein (gp45), the sliding clamp of the T4 replisome. Gp45 becomes topologically linked to DNA through the action of its clamp-loader, ...

  1. Late Data Fusion for Microblog Search

    NARCIS (Netherlands)

    Liang, S.; de Rijke, M.; Tsagkias, M.

    2013-01-01

    The character of microblog environments raises challenges for microblog search because relevancy becomes one of the many aspects for ranking documents. We concentrate on merging multiple ranking strategies at post-retrieval time for the TREC Microblog task. We compare several state-of-the-art late

  2. Late entrants into the academic profession: Conceptual ...

    African Journals Online (AJOL)

    A conceptual framework emerged which reflects the context, process and outcomes of programme participation in formal higher education qualifications. The framework could be the basis for developmental strategies of academic staff – particularly in researchoriented universities with late entrants from a variety of ...

  3. Late effects of radiation: host factors

    International Nuclear Information System (INIS)

    Fry, R.J.M.; Storer, J.B.

    1983-01-01

    The paper discusses the influence of host factors on radiation late effects and in particular cancer. Radiation induces cellular changes that result in initiated cells with a potential to become cancers. The expression of the initiated cells as tumors is influenced, if not determined, by both tissue and systemic factors that are sex-, age-, and species-dependent

  4. Late recurrent adrenocortical carcinoma presenting radiologically as ...

    African Journals Online (AJOL)

    Introduction: Adrenocortical carcinoma (ACC) is a rare malignancy with an estimated incidence of 1–2 per million people. It may recur, after complete surgical removal by local or distant metastasis. Observation: We report a case of late metastatic ACC presented as a mesenteric mass, 10 years post left adrenalectomy.

  5. Language Control Abilities of Late Bilinguals

    Science.gov (United States)

    Festman, Julia

    2012-01-01

    Although all bilinguals encounter cross-language interference (CLI), some bilinguals are more susceptible to interference than others. Here, we report on language performance of late bilinguals (Russian/German) on two bilingual tasks (interview, verbal fluency), their language use and switching habits. The only between-group difference was CLI:…

  6. Late-life anxiety disorders: a review

    NARCIS (Netherlands)

    Schuurmans, J.; van Balkom, A.J.L.M.

    2011-01-01

    Anxiety disorders are a major clinical problem in late life; estimated prevalence rates vary from 6% to 10%, and the disease impact is considerable and equal to that of depression. However, anxiety disorders often remain undetected and untreated in older adults. This discrepancy may be accounted for

  7. Late time phase transition as dark energy

    Indian Academy of Sciences (India)

    Abstract. We show that the dark energy field can naturally be described by the scalar condensates of a non-abelian gauge group. This gauge group is unified with the standard model gauge groups and it has a late time phase transition. The small phase transition explains why the positive acceleration of the universe is ...

  8. Climate predictors of late quaternary extinctions

    DEFF Research Database (Denmark)

    Nogués-Bravo, David; Ohlemüller, Ralf; Batra, Persaram

    2010-01-01

    Between 50,000 and 3,000 years before present (BP) 65% of mammal genera weighing over 44 kg went extinct, together with a lower proportion of small mammals. Why species went extinct in such large numbers is hotly debated. One of the arguments proposes that climate changes underlie Late Quaternary...

  9. Progression of Late-Onset Stargardt Disease

    NARCIS (Netherlands)

    Lambertus, S.; Lindner, M.; Bax, N.M.; Mauschitz, M.M.; Nadal, J.; Schmid, M.; Schmitz-Valckenberg, S.; Hollander, A.I. den; Weber, B.H.; Holz, F.G.; Wilt, G.J. van der; Fleckenstein, M.; Hoyng, C.B.

    2016-01-01

    Purpose: Identification of sensitive biomarkers is essential to determine potential effects of emerging therapeutic trials for Stargardt disease. This study aimed to describe the natural history of late-onset Stargardt, and demonstrates the accuracy of retinal pigment epithelium (RPE) atrophy

  10. Vocabulary of Toddlers Who Are Late Talkers

    Science.gov (United States)

    MacRoy-Higgins, Michelle; Shafer, Valerie L.; Fahey, Katlin J.; Kaden, Elyssa R.

    2016-01-01

    The purpose of this study was to understand vocabulary characteristics in toddlers who are late talkers (LT) as compared with age-matched (AM) and vocabulary-matched (VM) peers. The semantic categories (e.g., animals, foods, toys) and the percentage of nouns, verbs, and closed-class words in the vocabularies of 36 toddlers (12 LT, 12 AM, 12 VM)…

  11. The late Cainozoic East Antarctic ice sheet

    International Nuclear Information System (INIS)

    Colhoun, E.A.

    1999-01-01

    A review, mainly of East Antarctic late Cainozoic (post 40 Ma) geological and geomorphological evidence, supports the hypothesis of the continuous presence of an ice sheet, of about the present size, since the late Miocene. Evidence is presented and the view advanced that, during the late Wisconsin maximum of isotope stage 2, ice was not nearly as thick or extensive over the continental shelf as required by the model of 'maximum' Antarctic glaciation. Some of the factors influencing the contribution of Antarctica to post-glacial sea-level rise are discussed. It is considered that Antarctica's contribution was probably considerably less than previously estimated. The dating of marine and freshwater sequences in the Vestfold and Bunger Hills is consistent with deglaciation around the Pleistocene Holocene boundary, after the Late Wisconsin maximum. A date of ∼25 ka BP from permafrost in the Larsemann Hills means that either the Larsemann Hills were not glaciated during the Late Wisconsin or the ice failed to erode much of the permafrost surface. The degree of weathering of rock and glacial drifts in the Vestfold, Larsemann and Bunger Hills suggests a long time for formation, perhaps considerably longer than indicated by the dated marine and freshwater sediment sequences. Cosmogenic isotope dating in the Vestfold Hills has provided equivocal ages for deglaciation. While the results could indicate deglaciation before 80 ka BP, they do not confirm such early deglaciation. If the ice cover was thin and failed to remove the previous rock exposure profile, then the assays could predate the last ice advance. Weathered iron crust fragments in the till suggest little erosion. The raised beaches of the oases are Holocene. Assuming they have been produced by post Late Wisconsin isostatic uplift and by the Holocene transgression, calculations show that the Antarctic continental ice sheet could not have been more than ∼500 m thicker in the inner shelf-coastal zone. The

  12. Late complications after radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jung, H. [University Hospital Hamburg-Eppendorf (Germany). Inst. of Biophysics and Radiobiology; University Hospital Hamburg-Eppendorf (Germany). Lab. of Radiobiology and Experimental Radiooncology; Beck-Bornholdt, H.P. [University Hospital Hamburg-Eppendorf (Germany). Inst. of Biophysics and Radiobiology; Svoboda, V. [University Hospital Hamburg-Eppendorf (Germany). Inst. of Biophysics and Radiobiology; Portsmouth Oncology Centre, Saint Mary' s Hospital (United Kingdom). Dept. of Radiotherapy; Alberti, W. [University Hospital Hamburg-Eppendorf (Germany). Dept. of Radiotherapy and Radiooncology; Herrmann, T. [Technical Univ. Dresden (Germany). Dept. of Radiotherapy and Radiooncology

    2012-11-15

    Background: The aim of the present study was to analyze in detail the time course of the incidence of radiation-induced late effects. For this purpose, unpublished data of patients treated by radiation therapy in Hamburg in the late 1980s were analyzed. Relatively large volumes were exposed to comparatively high doses, thus leading to a high rate of treatment-related side effects. Patients and methods: A total of 180 consecutive patients received radiotherapy for prostate cancer. The median age was 66 years (range 41-88 years). The median of the maximum dose was 77.5 Gy (range 56.3-95 Gy) and overall treatment time was 51 days (range 28-128 days). Endpoints analyzed were late complications of grade 3 or higher, overall and disease-free survival, local tumor control, and distant metastases. Data analysis was actuarial and the log-rank test was used to compare the various subgroups. Results After 2 years, 80.5 {+-} 3.2% of the patients were without any complications of grade 3 or higher, and after 5 years a constant level of 70.3 {+-} 4.0% was approached. When multiple lesions occurred per patient, the later events were disregarded. A total of 66 complications occurred in 42 patients. The percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by an exponential function and a constant fraction. Complications approached a constant level of 70.3% at a rate of 5.3% per month. This means that patients who will develop a complication do so at exponential kinetics and at a relatively high rate, whereas about 70% of the patients will never experience a late effect even over long observation periods. After subdividing the maximum dose into three equal dose groups of 55 patients each (< 73.3 Gy, 73.3-80 Gy, > 80 Gy), the constant fraction decreased from 85.7 to 72.8% and 52.2%, whereas the incidence rate was 4.3%, 7.7%, and 5.6% per month and, thus, almost independent of radiation dose

  13. LATE RENAL GRAFT REJECTION: PATHOLOGY AND PROGNOSIS

    Directory of Open Access Journals (Sweden)

    E.S. Stolyarevich

    2014-01-01

    Full Text Available Rejection has always been one of the most important cause of late renal graft dysfunction. Aim of the study was to analyze the prevalence of different clinico-pathological variants of rejection that cause late graft dysfunction, and evaluate their impact on long-term outcome. Materials and methods. This is a retrospective study that analyzed 294 needle core biopsy specimens from 265 renal transplant recipients with late (48,8 ± 46,1 months after transplantation allograft dysfunction caused by late acute rejection (LAR, n = 193 or chronic rejection (CR, n = 78 or both (n = 23. C4d staining was performed by immunofl uorescence (IF on frozen sections using a standard protocol. Results. Peritubular capillary C4d deposition was identifi ed in 36% samples with acute rejection and in 62% cases of chronic rejection (including 67% cases of transplant glomerulopathy, and 50% – of isolated chronic vasculopathy. 5-year graft survival for LAR vs CR vs their combination was 47, 13 and 25%, respectively. The outcome of C4d– LAR was (p < 0,01 better than of C4d+ acute rejection: at 60 months graft survival for diffuse C4d+ vs C4d− was 33% vs 53%, respectively. In cases of chronic rejection C4d+ vs C4d– it was not statistically signifi cant (34% vs 36%. Conclusion. In long-term allograft biopsy C4d positivity is more haracteristic for chronic rejection than for acute rejection. Only diffuse C4d staining affects the outcome. C4d– positivity is associated with worse allograft survival in cases of late acute rejection, but not in cases of chronic rejection. 

  14. Reproductive rights: Current issues of late abortion

    Directory of Open Access Journals (Sweden)

    Mujović-Zornić Hajrija

    2009-01-01

    Full Text Available This article considers the legal issues surrounding induced late abortion in cases when severe medical, therapeutic or ethical reasons have not been in dispute. Generally discussing the essential question about abortion today, it means not anymore legality of abortion but, in the first place, safety of abortion. From the aspect of woman health the most important aim is to detect and avoid possible risks of medical intervention, such as late abortion present. This is the matter of medical law context and also the matter of the woman's reproductive rights, here observed through legislation and court practice. The gynecologist has an obligation to obtain the informed consent of each patient. Information's should be presented in reasonably understandable terms and include alternative modes of treatment, objectives, risks, benefits, possible complications, and anticipated results of such treatment. Pregnant woman should receive supportive counseling before and particularly after the procedure. The method chosen for all terminations should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Reform in abortion law, making it legally accessible to woman, is not necessarily the product of a belief in woman's rights, but can be a means of bringing the practice of abortion back under better control. Counseling and good medical practice in performing late abortion are the instruments to drive this point even further home. It does not undermine the woman who wants to make a positive decision about her life and its purpose is not to produce feelings of insecurity and guilt. It concludes that existing law should not be changed but that clear rules should be devised and board created to review late term abortion. In Serbia, this leads to creation and set up guidelines for reconciling medical justification for late abortion with existing law, especially with solutions which brings comparative law. .

  15. Outcomes of second self-expandable metallic stent insertion for malignant gastric outlet obstruction.

    Science.gov (United States)

    Kim, Chan Gyoo; Choi, Il Ju; Lee, Jong Yeul; Cho, Soo-Jeong; Kim, Soo Jin; Kim, Mi-Jung; Park, Sook Ryun; Park, Young Lee

    2014-01-01

    Self-expandable metallic stents are used widely to relieve malignant gastric outlet obstruction (GOO). However, restenosis or migration of first stents is a frequent complication. The purpose of this retrospective cohort study was to evaluate the effectiveness of second stents as an approach to manage failure of first stents in patients with malignant GOO. A total of 222 patients with gastric cancer received first stents due to inoperable GOO at National Cancer Center in Korea between January 2008 and June 2011. Monthly follow-up interviews were performed, and second stents (stent-in-stent or stent-after-migration) were inserted in 59 patients by June 2012. Technical and clinical successes and long-term complications were evaluated. The technical and immediate clinical success rates were 98.3 % (58/59) and 91.5 % (54/59), respectively. Patients who received a second stent due to late complications involving the first stent (migration, restenosis, and fracture) showed a higher clinical success rate (95.8 % [46/48]) than patients who received a second stent due to immediate clinical failure of the first stent (72.7 % [8/11], p = 0.04). The immediate clinical success rate of stent-after-migration (100 % [11/11]) was not different from that of stent-in-stent (89.6 % [43/48], p = 1.0). The stent dysfunction rate of stent-after-migration (27.3 % [3/11]) also was similar to that of stent-in-stent (29.2 % [14/48], p = 1.0). The median patencies of stent-in-stent and stent-after-migration were 27.4 and 58.4 weeks, respectively (p = 0.177). There were no significant prognostic factors for patency of second stents. Insertion of a second stent is effective for treating the first-stent failure in gastric cancer patients with GOO, especially if the immediate outcome of the first stent was successful.

  16. Late presentation of posterior urethral valves.

    Science.gov (United States)

    Jalbani, Imran Khan; Biyabani, Syed Raziuddin

    2014-05-01

    Presence of posterior urethral valves (PUV) is the most common cause of urinary tract obstruction in the male neonate. Late presentation occurs in 10% of cases. We present a case of PUVs in an adult male who presented with history of obstructive lower urinary tract symptoms and hematuria. On evaluation, he was found to have raised serum creatinine level. A voiding cystourethrogram (VCUG) could not be completely performed because of narrowing in the posterior urethra. A rigid urethrocystoscopy was performed at which he was found to have type-I posterior urethral valve which were fulgurated. A repeat uroflowmetry revealed maximum flow rate of 12 ml/second. This case highlights that PUVs is not solely a disease of infancy but may also present late. VCUG is the radiological investigation of choice but the diagnosis may be missed. A urethrocystoscopy is advised if there is a high index of suspicion.

  17. Features of Social Cognition in Late Adulthood

    Directory of Open Access Journals (Sweden)

    Melehin A.I.

    2015-12-01

    Full Text Available The paper presents outcomes of researches on the central component of social cognition — theory of mind in late adulthood. The outcomes show that, in normal aging, in advanced adulthood (55—74 years as well as in old age (75—90 years there are several qualitative changes in the affective (understanding and differentiation of emotions and cognitive (understanding irony and deceit components of theory of mind. Also, at these ages individuals may develop various forms of theory of mind deficits. They may encounter difficulties with reading facial expressions and recognizing other people’s emotions. It becomes harder for them to recognize negative emotions (such as sorrow, fear, anger than positive ones (joy. The paper describes features of pragmatic interpretation of events and understanding of deceit and irony in late adulthood.

  18. Late Vendian postcollisional leucogranites of Yenisei Ridge

    Science.gov (United States)

    Nozhkin, A. D.; Likhanov, I. I.; Reverdatto, V. V.; Bayanova, T. B.; Zinoviev, S. V.; Kozlov, P. S.; Popov, N. V.; Dmitrieva, N. V.

    2017-06-01

    The Late Vendian (540-550 Ma) U-Pb zircon age of postcollisional granitoids in the Osinovka Massif was obtained for the first time. The Osinovka Massif is located in rocks of the island-arc complex of the Isakovka Terrane, in the northwestern part of the Sayany-Yenisei accretion belt. These events stand for the final stage of the Neoproterozoic history of the Yenisei Ridge, related to the completing accretion of the oceanic crust fragments and the beginning of the Caledonian orogenesis. The petrogeochemical composition and the Sm-Nd isotopic characteristics support the fact that the granitoid melt originated from a highly differentiated continental crust of the southwestern margin of the Siberian Craton. Hence, the granite-bearing Late Riphean island-arc complexes were thrust over the craton margin at a distance considerably exceeding the dimensions of the Osinovka Massif.

  19. Late physical effects of childhood cancer survivors

    OpenAIRE

    Young-Ho Lee

    2010-01-01

    Advances in research and medical and supportive care have contributed to a growing population of adults formerly treated for childhood cancer. History of cancer and its therapy can have significant life-long health implications. Late effects of cancer therapy can be insidious on onset, occur outside the pediatric age, and contribute to premature morbidity and mortality. In this review, I have focused on the key long-term effects of pediatric cancer therapy, particularly on the metabolic syndr...

  20. Early- versus Late-Onset Systemic Sclerosis

    Science.gov (United States)

    Alba, Marco A.; Velasco, César; Simeón, Carmen Pilar; Fonollosa, Vicent; Trapiella, Luis; Egurbide, María Victoria; Sáez, Luis; Castillo, María Jesús; Callejas, José Luis; Camps, María Teresa; Tolosa, Carles; Ríos, Juan José; Freire, Mayka; Vargas, José Antonio; Espinosa, Gerard

    2014-01-01

    Abstract Peak age at onset of systemic sclerosis (SSc) is between 20 and 50 years, although SSc is also described in both young and elderly patients. We conducted the present study to determine if age at disease onset modulates the clinical characteristics and outcome of SSc patients. The Spanish Scleroderma Study Group recruited 1037 patients with a mean follow-up of 5.2 ± 6.8 years. Based on the mean ± 1 standard deviation (SD) of age at disease onset (45 ± 15 yr) of the whole series, patients were classified into 3 groups: age ≤30 years (early onset), age between 31 and 59 years (standard onset), and age ≥60 years (late onset). We compared initial and cumulative manifestations, immunologic features, and death rates. The early-onset group included 195 patients; standard-onset group, 651; and late-onset, 191 patients. The early-onset group had a higher prevalence of esophageal involvement (72% in early-onset compared with 67% in standard-onset and 56% in late-onset; p = 0.004), and myositis (11%, 7.2%, and 2.9%, respectively; p = 0.009), but a lower prevalence of centromere antibodies (33%, 46%, and 47%, respectively; p = 0.007). In contrast, late-onset SSc was characterized by a lower prevalence of digital ulcers (54%, 41%, and 34%, respectively; p < 0.001) but higher rates of heart conduction system abnormalities (9%, 13%, and 21%, respectively; p = 0.004). Pulmonary hypertension was found in 25% of elderly patients and in 12% of the youngest patients (p = 0.010). After correction for the population effects of age and sex, standardized mortality ratio was shown to be higher in younger patients. The results of the present study confirm that age at disease onset is associated with differences in clinical presentation and outcome in SSc patients. PMID:24646463

  1. Intermediate Inflation or Late Time Acceleration?

    International Nuclear Information System (INIS)

    Sanyal, A.K.

    2008-01-01

    The expansion rate of intermediate inflation lies between the exponential and power law expansion but corresponding accelerated expansion does not start at the onset of cosmological evolution. Present study of intermediate inflation reveals that it admits scaling solution and has got a natural exit form it at a later epoch of cosmic evolution, leading to late time acceleration. The corresponding scalar field responsible for such feature is also found to behave as a tracker field for gravity with canonical kinetic term.

  2. [Late primary abdominal pregnancy. Case report].

    Science.gov (United States)

    Farías, Emigdio Torres; Gómez, Luis Guillermo Torres; Allegre, René Márquez; Higareda, Salvador Hernández

    2008-09-01

    Abdominal advanced pregnancy is an obstetric complication that put at risk maternal and fetal life. We report a case of advanced abdominal pregnancy with intact ovaries and fallopian tubes, without ureteroperitoneal fistulae and, late prenatal diagnosis, in a multiparous patient without risk factors, with alive newborn, and whose pregnancy was attended at Unidad Medica de Alta Especialidad, Hospital de Gineco-Obstetricia, Centro Medico Nacional de Occidente del IMSS, Guadalajara, Jalisco, México.

  3. VERY LATE PHOTOMETRY OF SN 2011fe

    Energy Technology Data Exchange (ETDEWEB)

    Kerzendorf, W. E. [Department of Astronomy and Astrophysics, University of Toronto, 50 Saint George Street, Toronto, ON M5S 3H4 (Canada); Taubenberger, S.; Seitenzahl, I. R.; Ruiter, A. J., E-mail: wkerzendorf@gmail.com [Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Straße 1, D-85748 Garching (Germany)

    2014-12-01

    The Type Ia supernova SN 2011fe is one of the closest supernovae of the past decades. Due to its proximity and low dust extinction, this object provides a very rare opportunity to study the extremely late time evolution (>900 days) of thermonuclear supernovae. In this Letter, we present our photometric data of SN 2011fe taken at an unprecedented late epoch of ≈930 days with GMOS-N mounted on the Gemini North telescope (g = 23.43 ± 0.28, r = 24.14 ± 0.14, i = 23.91 ± 0.18, and z = 23.90 ± 0.17) to study the energy production and retention in the ejecta of SN 2011fe. Together with previous measurements by other groups, our result suggests that the optical supernova light curve can still be explained by the full thermalization of the decay positrons of {sup 56}Co. This is in spite of theoretical predicted effects (e.g., infrared catastrophe, positron escape, and dust) that advocate a substantial energy redistribution and/or loss via various processes that result in a more rapid dimming at these very late epochs.

  4. Changing perspectives regarding late-life dementia.

    Science.gov (United States)

    Fotuhi, Majid; Hachinski, Vladimir; Whitehouse, Peter J

    2009-12-01

    Individuals over 80 years of age represent the most rapidly growing segment of the population, and late-life dementia has become a major public health concern worldwide. Development of effective preventive and treatment strategies for late-life dementia relies on a deep understanding of all the processes involved. In the centuries since the Greek philosopher Pythagoras described the inevitable loss of higher cognitive functions with advanced age, various theories regarding the potential culprits have dominated the field, ranging from demonic possession, through 'hardening of blood vessels', to Alzheimer disease (AD). Recent studies suggest that atrophy in the cortex and hippocampus-now considered to be the best determinant of cognitive decline with aging-results from a combination of AD pathology, inflammation, Lewy bodies, and vascular lesions. A specific constellation of genetic and environmental factors (including apolipoprotein E genotype, obesity, diabetes, hypertension, head trauma, systemic illnesses, and obstructive sleep apnea) contributes to late-life brain atrophy and dementia in each individual. Only a small percentage of people beyond the age of 80 years have 'pure AD' or 'pure vascular dementia'. These concepts, formulated as the dynamic polygon hypothesis, have major implications for clinical trials, as any given drug might not be ideal for all elderly people with dementia.

  5. Pyomyositis of Obturator Muscles: Unusual Late Presentation

    Directory of Open Access Journals (Sweden)

    Prasad Channappa Soraganvi

    2013-04-01

    Full Text Available Introduction: Pyomyositis of obturator muscles is rare condition. Late presentation with deformities of hip misleads the clinician. Late presentation (6 weeks of this condition has not been reported earlier. This report highlights this unusual presentation of Pyomyositis of the obturator muscles. Case Report: We are reporting a 14year old female patient presented with limp and pain in hip since 6 weeks. Her hip radiographs were unremarkable. Patient was admitted and MRI done. MRI findings were consistent with obturator pyomyositis. Diagnosis of pyomyositis confirmed by MRI and we performed percutaneous aspiration and drained about 25ml of purulent material mixed with blood. The culture grew Staphylococcus aureus. Patient received intravenous antibiotic for 1week and oral antibiotic for 2weeks. Patient was immobilized in fixed skin traction in Thomas splint for 5days, later gentle mobilization was started. Her condition improved dramatically after aspiration. A follow up MRI done at 3 weeks following aspiration revealed a significant reduction in intramuscular collection of obturator internus and obturator externus. Three weeks following aspiration patient was relieved of the pain and was able to walk normally. At 6 months follow up visit patient was asymptomatic. Conclusion: Late presentation of obturator pyomyositis is rare. We emphasise on careful examination and need for early imaging for diagnosis. Percutaneous drainage results in successful treatment. Keywords: Pyomyositis, septic arthritis, infection, obturator muscle.

  6. Late haemorrhagic disease of the newborn.

    Science.gov (United States)

    Zengin, Emine; Sarper, Nazan; Türker, Gülcan; Corapçioğlu, Funda; Etuş, Volkan

    2006-09-01

    Late haemorrhagic disease of the newborn (HDN) can occur owing to a lack of vitamin K prophylaxis, as a manifestation of an underlying disorder or idiopatically from the 8th day to 12 weeks after birth. Eight infants admitted to Kocaeli University Hospital with nine episodes of late HDN between January 2002 and April 2005 were evaluated retrospectively from hospital records. The median age at presentation was 46 (26-111) days. All the infants were born at full-term to healthy mothers and were exclusively breast-fed. All had an uneventful perinatal history, except one who had meconium aspiration. Four patients had received no vitamin K prophylaxis and another three had uncertain histories. At presentation, six had intracranial bleeding and the remainder had bleeding either from the venepuncture site or the gastro-intestinal tract. The presenting signs and symptoms were irritability, vomiting, bulging or full fontanelle, convulsions and diminished or absent neonatal reflexes. Galactosaemia was detected in a 2-month-old infant with prolonged jaundice. There was no surgery-related mortality or complications but one survived for only 2 days on ventilatory support following surgery. Only one of the six survivors had severe neurological sequelae. Late HDN frequently presents with intracranial haemorrhage, leading to high morbidity and mortality. HDN can be the manifestation of an underlying metabolic disorder. Vitamin K prophylaxis of the newborn should be routine in developing countries.

  7. Revisiting the concept of late catatonia.

    Science.gov (United States)

    Kocha, Hiroki; Moriguchi, Sho; Mimura, Masaru

    2014-10-01

    The objective of this paper is to introduce the concept of late catatonia to foreign readers for the first time in English. The original study was conducted about 20 years ago. The subjects were 16 persons who first visited our institutions between 1990 and 1996. They fulfilled the following criteria: 1) late-onset psychosis, with the initial mental changes occurring after 40 years of age; 2) more than one catatonic symptom observed during the clinical course; 3) a total clinical course lasting more than 2 years; and 4) no evidence of apparent organic brain disease. The medical records of individual patients were retrospectively reviewed to summarize the clinical features of this diagnosis. The crucial feature was the evolution or longitudinal change in the clinical picture over time, with the clinical course being divided into five stages: stage I (prodromal depression), stage II (anxiety and agitation), stage III (hallucination and delusion), stage IV (catatonia syndrome), and residual state. As for treatment, the effect of psychotropic agents was very limited. The electroconvulsive treatment was the most effective treatment option. Apart from the current diagnostic dichotomy of schizophrenia and mood disorder, the concept of late catatonia is useful in clinical settings and may provide clinically important knowledge. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. VERY LATE PHOTOMETRY OF SN 2011fe

    International Nuclear Information System (INIS)

    Kerzendorf, W. E.; Taubenberger, S.; Seitenzahl, I. R.; Ruiter, A. J.

    2014-01-01

    The Type Ia supernova SN 2011fe is one of the closest supernovae of the past decades. Due to its proximity and low dust extinction, this object provides a very rare opportunity to study the extremely late time evolution (>900 days) of thermonuclear supernovae. In this Letter, we present our photometric data of SN 2011fe taken at an unprecedented late epoch of ≈930 days with GMOS-N mounted on the Gemini North telescope (g = 23.43 ± 0.28, r = 24.14 ± 0.14, i = 23.91 ± 0.18, and z = 23.90 ± 0.17) to study the energy production and retention in the ejecta of SN 2011fe. Together with previous measurements by other groups, our result suggests that the optical supernova light curve can still be explained by the full thermalization of the decay positrons of 56 Co. This is in spite of theoretical predicted effects (e.g., infrared catastrophe, positron escape, and dust) that advocate a substantial energy redistribution and/or loss via various processes that result in a more rapid dimming at these very late epochs

  9. Late-time cosmological phase transitions

    International Nuclear Information System (INIS)

    Schramm, D.N.

    1990-11-01

    It is shown that the potential galaxy formation and large-scale structure problems of objects existing at high redshifts (Z approx-gt 5), structures existing on scales of 100M pc as well as velocity flows on such scales, and minimal microwave anisotropies (ΔT/T) approx-lt 10 -5 can be solved if the seeds needed to generate structure form in a vacuum phase transition after decoupling. It is argued that the basic physics of such a phase transition is no more exotic than that utilized in the more traditional GUT scale phase transitions, and that, just as in the GUT case, significant random gaussian fluctuations and/or topological defects can form. Scale lengths of ∼100M pc for large-scale structure as well as ∼1 M pc for galaxy formation occur naturally. Possible support for new physics that might be associated with such a late-time transition comes from the preliminary results of the SAGE solar neutrino experiment, implying neutrino flavor mixing with values similar to those required for a late-time transition. It is also noted that a see-saw model for the neutrino masses might also imply a tau neutrino mass that is an ideal hot dark matter candidate. However, in general either hot or cold dark matter can be consistent with a late-time transition. 47 refs., 2 figs

  10. Treatment of chronic SFA in-stent occlusion with combined laser atherectomy and drug-eluting balloon angioplasty in patients with critical limb ischemia: a single-center, prospective, randomized study.

    Science.gov (United States)

    Gandini, Roberto; Del Giudice, Costantino; Merolla, Stefano; Morosetti, Daniele; Pampana, Enrico; Simonetti, Giovanni

    2013-12-01

    To compare the safety and efficacy of laser debulking (LD) and drug-eluting balloon (DEB) angioplasty to treatment with DEB angioplasty alone in patients affected by critical limb ischemia (CLI) and superficial femoral artery (SFA) chronic stent occlusion in a prospective, randomized study. Among 448 CLI patients treated from December 2009 to March 2011, 48 patients (39 men; mean age 72.7±7.8 years) with chronic SFA in-stent occlusion were randomly assigned to treatment using LD+DEB (n=24) or DEB angioplasty alone (n=24). Patency at 12 months was the primary outcome measure; secondary outcomes were target lesion revascularization (TLR) and clinical success at 12 months. In the LD+DEB group, the patency rates at 6 and 12 months (91.7% and 66.7%, respectively) were significantly higher (p=0.01) than in the DEB only patients (58.3% and 37.5%, respectively). TLR at 12 months was 16.7% in the LD+DEB group and 50% in the DEB only group (p=0.01). Two (8%) patients needed major amputations in the LD+DEB group vs. 11 (46%) in the DEB only group at 12 months (p=0.003). In this small initial experience, combined treatment with LD and DEB angioplasty is correlated with better outcomes in CLI patients with occluded SFA stents.

  11. Prevalence and prognosis of coronary stent gap detected by multi-detector CT: a follow-up study

    International Nuclear Information System (INIS)

    Zhang, Xinghua; Yang, Li; Ju, Haiyue; Zhang, Fan; Wu, Jian; He, Bin; Chen, Yundai

    2012-01-01

    To evaluate the features of stent gap (SG) and the long-term impact of SG on in-stent restenosis (ISR) in patent stents. A total of 347 consecutive patients with 781 stents who underwent MDCT were assessed for SG and ISR. Clinical and stent features were compared between the SG and non-SG groups. In the follow-up study, among 82 patients with 175 patent stents [26 assessed by conventional coronary angiography (CCA) including 6 contacted in a telephone survey, 46 assessed by computed tomography angiography (CTA) and 10 by both], the incidence of ISR was compared between stents with and without SG. Three patients and 13 stents were excluded. SG was observed in 12.5% of patients and 8.6% of stents. ISR detected by CTA was noted in 21.2% of SG, and SG accounted for 23.7% of ISR. Stent number, length, location, overlapping pattern, tortuosity and in-out angle were predisposing factors for SG. During a mean follow-up period of 15 months after detection of SG, the incidence of ISR was significantly higher in the SG group than in the non-SG group (43.8/14.9% by CCA, 33.3/10.1% by CTA and CCA). Patent stents with SG detected by CTA had a higher incidence of late restenosis, indicating that long-term follow-up or further intervention is necessary. (orig.)

  12. Bioresorbable scaffolds in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2013-03-01

    Full Text Available Yaojun Zhang,1,2 Christos V Bourantas,1 Vasim Farooq,1 Takashi Muramatsu,1 Roberto Diletti,1 Yoshinobu Onuma,1 Hector M Garcia-Garcia,1 Patrick W Serruys11Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; 2Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of ChinaAbstract: Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.Keywords: bioresorbable scaffold, drug-eluting stent, biodegradable, design, mechanism, coronary artery disease

  13. Nile behaviour and Late Palaeolithic humans in Upper Egypt during the Late Pleistocene

    Science.gov (United States)

    Vermeersch, Pierre M.; Van Neer, Wim

    2015-12-01

    The reconstruction of the environment and the human population history of the Nile Valley during the Late Pleistocene have received a lot of attention in the literature thus far. There seems to be a consensus that during MIS2 extreme dry conditions prevailed over north-eastern Africa, which was apparently not occupied by humans. The Nile Valley seems to be an exception; numerous field data have been collected suggesting an important population density in Upper Egypt during MIS2. The occupation remains are often stratified in, or at least related to, aeolian and Nile deposits at some elevation above the present-day floodplain. They are rich in lithics and animal bones, mainly fish, illustrating the exploitation of the Nile Valley by the Late Palaeolithic inhabitants. The fluvial processes active during that period have traditionally been interpreted as a continuously rising highly braided river. In this paper we summarize the evidence thus far available for the Late Pleistocene on the population densities in the Nile Valley, and on the models of Nilotic behaviour. In the discussion we include data on the environmental conditions in Eastern Africa, on the aeolian processes in the Western Desert of Egypt derived from satellite images, 14C and OSL dates, in order to formulate a new model that explains the observed high remnants of aeolian and Nilotic deposits and the related Late Palaeolithic sites. This model hypothesizes that, during the Late Pleistocene, and especially the LGM, dunes from the Western Desert invaded the Nile Valley at several places in Upper Egypt. The much reduced activity of the White Nile and the Blue Nile was unable to evacuate incoming aeolian sand and, as a consequence, several dams were created in the Upper Egyptian Nile Valley. Behind such dams the created lakes offered ideal conditions for human subsistence. This model explains the occurrence of Late Palaeolithic hunter-fisher-gatherers in a very arid environment with very low Nile flows

  14. Chronic or Late Lyme Neuroborreliosis: Analysis of Evidence Compared to Chronic or Late Neurosyphilis

    Science.gov (United States)

    Miklossy, Judith

    2012-01-01

    Whether spirochetes persist in affected host tissues and cause the late/chronic manifestations of neurosyphilis was the subject of long-lasting debate. Detection of Treponema pallidum in the brains of patients with general paresis established a direct link between persisting infection and tertiary manifestations of neurosyphilis. Today, the same question is in the center of debate with respect to Lyme disease. The goal of this review was to compare the established pathological features of neurosyphilis with those available for Lyme neuroborreliosis. If the main tertiary forms of neurosyphilis also occur in Lyme neuroborreliosis and Borrelia burgdorferi can be detected in brain lesions would indicate that the spirochete is responsible for the neuropsychiatric manifestations of late/chronic Lyme neuroborreliosis. The substantial amounts of data available in the literature show that the major forms of late/chronic Lyme neuroborreliosis (meningovascular and meningoencephalitis) are clinically and pathologically confirmed. Borrelia burgdorferi was detected in association with tertiary brain lesions and cultivated from the affected brain or cerebrospinal fluid. The accumulated data also indicate that Borrelia burgdorferi is able to evade from destruction by the host immune reactions, persist in host tissues and sustain chronic infection and inflammation. These observations represent evidences that Borrelia burgdorferi in an analogous way to Treponema pallidum is responsible for the chronic/late manifestations of Lyme neuroborreliosis. Late Lyme neuroborreliosis is accepted by all existing guidelines in Europe, US and Canada. The terms chronic and late are synonymous and both define tertiary neurosyphilis or tertiary Lyme neuroborreliosis. The use of chronic and late Lyme neuroborreliosis as different entities is inaccurate and can be confusing. Further pathological investigations and the detection of spirochetes in infected tissues and body fluids are strongly needed

  15. Comparing Measures of Late HIV Diagnosis in Washington State

    Directory of Open Access Journals (Sweden)

    Laura Saganic

    2012-01-01

    Full Text Available As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4+ results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis. We also conducted tests for trend to determine whether the proportion of cases diagnosed late has changed over time. Both measures lead us to similar conclusions about late HIV diagnosis, suggesting that being male, older, foreign-born, or heterosexual increase the likelihood of late HIV diagnosis. Our findings reaffirm the validity of a time-based definition of late HIV diagnosis, while at the same time demonstrating the potential value of a lab-based measure.

  16. Evaluation of the late merge work zone traffic control strategy.

    Science.gov (United States)

    2004-01-01

    Several alternative lane merge strategies have been proposed in recent years to process vehicles through work zone lane closures more safely and efficiently. Among these is the late merge. With the late merge, drivers are instructed to use all lanes ...

  17. Late Devonian and Triassic basalts from the southern continental ...

    Indian Academy of Sciences (India)

    In Late Devonian and Early-to-Late Triassic times, the southern continental margin of the Eastern. European Platform was the site of a basaltic volcanism in the Donbas and Fore-Caucasus areas respectively. Both volcanic piles rest unconformably upon Paleoproterozoic and Late Paleozoic units respectively, and emplaced ...

  18. Late Devonian and Triassic basalts from the southern continental ...

    Indian Academy of Sciences (India)

    In Late Devonian and Early-to-Late Triassic times, the southern continental margin of the Eastern European Platform was the site of a basaltic volcanism in the Donbas and Fore-Caucasus areas respectively. Both volcanic piles rest unconformably upon Paleoproterozoic and Late Paleozoic units respectively, and emplaced ...

  19. 48 CFR 852.273-70 - Late offers.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Late offers. 852.273-70... SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 852.273-70 Late offers. As prescribed in 873.110(a), insert the following provision: Late Offers (JAN 2003) This provision replaces...

  20. Late-presenting congenital diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Raashid Hamid

    2014-01-01

    Full Text Available Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients to non-specific gastrointestinal complaints (5 patients. In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years. Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

  1. Late onset corneal ectasia after LASIK surgery.

    Science.gov (United States)

    Said, Ashraf; Hamade, Issam H; Tabbara, Khalid F

    2011-07-01

    To report late onset corneal ectasia following myopic LASIK. A retrospective cohort case series. Nineteen patients with late onset corneal ectasia following LASIK procedure were examined at The Eye Center, Riyadh, Saudi Arabia. Patients underwent LASIK for myopia with spherical equivalent ranging from -1.4 to -13.75 diopters. Age and gender, history of systemic or local diseases, and time of onset of corneal ectasia were recorded. Eye examination and corneal topographical analyses were done before and after LASIK surgery. Nineteen patients (29 eyes) with late onset corneal ectasia were identified from 1998 to 2008 in 13 male and six female patients. The mean follow-up period was 108 ± 23 months (range 72-144 months). No patient had pre-operative identifiable risk factors for corneal ectasia and the mean time of onset was 57 ± 24 months (range 24-120 months after LASIK). The pre-operative values included mean central pachymetry 553 ± 25 μm, mean keratometry reading of 42.9 ± 1.5 diopters, average oblique cylinder of 1.4 ± 1.2 diopters, posterior surface elevation of 26 ± 2.1 diopters, corneal flap thickness of 160 μm, mean spherical equivalent of -5.6 ± 3.6 diopters, and calculated residual corneal stromal bed thickness was 288 ± 35 μm. Three (5 eyes) patients developed ectasia after pregnancy. Three (4 eyes) patients developed corneal ectasia following severe adenoviral keratoconjunctivitis and had positive PCR for adenovirus type 8. Corneal ectasia may develop many years after LASIK surgery and symptoms could go undetected for some time. Pregnancy and adenoviral keratoconjunctivitis occurred post-operatively in six patients.

  2. Late toxicity in breast cancer radiotherapy

    International Nuclear Information System (INIS)

    Gonzalez Coletti, F.; Rafailovici, L.; Filomia, M.L.; Chiozza, J.; Dosoretz, B.

    2008-01-01

    Full text: The aim of this study is to describe and classify chronic complications due to radiotherapy in breast cancer. Also the impact of radiotherapy on the quality of life of patients is evaluated. Materials and methods: 50 patients with breast cancer at early stages (78% in situ, 22% I and II) treated with radiotherapy in breast volume plus boost (45/50 Gy + 18/20 Gy) with a follow up over 5 years. Acute toxicities were found retrospectively and chronic toxicities were assessed though physical examination and review of complementary studies. To facilitate data collection, pre printed forms were used. Bibliographic searches were made. Results: 10% received chemotherapy and 64% tamoxifen. The predominant chronic toxicity were found in skin (66%), although grade I and II (hyperpigmentation 26%, dryness 22%, telangiectasia 10% fibrosis, 4%, other 4%). A 50% of the patients showed hypoesthesia in ipsilateral upper limb. The other toxicities were presented in low rate and magnitude: mastodynia 16%; actinic pneumonitis 4%, pyrosis 4%, Tachycardia 2%, among others. Of the patients with acute toxicity, only 30% were grade III. The 70% of the patients had a positive impact of radiotherapy on quality of life. Conclusions: We found low rates and degrees of late toxicity. It was noticed a relationship between acute and chronic toxicity, because those who presented adverse effects during treatment developed late effects. It reflects the importance of integrating monitoring as part of radiation treatment. It should be adopted a single score of late toxicity measurement to unify data from different series. (authors) [es

  3. Computed tomography of late-onset epilepsy

    International Nuclear Information System (INIS)

    Kim, Young Sik; Im, Jae Yung; Joo, Yang Goo; Park, Sam Kyoon

    1982-01-01

    Epilepsy can be divided into idiopathic epilepsy and symptomatic epilepsy according to the existence of underlying organic brain disease. It has been said that the incidence of the symptomatic epilepsy caused by underlying organic brain disease is higher in late-onset epilepsy after the age of 20 than in childhood-onset epilepsy. CT is very sensitive and non-invasive method for detection of organic brain disease. 168 cases of late-onset epilepsy after the age of of 20 were studied by CT in recent 2 years were analyzed. The results were as follows: 1. The 3rd decade was the most frequent age group, and the ratio of male to female was 2.5 : 1. 2. Structural abnormality on brain CT was demonstrated in 51.8% of the patient. 3. The older onset of age was, the higher the ratio of abnormal CT findings, except 5th decade which showed less CT abnormality than 4th decade. 4. The most frequent history related to epilepsy was trauma. 63.1% of patients had no relevant history: and they showed CT findings of brain tumor, atrophy and infraction in decreasing order of frequency. 5. Abnormal CT findings was demonstrated in 49.2% of normal neurologic examination and in 46.4% of normal EEG study. 6. The most frequent lesion of abnormal CT scan in late-onset epilepsy was 30 cases (18.4%) of brain atrophy. The next frequent lesion was 18 cases (10.7%) of brain tumor. Infarction, parasites and calcification were other frequent lesions

  4. Cognitive functioning and late-life depression.

    Science.gov (United States)

    Koenig, Aaron M; Bhalla, Rishi K; Butters, Meryl A

    2014-05-01

    This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient's symptoms.

  5. Late physical effects of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Young-Ho Lee

    2010-04-01

    Full Text Available Advances in research and medical and supportive care have contributed to a growing population of adults formerly treated for childhood cancer. History of cancer and its therapy can have significant life-long health implications. Late effects of cancer therapy can be insidious on onset, occur outside the pediatric age, and contribute to premature morbidity and mortality. In this review, I have focused on the key long-term effects of pediatric cancer therapy, particularly on the metabolic syndrome, including cardiopulmonary complications, infertility, and secondary neoplasm.

  6. Late-night talk show v USA

    OpenAIRE

    Halamásek, Šimon

    2013-01-01

    This thesis focuses on the history of talk show in USA with emphasis on its specific form, which is late-night talk show. The first chapter focuses on the creation of new television networks and the overall state of american broadcasting during the first era of the television talk show format. The thesis briefly describes radio broadcasting which served not only as an important source of inspiration for television but also as a starting platform for most talk show hosts. Next chapter theoreti...

  7. [Polio, late effects and post-polio].

    Science.gov (United States)

    Kay, Lise

    2014-10-20

    Approximately 7,000 Danes are still living with sequelae after surviving an acute polio infection. Late effects of polio include deformities, arthrosis and overloaded muscles. In the long run polio patients are at risk of having a further decrease of muscle function and a wide variety of other symptoms, a condition called post-polio syndrome (PPS). Treatment of PPS is in general symptomatic. Recently it has been shown that treatment with intravenous immunoglobulin may have an effect on pain, tiredness and walking distance. Patients with prior polio have an increase in morbidity and mortality, and may be more sensitive to a variety of medicine.

  8. Late complications following cryotherapy of lattice degeneration.

    Science.gov (United States)

    Benson, W E; Morse, P H; Nantawan, P

    1977-10-01

    We observed 341 patients who had received cryotherapy for lattice degeneration in order to identify possible late complications. Sequelae such as retinal tears posterior to an operculum or flap tears within treated areas showed that treatment did not necessarily prevent subsequent vitreous traction. Moreover, the newly created flap tears may extend beyond the treated area and can cause retinal detachment. Even scleral buckling did not necesserily prevent further traction. Therefore, we concluded that when cryotherapy is used to treat lattice degeneration, an adequate margin of surrounding retina should be treated and the treatment should extend to the ora serrata.

  9. An ovarian teratoma of late Roman age.

    Science.gov (United States)

    Armentano, Núria; Subirana, Mercè; Isidro, Albert; Escala, Oscar; Malgosa, Assumpció

    2012-12-01

    We report here a very unusual pelvic calcification recovered from the remains of a 30-40-year-old woman found at the late Roman period archeological site of La Fogonussa (Lleida, Catalonia). Although differential diagnoses for calcifications of the pelvis are complicated in archeological contexts, the precise localization, macroscopic features, and the presence of teeth along with part of a small bone led us to identify this case as an ovarian teratoma, based upon gross observations and computerized tomography (CT). Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Late quaternary Southern Indian Ocean circulation

    International Nuclear Information System (INIS)

    Howard, W.R.

    1985-01-01

    The climate of the Southern Indian Ocean is controled by the distinctive mid-to-high latitude oceanographic circulation features of the region. The oceanographic features have distinctive biotic signatures, which can be recognized in surface sediment furnaces. Studies of the Southern Indian Ocean down core time series indicated that oceanographic changes similar in magnitude to LGM-Modern shifts have been a regular, consistent and cyclic feature of the late Quaternary history of the Southern Indian Ocean. Oxygen isotopes and estimated sea-surface temperature records were used for this

  11. Pervasive oxygenation along late Archaean ocean margins

    Science.gov (United States)

    Kendall, Brian; Reinhard, Christopher T.; Lyons, Timothy W.; Kaufman, Alan J.; Poulton, Simon W.; Anbar, Ariel D.

    2010-09-01

    The photosynthetic production of oxygen in the oceans is thought to have begun by 2.7 billion years ago, several hundred million years before appreciable accumulation of oxygen in the atmosphere. However, the abundance and distribution of dissolved oxygen in the late Archaean oceans is poorly constrained. Here we present geochemical profiles from 2.6- to 2.5-billion-year-old black shales from the Campbellrand-Malmani carbonate platform in South Africa. We find a high abundance of rhenium and a low abundance of molybdenum, which, together with the speciation of sedimentary iron, points to the presence of dissolved oxygen in the bottom waters on the platform slope. The water depth on the slope probably reached several hundred metres, implying the export of O2 below the photic zone. Our data also indicate that the mildly oxygenated surface ocean gave way to an anoxic deep ocean. We therefore suggest that the production of oxygen in the surface ocean was vigorous at this time, but was not sufficient to fully consume the deep-sea reductants. On the basis of our results and observations from the Hamersley basin in Western Australia, we conclude that the productive regions along ocean margins during the late Archaean eon were sites of substantial O2 accumulation, at least 100million years before the first significant increase in atmospheric O2 concentration.

  12. Growth of early and late maturers.

    Science.gov (United States)

    Gasser, T; Sheehy, A; Molinari, L; Largo, R H

    2001-01-01

    This is a study on the growth of subgroups of normal children, maturing early or late, in the variables height, leg and sitting height, arm length, biiliac and bihumeral width. While a longer growth period affects adult height only marginally, less is known about the other variables. It is also of interest to see in what way a shorter growth period is compensated by a higher velocity. Out of 120 boys and 112 girls followed from 4 weeks until adulthood, subgroups of 40 boys and 37 girls were formed with respect to the average timing (across variables) of the pubertal spurt as an indicator of maturity. Only leg height shows a smaller adult size for early maturers. The shorter growth period is compensated by a higher prepubertal velocity and a higher level in pubertal years. The pubertal peak is a little larger for early maturing boys but not for girls. There is an inherent pacemaker for growth that leads to the same adult size for a shorter growth period via a higher basic intensity. Legs are an exception since late maturers have, on average, longer legs as adults.

  13. Can Mustard Gas Induce Late Onset Polyneuropathy?

    Directory of Open Access Journals (Sweden)

    SJ. Mousavi

    2007-11-01

    Full Text Available Background:Mustard gas, lethal in high doses, affects multiple organs such as skin, eye and respiratory system. We studied the development of late onset mustardinduced polyneuropathy among chemically wounded Iranian veterans.Methods:In this descriptive study,100 chemically wounded Iranian veterans with severe eye involvement were examined for any signs and symptoms of polyneuropathy by an internist.20 patients were suspected to have neurological symptoms or signs.These patients were examined by a neurologist again. 13 showed abnormal neurological symptoms. Electrodiagnostic exams were performed for this group by another physician.Results:13 veterans had abnormal neurological exam results with prominent sensory signs and symptoms in almost all of them. Brisk deep tendon reflexes were found in 3 cases. Electrodiagnostic studies were compatible with axonal type distal sensory polyneuropathy in 6 subjects. Conclusion: To the best of our knowledge, this is the first report of late onset polyneuropathy among chemically-wounded victims who were exposed to mustard gas. The pathophysiology of this form of neuropathy is still unknown. Unlike most toxic neuropathies,obvious clinical signs and symptoms appeared several years after exposure. No specific treatment for.polyneuropathy due to chemical weapons exposure has been described to date.

  14. Physiologic brain dysmaturity in late preterm infants

    Science.gov (United States)

    Scher, Mark S.; Johnson, Mark W.; Ludington, Susan M.; Loparo, Kenneth

    2011-01-01

    Neonatal EEG sleep was used to determine if differences are expressed between healthy late preterm and full term groups. Twenty-seven 24-channel multi-hour studies were recorded at similar post–menstrual ages (PMA) and analyzed for eight asymptomatic late preterm infants (LPT) compared with nineteen healthy full term (FT) infants as a preliminary analysis, followed by a comparison of a subset of 8 FT infants, matched for gender, race, and PMA. Z scores were performed on data sets from each group pair comparing each of seven EEG/Sleep measures for entire recordings, active (AS) and quiet sleep (QS) segments and artifact-free intervals. Six of seven measures showed differences between the 8 LPT and 8 matched FT cohort pair comparisons of >0.3; REMs, arousals during QS, spectral correlations between homologous centro-temporal regions during QS, spectral beta/alpha power ratios during AS and QS, a spectral measure of respiratory regularity during QS, and sleep cycle length. Quantitative neurophysiologic analyses define differences in brain maturation between LPT and FT infants at similar PMA. Altered EEG/Sleep behaviors in the LPT are biomarkers of developmental neuroplasticity involving interconnected neuronal networks adapting to conditions of prematurity for this largest segment of the preterm neonatal population. PMID:21796018

  15. Late seed maturation: drying without dying.

    Science.gov (United States)

    Leprince, Olivier; Pellizzaro, Anthoni; Berriri, Souha; Buitink, Julia

    2017-02-01

    Besides the deposition of storage reserves, seed maturation is characterized by the acquisition of functional traits including germination, desiccation tolerance, dormancy, and longevity. After seed filling, seed longevity increases up to 30-fold, concomitant with desiccation that brings the embryo to a quiescent state. The period that we define as late maturation phase can represent 10-78% of total seed development time, yet it remains overlooked. Its importance is underscored by the fact that in the seed production chain, the stage of maturity at harvest is the primary factor that influences seed longevity and seedling establishment. This review describes the major events and regulatory pathways underlying the acquisition of seed longevity, focusing on key indicators of maturity such as chlorophyll degradation, accumulation of raffinose family oligosaccharides, late embryogenesis abundant proteins, and heat shock proteins. We discuss how these markers are correlated with or contribute to seed longevity, and highlight questions that merit further attention. We present evidence suggesting that molecular players involved in biotic defence also have a regulatory role in seed longevity. We also explore how the concept of plasticity can help understand the acquisition of longevity. © The Author 2016. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  16. Late neurotoxicity after nasopharyngeal carcinoma treatment

    International Nuclear Information System (INIS)

    Siala, W.; Mnejja, W.; Daoud, J.; Khabir, A.; Boudawara, T.; Ben Mahfoudh, K.; Ghorbel, A.; Frikha, M.

    2009-01-01

    Purpose A retrospective analysis of risk factors for late neurological toxicity after nasopharyngeal carcinoma radiotherapy. Patients and methods Between 1993 and 2004, 239 patients with non metastatic nasopharyngeal carcinoma were treated by radiotherapy associated or not to chemotherapy. Radiotherapy was delivered with two modalities: hyperfractionated for 82 patients and conventional fractionation for 157 patients. We evaluated the impact of tumour stage, age, gender, radiotherapy schedule and chemotherapy on neurological toxicity. Results After a mean follow-up of 107 months (35-176 months), 21 patients (8.8%) developed neurological complications, such as temporal necrosis in nine cases, brain stem necrosis in five cases, optics nerve atrophy in two cases and myelitis in one case. Five- and ten-year free of toxicity survival was 95 and 84% respectively. Young patients had greater risk of temporal necrosis, and hyperfractionated radiotherapy was associated with a significantly higher risk of neurological complications (14.6% vs 5.7%, p = 0.02). On multivariate analysis, hyperfractionation and age were insignificant. Conclusion Late neurological toxicity after radiotherapy for nasopharyngeal carcinoma was rare. Younger age and hyperfractionation were considered as risk factors of neurological toxicity in our study

  17. Late-modern transformation of Islam or Islamic transformation of Late-modern Religiosity?

    DEFF Research Database (Denmark)

    Riexinger, Martin Thomas

    2017-01-01

    The Turkish author Muhammed Bozdağ, who has no formal religious education, has been popular since the late 1990s because of his self-help seminars and self-help books. Though they are based on the adaptation of Western New Age-inspired models, Bozdağ uses many of the models’ parascientific concepts...

  18. Cohort Profile: The Danish Testicular Cancer Late Treatment Effects Cohort (DaTeCa-LATE

    Directory of Open Access Journals (Sweden)

    Michael Kreiberg

    2018-02-01

    Full Text Available The cohort was set up in order to analyze late effects in long-term testicular cancer survivors (TCS and to contribute to the design of future follow-up programs addressing and potentially preventing late effects. Data for this cross-sectional study were collected between January 1, 2014, and December 31, 2016, among living Danish TCS and 60% agreed to participate in the cohort (N = 2,572. Mean time since testicular cancer (TC diagnosis was 18 years (range 7–33 and mean age of participants was 53 years (range 25–95. Data consist of results of a questionnaire with patient reported outcomes which covers a broad range of items on late-effects. The study also included data obtained through linkages to Danish registries, a biobank, and clinical data from hospital files and pathology reports originating from the Danish Testicular Cancer Database (DaTeCa. The treatment during the observation period has been nearly the same for all stages of TC and is in agreement with today’s standard treatment, this allows for interesting analysis with a wide timespan. We have extensive data on non-responders and are able to validate our study findings. Data from a Danish reference population (N = 162,283 allow us to compare our findings with a Danish background population. The cohort can easily be extended to access more outcomes, or include new TCS. A limitation of the present study is the cross-sectional design and despite the large sample size, The Danish Testicular Cancer Late Treatment Effects Cohort (DaTeCa-LATE lacks statistical power to study very rare late effects. Since it was voluntary to participate in the study we have some selection bias, for instance, we lack responders who were not in a paired relationship, but we would still argue that this cohort of TCSs is representative for TCSs in Denmark.Collaboration and data accessResearches interested in collaboration with the DaTeCa-LATE study group please contact Professor Gedske Daugaard

  19. Late removal of retrievable caval filters.

    Science.gov (United States)

    von Segesser, Ludwig K; Ferrari, Enrico; Tozzi, Piergiorgio; Abdel-Sayed, Saad; Berdajs, Denis

    2014-01-01

    The advent of retrievable caval filters was a game changer in the sense, that the previously irreversible act of implanting a medical device into the main venous blood stream of the body requiring careful evaluation of the pros and cons prior to execution suddenly became a "reversible" procedure where potential hazards in the late future of the patient lost most of their weight at the time of decision making. This review was designed to assess the rate of success with late retrieval of so called retrievable caval filters in order to get some indication about reasonable implant duration with respect to relatively "easy" implant removal with conventional means, i.e., catheters, hooks and lassos. A PubMed search (www.pubmed.gov) was performed with the search term "cava filter retrieval after 30 days clinical", and 20 reports between 1994 and 2013 dealing with late retrieval of caval filters were identified, covering approximately 7,000 devices with 600 removed filters. The maximal duration of implant reported is 2,599 days and the maximal implant duration of removed filters is also 2,599 days. The maximal duration reported with standard retrieval techniques, i.e., catheter, hook and/or lasso, is 475 days, whereas for the retrievals after this period more sophisticated techniques including lasers, etc. were required. The maximal implant duration for series with 100% retrieval accounts for 84 days, which is equivalent to 12 weeks or almost 3 months. We conclude that retrievable caval filters often become permanent despite the initial decision of temporary use. However, such "forgotten" retrievable devices can still be removed with a great chance of success up to three months after implantation. Conventional percutaneous removal techniques may be sufficient up to sixteen months after implantation whereas more sophisticated catheter techniques have been shown to be successful up to 83 months or more than seven years of implant duration. Tilting, migrating, or misplaced

  20. Evaluation of metal allergies in patients with coronary stents.

    Science.gov (United States)

    Hillen, U; Haude, M; Erbel, R; Goos, M

    2002-12-01

    In-stent restenosis is a complication which impairs the success of coronary stenting. Recently, it was supposed that a delayed hypersensitivity reaction to nickel and molybdenum might be one of the triggering factors in in-stent restenosis. We have analyzed the data collected in our centre with respect to this hypothesis. Altogether, 34 patients were investigated (24 male, 10 female). Patch tests were performed with the standard series of the German Contact Dermatitis Research Group and a metal series containing the metal components of 316 L stainless steel. A positive patch test reaction to nickel was observed in 4 (11.8%) patients. None of the patients showed sensitization to the other metals. Retrospective analysis was performed in 20 patients: 2 of these patients had a positive patch test reaction to nickel, one of whom had an in-stent restenosis, and the other not. Restenoses were predominantly observed in patients with negative patch test reactions to nickel (6/18 patients). Out of the patients who were investigated prospectively only one showed sensitization to nickel. Restenosis was observed in 2 patients: neither patient had nickel allergy. Although it still cannot be excluded that metal allergy may play a role in the restenosis process in coronary stenting, there is at present little evidence for it.

  1. An in silico study on the role of smooth muscle cell migration in neointimal formation after coronary stenting

    NARCIS (Netherlands)

    Tahir, H.; Niculescu, I.; Bona-Casas, C.; Merks, R.M.H.; Hoekstra, A.G.

    2015-01-01

    Excessive migration and proliferation of smooth muscle cells (SMCs) has been observed as a major factor contributing to the development of in-stent restenosis after coronary stenting. Building upon the results from in vivo experiments, we formulated a hypothesis that the speed of the initial tissue

  2. An in silico study on the role of smooth muscle cell migration in neointimal formation after coronary stenting. Journal of the Royal Society Interface, 12(108), 20150358.

    NARCIS (Netherlands)

    H. Tahir (Hannan); I. Niculescu (Ioana); C. Bona-Casa; R.M.H. Merks (Roeland); A.G. Hoekstra

    2015-01-01

    htmlabstractExcessive migration and proliferation of smooth muscle cells (SMCs) has been observed as a major factor contributing to the development of in-stent restenosis after coronary stenting. Building upon the results from in vivo experiments, we formulated a hypothesis that the speed of the

  3. Clinical outcome after stem cell mobilization with granulocyte-colony-stimulating factor after acute ST-elevation myocardial infarction:

    DEFF Research Database (Denmark)

    Ripa, Rasmus S; Jørgensen, Erik; Kastrup, Jens

    2013-01-01

    Background. Granulocyte-colony-stimulating factor (G-CSF) has been investigated in trials aiming to promote recovery of myocardial function after myocardial infarction. Long-term safety-data have never been reported. A few studies indicated an increased risk of in-stent re-stenosis. We aimed...

  4. Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions

    DEFF Research Database (Denmark)

    Richelsen, Rasmus Kapalu Broge; Overvad, Thure Filskov; Jensen, Svend Eggert

    2016-01-01

    Drug-eluting balloons (DEBs) have emerged as a new application in percutaneous coronary intervention. DEBs have proven successful in the treatment of in-stent restenosis, but their role in de novo lesions is less clear. This paper provides a review of the current studies where DEBs have been used...

  5. Bioresorbable scaffolds in the treatment of coronary artery disease

    NARCIS (Netherlands)

    Y. Zhang (Yaojun); C.V. Bourantas (Christos); V. Farooq (Vasim); T. Muramatsu (Takashi); R. Diletti (Roberto); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick)

    2013-01-01

    textabstractDrug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has

  6. Late presentation for HIV care across Europe

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens; Antinori, Andrea

    2015-01-01

    Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010-2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrollment......) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count HIV diagnosis. Logistic regression investigated changes in LP over time. A total.......02-1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85-0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent....

  7. Late Quaternary vegetation-climate feedbacks

    Directory of Open Access Journals (Sweden)

    M. Claussen*

    2009-06-01

    Full Text Available Feedbacks between vegetation and other components of the climate system are discussed with respect to their influence on climate dynamics during the late Quaternary, i.e., the last glacial-interglacial cycles. When weighting current understanding based on interpretation of palaeobotanic and palaeoclimatic evidence by numerical climate system models, a number of arguments speak in favour of vegetation dynamics being an amplifier of orbital forcing. (a The vegetation-snow albedo feedback in synergy with the sea-ice albedo feedback tends to amplify Northern Hemisphere and global mean temperature changes. (b Variations in the extent of the largest desert on Earth, the Sahara, appear to be amplified by biogeophysical feedback. (c Biogeochemical feedbacks in the climate system in relation to vegetation migration are supposed to be negative on time scales of glacial cycles. However, with respect to changes in global mean temperature, they are presumably weaker than the positive biogeophysical feedbacks.

  8. Assessing Fatigue in Late-Midlife

    DEFF Research Database (Denmark)

    Fieo, Robert A; Mortensen, Erik Lykke; Lund, Rikke

    2014-01-01

    Previous methods examining the Multiple Fatigue Inventory-20 (MFI-20) fatigue questionnaire have been limited to classical test theory, for example, factor analytic approaches. We employed modern test theory to further strengthen the construct validity of the MFI-20 fatigue in a sample of healthy...... late-midlife subjects. Five subdimensions of perceived fatigue were examined in n = 7,233 subjects: general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. Fatigue burden was compared across age groups (aged 48-52 vs. 57-63) and gender. Mokken item response theory...... was used to investigate dimensionality, monotonicity, and invariant item ordering (IIO). In both age groups, as well as by gender, the Motivation domain presented with weak scalability, suggesting that caution be exercised when interpreting sum scores. For all groupings, the strongest scaling properties...

  9. Quantification of virtue in late Medieval Europe.

    Science.gov (United States)

    Kemp, Simon

    2018-02-01

    Fourteenth century Europe saw a growing interest in quantification. This interest has been well studied by historians of physical sciences, but medieval scholars were also interested in the quantification of psychological qualities. In general, the quantification issues addressed by medieval scholars were theoretical, even (by our standards) mathematical, rather than those of practical measurement. There was recognition that the seriousness of a sin and the penance laid down for it should be proportionate. A number of late medieval scholars were interested in the quantification of caritas, a Latin word that is translatable as charity or loving benevolence. The scholastic interest linked to the practical issue of how caritas might become habitual through the repeated performance of virtuous acts. Gregory of Rimini's treatment of caritas in his commentary on Peter Lombard's Sentences illustrates how one medieval scholar related the quantification of virtue to the quantification of physical qualities such as temperature and luminescence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  10. Phylogenetic paleobiogeography of Late Ordovician Laurentian brachiopods

    Directory of Open Access Journals (Sweden)

    Jennifer E. Bauer

    2014-12-01

    Full Text Available Phylogenetic biogeographic analysis of four brachiopod genera was used to uncover large-scale geologic drivers of Late Ordovician biogeographic differentiation in Laurentia. Previously generated phylogenetic hypotheses were converted into area cladograms, ancestral geographic ranges were optimized and speciation events characterized as via dispersal or vicariance, when possible. Area relationships were reconstructed using Lieberman-modified Brooks Parsimony Analysis. The resulting area cladograms indicate tectonic and oceanographic changes were the primary geologic drivers of biogeographic patterns within the focal taxa. The Taconic tectophase contributed to the separation of the Appalachian and Central basins as well as the two midcontinent basins, whereas sea level rise following the Boda Event promoted interbasinal dispersal. Three migration pathways into the Cincinnati Basin were recognized, which supports the multiple pathway hypothesis for the Richmondian Invasion.

  11. MHD energy fluxes for late type dwarfs

    Science.gov (United States)

    Rosner, R.; Musielak, Z. E.

    1987-01-01

    The efficiency of MHD wave generation by turbulent motions in stratified stellar atmospheres with embedded uniform magnetic fields is calculated. In contradiction with previous results, it is shown that there is no significant increase in the efficiency of wave generation because of the presence of magnetic fields, at least within the theory's limits of applicability. It is shown that MHD energy fluxes for late-type stars are less than those obtained for acoustic waves in a magnetic-field-free atmosphere, and do not vary enough for a given spectral type in order to explain observed UV and X-ray fluxes. Thus, the results show that MHD energy fluxes obtained if stellar surface magnetic fields are uniform cannot explain the observed stellar coronal emissions.

  12. The Orient Express and Late Development

    DEFF Research Database (Denmark)

    Schmidt, Johannes Dragsbæk; Hersh, Jacques

    on the victory of liberal democracy and continued US hegemony. The second was the counter-assumption of the thesis of "The Clash of Civilizations" which rejected the harmony interpretation of international relations and which considered the future contradictions and conflicts to be related to cultural......The demise of the Soviet Union, which was celebrated in the Anglosphere as the triumph of US supremacy, gave rise to different paradigmatic interpretations of the evolution of the world. The bulk of the evolving mainstream discourse was agenda-driven and projected a continuation of US hegemony...... decline of the hegemony of the Anglosphere. Understanding the process at work makes it imperative to include the historical perspective. In this context, the growth of China and India as powerhouses in the world political economy cannot be exclusively defined as exemplars of catching-up or late...

  13. Plate tectonics in the late Paleozoic

    Directory of Open Access Journals (Sweden)

    Mathew Domeier

    2014-05-01

    Full Text Available As the chronicle of plate motions through time, paleogeography is fundamental to our understanding of plate tectonics and its role in shaping the geology of the present-day. To properly appreciate the history of tectonics—and its influence on the deep Earth and climate—it is imperative to seek an accurate and global model of paleogeography. However, owing to the incessant loss of oceanic lithosphere through subduction, the paleogeographic reconstruction of ‘full-plates’ (including oceanic lithosphere becomes increasingly challenging with age. Prior to 150 Ma ∼60% of the lithosphere is missing and reconstructions are developed without explicit regard for oceanic lithosphere or plate tectonic principles; in effect, reflecting the earlier mobilistic paradigm of continental drift. Although these ‘continental’ reconstructions have been immensely useful, the next-generation of mantle models requires global plate kinematic descriptions with full-plate reconstructions. Moreover, in disregarding (or only loosely applying plate tectonic rules, continental reconstructions fail to take advantage of a wealth of additional information in the form of practical constraints. Following a series of new developments, both in geodynamic theory and analytical tools, it is now feasible to construct full-plate models that lend themselves to testing by the wider Earth-science community. Such a model is presented here for the late Paleozoic (410–250 Ma together with a review of the underlying data. Although we expect this model to be particularly useful for numerical mantle modeling, we hope that it will also serve as a general framework for understanding late Paleozoic tectonics, one on which future improvements can be built and further tested.

  14. Late-glacial of southern South America

    Science.gov (United States)

    Heusser, C. J.

    Overall trends in late-glacial paleoenvironments of southern South America are interpretable from the pollen stratigraphy of radiocarbon dated sections of mires in Tierra del Fuego (55°S), the Chilotan archipelago (42-43°S), and the Chilean Lake District (39-41°S). In Tierra del Fuego, southern beech ( Nothofagus) and shrub and herb taxa (Gramineae, Empetrum, Acaena, Gunnera, Compositae and Cyperaceae) serve as indicators of the changing climate; in the Chilotan archipelago and in the Chilean Lake District, southern beech and other trees (species of Myrtaceae, Podocarpus, Prumnopitys, Pseudopanax and Weinmannia) suffice as indices of climatic change. Pollen records from each of these regions, although in need of greater dating control, indicate climatic sequences that are broadly similar. The records, however, are not regionally consistent in all aspects and differ in their indicator value with the implication of fossil beetle evidence. Attempts at correlation can be unsatisfactory at times and can stem inter alia from the different ecophysiological responses of both plants and beetles to environmental pressures. These differences, which affect the timing of reproduction and migration, may result in the variable occurrence of different species in the records. The broad implication of the pollen data is that following a glacial readvance culminating at about 15,000-14,500 BP, late-glacial climate was generally warmer during intervals before 13,000 and between 12,000 and 11,000 BP, and was cooler between 13,000 and 12,000 and from 11,000 to 10,000 BP.

  15. Teaching surgery in late Byzantine Alexandria.

    Science.gov (United States)

    Scarborough, John

    2010-01-01

    When one examines Alexandrian commentaries on works of Galen and Hippocrates, disclosed are essential guides to the Art of Medicine as practiced in the late fifth, sixth, and early seventh centuries. These are outlines and contents of a 'medical curriculum' in late Byzantine Alexandria, as well as Ravenna, and thanks to the patient and skilled labors of Dickson,' Duffy,2 Irmer, Palmieri, Pritchet, Westerink, and others, following and building on the pioneering studies of Bräutigam, Meyerhoff, and Temkin, medical historians can now peruse carefully edited Greek and Latin texts and generally reliable translations of some commentaries by Agnellus of Ravenna, John of Alexandria, Palladius, and Stephanus of Athens. Deeply experienced medical practitioners became teachers of would-be medical students in Alexandria and Ravenna. Alexandria had long functioned as a city reputed to be the home of medical instruction, and by ca. 550 or slightly later, teachers began to produce commentaries on the classic texts of Greek and Roman medicine, with Galen and Hippocrates as major authorities. Underpinning what the medical professors set down in their commentaries were extended lives spent in the actual practice of medicine, sometimes as military physicians (as may have been the case of Paul of Aegina in the early seventh century), sometimes as doctors who had gained lengthy experience in Alexandria itself, and sometimes as medical professionals who had emigrated to Egypt after successful careers in another part of the Greek-speaking eastern Roman Empire. Reflecting time as a medical student and later career in Constantinople, Aetius of Amida's Tetrabiblon foreshadows editorial mechanics and techniques of textual exegesis as they emerge more clearly with the medical commentators after 550. It may well be that Stephanus, 'the Philosopher and Physician', was originally from Athens, but whether he was or not, the attribution of an Athenian background suggests that non

  16. Neuropsychological functioning in late-life depression

    Directory of Open Access Journals (Sweden)

    Gro Strømnes Dybedal

    2013-06-01

    Full Text Available Background: The literature describing neurocognitive function in patients with late-life depression (LLD show inconsistent findings in regard to incidence and main deficits. Reduced information processing speed is in some studies found to explain deficits in higher order cognitive function, while other studies report specific deficits in memory and executive function. Our aim was to determine the characteristics of neuropsychological functioning in non-demented LLD patients.Methods; A comprehensive neuropsychological battery was administered to a group of hospitalized LLD patients and healthy control subjects. Thirty-nine patients without dementia, 60 years or older meeting DSM-IV criteria for current episode of major depression, and 18 nondepressed control subjects were included. The patient group was characterized by having a long lasting current depressive episode of late-onset depression and by being non-responders to treatment with antidepressants. Neurocognitive scores were calculated for the domains of information processing speed, verbal memory, visuospatial memory, executive function, and language. Number of impairments (performance below the 10th percentile of the control group per domain for each participant was calculated. Results: Nearly half of the patients had a clinically significant cognitive impairment in at least one neurocognitive domain. Relative to healthy control subjects, LLD patients performed significantly poorer in the domains of information processing speed and executive function. Executive abilities were most frequently impaired in the patient group (39 % of the patients. Even when controlling for differences in processing speed, patients showed more executive deficits than controls. CONCLUSIONS: Controlling for processing speed, patients still showed impaired executive function compared to healthy controls. Reduced executive function thus appears to be the core neurocognitive deficit in LLD. Executive function seems

  17. Gratkorn - A new late Middle Miocene vertebrate fauna from Styria (Late Sarmatian, Austria)

    Science.gov (United States)

    Gross, M.; Böhme, M.; Prieto, J.

    2009-04-01

    Integrated stratigraphic approaches provide precise correlations of global standard stages with regional Paratethys stages. Nevertheless, higher resolution stratigraphic matching of terrestrial deposits remains challenging due to the lack of a practical continental biostratigraphy. The mostly used tool for biostratigraphic correlation of non-marine deposits in the Old World is still the concept of Neogene Mammal-zones (MN-zones). However, at higher biostratigraphic resolution (reptiles (scincids, lacertids, gekkonids, anguids, varanids, colubrids, testudinids, emydids), birds (coliiformes), rodents and lagomorphs (cricetids, glirids, eomyids, sciurids, castorids), insectivores and chiropterans (erinaceids, soricids, talpids), and large mammals (suids, tragulids, moschids, cervids, ?palaeomerycids, equids, chalicotheriids, rhinos, proboscidians, carnivors). Litho- and biostratigraphy (terrestrial gastropods) as well as magnetostratigraphic data and the sequence stratigraphic and geodynamic frame indicate an age of 12-12.2 Ma (early Late Sarmatian s.str., chron 5An.1n) for the locality. Therefore, Gratkorn is one of richest and most complete fauna of the late Middle Miocene of Central Europe and will be confidentially one of the key faunas for a high-resolution continental biostratigraphy and the comprehension of the faunal succession and interchanges near the Middle/Late Miocene transition. Acknowledgements This is a preliminary overview of the Gratkorn vertebrate fauna. Several taxa are still under investigation. We are especially grateful to Gudrun Daxner-Höck, Ursula Göhlich (both Natural History Museum Vienna) and Getrud Rössner (University of Munich) for their comments to the rodents, ruminants, proboscidians and bird remains. References Böhme, M., Ilg, A., Winklhofer, M. 2008. Late Miocene "washhouse" climate in Europe.- Earth and Planetary Science Letters, 275: 393-401. Gross, M., 2008. A limnic ostracod fauna from the surroundings of the Central

  18. Late injury of cancer therapy on the female reproductive tract

    International Nuclear Information System (INIS)

    Grigsby, Perry W.; Russell, Anthony; Bruner, Deborah; Eifel, Patricia; Koh, Wui-Jin; Spanos, William; Stetz, Joann; Stitt, Judith Anne; Sullivan, Jessie

    1995-01-01

    The purpose of this article is to review the late effects of cancer therapy on the female reproductive tract. The anatomic sites detailed are the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. The available pathophysiology is discussed. Clinical syndromes are presented. Tolerance doses of irradiation for late effects are rarely presented in the literature and are reviewed where available. Management strategies for surgical, radiotherapeutic, and chemotherapeutic late effects are discussed. Endpoints for evaluation of therapeutic late effects have been formulated utilizing the symptoms, objective, management, and analytic (SOMA) format. Late effects on the female reproductive tract from cancer therapy should be recognized and managed appropriately. A grading system for these effects is presented. Endpoints for late effects and tolls for the evaluation need to be further developed

  19. Impact of childhood experience of famine on late life health.

    Science.gov (United States)

    Woo, J; Leung, J C S; Wong, S Y S

    2010-02-01

    This study examines whether experience of famine during late childhood affect late life health. Cross sectional cohort survey carried out from 2001-2004. Community in Hong Kong. 1,906 men and 1,826 women aged >or= 65 years living in the community. We examined the impact of experience of famine during late childhood, defined as caloric restriction for at least one year, on body mass index, body composition using DEXA, grip strength, walking speed and stride length, blood pressure, and ankle-brachial index,using logistic regression adjusting for various co-variates (age, lifestyle, socioeconomic factors). Participants who had been exposed to a period of undernutrition in late childhood were shorter, had higher body mass index (BMI) and appendicular lean mass/height2, higher prevalence of recurrent falls, higher prevalence of myocardial infarct, arthritis and back pain. Late childhood undernutrition has some adverse impact on late life health and functional outcomes.

  20. Maternal and fetal factors observed with late preterm births

    OpenAIRE

    Madhusudan Dey; Raju Agarwal; Devkalyan Maji; Uttara A. Kohli

    2015-01-01

    Backround: Although neonatal morbidity and mortality rates are fallen in recent decades, the prevalence of preterm deliveries has increased especially late preterm births. Late preterm deliveries are at increased risk of various neonatal complications compared to term deliveries. This study was carried out to identify the maternal characteristics and co-morbidites found with late preterm births and feto-maternal outcome in terms of indication of delivery, route of delivery, Apgar score and...

  1. Paradoxical physiological transitions from aging to late life in Drosophila.

    Science.gov (United States)

    Shahrestani, Parvin; Quach, Julie; Mueller, Laurence D; Rose, Michael R

    2012-02-01

    In a variety of organisms, adulthood is divided into aging and late life, where aging is a period of exponentially increasing mortality rates and late life is a period of roughly plateaued mortality rates. In this study we used ∼57,600 Drosophila melanogaster from six replicate populations to examine the physiological transitions from aging to late life in four functional characters that decline during aging: desiccation resistance, starvation resistance, time spent in motion, and negative geotaxis. Time spent in motion and desiccation resistance declined less quickly in late life compared to their patterns of decline during aging. Negative geotaxis declined at a faster rate in late life compared to its rate of decline during aging. These results yield two key findings: (1) Late-life physiology is distinct from the physiology of aging, in that there is not simply a continuation of the physiological trends which characterize aging; and (2) late life physiology is complex, in that physiological characters vary with respect to their stabilization, deceleration, or acceleration in the transition from aging to late life. These findings imply that a correct understanding of adulthood requires identifying and appropriately characterizing physiology during properly delimited late-life periods as well as aging periods.

  2. Late Spring Freezes in Poland in Relation to Atmospheric Circulation

    Directory of Open Access Journals (Sweden)

    Ustrnul Zbigniew

    2014-09-01

    Full Text Available Late spring freeze events, a significant agroclimatic hazard, are investigated for Poland. Daily minimum air temperatures from 184 stations for the period 1951-2010 were used to analyze the frequency and conditional probability of late spring freezes. In addition, three classification schemes were employed to investigate the atmospheric circulation responsible for late spring freezes events. The findings suggest that knowledge of the airflow influencing late spring freezes can help to understand the complex historical trends and projected future changes in freeze risk for perennial crops

  3. Late style as exile: De/colonising the life course.

    Science.gov (United States)

    Hartung, Heike

    2016-12-01

    In the collection of essays On Late Style, Edward Said reflects on the new idiom achieved by great artists in their work near the end of their lives as "late style." Drawing on Adorno's essay on Beethoven's late style, Said also focuses on the aesthetic aspects of lateness. Defining the late works of artists as "a form of exile," however, Said moves beyond Adorno's aesthetic conception of late style. Highlighting the artist's abandonment of communication with the established social order, who achieves a contradictory, alienated relationship with it instead, Said compares artistic lateness with the experience of the subject in exile. Drawing on the analogy provided by Said, this article argues that the relationship between "self" and "other" in the different theoretical contexts of Postcolonial Studies and Age Studies can be usefully combined in the composite concept of "late style as exile." In order to explore how the concept of lateness correlates with that of exile, this contribution turns to theoretical and autobiographical texts by Edward Said. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Activation of Baculovirus Very Late Promoters by Interaction with Very Late Factor 1

    Science.gov (United States)

    Yang, Song; Miller, Lois K.

    1999-01-01

    Very late factor 1 (VLF-1) of Autographa californica multicapsid nuclear polyhedrosis virus (AcMNPV) activates the transcription of two genes, polyhedrin (polh) and p10, during the final, occlusion-specific phase of infection. Using transient expression assays responsive to VLF-1, we identified linker scan mutations in the polh and p10 promoters which abolished or weakened the ability of the promoters to respond to stimulation by VLF-1. These mutations were located between the transcriptional and translational initiation sites, a region previously shown to be essential for the burst of expression during the very late phase. Addition of partially purified, epitope-tagged VLF-1 to DNA encompassing this “burst sequence” resulted in a shift in the gel electrophoretic mobility of the DNA, indicating that VLF-1 forms a complex with DNA. Addition of an antibody specific for the epitope tag of VLF-1 decreased the mobility of the DNA further, confirming the presence of VLF-1 in the complex. DNase I footprint assays revealed that VLF-1 partially purified from either insect cells or bacterial cells interacted with the burst sequences of both the polh and p10 very-late promoters. Linker scan mutations within the burst sequences severely impaired interaction between VLF-1 and the promoters. We propose that VLF-1 transactivates the polh and p10 promoters by interacting with the burst sequences. PMID:10074194

  5. Cerebral NIRS patterns in late preterm and very preterm infants becoming late preterm.

    Science.gov (United States)

    Grometto, Alice; Pizzo, Benedetta; Strozzi, Maria Chiara; Gazzolo, Francesca; Gazzolo, Diego

    2017-11-20

    Near Infrared Spectroscopy (NIRS) has been proposed as a useful, noninvasive monitoring technique providing reliable information about central nervous system (CNS) oximetry and function. Recently, brain damage has been reconsidered as a dynamic process evolving over the weeks of gestation. We therefore investigated NIRS cerebral pattern differences between healthy late preterm infants (LPTo) and very preterm infants becoming late preterm (LPT). We conducted an observational study in 40 healthy late preterm infants, matched for gestational age at monitoring, of whom 20 where LPTo and 20 LPT. Clinical, diagnostic and laboratory monitoring procedures and cerebral oximetry (crSO 2 ) and function (cFTOE) were recorded on admission into the study. No significant differences (p > .05, for all) were found between groups regarding clinical, diagnostic or laboratory parameters. Higher crSO 2 and lower cFTOE (p preterm infants becoming LPT. Future studies correlating NIRS variables and long-term neurological outcome in LPT are needed to elucidate the concept of dynamic brain damage pathogenesis.

  6. Surfactant therapy in late preterm infants

    Directory of Open Access Journals (Sweden)

    Murat Yurdakök

    2013-06-01

    Full Text Available Late preterm (LPT neonates are at a high risk for respiratory distress soon after birth due to respiratory distress syndrome (RDS, transient tachypnea of the newborn, persistent pulmonary hypertension, and pneumonia along with an increased need for surfactant replacement therapy, continuous positive airway pressure, and ventilator support when compared with the term neonates. In the past, studies on outcomes of infants with respiratory distress have primarily focused on extremely premature infants, leading to a gap in knowledge and understanding of the developmental biology and mechanism of pulmonary diseases in LPT neonates. Surfactant deficiency is the most frequent etiology of RDS in very preterm and moderately preterm infants, while cesarean section and lung infection play major roles in RDS development in LPT infants. The clinical presentation and the response to surfactant therapy in LPT infants may be different than that seen in very preterm infants. Incidence of pneumonia and occurrence of pneumothorax are significantly higher in LPT and term infants. High rates of pneumonia in these infants may result in direct injury to the type II alveolar cells of the lung with decreasing synthesis, release, and processing of surfactant. Increased permeability of the alveolar capillary membrane to both fluid and solutes is known to result in entry of plasma proteins into the alveolar hypophase, further inhibiting the surface properties of surfactant. However, the oxygenation index value do not change dramatically after ventilation or surfactant administration in LPT infants with RDS compared to very preterm infants. These finding may indicate a different pathogenesis of RDS in late preterm and term infants. In conclusion, surfactant therapy may be of significant benefit in LPT infants with serious respiratory failure secondary to a number of insults. However, optimal timing and dose of administration are not so clear in this group. Additional

  7. Late accretion to the terrestrial planets

    Science.gov (United States)

    Brasser, Ramon; Mojzsis, Stephen; Werner, Stephanie; Matsumura, Soko; Ida, Shigeru

    2017-10-01

    IntroductionIt is generally accepted that silicate-metal (`rocky') planet formation relies on coagulation from a mixture of sub-Mars sized planetary embryos and (smaller) planetesimals that dynamically emerge from the evolving circum-solar disc in the first few million years of our Solar System. Once the planets have, for the most part, assembled after a giant impact phase, they continue to be bombarded by a multitude of planetesimals left over from accretion. Here we place limits on the mass and evolution of these planetesimals based on constraints from the highly siderophile element (HSE) budget of the Moon. The terrestrial and lunar HSE budgets indicate that Earth’s and Moon’s additions through late accretion were 0.7 wt% and 0.02 wt% respectively. The disproportionate high accretion between the Earth and Moon could be explained by stochastic accretion of a few remaining Ceres-sized bodies that preferentially targeted the Earth.ResultsFrom a combination of N-body and Monte Carlo simulations of planet formation we conclude:1) matching the terrestrial to lunar HSE ratio requires that late accretion on Earth mostly consisted of a single lunar-size impactor striking the Earth before 4.45 Ga2) the flux of terrestrial impactors must have been low avoid wholesale melting of Earth's crust after 4.4 Ga[6], and to simultaneously match the number of observed lunar basins3) after the terrestrial planets have fully formed, the mass in remnant planetesimals was ~0.001 Earth mass, lower than most previous models suggest.4) Mars' HSE budget also requires a colossal impact with a Ceres-sized object before 4.43 Ga, whose visible remnant could be the hemispherical dichotomy.These conclusions lead to an Hadean eon which is more clement than assumed previously. In addition, our dynamically and geochemically self-consistent scenario requires that future N-body simulations of rocky planet formation either directly incorporate collisional grinding or rely on pebble accretion.

  8. Floral responses to the Late Paleozoic deglaciation

    Science.gov (United States)

    Looy, C. V.; DiMichele, W. A.

    2011-12-01

    The current human-induced thawing of ice house Earth prompts the careful examination of similar earlier events and their biotic consequences. The most recent full transition from a cool earth to a warm world took place in the Early to Middle Permian. Against a background of global warming, plant communities were affected globally resulting in migrations, extinctions and changed evolutionary patterns as a response to the environmental changes. The collapse of the southern hemisphere ice-sheets resulted in significant changes, not just at higher latitudes, but also in the tropics where the rainfall regime changed from seasonally dry to seasonally wet. In the Early Permian tropics - in areas where net sedimentation facilitates fossilization, to be more specific - vegetation rich in walchian conifers began to replace the spore plants and seed ferns that previously dominated the Late Pennsylvanian wetlands. The replacing drier floras probably lived in the basinal lowlands as well, but episodically at the drier times of climate cycles. New finds within the tropics of latest Early to Middle Permian-age, in particular from north-central Texas, indicate the existence of floras which were adapted to even more extended periods of drought. These were populated by the more derived voltzian conifers and other seed plants, such as cycads. Surprisingly, the clades in these floras were until recently only known from the tens-of-millions-of-years younger Late Permian and Early Mesozoic, where they were the dominant forms. These occurrences demonstrate that even more derived groups were already in existence and well differentiated by the Early Permian, outside the window of preservation. This pattern of change in conifers and their communities from north-central Texas is unique in that it represents the best documented record in the Phanerozoic of terrestrial ecosystem response to a change from a global cool-mode to warm-mode Earth. Conifers serve as "marker plants" for the

  9. Oral piercings: immediate and late complications.

    Science.gov (United States)

    Vieira, Elma P; Ribeiro, Andre Luis Ribeiro; Pinheiro, João de Jesus V; Alves, Sérgio de M

    2011-12-01

    Oral piercings have a long history as part of religious, cultural, or sexual symbolism in many traditional tribes; currently, these ornaments have wide acceptance among young people. Several oral and systemic complications may be associated with this practice; however, limited data related to these complications can be obtained in the literature. This study includes 42 cases of oral piercings in 39 young adults, who were using or had used oral piercings, and the complications associated with their use. Immediate complications occurred in 29 cases, including excessive bleeding (69%) and pain (52.3%) as the most representative. Two cases of syncope were found. Late complications related to the piercing insertion site were observed in 97.6% of cases, with pain and swelling being present in 92.9% and 61.9% of cases, respectively. Dental pain and lacerations on the tongue represented the most prevalent complications associated with the surrounding tissues, accounting for 33.3% and 31% of cases. The use of oral piercings is related to a series of mainly local complications, and individuals who decide to use piercings should be aware of such complications. Individuals wishing to get a part of their body pierced should do so with qualified professionals and should regularly visit the dentist so that a regular control is achieved, thus ensuring the early detection of the adverse effects associated with this practice. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Review Essay: Governmentality in Late Colonial Korea?

    Directory of Open Access Journals (Sweden)

    Henry Em

    2012-12-01

    Full Text Available Takashi Fujitani, Race for Empire: Koreans as Japanese and Japanese as Americans during World War II. Berkeley: University of California Press, 2011. 520 pp. $65 (cloth.Jun Uchida, Brokers of Empire: Japanese Settler Colonialism in Korea, 1876-1945. Cambridge, MA: Harvard University Press, 2011. 500 pp. $50 (cloth.In South Korea, more so than in most other postcolonial countries, the issue of sovereignty and the colonial past remains a central feature of politics. Most recently, during a televised presidential debate on December 4, 2012, Lee Jung-hee of the Unified Progressive Party said something that likely had never been said on South Korean television: “Takaki Masao signed an oath of loyalty [to the Emperor of Japan], in his own blood, to become an officer in the Japanese [Imperial] Army. You know who he is. His Korean name is Park Chung Hee.” Lee Jung-hee then made the connection between that colonial past and the willingness to sell out the nation’s sovereignty in the present. The conservative candidate Park Geun-hye, the daughter of the late President Park Chung Hee who ruled South Korea from 1961 through 1979, and members of Park’s Saenuri Party, remain true to their “roots”: these “descendants of pro-Japanese collaborators and dictators” (again sold out South Korea’s sovereignty (on November 22, 2011 when they rammed the US-ROK Free Trade Agreement through the National Assembly.

  11. Musical Training and Late-Life Cognition.

    Science.gov (United States)

    Gooding, Lori F; Abner, Erin L; Jicha, Gregory A; Kryscio, Richard J; Schmitt, Fredrick A

    2014-06-01

    This study investigated the effects of early- to midlife musical training on cognition in older adults. A musical training survey examined self-reported musical experience and objective knowledge in 237 cognitively intact participants. Responses were classified into low-, medium-, and high-knowledge groups. Linear mixed models compared the groups' longitudinal performance on the Animal Naming Test (ANT; semantic verbal fluency) and Logical Memory Story A Immediate Recall (LMI; episodic memory) controlling for baseline age, time since baseline, education, sex, and full-scale IQ. Results indicate that high-knowledge participants had significantly higher LMI scores at baseline and over time compared to low-knowledge participants. The ANT scores did not differ among the groups. Ability to read music was associated with higher mean scores for both ANT and LMI over time. Early- to midlife musical training may be associated with improved late-life episodic and semantic memory as well as a useful marker of cognitive reserve. © The Author(s) 2013.

  12. Late Holocene rainforest disturbance in French Guiana.

    Science.gov (United States)

    Ledru, M -P.

    2001-06-01

    Palm swamp forest sediments collected in French Guiana provide new data about late Holocene rainforest. Two cores were collected in 'Les Nouragues' ecological station (4 degrees 05'N, 52 degrees 40'W). The lithology shows two different types of sediment, organic peat in the upper part and oxidized clay with low organic content and lacking pollen in the lower part, both separated by a gravel horizon. Radiocarbon dates show that this gravel horizon could have been deposited between 4500 and 3000yrBP. Pollen analysis carried out on the organic sediments record rainforest disturbances between ca 1520-1380 and 1060-860cal yrBP suggested by the presence of the pioneer tree species Cecropia together with other shade intolerant genera. Cecropia is recorded for a period that lasts between 660 and 320 years. This abnormal duration for presence of a pioneer species in rainforest is explained by brief and repeated changes in the composition of the canopy asssociated to perturbations of the palm swamp.

  13. Postprandial dysmetabolism: Too early or too late?

    Science.gov (United States)

    Pappas, Christos; Kandaraki, Eleni A; Tsirona, Sofia; Kountouras, Dimitrios; Kassi, Georgia; Diamanti-Kandarakis, Evanthia

    2016-07-01

    Postprandial dysmetabolism is a postprandial state characterized by abnormal metabolism of glucose and lipids and, more specifically, of elevated levels of glucose and triglyceride (TG) containing lipoproteins. Since there is evidence that postprandial dysmetabolism is associated with increased cardiovascular mortality and morbidity, due to macro- and microvascular complications, as well as with conditions such as polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD), it is recommended that clinicians be alert for early detection and management of this condition. Management consists of a holistic approach including dietary modification, exercise and use of hypoglycemic and hypolipidemic medication aiming to decrease the postprandial values of circulating glucose and triglycerides. This review aims to explain glucose and lipid homeostasis and the impact of postprandial dysmetabolism on the cardiovascular system as well as to offer suggestions with regard to the therapeutic approach for this entity. However, more trials are required to prevent or reverse early and not too late the actual tissue damage due to postprandial dysmetabolism.

  14. Trade and Transport in Late Roman Syria

    Science.gov (United States)

    Fletcher, Christopher

    Despite the relative notoriety and miraculous level of preservation of the Dead Cities of Syria, fundamental questions of economic and subsistence viability remain unanswered. In the 1950s Georges Tchalenko theorized that these sites relied on intensive olive monoculture to mass export olive oil to urban centers. Later excavations discovered widespread cultivation of grains, fruit, and beans which directly contradicted Tchalenko's assertion of sole reliance on oleoculture. However, innumerable olive presses in and around the Dead Cities still speak to a strong tradition of olive production. This thesis tests the logistical viability of olive oil transportation from the Dead Cities to the distant urban centers of Antioch and Apamea. Utilization of Raster GIS and remote sensing data allows for the reconstruction of the physical and social landscapes of Late Roman Syria. Least Cost Analysis techniques produce a quantitative and testable model with which to simulate and evaluate the viability of long distance olive oil trade. This model not only provides a clearer understanding of the nature of long distance trade relationships in Syria, but also provides a model for investigating ancient economic systems elsewhere in the world. Furthermore, this project allows for the generation of new information regarding sites that are currently inaccessible to researchers.

  15. Queer theory, late capitalism, and internalized homophobia.

    Science.gov (United States)

    Kirsch, Max

    2006-01-01

    The emergence of queer theory represents a transformation in the approach to lesbian, gay, bisexual and transgendered peoples. It has claimed new ground for treating sexuality and gender as worthy subjects in their own rights, rather than offshoots of gay and lesbian studies or of general cultural theory. The author contends, however, that it is doubtful that this approach can lead to social change. Queer theory has dismissed the usefulness of the disciplines that were the foundation of the social movements that initiated gay and lesbian studies, such as political economy, and in doing so, it has surreptitiously mirrored the social relations of reproduction that constitute late capitalism. This mirroring has had unseen consequences for the individual in society, and with queer theory's insistence on the relativity of experience and the dismissal of identity, has set the stage for a benign reinforcement of internalized homophobia. The author argues that this approach can be mediated by recognizing that identity is fluid, and that by focusing on identifying with social movements rather than centering analyses on the problems associated with identifying as a particular category of status and being, we can refocus our energies on the building and maintenance of mutual support and collective recognition that can lead to resolving the stagnation now dominating attempts to develop coalitions around issues that matter.

  16. History of Late-Notice HIEs

    Science.gov (United States)

    Frakes, P.

    2016-01-01

    Question was raised: are we seeing more late-notice events in recent months? Two definitions oflate-notice used to compare data: Event has at least one data point between TCA-4 days and TCA-2 days where the Pcwas below 1E-7, OR there were no data points in that timeframe. Event has at least one data point between TCA-2days and TCA where the Pc was at least 1E-4Event has at least one data point between TCA-4 days and TCA-2 dayswhere the Pc was below 1E-5, OR there were no data points in that timeframe. Event has at least one data pointbetween TCA-2 days and TCA where the Pc was at least 1E-4. The case studies that were examined all fall within criteriafor both definitions Terra vs 38192; TCA 24 JUN 2015Aura vs 89477; TCA 29 AUG 2015Terra vs 37131; TCA 19 DEC2015GPM vs 28685; TCA 5 SEP 2015.

  17. Late neuro endocrinological sequelae of radiation therapy

    International Nuclear Information System (INIS)

    Bieri, S.; Bernier, J.; Sklar, C.; Constine, L.

    1997-01-01

    When the hypothalamic-pituitary axis (HPA) is included in the treatment field in children and adults, a variety of neuroendocrine disturbances are more common than has been appreciated in the past. Clinical damage to the pituitary and thyroid glands usually occurs months to years after treatment, and is preceded by a long subclinical phase. Primary brain tumors represent the largest group of malignant solid tumors in children. The survival rates of 50 reported in the literature are achieved at the expense of late occurring effects. Radiation-induced abnormalities are generally dose-dependent. Growth hormone deficiency and premature sexual development can occur at doses as low as 18 Gy in conventional fractionation, and is the most common neuroendocrine problem in children. In patients treated with > 40 Gy on the HPA, deficiency of gonadotropins, thyroid stimulation hormone, and adrenocorticotropin (> 50 Gy), hyperprolactinemia can be seen, especially among young women. Most neuroendocrine disturbances that develop as a result of HPA can be treated efficiently, provided that an early detection of these endocrine dysfunctions abnormalities is done. (authors)

  18. Post-Traumatic Late Onset Cerebral Ischemia

    Directory of Open Access Journals (Sweden)

    Gencer Genc

    2014-03-01

    Full Text Available Artery-to-artery emboli or occlusion of craniocervical arteries mostly due to dissection are the most common causes of ischemia after trauma. A 29 year-old male had been admitted to another hospital with loss of consciousness lasting for about 45 minutes after a hard parachute landing without head trauma three days ago. As his neurological examination and brain CT were normal, he had been discharged after 24 hours of observation. Two days after his discharge, he was admitted to our department with epileptic seizure. His neurological examination revealed left hemianopia. After observing occipital subacute ischemia at right side in brain magnetic resonance imaging (MRI, we performed cerebral angiography and no dissection was observed. Excluding the rheumatologic, cardiologic and vascular events, our final diagnosis was late onset cerebral ischemia. Anti-edema and antiepileptic treatment was initiated. He was discharged with left hemianopia and mild cognitive deficit. We suggest that it will be wise to hospitalize patients for at least 72 hours who has a history of unconsciousness following trauma.

  19. [Late respiratory function complications following burns].

    Science.gov (United States)

    Ernesto, S; Marduel, Y; Freymond, N; Pacheco, Y; Devouassoux, G

    2008-03-01

    Twenty five per cent of thermal injuries are associated with secondary respiratory events linked to several mechanisms. In the acute phase of the accident oedema of the airways, the fume inhalation syndrome and ARDS are the most common causes responsible for death in 60% of cases. Late respiratory complications are little known and neglected. They comprise obstructive ventilatory defects due to the inhalation syndrome and restrictive defects secondary to ARDS or to dermal injury. We report the case of a female patient, extensively burnt 2 years previously, admitted to hospital with severe acute respiratory failure complicating COPD. The presence of both restrictive and obstructive defects led to the suggestion of alternative underlying mechanisms such as the pulmonary consequences of ARDS and extensive dermal scars. The latter were responsible for an armour like thickening of the skin of the thorax compatible with the restrictive defect. These functional abnormalities and the potential severity of acute respiratory failure are indications for regular pulmonary follow-up of patients with severe circumferential scarring of the thorax who are at high risk for respiratory complications.

  20. Compton Composites Late in the Early Universe

    Directory of Open Access Journals (Sweden)

    Frederick Mayer

    2014-07-01

    Full Text Available Beginning roughly two hundred years after the big-bang, a tresino phase transition generated Compton-scale composite particles and converted most of the ordinary plasma baryons into new forms of dark matter. Our model consists of ordinary electrons and protons that have been bound into mostly undetectable forms. This picture provides an explanation of the composition and history of ordinary to dark matter conversion starting with, and maintaining, a critical density Universe. The tresino phase transition started the conversion of ordinary matter plasma into tresino-proton pairs prior to the the recombination era. We derive the appropriate Saha–Boltzmann equilibrium to determine the plasma composition throughout the phase transition and later. The baryon population is shown to be quickly modified from ordinary matter plasma prior to the transition to a small amount of ordinary matter and a much larger amount of dark matter after the transition. We describe the tresino phase transition and the origin, quantity and evolution of the dark matter as it takes place from late in the early Universe until the present.

  1. Late effects of total body irradiation

    International Nuclear Information System (INIS)

    Barrett, A.; Gibson, B.

    1987-01-01

    Late effects of chemo-radiotherapy conditioning before bone marrow transplantation (BMT) are being increasingly recognised in long-term survivors, particularly children. They can be divided into two categories: those affecting hormonal status and those affecting specific organ function. All women treated develop ovarian failure with low levels of β-oestradiol and raised values of follicle-stimulating hormone (FSH) and leutinizing hormone (LH). In males, raised FSH and LH values are found with normal testosterone levels but most patients have azoospermia. In children, puberty is usually but not invariably delayed by treatment but can be induced by appropriate hormone replacement. Compensated hypothyroidism was found in 6/30 children. Growth hormone secretion may be impaired especially if previous cranial irradiation has been given. In children, a reduction in sitting height has been observed. Cataract has occurred in 20% of children between 3 and 6 years after treatment. Two second tumours have been observed. No other major organ toxicities have been encountered. (Auth.)

  2. Pragmatic Functions of Toddlers Who Are Late Talkers

    Science.gov (United States)

    MacRoy-Higgins, Michelle; Kaufman, Ilana

    2012-01-01

    Toddlers who are "late talkers" demonstrate reduced expressive vocabulary in the absence of physical, social, cognitive, or sensory impairment; they are usually identified at age 2, when they produce fewer than 50 words and do not combine words (Rescorla, 1989). This study analyzed spontaneous language samples of 10 late talking toddlers and 11…

  3. Malignant diseases at Nnewi: the continuing scourge of late ...

    African Journals Online (AJOL)

    Poverty and illiteracy on the part of the patients, as well as deceit of patients by quacks contribute significantly to these late presentations. Missed diagnosis by some doctors is also contributory. To decrease these late presentations, efforts should be directed at improving the general literacy level and the financial capability ...

  4. 38 CFR 36.4212 - Interest rates and late charges.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Interest rates and late... Site Preparation General Provisions § 36.4212 Interest rates and late charges. (a) In guaranteeing or... interest at a rate that is agreed upon by the veteran and the lender, or bear interest at a rate not in...

  5. Late Globalization and Evolution and Metamorphoses of Industries

    DEFF Research Database (Denmark)

    Boujarzadeh, Behnam; Turcan, Romeo V.; Dholakia, Nikhilesh

    2016-01-01

    In this paper we explore the effect of late globalization on evolution of industries. Specifically we investigate the impact of late globalization on the evolution and metamorphoses of Danish Textile and Fashion Industry (DTFI). Using historical data, we survey the development of DTFI between 1945...

  6. The Early vs. Late Infantile Strabismus Surgery Study: Monitoring Report

    NARCIS (Netherlands)

    H.J. Simonsz (Huib)

    1995-01-01

    textabstractAbstract: The Early vs. Late Infantile Strabismus Surgery Study Group is a group of strabismologists and orthoptists who investigate whether early or late surgery is preferable in infantile strabismus, in a non-randomized, prospective, multi-center trial. Infants between six and 18

  7. Late Career Decision-Making: A Qualitative Panel Study

    NARCIS (Netherlands)

    Wilmar Schaufeli; Annet de Lange; Juhani Ilmarinen; Per Erik Solem; Trude Furunes; Reidar Mykletun; Astri Syse

    2015-01-01

    The aim of this longitudinal qualitative interview study (3 waves of interviews) was to examine the nature of older workers’ late career decision-making processes, including the main drivers and obstacles for prolonging working life or retiring. Late career decision-making is regarded as a process

  8. Prevalence and associated factors of late HIV diagnosis in north ...

    African Journals Online (AJOL)

    Information regarding age, sex, WHO stage, type of opportunistic condition, HIV testing service and on diagnosis CD4 counts were all collected. On diagnosis CD4 counts <200cells/µl was coded as Late HIV diagnosis. The proportion of with Late HIV diagnosis was calculated and logistic regression modal was used to ...

  9. Late Cretaceous neosuchian crocodiles from the Sultanate of Oman

    NARCIS (Netherlands)

    Buscalioni, Angela D.; Schulp, Anne S.; Jagt, John W M; Hanna, Samir S.; Hartman, Axel Frans

    Two apparently new crocodilian taxa from the Late Cretaceous (Late Campanian-Maastrichtian) Al-Khod Conglomerate of the Sultanate of Oman are described. The fragmentary state of preservation precludes formal naming, yet enables comparisons to be made with other taxa. One is a short-snouted

  10. Morphology and Syntax in Late Talkers at Age 5

    Science.gov (United States)

    Rescorla, Leslie; Turner, Hannah L.

    2015-01-01

    Purpose: This study reports age 5 morphology and syntax skills in late talkers identified at age 2 (n = 34) and typically developing comparison children (n = 20). Results: The late talkers manifested significant morphological delays at ages 3 and 4 relative to comparison peers. Based on the 14 morphemes analyzed at age 5, the only significant…

  11. Role of Solanum dulcamara L. in Potato Late Blight Epidemiology

    NARCIS (Netherlands)

    Golas, T.M.; Weerden, van der G.M.; Berg, van den R.G.; Mariani, C.; Allefs, J.J.H.M.

    2010-01-01

    Four sites with naturally growing Solanum dulcamara were surveyed during 2006 and 2007 for the presence of late blight. Despite 2 years of observations, no late blight was detected among natural populations of bittersweet. Nevertheless, repeated infections occurred on few S. dulcamara plants from a

  12. Coping and Late-Deafness: An Examination of Two Measures

    Science.gov (United States)

    Meyer, Jill M.; Kashubeck-West, Susan

    2015-01-01

    Purpose: To examine the psychometric properties of two measures of coping in a sample of individuals with acquired hearing loss, specifically late-deafness. Methods: Using a quantitative descriptive design, coping of participants (N = 277) with late-deafness was measured to examine the reliability and validity of the Ways of Coping Questionnaire…

  13. Late-Treated Phenylketonuria and Partial Reversibility of Intellectual Impairment

    Science.gov (United States)

    Grosse, Scott D.

    2010-01-01

    Individuals with late-treated phenylketonuria (PKU) not detected by newborn screening but who followed dietary treatment for at least 12 months before 7 years of age have intelligence quotient (IQ) scores that range from severe impairment to the low-normal range. Among adults with late-treated PKU in California, 85% of those who were born from…

  14. The 2009 late blight pandemic in eastern USA

    Science.gov (United States)

    The tomato late blight pandemic of 2009 made late blight into a household term in much of the eastern United States. Many home gardeners and organic producers lost most, if not all, of their tomato crop, and their experiences were reported in the mainstream press. This article, which is written for ...

  15. Heterogeneity of late-life depression : relationship with cognitive functioning

    NARCIS (Netherlands)

    Korten, Nicole C. M.; Penninx, Brenda W. J. H.; Kok, Rob M.; Stek, Max L.; Oude Voshaar, Richard; Deeg, Dorly J. H.; Comijs, Hannie C.

    Background: Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains. Methods: Cross-sectional data of

  16. Heterogeneity of late-life depression : relationship with cognitive functioning

    NARCIS (Netherlands)

    Korten, Nicole C M; Penninx, Brenda W J H; Kok, Rob M; Stek, Max L; Oude Voshaar, Richard C; Deeg, Dorly J H; Comijs, Hannie C

    BACKGROUND: Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains. METHODS: Cross-sectional data of

  17. Apathy in early and late-life depression

    NARCIS (Netherlands)

    Groeneweg-Koolhoven, Isis; Ploeg, Merel; Comijs, Hannie C; Penninx, Brenda WJH; van der Mast, Roos C; Schoevers, Robert A; Rhebergen, Didi; Exel, Eric van

    2017-01-01

    Background: Late-life depression is thought to differ in clinical presentation from early-life depression. Particularly, late-life depression is considered to be more characterized by apathy than is early-life depression. Lacking convincing evidence, this study examines the presence and associated

  18. Attention and Word Learning in Toddlers Who Are Late Talkers

    Science.gov (United States)

    MacRoy-Higgins, Michelle; Montemarano, Elizabeth A.

    2016-01-01

    The purpose of this study was to examine attention allocation in toddlers who were late talkers and toddlers with typical language development while they were engaged in a word-learning task in order to determine if differences exist. Two-year-olds who were late talkers (11) and typically developing toddlers (11) were taught twelve novel…

  19. SPECT and PET in Late-Life Depression

    NARCIS (Netherlands)

    Vieira, Tiago S; Oude Voshaar, Richard; De Deyn, Peter; Dierckx, Rudi; van Waarde, Aren; Dierckx, Rudi AJO; Otte, Andreas; de Vries, Erik FJ; van Waarde, Aren; den Boer, Johan A

    2014-01-01

    Late-life late onset depression (i.e., depression with an age of onset above 60 yrs) appears to differ from depression with early onset in its association with cerebral small vessel disease, beta-amyloid and tau deposition, and neurodegenerative processes. Multimodality imaging (SPECT, PET, MRI)

  20. Differential Parenting between Mothers and Fathers: Implications for Late Adolescents

    Science.gov (United States)

    McKinney, Cliff; Renk, Kimberly

    2008-01-01

    Although the relationship between parenting and outcomes for children and adolescents has been examined, differences between maternal and paternal parenting styles have received less attention, particularly in the case of late adolescents. As a result, this article examines the relationship between late adolescents' perceptions of their mothers'…

  1. A Multilevel Analysis of Late Entry in Nigeria

    Science.gov (United States)

    Delprato, Marcos; Sabates, Ricardo

    2015-01-01

    This paper explores how factors operating at the state and community levels are associated with the prevalence of late school enrolment in Nigeria. We investigate the following three research themes. First, whether late entry varies across states and across communities and how much of this variation can be explained by the composition of…

  2. The Effect of Late Registration for College Classes

    Science.gov (United States)

    Safer, Alan M.

    2009-01-01

    Objective: To assess the outcome of late registration for college classes and early class withdrawal. Method: Computerized 2007-9 school record data on 7,200 college students were analyzed to evaluate the effect of late class registration on the class grade--relative to the average class grade--and on class withdrawal. Assessed by multiple…

  3. The Relationship between Late Registration and Student Persistence and Achievement.

    Science.gov (United States)

    Angelo, Daniel T.

    1990-01-01

    A study of late registration among community college students (n=almost 39,000 class registrations) found that late registrants were more likely to complete courses than those who registered in a timely fashion, and there was no appreciable difference in the two groups' academic performance. (MSE)

  4. Family and Individual Predictors of Late Adolescents' Romantic Relationships.

    Science.gov (United States)

    Reese-Weber, Marla; Marchand, Jennifer F.

    2002-01-01

    Studied parent-adolescent conflict and late adolescents' attachment anxiety and depressive symptoms as predictors of late adolescents' romantic relationships. Findings based on questionnaire responses of 256 college students highlight the differential roles of familial and individual attributes in female and male adolescents' romantic relationship…

  5. Etiology and electroclinical pattern of late onset epilepsy in Ibadan ...

    African Journals Online (AJOL)

    Late onset epilepsy (LOE) is a common neurological problem throughout the world. It is an area that has not been fully explored in the developing countries like Nigeria. The aim of the present study is to determine the pattern of presentation of late onset epilepsy with the view to identifying the etiologic as well as describe ...

  6. Research and clinical aspects of the late effects of poliomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Halstead, L.S.; Wiechers, D.O.

    1986-01-01

    This book contains 32 selections. Some of the titles are: Late effects of Polio: Historical Perspectives; Sleep-Disordered Breathing as a Late Effect of Poliomyelitis; Clinical Subtypes, DNA Repair Efficiency, and Therapeutic Trials in the Post-Polio Syndromes; and Post-Polio Muscle Function.

  7. Reactions of some potato genotypes to late blight in Cameroon ...

    African Journals Online (AJOL)

    ... evaluate reactions of different potato genotypes to late blight. There were significant differences among genotypes for tuber yield, late blight readings and earliness. The application of fungicides significantly increased potato yield but had a non significant effect on the damage due to foliage blight (Phytophthora infestans).

  8. Late post-operative hypoxaemia and organ dysfunction

    DEFF Research Database (Denmark)

    Kehlet, H; Rosenberg, J

    1995-01-01

    an adverse effect of tissue hypoxia on wound healing and on resistance to bacterial wound infections. Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore...

  9. Late Quaternary stratigraphic development in the lower Luni, Mahi ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Earth System Science; Volume 113; Issue 3. Late Quaternary stratigraphic development in the lower Luni, Mahi and Sabarmati river basins, western India. M Jain S K ... Keywords. Late Quaternary; lithofacies; luminescence chronology; stratigraphic correlation; fluvial response; climate change.

  10. Interpersonal influences on late adolescent girls' and boys' disordered eating.

    Science.gov (United States)

    Shomaker, Lauren B; Furman, Wyndol

    2009-04-01

    Perceived socio-cultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Most prospective studies included only girls, and less is known about the influence on boys. This study investigated interpersonal influences on changes in late adolescent boys' and girls' symptoms of disordered eating over one year. Participants were a community sample of late adolescents 16-19 years of age (N=199; 49.75% girls), their mothers, and friends. Structural equation modeling revealed that interpersonal pressure to be thin and criticism about appearance predicted increases in disordered eating over time. Late adolescents', mothers' and friends' reports of pressure were associated with disordered eating at Time 1 and Time 2. Further, adolescents' perceptions and friends' reports of pressure to be thin predicted changes in disordered eating over time. Findings underscore the significance of interpersonal relationships for disordered eating during late adolescence in both girls and boys.

  11. Late presentation of HIV infection: a consensus definition

    DEFF Research Database (Denmark)

    Antinori, A; Coenen, T; Costagiola, D

    2010-01-01

    of what is meant by a 'late-presenting' patient. Results Two definitions were agreed upon, as follows. Late presentation: persons presenting for care with a CD4 count below 350 cells/muL or presenting with an AIDS-defining event, regardless of the CD4 cell count. Presentation with advanced HIV disease...... clinical definition of late presentation. The objective of this article is to present a consensus definition of late presentation of HIV infection. Methods Over the past year, two initiatives have moved towards a harmonized definition. In spring 2009, they joined efforts to identify a common definition...... able to implement this definition (either on its own or alongside their own preferred definition) when reporting surveillance or research data relating to late presentation of HIV infection....

  12. The benefits of drug-eluting stents in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Kiramijyan S

    2016-03-01

    Full Text Available Sarkis Kiramijyan,1 Ming W Liu2 1Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 2Heart and Vascular Care Center, White Memorial Medical Center, Los Angeles, CA, USA Abstract: The advent of coronary stents has been a landmark development in the treatment of coronary artery disease with percutaneous coronary intervention. Initial percutaneous treatment using balloon angioplasty alone had limited clinical efficacy due to immediate vascular elastic recoil and dissection, in addition to late negative vascular remodeling and neointimal hyperplasia. With the introduction of coronary stents, initially bare-metal stents (BMS, the problems of dissection and negative remodeling due to injury in addition to vascular elastic recoil were eliminated; however, neointimal hyperplasia remained an ongoing obstacle in the long-term efficacy of stents. Neointimal hyperplasia resulted in in-stent restenosis in 20%–30% of cases after intervention with BMS, which led to high rates of target lesion revascularization. Subsequently, drug-eluting stents (DES were introduced, which had the added advantage of releasing an anti-proliferative drug from the stent to reduce the neointimal proliferation, thus resulting in the reduction of the rates of in-stent restenosis. Although the first-generation DES had significantly improved outcomes over its predecessor, the BMS, several challenges including stent thrombosis and delayed endothelialization of the stent remained. The second-generation DES have been significantly improved over their first-generation predecessors in regard to efficacy and safety, ie, improved long-term outcomes and significant reductions in stent thrombosis. The duration of dual antiplatelet therapy after DES has also been studied extensively in multiple large trials. A newer generation of stents, including those with bioresorbable polymers, polymer-free, and fully bioresorbable scaffolds is still in the early

  13. Three comments on late antiquity history

    Directory of Open Access Journals (Sweden)

    Milin Milena L.

    2003-01-01

    Full Text Available The author suggests corrections in reading the inscription CIL III 4002 lines 3-7 (see pp. 1-2. The formula q(ui vixit ann(os, lines 3-4, was common in Late Antiquity, unlike the previous reading...ann(orum, which was typical for the Early Empire. L.5 memoria frequently appeared in funerary monuments in Late Antiquity. L. 6 Instead of unlikely collegae, the complement colloc(avit or –erunt has been suggested, according to analogies sedem conlocasse (Siscia, CIL 3996 sepulcrum (! collocavit, with the Christogram ( Siscia,CIL 3996a. The inscription can be more precisely dated with regard to the Christogram. In nearby Sirmium, this symbol repeatedly appears in epitaphs, whether unaccompanied, or between the letters a and w. According to a dated inscription with a Christogram from Constantius times the entire group of inscriptions bearing this symbol may be supposed to have originated from mid-, or, at the latest, second half of 4th century (notes 2-4. Durostoranus (Amm. Marc. XXXI 15, 6 In the paragraph referred to above: Verum introire non ausus, qui missus est, per Christianum quendam portatis scriptis et recitatis, utque decebat, contemptatis parandis operibus dies et nox omnis absumpta (ed. W.Seyfarth, Leipzig 1978, the author instead of the reading to date, christianum, suggests the restitution of the Codex lection Vat. lat. 1873 diristanum, which would be the adjective derived from the toponym D(iristra, a variant of Durostorus, cf. Zonara (XVI 12 e/n Dorosto$lw...toy#to d h% Dri$stra e/sti. Further on, (...scriptis et recitatis, utque dicebat, contemptatis, parandis operibus dies et nox omnis absumpta, two differently noted or emendated points are present. The one is ut dicebat, in a later manuscript, and in Seyfarth's critical edition changed into ut decebat. This emendation is not necessary: the emissary said that he had taken the letter and given the message that was ignored by the inhabitants, and not "given the message as was

  14. Late Pleistocene geomagnetic excursion in Icelandic lavas

    International Nuclear Information System (INIS)

    Levi, S.; Audunsson, H.; Duncan, R.A.; Kristjansson, L.; Jakobsson, S.P.

    1990-01-01

    In 1980 Kristjansson and Gudmundsson reported a late glacial geomagnetic excursion in three hills in the Reykjanes peninsula, Iceland, with shallow negative inclinations and westerly declinations. They named it the Skalamaelifell excursion. More extensive field work has identified the same excursional paleomagnetic direction (declination = 258deg, inclination = -15deg) at four additional outcrops in a 10x10 km area in the Reykjanes peninsula. The excursion lavas are olivine tholeiites with similar petrography and chemical compositions. Paleointensity determinations by the Thellier method average 4.2±0.2 μT for 8 samples, more than an order of magnitude weaker than the present geomagnetic field in Iceland. Together, these results suggest extrusion of the excursion lavas in a very brief span of time, probably less than a few hundred years. K-Ar dating of the excursion lavas gives a mean age for 19 determinations of 42.9±7.8 ka (2σ). Compilation of thirty K-Ar ages of the Laschamp and Olby flows by three laboratories yield a new age for the Laschamp excursion in France of 46.6±2.4 ka (2σ). The age of the excursion in southwestern Iceland is statistically indistinguishable from the Laschamp excursion at the 95% confidence level, and both have very low paleointensities. Therefore, we suggest that the Laschamp and Olby flows in France and the Skalamaelifell units of Iceland recorded essentially the same geomagnetic excursion. Differences in the virtual paleomagnetic poles (VGPs) of these excursions may be due to (1) the probable non-dipole character of the geomagnetic field during the excursion, (2) rapid geomagnetic secular variation and possible small age differences of the extrusive rocks in France and Iceland, and/or (3) crustal magnetic anomalies which might dominate the local geomagnetic field during the excursion at either or both locations. (orig.)

  15. Late renal function after upper abdominal irradiation

    International Nuclear Information System (INIS)

    Morris, Monica M.; Willett, Christopher G.

    1997-01-01

    Purpose: This study assesses the late renal function and complications following upper abdominal irradiation. Methods and Materials: Eighty-six adult patients were identified who were treated with curative intent to the upper abdomen, received greater than 50% unilateral kidney irradiation to doses of at least 26 Gy, and survived for 1 year or more. Following treatment, the clinical course, blood pressure, addition of anti-hypertensive medications, serum creatinine and creatinine clearance were determined. Creatinine clearance was calculated by the formula: creatinine clearance equals [(140 - age) x (weight in kilograms)] / (72 x serum creatinine), which has a close correlation to creatinine clearances measured by 24 hour urine measurement. The percent change in creatinine clearance from pre-treatment values was analyzed. Mean follow-up was 6.7 years. Seventeen patients were followed for 11 or more years. Results: Of the 16 patients with pre-radiotherapy hypertension, eight required an increase in the number of medications for control and eight required no change in medication. Twenty-one patients developed hypertension in follow-up, 15 of whom required no medication. One patient developed malignant hypertension on the basis of renal artery stenosis. Acute or chronic renal failure was not observed in any patient. The serum creatinine for all 86 patients prior to irradiation was below 2 mg/100 ml; in follow-up it rose to between 2-3 mg/100 ml in five patients. On univariate analysis, older patient age, female sex, pre-existing hypertension and initially abnormal renal function (creatinine clearance <90mg/ml) were significantly correlated with later poor creatinine clearance (<50 mg/ml). Conclusions: After significant unilateral kidney irradiation, patients demonstrated a laboratory trend to increased creatinine and decreased creatinine clearance. With long-term follow-up, these physiologic changes did not appear to translate into a clinically relevant alteration in

  16. The terrestrial record of Late Heavy Bombardment

    Science.gov (United States)

    Lowe, Donald R.; Byerly, Gary R.

    2018-04-01

    Until recently, the known impact record of the early Solar System lay exclusively on the surfaces of the Moon, Mars, and other bodies where it has not been erased by later weathering, erosion, impact gardening, and/or tectonism. Study of the cratered surfaces of these bodies led to the concept of the Late Heavy Bombardment (LHB), an interval from about 4.1 to 3.8 billion years ago (Ga) during which the surfaces of the planets and moons in the inner Solar System were subject to unusually high rates of bombardment followed by a decline to present low impact rates by about 3.5 Ga. Over the past 30 years, however, it has become apparent that there is a terrestrial record of large impacts from at least 3.47 to 3.22 Ga and from 2.63 to 2.49 Ga. The present paper explores the earlier of these impact records, providing details about the nature of the 8 known ejecta layers that constitute the evidence for large terrestrial impacts during the earlier of these intervals, the inferred size of the impactors, and the potential effects of these impacts on crustal development and life. The existence of this record implies that LHB did not end abruptly at 3.8-3.7 Ga but rather that high impact rates, either continuous or as impact clusters, persisted until at least the close of the Archean at 2.5 Ga. It implies that the shift from external, impact-related controls on the long-term development of the surface system on the Earth to more internal, geodynamic controls may have occurred much later in geologic history than has been supposed previously.

  17. Suicide and euthanasia in late life.

    Science.gov (United States)

    De Leo, Diego; Spathonis, Kym

    2003-04-01

    Epidemiological studies of suicide in the elderly indicate that, in the last few decades, there has been a relevant increase in suicide rates in old age in a number of Asian and Latin nations, with an almost parallel decrease in Anglo-Saxon counties. Mental disorders, particularly depression, physical illness, personality traits such as hostility, hopelessness, the inability to verbally express psychological pain and dependency on others, recent life events and losses are all factors that may contribute to suicide in later life. Compared with suicide in other age groups, mors voluntaris in late life is associated with the use of highly lethal methods, less ambivalence and impulsivity, and more determination and intent to die. Accordingly, elderly suicidal individuals are more likely than younger subjects to complete rather than attempt suicide. Some evidence suggests also that the characteristics of elderly individuals who attempt suicide may not overlap with those who complete suicide. Death thoughts and suicidal ideations are relatively rare among mentally healthy elderly adults, and are less predominant in this age bracket. However, whether elderly suicidal behaviour exists along a continuum, progressing in severity from death thoughts and suicidal ideation to suicide attempts and completed suicide, remains unclear. Assisted suicide and euthanasia in the elderly have been associated with the desire to escape chronic physical pain and suffering caused by terminal illness, and to relieve mental anguish and feelings of hopelessness, depression and extreme "tiredness of life." The role of the family and those treating chronically ill members is crucial in the final stages of life, particularly when autonomy and the ability of the elderly individual to make end-of-life decisions are compromised. The main aspects associated with these controversial phenomena, particularly from a transcultural perspective, are reviewed in this article.

  18. Late Pleistocene dune activity in the central Great Plains, USA

    Science.gov (United States)

    Mason, J.A.; Swinehart, J.B.; Hanson, P.R.; Loope, D.B.; Goble, R.J.; Miao, X.; Schmeisser, R.L.

    2011-01-01

    Stabilized dunes of the central Great Plains, especially the megabarchans and large barchanoid ridges of the Nebraska Sand Hills, provide dramatic evidence of late Quaternary environmental change. Episodic Holocene dune activity in this region is now well-documented, but Late Pleistocene dune mobility has remained poorly documented, despite early interpretations of the Sand Hills dunes as Pleistocene relicts. New optically stimulated luminescence (OSL) ages from drill cores and outcrops provide evidence of Late Pleistocene dune activity at sites distributed across the central Great Plains. In addition, Late Pleistocene eolian sands deposited at 20-25 ka are interbedded with loess south of the Sand Hills. Several of the large dunes sampled in the Sand Hills clearly contain a substantial core of Late Pleistocene sand; thus, they had developed by the Late Pleistocene and were fully mobile at that time, although substantial sand deposition and extensive longitudinal dune construction occurred during the Holocene. Many of the Late Pleistocene OSL ages fall between 17 and 14 ka, but it is likely that these ages represent only the later part of a longer period of dune construction and migration. At several sites, significant Late Pleistocene or Holocene large-dune migration also probably occurred after the time represented by the Pleistocene OSL ages. Sedimentary structures in Late Pleistocene eolian sand and the forms of large dunes potentially constructed in the Late Pleistocene both indicate sand transport dominated by northerly to westerly winds, consistent with Late Pleistocene loess transport directions. Numerical modeling of the climate of the Last Glacial Maximum has often yielded mean monthly surface winds southwest of the Laurentide Ice Sheet that are consistent with this geologic evidence, despite strengthened anticyclonic circulation over the ice sheet. Mobility of large dunes during the Late Pleistocene on the central Great Plains may have been the result of

  19. Diabetes mellitus: a predictor for late radiation morbidity

    International Nuclear Information System (INIS)

    Herold, David M.; Hanlon, Alexandra L.; Hanks, Gerald E.

    1999-01-01

    Purpose: Given the high frequency of diabetes, as well as prostate cancer in the elderly population, we sought to determine whether diabetic patients treated with three-dimensional conformal external-beam radiotherapy (3DCRT) had an increased risk of late gastrointestinal (GI) or genitourinary (GU) complications. Methods and Materials: Nine-hundred forty-four prostate cancer patients were treated between April 1989 and October 1996 using 3DCRT. Median patient age was 69 years (range 48-89), median center of prostate dose was 7211 cGy (range 6211-8074) and median follow-up was 36 months (range 2-99). Patients were evaluated every 6 months with digital rectal examinations, serum PSAs and symptom questionnaires. Radiation morbidity was quantified using Radiation Therapy Oncology Group (RTOG) and modified Late Effects Normal Tissue Task Force (LENT) scales. Patients with a preexisting history of either Type I or Type II diabetes mellitus were coded as diabetics. Results: One hundred twenty-one patients had diabetes (13% of total). Rates of acute morbidity did not differ between diabetics and nondiabetics; however, diabetics experienced significantly more late grade 2 GI toxicity (28% vs. 17%, p = 0.011) and late grade 2 GU toxicity (14% vs. 6%, p 0.001). There was a trend toward increased late grade 3 and 4 GI complications in diabetics, but not for late grade 3 and 4 GU complications; however, the total number of recorded events for these categories was small. Examining the onset of late toxicity, diabetics developed GU complications earlier than nondiabetics (median: 10 months vs. 24 months, p = 0.02). Considering age, dose, rectal blocking, field size, and history of diabetes in a stepwise multivariate regression model for late grade 2 GI toxicity, dose (p 0.0001), diabetes (p = 0.0110), and rectal blocking (p = 0.0163) emerged independently predictive for complications. For late grade 2 GU toxicity, only the presence of diabetes remained independently significant

  20. IVUS Findings in Late and Very Late Stent Thrombosis. A Comparison Between Bare-metal and Drug-eluting Stents.

    Science.gov (United States)

    Fuentes, Lara; Gómez-Lara, Josep; Salvatella, Neus; Gonzalo, Nieves; Hernández-Hernández, Felipe; Fernández-Nofrerias, Eduard; Sánchez-Recalde, Ángel; Alfonso, Fernando; Romaguera, Rafael; Ferreiro, José Luis; Roura, Gerard; Teruel, Luis; Gracida, Montserrat; Marcano, Ana Lucrecia; Gómez-Hospital, Joan-Antoni; Cequier, Ángel

    2017-09-01

    Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year). Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis. The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60). Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Late Pennsylvanian climate changes and palynomorph extinctions

    Science.gov (United States)

    Kosanke, R.M.; Cecil, C.B.

    1996-01-01

    A major floral change occurs in the Upper Pennsylvanian strata in the Midcontinent, Illinois basin, and in the northern Appalachian basin of eastern United States. Lycospora spp. (derived from arborescent lycopsids) became extinct along with some other palynomorph taxa. This investigation is concerned with the importance of this major floral change. Samples were studied from western Pennsylvania, eastern Ohio, and West Virginia (from a previous study) cover the stratigraphic interval from the Upper Freeport coal bed, uppermost part of the Allegheny Formation, to the Mahoning, Mason, Brush Creek, Wilgus, and Anderson coal beds in the lower part of the Conemaugh Formation. The floral change occurs either at or below the accepted Desmoinesian-Missourian boundary in the Midcontinent and Illinois basin, whereas in the northern Appalachians this change occurs in the lower part of the Conemaugh Formation, between the Mahoning and Brush Creek coal beds, or when the Mason is present, between the Mahoning and Mason coal beds. With the advent of late Middle Pennsylvanian time, the climate began to change from wet tropical to seasonal tropical. The Middle-Upper Pennsylvanian boundary is the culmination of this drying trend, which was marked by reduction of available water. The peat swamps are interpreted as having changed from the domed type of bog to the planar type under these circumstances. Thus, in general, the coals of the Conemaugh Formation are characteristically much thinner than those of the Allegheny Formation. This was caused by a number of factors including reduced or more seasonal rainfall, decline of arborescent lycopsids, and the increased dominance of herbaceous and fern plants. As a result, there are fewer minable coal beds in the Conemaugh Formation. The first coal bed above the extinction of Lycospora spp. is dominated by the palynomorph taxon Endosporites globiformis which is derived from a heterosporous, herbaceous lycopsid. However, Sigillaria, another

  2. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  3. Late post-operative hypoxaemia and organ dysfunction

    DEFF Research Database (Denmark)

    Kehlet, H; Rosenberg, J

    1995-01-01

    Constant and episodic hypoxaemia are common after major operations in the late post-operative period in the surgical ward. Recent studies have shown that hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias. Experimental and clinical studies have demonstrated...... an adverse effect of tissue hypoxia on wound healing and on resistance to bacterial wound infections. Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore...

  4. Diurnal phase of late-night against late-afternoon of stratiform and convective precipitation in summer southern contiguous China

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Rucong [Chinese Academy of Sciences, LASG, Institute of Atmospheric Physics, Beijing (China); China Meteorological Administration, LaSW, Chinese Academy of Meteorological Sciences, Beijing (China); Yuan, Weihua [Chinese Academy of Sciences, LASG, Institute of Atmospheric Physics, Beijing (China); Graduate School of the Chinese Academy of Sciences, Beijing (China); Li, Jian [China Meteorological Administration, LaSW, Chinese Academy of Meteorological Sciences, Beijing (China); Fu, Yunfei [Chinese Academy of Sciences, LASG, Institute of Atmospheric Physics, Beijing (China); University of Science and Technology of China, Laboratory of Satellite Remote Sensing and Climate Environment, Hefei, Anhui (China)

    2010-09-15

    Using the tropical rainfall measuring mission (TRMM) Precipitation Radar (PR) observations combined with the surface rain gauge data during 1998-2006, the robust diurnal features of summer stratiform and convective precipitation over the southern contiguous China are revealed by exploring the diurnal variations of rain rate and precipitation profile. The precipitation over the southern contiguous China exhibits two distinguishing diurnal phases: late-night (2200-0600 LST) and late-afternoon (1400-2200 LST), dependent on the location, precipitation type and duration time. Generally, the maximum rain rate and the highest profile of stratiform precipitation occur in the late-afternoon (late-night) over the southeastern (southwestern) China, while most of the stratiform short-duration rain rate tends to present late-afternoon peaks over the southern China. For convective precipitation, the maximum rain rate and the highest profile occur in the late-afternoon over most of the southern contiguous China, while the convective long-duration rain rate exhibits late-night peaks over the southwestern China. Without regional dependence, the convective precipitation exhibits much larger amplitude of diurnal variations in both near surface rain rate and vertical extension compared with stratiform precipitation and the convective rain top rises most rapidly between noon and afternoon. However, there are two distinctive sub-regions. The diurnal phases of precipitation there are very weakly dependent on precipitation type and duration time. Over the eastern periphery of the Tibetan Plateau, the maximum rain rate and the highest profile of either convective or stratiform precipitation occur in the late-night. Over the southeastern coastal regions, both the near surface rain rate and rain top of convective and stratiform precipitation peak in the late-afternoon. (orig.)

  5. Late-replicating CNVs as a source of new genes

    Directory of Open Access Journals (Sweden)

    David Juan

    2013-11-01

    Asynchronous replication of the genome has been associated with different rates of point mutation and copy number variation (CNV in human populations. Here, our aim was to investigate whether the bias in the generation of CNV that is associated with DNA replication timing might have conditioned the birth of new protein-coding genes during evolution. We show that genes that were duplicated during primate evolution are more commonly found among the human genes located in late-replicating CNV regions. We traced the relationship between replication timing and the evolutionary age of duplicated genes. Strikingly, we found that there is a significant enrichment of evolutionary younger duplicates in late-replicating regions of the human and mouse genome. Indeed, the presence of duplicates in late-replicating regions gradually decreases as the evolutionary time since duplication extends. Our results suggest that the accumulation of recent duplications in late-replicating CNV regions is an active process influencing genome evolution.

  6. NIH Blood and Marrow Transplant Late Effects Consensus Conference

    Science.gov (United States)

    This day and a half symposium will bring together experts in blood and marrow transplantation, late effects, and health care delivery to discuss current evidence and knowledge gaps, develop consensus guidelines, and inform future research in the BMT survivor population.

  7. Iconography and Costume from the Late Iron Age in Scandinavia

    DEFF Research Database (Denmark)

    Mannering, Ulla

    2008-01-01

    In this paper, new ways of interpreting and evaluating costume are introduced through the analysis of iconographic sources, among others gold sheets from the Late Iron Age in Scandinavia. These sources provide information about prehistoric attitudes towards body and dress....

  8. Observations of the late superhump in VW Hydri

    International Nuclear Information System (INIS)

    Van Der Woerd, H.; Van Der Klis, M.; Van Paradijs, J.; Beuermann, K.; Motch, C.

    1988-01-01

    This paper presents the results of simultaneous optical and near-IR photometry, optical fast spectroscopy, and Exosat X-ray observations of the dwarf nova VW Hyi, obtained simultaneously during three consecutive orbital cycles, approximately two days after the 1983 November superoutburst terminated. The optical data show clear evidence for a late superhump, which is shifted + 0.7 in phase relative to the orbital modulation. An attempt is made to derive from the observed spectral distribution the contribution of the late superhump. The orbital hump and the late superhump apparently are not related to each other. This important effect excludes all models, in which the late superhump phenomenon is interpreted in terms of variations in the bright-spot brightness. 43 references

  9. Toward late career transitioning: a proposal for academic surgeons.

    Science.gov (United States)

    Richards, Robin; McLeod, Robin; Latter, David; Keshavjee, Shaf; Rotstein, Ori; Fehlings, Michael G; Ahmed, Najma; Nathens, Avery; Rutka, James

    2017-09-01

    In the absence of a defined retirement age, academic surgeons need to develop plans for transition as they approach the end of their academic surgical careers. The development of a plan for late career transition represents an opportunity for departments of surgery across Canada to initiate a constructive process in cooperation with the key stakeholders in the hospital or institution. The goal of the process is to develop an individual plan for each faculty member that is agreeable to the academic surgeon; informs the surgical leadership; and allows the late career surgeon, the hospital, the division and the department to make plans for the future. In this commentary, the literature on the science of aging is reviewed as it pertains to surgeons, and guidelines for late career transition planning are shared. It is hoped that these guidelines will be of some value to academic programs and surgeons across the country as late career transition models are developed and adopted.

  10. Surgical interventions for late ocular complications of relapsing polychondritis

    Directory of Open Access Journals (Sweden)

    Yuan He

    2017-04-01

    Conclusions and importance: The present case of relapsing polychondritis is the first to be reported wherein late ocular complications were alleviated by surgical interventions. Routine use of corticosteroids is necessary for successful anti-glaucoma and phacoemulsification operations.

  11. Late Archean Surface Ocean Oxygenation (Invited)

    Science.gov (United States)

    Kendall, B.; Reinhard, C.; Lyons, T. W.; Kaufman, A. J.; Anbar, A. D.

    2009-12-01

    Oxygenic photosynthesis must have evolved by 2.45-2.32 Ga, when atmospheric oxygen abundances first rose above 0.001% present atmospheric level (Great Oxidation Event; GOE). Biomarker evidence for a time lag between the evolution of cyanobacterial oxygenic photosynthesis and the GOE continues to be debated. Geochemical signatures from sedimentary rocks (redox-sensitive trace metal abundances, sedimentary Fe geochemistry, and S isotopes) represent an alternative tool for tracing the history of Earth surface oxygenation. Integrated high-resolution chemostratigraphic profiles through the 2.5 Ga Mt. McRae Shale (Pilbara Craton, Western Australia) suggest a ‘whiff’ of oxygen in the surface environment at least 50 M.y. prior to the GOE. However, the geochemical data from the Mt. McRae Shale does not uniquely constrain the presence or extent of Late Archean ocean oxygenation. Here, we present high-resolution chemostratigraphic profiles from 2.6-2.5 Ga black shales (upper Campbellrand Subgroup, Kaapvaal Craton, South Africa) that provide the earliest direct evidence for an oxygenated ocean water column. On the slope beneath the Campbellrand - Malmani carbonate platform (Nauga Formation), a mildly oxygenated water column (highly reactive iron to total iron ratios [FeHR/FeT] ≤ 0.4) was underlain by oxidizing sediments (low Re and Mo abundances) or mildly reducing sediments (high Re but low Mo abundances). After drowning of the carbonate platform (Klein Naute Formation), the local bottom waters became anoxic (FeHR/FeT > 0.4) and intermittently sulphidic (pyrite iron to highly reactive iron ratios [FePY/FeHR] > 0.8), conducive to enrichment of both Re and Mo in sediments, followed by anoxic and Fe2+-rich (ferruginous) conditions (high FeT, FePY/FeHR near 0). Widespread surface ocean oxygenation is suggested by Re enrichment in the broadly correlative Klein Naute Formation and Mt. McRae Shale, deposited ~1000 km apart in the Griqualand West and Hamersley basins

  12. Patriarch Ephrem: A late medieval saintly cult

    Directory of Open Access Journals (Sweden)

    Popović Danica

    2006-01-01

    Full Text Available Patriarch Ephrem, monk and hermit, writer and saint, Bulgarian-born but twice the leader of the Serbian Church (1375-78 and 1389-92, is an outstanding figure of the late medieval Balkans. His "life and works" are discussed here in the light of hagiological texts and the information provided by various types of sources with the view to drawing some historically relevant conclusions. The main source of information about Ephrem's life and activity are the eulogies, Life and service composed by bishop Mark, his disciple and loyal follower for twenty-three years. Making use of hagiographical topica combined with plentiful data of undoubted documentary value, he relates the story of Ephrem's life through all of its major stages: from his birth and youth to his withdrawal from the world and taking of a monk's habit. Of formative influence were his years on the Holy Mount Athos, where he experienced different styles of monastic life, coenobitic, as well as solitary, which he practiced in the well-known hermitages in the heights of Athos. The further course of Ephrem's life was decided by the turbulent developments in the Balkans brought about by the Ottoman conquests. In that sense, his biography, full of forced and voluntary resettlements, is a true expression of the spirit of the times. Forced to flee Mount Athos, Ephrem made a short stay in Bulgaria and then, about 1347, came to Serbia, where he spent the rest of his life. An eminent representative of the monastic elite and under the aegis of the Serbian patriarch, he spent ten years in a hesychastria of the Monastery of Decani. For reasons of security, he then moved to a cave hermitage founded specially for him in the vicinity of the Patriarchate of Pec. It was in that cell, where he lived for twenty years powerfully influencing the monastic environment, that his literary work profoundly marked by hesychast thought and eschatology, was created. Ephrem twice accepted the office of patriarch in the

  13. Iron deficiency anemia in late-preterm infants.

    Science.gov (United States)

    Ozdemir, Hülya; Akman, Ipek; Demirel, Utku; Coşkun, Senay; Bilgen, Hülya; Ozek, Eren

    2013-01-01

    Iron deficiency anemia is a common problem in newborn infants. The American Academy of Pediatrics recommends iron prophylaxis at 4 months of age for term infants. There is no specific recommendation for iron prophylaxis in late-preterm infants. We aimed to establish the optimum time for iron prophylaxis in late-preterm infants. Thirty-eight late-preterm (Group 1) and 38 term (Group 2) infants born on the same day were enrolled in the study. Hemoglobin, ferritin and reticulocyte values at birth, 2nd month and 4th month were assessed. The cord ferritin, hemoglobin and reticulocyte levels did not differ significantly between groups. However, at the 2nd month, median ferritin and hemoglobin values were lower in late-preterm infants than term infants (145 mg/dl vs. 195 mg/dl, p=0.001 and 10.1 g/dl vs. 11.6 g/dl, pinfants than term infants, but this difference was not significant after exclusion of three late- preterm infants who required iron therapy (49 mg/dl vs. 62 mg/dl, p=0.2). There was a tendency of higher frequency of anemia in late-preterm infants at 4 months (42.8% vs. 21.1%), but this was statistically insignificant (p=0.07). At the 2nd month of age, the median ferritin and hemoglobin levels of late-preterm infants were lower than those of term infants. Further studies with larger sample sizes are required to determine the need for earlier supplementation of iron in late-preterm infants.

  14. Early and late synovectomy of the knee in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Jensen, C M; Poulsen, S; Ostergren, M

    1991-01-01

    was reduced and range of motion was unchanged. Total knee alloplasty (TKA) was performed in one knee among the patients who underwent early synovectomy, while reoperation with TKA had been performed in 12 out of 28 knees after late synovectomy. It is concluded that early synovectomy is indicated when medical...... treatment has failed. Late synovectomy must be regarded as a palliative procedure in order to postpone TKA....

  15. Geochronology of Type Uquian (Late Cenozoic) Land Mammal Age, Argentina

    Science.gov (United States)

    Marshall, Larry G.; Butler, Robert F.; Drake, Robert E.; Curtis, Garniss H.

    1982-05-01

    Mammal faunas collected from the Uquia Formation at Chucalezna and Esquina Blanca in Jujuy Province, northwest Argentina, are calibrated by potassium-argon age determinations and paleomagnetic polarity data. The sediments range in age from 2.5 million years old to perhaps as young as 1.5 million years, from late Pliocene through early Pleistocene, and correspond in time to late Blancan and early Irvingtonian land mammal age faunas in North America.

  16. Psychiatry: life events and social support in late life depression

    Directory of Open Access Journals (Sweden)

    Clóvis Alexandrino-Silva

    2011-01-01

    Full Text Available OBJECTIVES: To examine the association of life events and social support in the broadly defined category of depression in late life. INTRODUCTION: Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil. METHODS: We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. ''Old age symptomatic depression'' was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed ''late subthreshold depression''. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE inventory. RESULTS: ''Old age symptomatic depression'' occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, ''old age symptomatic depression'' was associated with a perceived lack of social support in men and life events in women. DISCUSSION: Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance. CONCLUSIONS: We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.

  17. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten.

    Science.gov (United States)

    Shah, Prachi; Kaciroti, Niko; Richards, Blair; Oh, Wonjung; Lumeng, Julie C

    2016-08-01

    To compare developmental outcomes of late preterm infants (34-36 weeks' gestation) with infants born at early term (37-38 weeks' gestation) and term (39-41 weeks' gestation), from infancy through kindergarten. Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form-Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P kindergarten reading (P = .0007) compared with infants born at term gestation. Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten. Copyright © 2016 by the American Academy of Pediatrics.

  18. Late and very-late first-contact schizophrenia and the risk of dementia--a nationwide register based study

    DEFF Research Database (Denmark)

    Kørner, Alex; Lopez, Ana Garcia; Lauritzen, Lise

    2009-01-01

    OBJECTIVE: To examine whether late and very-late first-contact schizophrenia carry a risk for later development of dementia. METHODS: By linkage of the psychiatric and the somatic nation-wide registers of all out- and in-patients with hospital contact in Denmark, we identified all patients...... with first ever contact during the period from January 1994 to December 2001 with one of the index main diagnoses: late (age >or=40) and very-late first-contact (age >or=60) schizophrenia. First contact osteoarthritis patients as well as data on the general population were used as controls. The first...... diagnosis of dementia for each individual at discharge or at out-patient contact was established. The probability of getting a dementia diagnosis is estimated using Poisson regression models with dementia as the outcome of interest. RESULTS: Twelve thousand six hundred and sixteen and 7,712 individuals were...

  19. Time-dependent 3D simulations of the hemodynamics in a stented coronary artery

    International Nuclear Information System (INIS)

    Faik, Isam; Mongrain, Rosaire; Leask, Richard L; Rodes-Cabau, Josep; Larose, Eric; Bertrand, Olivier

    2007-01-01

    Stenting is becoming the major interventional cardiology procedure worldwide. However restenosis remains a major limitation to the effectiveness of stents. Alterations to the local hemodynamics in the stented segment of the artery could be a potential factor in the development of in-stent restenosis. The characterization of wall shear stress and of blood flow patterns in a stented artery is therefore necessary for a good understanding of the role of hemodynamics in the development of in-stent restenosis. We have used a time-dependent 3D numerical model of a stented coronary artery to study the characteristics of the blood flow and the shear stress distribution. Our results show that the presence of the stent produces significant secondary flow that is limited to an annulus in the near wall region. Low shear stress zones were localized in the vicinity of the struts while the tips of the struts exhibited high values of shear stress. These results support the hypothesis that local hemodynamics may affect the development of in-stent restenosis and could influence the choice of stent geometries for future stent designs

  20. Identification and the development of competence: a 44-year longitudinal study from late adolescence to late middle age.

    Science.gov (United States)

    Cramer, Phebe

    2008-06-01

    The role of defense mechanisms in the development of planful competence (J. A. Clausen, 1993) was studied over a period of 44 years in participants from the Oakland Growth Study, who are part of the Intergenerational Studies of the Institute of Human Development. Planful competence was assessed on 4 occasions, from late adolescence (ages 15-18) to late middle age (age 62). The use of the defense mechanisms of denial, projection, and identification was assessed in late adolescence, based on Thematic Apperception Test (H. A. Murray, 1943) stories coded with the Defense Mechanism Manual (P. Cramer, 1991b). In late adolescence, the defense mechanism of identification was found to be positively related to competence, whereas the less mature defense of projection was related to lower levels of competence. For the group as a whole, hierarchical linear modeling (Bryk & Raudenbush, 1992) indicated that competence increased across the adult years, with a modest decline at late middle age. Individual differences for intraindividual change in competence were related to the use of identification: high use of identification in late adolescence was associated with relative stability in adult competence, whereas low use of identification in adolescence predicted changes in adult competence.

  1. Nurses' and nursing students' attitudes towards late abortions.

    Science.gov (United States)

    Ben Natan, M; Melitz, O

    2011-03-01

    The aim of the present study is to compare the attitudes of nursing students and nurses working in maternity wards towards late abortions performed after the 16th week of pregnancy and to identify the factors influencing their attitudes. A quantitative design was employed in this descriptive study, using two convenience samples: 100 nurses working in the maternity ward of a large hospital and 100 nursing students from a nursing school in Israel. The self-report questionnaire was specially designed for purposes of this study. Results showed that the nurses had less prejudicial attitudes towards late abortions than the nursing students. Overall, the participants had a more positive attitude towards late abortions in the following cases: (1) risk of malformation or developmental disability, (2) pregnancy as a result of rape, and (3) danger to the life of the mother. There was a weak negative connection between the participants' number of children and their attitudes towards late abortions. In addition, there was a significant relationship found between the level of religious observance and attitudes towards late abortions, as negative attitudes increased with higher religious observance. Indeed, the level of religious observance was found to be the most significant predictor of the participants' attitudes towards late abortions. Differences in attitudes were found between nursing students and nurses providing care to patients undergoing late abortions. Their personal religious beliefs, as well as the reason for the abortion, were found to be influential in determining their attitudes. © 2010 The Authors. International Nursing Review © 2010 International Council of Nurses.

  2. Outcome of Very Late Relapse in Patients with Hodgkin's Lymphomas

    Directory of Open Access Journals (Sweden)

    Francesco Gaudio

    2011-01-01

    Full Text Available Recurrences of Hodgkin's Lymphoma (HL 5 years after the initial therapy are rare. The aim of this study is to report a single centre experience of the clinical characteristics, outcome, and toxicity of pts who experienced very late relapses, defined as relapses that occurred 5 or more years after the achievement of first complete remission. Of 532 consecutive pts with classical HL treated at our Institute from 1985 to 1999, 452 pts (85% achieved a complete remission. Relapse occurred in 151 pts: 135 (29.8% within 5 years and 16 over 5 years (3.5%, very late relapses. Very late relapses occurred after a median disease-free interval of 7 years (range: 5–18. Salvage treatment induced complete remission in 14 pts (87.5%. At a median of 4 years after therapy for very late relapse, 10 pts (63% are still alive and free of disease and 6 (37% died (1 from progressive HL, 1 from cardiac disease, 1 from thromboembolic disease, 1 from HCV reactivation, and 2 from bacterial infection. The probability of failure-free survival at 5 years was 75%. The majority of deaths are due to treatment-related complications. Therapy regimens for very late relapse HL are warranted to minimize complications.

  3. Late presentation of breast cancer in Aden, Yemen.

    Science.gov (United States)

    Al-Kahiry, W; Omer, H H; Saeed, N M; Hamid, G A

    2011-01-01

    The aim of this study is to determine the frequency and characteristics of patients who presented with late stage breast cancer at Al-Amal Oncology Unit in Aden. It was conducted retrospectively in Aden, at Al-Amal Oncology Unit of Al-Gamhouria Modern General Hospital, by reviewing all records of breast cancer patients at any stage and attended with histopathologically documented breast cancer from the time of establishment of the unit on December 1, 2007 to December 31, 2009. The total number of documented breast cancer patients was 197 and classified according to the stage at presentation and after the exclusion of 21 patients who were not staged. 118 patients with late inoperable stages were selected and carefully evaluated of their demographic characteristics and was found that they represented 67.0% of the total staged breast cancer patients. Most of these patients are in the reproductive age and residents of Aden governorate and neighboring governorates. Metastasis was mainly evident at the lymph nodes, bones, liver and lungs. The case fatality rate for late stage breast cancer is 8.5 per 100 patients. This study concludes that a high percentage of Yemeni patients in Aden presented with late stage breast cancer which led to the failure of possible curative surgical intervention and resulted to high metastatic disease and fatality rate. Late Presentation, Aden, Yemen, Breast Cancer, Stages.

  4. Late adverse reactions to intravascular iodinated contrast media

    International Nuclear Information System (INIS)

    Webb, Judith A.W.; Stacul, Fulvio; Thomsen, Henrik S.; Morcos, Sameh K.

    2003-01-01

    Late adverse reactions to intravascular iodinated contrast media are defined as reactions occurring 1 h to 1 week after contrast medium injection. They have received increasing interest over the past decade, but their prevalence remains uncertain and their pathophysiology is not fully understood. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and to issue guidelines. An extensive literature search was carried out and summarized in a report. Based on the available information, simple guidelines have been drawn up. The report and guidelines were discussed at the 8th European Symposium on Urogenital Radiology in Genoa. Late adverse reactions after intravascular iodinated contrast medium include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. A significant proportion of these reactions is unrelated to the contrast medium; however, allergy-like skin reactions are well-documented side effects of contrast media with an incidence of approximately 2%. Late reactions appear to be commoner after non-ionic dimers. The majority of late skin reactions after contrast medium exposure are probably T-cell-mediated allergic reactions. Patients at increased risk of late skin reactions are those with a history of previous contrast medium reaction and those on interleukin-2 treatment. Most skin reactions are self-limiting and resolve within a week. Management is symptomatic and similar to the management of other drug-induced skin reactions. (orig.)

  5. Late pregnancy is vulnerable period for exposure to BPA.

    Science.gov (United States)

    Ohtani, Naoko; Suda, Koshi; Tsuji, Erika; Tanemura, Kentaro; Yokota, Hiroshi; Inoue, Hiroki; Iwano, Hidetomo

    2018-01-25

    Bisphenol A (BPA) is among the better-known endocrine disruptors. BPA is used in various food-contacting materials and is easily eluted into food; as a result, we are exposed to BPA on a daily basis. In adults, BPA is metabolized and eliminated rapidly from the body. However, numerous reports suggest that fetuses and young children are susceptible to BPA. One of the concerning adverse effects of BPA is disruption of behavior, especially anxiety-like behavior. In order to study the mechanism of influences on offspring, it is important to clarify the most vulnerable gestation period. We hypothesized that offspring in late pregnancy would be more susceptible to BPA, because late pregnancy is a critical time for functional brain development. In this study, C57BL/6 mouse fetuses were exposed prenatally by oral dosing of pregnant dams, once daily from gestational day 5.5 to 12.5 (early pregnancy) or 11.5 to 18.5 (late pregnancy), with BPA (0 or 10 mg/kg body weight). Following birth and weaning, the resulting pups were tested using an elevated plus maze at postnatal week 10. The behavior of the offspring was altered by prenatal BPA exposure during late pregnancy but not during early pregnancy. These results indicated that offspring are more vulnerable to exposure to BPA in late pregnancy.

  6. Renal artery stenting with noninvasive duplex ultrasound follow-up: 3-year results from the RENAISSANCE renal stent trial.

    Science.gov (United States)

    Rocha-Singh, Krishna; Jaff, Michael R; Lynne Kelley, E

    2008-11-15

    The multicenter, single-arm RENAISSANCE trial evaluated outcomes in patients with progressive atherosclerotic renal artery stenosis (ARAS) treated with the Express Renal Premounted Stent System (Boston Scientific, Natick, MA). Renal artery stenting may prevent the morbidity and mortality of surgical revascularization and high restenosis rates of percutaneous renal angioplasty (PTRA). Renal artery duplex ultrasonography (DUS) offers an alternative to traditional invasive poststenting angiographic surveillance, though concordance with angiography for in-stent restenosis has yet to be validated independently. RENAISSANCE enrolled 100 patients (117 lesions) with de novo or restenotic ostial atherosclerotic lesions or=4.0 and or=70%. The primary endpoint, 9-month binary restenosis, was compared to an objective performance criterion (OPC) of 40% for published PTRA results. Follow-up was conducted through 3 years. Technical and procedural success was both 99%. Follow-up angiography, triggered clinically or by ultrasonography, revealed 21.3% binary restenosis at 9 months, which was superior to the OPC (P RENAISSANCE demonstrates that renal artery stenting is superior to the prespecified OPC at 9 months, and also shows that DUS can accurately identify in-stent restenosis. (c) 2008 Wiley-Liss, Inc.

  7. Preventing neurocognitive late effects in childhood cancer survivors.

    Science.gov (United States)

    Askins, Martha A; Moore, Bartlett D

    2008-10-01

    Neurocognitive late effects are common sequelae of cancer in children, especially in those who have undergone treatment for brain tumors or in those receiving prophylactic cranial radiation therapy to treat leukemia. Neurocognitive morbidity in attention, executive functioning, processing speed, working memory, and memory frequently occurs and contributes to declines in intellectual and academic abilities. Oncologists are faced with the challenge of using the most effective, often the most intense, therapy to achieve the primary goal of medical success, balanced with the desire to prevent adverse late effects. Not all children with similar diagnoses and treatment have identical neurocognitive outcomes; some do very poorly and some do well. Attention now turns to the reliable prediction of risk for poor outcomes and then, using risk-adapted therapy, to preserve neurocognitive function. Prevention of late effects through rehabilitative strategies, continuation of school, and pharmacotherapy will be explored.

  8. Low Self-Control and Crime in Late Adulthood.

    Science.gov (United States)

    Wolfe, Scott E; Reisig, Michael D; Holtfreter, Kristy

    2016-10-01

    This study investigates whether low self-control theory explains self-reported criminal activity in late adulthood. Cross-sectional survey data from telephone interviews conducted with individuals aged 60 years and older in Arizona and Florida (N = 2,000) are used. Regression analyses show that low self-control is related to criminal offending. The relationship between low self-control and offending persists after the introduction of potential mediators (e.g., unstructured socializing, negative emotions, and familial ties) and is even observed across different stages of late adulthood (i.e., young-old, old-old, and oldest-old) characterized by declining physical and cognitive abilities. Robustness checks using alternative measurement and modeling strategies also provide empirical support. Although strong causal inferences are limited by the nature of the data, the findings generally support the notion that low self-control theory partially explains criminal offending in late adulthood. © The Author(s) 2015.

  9. Effect of Vegetation on the Late Miocene Ocean Circulation

    Directory of Open Access Journals (Sweden)

    Gerrit Lohmann

    2015-11-01

    Full Text Available We examine the role of the vegetation cover and the associated hydrological cycle on the deep ocean circulation during the Late Miocene (~10 million years ago. In our simulations, an open Central American gateway and exchange with fresh Pacific waters leads to a weak and shallow thermohaline circulation in the North Atlantic Ocean which is consistent with most other modeling studies for this time period. Here, we estimate the effect of a changed vegetation cover on the ocean general circulation using atmospheric circulation model simulations for the late Miocene climate with 353 ppmv CO2 level. The Late Miocene land surface cover reduces the albedo, the net evaporation in the North Atlantic catchment is affected and the North Atlantic water becomes more saline leading to a more vigorous North Atlantic Deep Water circulation. These effects reveal potentially important feedbacks between the ocean circulation, the hydrological cycle and the land surface cover for Cenozoic climate evolution.

  10. Cornulitids (tubeworms) from the Late Ordovician Hirnantia fauna of Morocco

    Science.gov (United States)

    Gutiérrez-Marco, Juan Carlos; Vinn, Olev

    2018-01-01

    Two species of cornulitids, Cornulites gondwanensis sp. nov. and C. aff. shallochensis Reed are described from the Hirnantian of Morocco, within an assemblage representative of the Hirnantia brachiopod fauna occurring near the Ordovician South Pole. The dominance of aggregated and solitary free forms could be explained by particular sedimentary environments preceding the Hirnantian glaciation and the latest Ordovician Extinction Event. The diversity of cornulitids in the Late Ordovician of Gondwana and related terranes was relatively low, and less diverse than the cornulitids of Laurentia and Baltica. Hirnantian cornulitids from Morocco do not resemble Late Ordovician cornulitids of Baltica and Laurentia. Moroccan cornulitids seem to be closely allied to some older Gondwanan cornulitids, especially Sardinian ones. They resemble species described from the Late Ordovician and Llandovery of Scotland suggesting a palaeobiogeographic link.

  11. TIDES-ACS Trial: comparison of titanium-nitride-oxide coated bio-active-stent to the drug (everolimus)-eluting stent in acute coronary syndrome. Study design and objectives.

    Science.gov (United States)

    Colkesen, E B; Eefting, F D; Rensing, B J; Suttorp, M J; Ten Berg, J M; Karjalainen, P P; Van Der Heyden, J A

    2015-02-01

    Drug-eluting stents (DES), delivering antiproliferative drugs from a durable polymer, have shown to reduce in-stent restenosis after percutaneous coronary intervention (PCI) compared to bare-metal stents (BMS). However, they have been associated with a hypersensitivity reaction, delayed healing, and incomplete endothelialization, which may contribute to an increased risk of late stent thrombosis. Consequently, a prolonged duration of dual antiplatelet therapy (DAPT) is needed, with an increased risk of bleeding complication. A number of stent technologies are being developed in an attempt to modify late thrombotic events and DAPT duration. The Optimax™ stent is such a novel, next generation bioactive stent (BAS), in which a thicker layer of titanium-nitride-oxide coating is inserted over the stent struts. The rationale of this is to obtain more efficient and rapid vascular healing at the site of the stent implantation. The aim of TIDES-ACS Trial is to compare clinical outcome in patients presenting with ACS, treated with PCI using Optimax-BAS versus Synergy™-EES. Second objective is to explore whether the Optimax™-BAS use is superior compared with Synergy™-EES use with respect of hard end points (cardiac death, myocardial infarction [MI] and major bleeding). A prospective, randomized, multicenter trial (ClinicalTrials.gov Identifier: NCT02049229), will be conducted in interventional centres in Finland (six centres), France (five centres) and Holland (two centres), including a total of 1800 patients.

  12. Opportunistic Ports and Spaces of Exchange in Late Roman Cyprus

    Science.gov (United States)

    Leidwanger, Justin

    2013-12-01

    Ports served not only as interfaces between land and sea, but as central gathering spaces for economic and cultural exchange. Drawing on case studies from the eastern Mediterranean island of Cyprus, this paper situates opportunistic ports lacking built facilities within a broader socioeconomic context of diverse maritime communications, expanding rural settlement, and increased agricultural productivity during late antiquity. Though simple, these sites served as active agents in the development of new maritime networks as well as local markets throughout their hinterlands, adding flexibility and dynamism to the economic ties between city, countryside, and the wider late Roman world.

  13. Late-onset Leclercia adecarboxylata sepsis in a premature neonate.

    Science.gov (United States)

    Nelson, M U; Maksimova, Y; Schulz, V; Bizzarro, M J; Gallagher, P G

    2013-09-01

    The epidemiology, etiology and outcome of neonatal sepsis are changing over time. While monitoring longitudinal trends in neonatal sepsis in our institution, we encountered a case of late-onset neonatal sepsis due to Leclercia adecarboxylata. A Gram-negative rod previously not encountered in the clinical setting, L. adecarboxylata has recently emerged as a human pathogen, primarily in immunosuppressed patients. This report describes the clinical and laboratory features of this case of late-onset L. adecarboxylata sepsis, and reviews significant features of infection associated with this emerging pathogen.

  14. The Expressive Turn of Citizenship in Digital Late Modernity

    Directory of Open Access Journals (Sweden)

    Jakob Svensson

    2011-03-01

    Full Text Available The purpose of this paper is to connect the idea of expressive rationality to current debates on citizenship and political participation online. Socializing, cultural consumption/ production, identity management, information and publication strategies are both different and accentuated in digital, networked and late modern environments. In the paper I argue that the kind of network sociability that is emerging today favours an expressive form of rationality. I also claim that expressive rationality transcends the bipolar instrumental – communicative dimension that has been so important for normative theorizing in Political (and Social Sciences and hence is a more rewarding theoretical concept for understanding political participation in digital late modernity.

  15. Strontium isotope evolution of Late Permian and Triassic seawater

    Science.gov (United States)

    Korte, Christoph; Kozur, Heinz W.; Bruckschen, Peter; Veizer, Ján

    2003-01-01

    The 87Sr/ 86Sr values based on brachiopods and conodonts define a nearly continuous record for the Late Permian and Triassic intervals. Minor gaps in measurements exist only for the uppermost Brahmanian, lower part of the Upper Olenekian, and Middle Norian, and only sparse data are available for the Late Permian. These 219 measurements include 67 brachiopods and 114 conodont samples from the Tethyan realm as well as 37 brachiopods and one conodont sample from the mid-European Middle Triassic Muschelkalk Sea. The Late Permian/Lower Triassic interval is characterized by a steep 1.3 × 10 -3 rise, from 0.7070 at the base of the Dzhulfian to 0.7082 in the late Olenekian, a rate of change comparable to that in the Cenozoic. In the mid-Triassic (Anisian and Ladinian), the isotope values fall to 0.7075, followed again by a rise to 0.7081 in the Middle/Late Norian. The 87Sr/ 86Sr values decline again in the Late Norian (Sevatian) and Rhaetian to 0.7076. The sharp rise in the 87Sr/ 86Sr values during the Late Permian/Early Triassic was coincident with widespread clastic sedimentation. Because of the paucity of tectonic uplifts, the enhanced erosion may have been due to intermittent humid phases, during mainly an arid interval, coupled with the absence of a dense protective land plant cover following the mass extinction during the latest Permian. The apex of the 87Sr/ 86Sr curve at the Olenekian/Anisian boundary coincides with cessation of the large-scale clastic sedimentation and also marks the final recovery of land vegetation, as indicated by the renewed onset of coal formation in the Middle Triassic. The rising 87Sr/ 86Sr values from the Middle Carnian to the Late Norian coincide with the uplift and erosion of the Cimmeride-Indosinian orogens marking the closure of the Palaeotethys. The subsequent Rhaetian decline that continues into Jurassic (Pliensbachian/Toarcian boundary), on the other hand, coincides with the opening of the Vardar Ocean and its eastern continuation

  16. Better late than never: information retrieval from black holes.

    Science.gov (United States)

    Braunstein, Samuel L; Pirandola, Stefano; Życzkowski, Karol

    2013-03-08

    We show that, in order to preserve the equivalence principle until late times in unitarily evaporating black holes, the thermodynamic entropy of a black hole must be primarily entropy of entanglement across the event horizon. For such black holes, we show that the information entering a black hole becomes encoded in correlations within a tripartite quantum state, the quantum analogue of a one-time pad, and is only decoded into the outgoing radiation very late in the evaporation. This behavior generically describes the unitary evaporation of highly entangled black holes and requires no specially designed evolution. Our work suggests the existence of a matter-field sum rule for any fundamental theory.

  17. Late-Glacial radiocarbon- and palynostratigraphy in the Swiss Plateau

    International Nuclear Information System (INIS)

    Ammann, B.; Lotter, A.F.

    1989-01-01

    A detailed Late-Glacial radiocarbon stratigraphy for the Swiss Plateau has been established on the basis of over 90 accelerator 14 C dates on terrestrial plant macrofossils. A comparison of the radiocarbon ages derived from terrestrial, telmatic and limnic material at different sites on the Swiss Plateau yields a proposal for modifying the zonation system of Welten for the Late-Glacial. By retaining the limits of chronozones and by refining the palynostratigraphic criteria for the limits of biozones, a separation between chrono- and biozonation at the beginning of the Boelling and the Younger Dryas becomes obvious. 54 refs

  18. Calf muscle hypertrophy in late onset pompe's disease

    Directory of Open Access Journals (Sweden)

    M Suraj Menon

    2016-01-01

    Full Text Available Pompe's disease (glycogen storage disease Type 2, acid maltase deficiency is characterized by a progressive myopathy due to accumulation of glycogen in skeletal muscles in addition to various tissues. Late onset Pompe's disease is characterized by slowly progressive proximal myopathy with respiratory muscle involvement. We present the case of a 16-year-old female presenting with proximal muscle weakness with calf hypertrophy diagnosed to be late onset Pompe's disease. This case highlights the need to consider Pompe's disease in the differential diagnosis of calf muscle hypertrophy, in patients with proximal myopathy even without overt respiratory muscle involvement.

  19. Lunar tungsten isotopic evidence for the late veneer.

    Science.gov (United States)

    Kruijer, Thomas S; Kleine, Thorsten; Fischer-Gödde, Mario; Sprung, Peter

    2015-04-23

    According to the most widely accepted theory of lunar origin, a giant impact on the Earth led to the formation of the Moon, and also initiated the final stage of the formation of the Earth's core. Core formation should have removed the highly siderophile elements (HSE) from Earth's primitive mantle (that is, the bulk silicate Earth), yet HSE abundances are higher than expected. One explanation for this overabundance is that a 'late veneer' of primitive material was added to the bulk silicate Earth after the core formed. To test this hypothesis, tungsten isotopes are useful for two reasons: first, because the late veneer material had a different (182)W/(184)W ratio to that of the bulk silicate Earth, and second, proportionally more material was added to the Earth than to the Moon. Thus, if a late veneer did occur, the bulk silicate Earth and the Moon must have different (182)W/(184)W ratios. Moreover, the Moon-forming impact would also have created (182)W differences because the mantle and core material of the impactor with distinct (182)W/(184)W would have mixed with the proto-Earth during the giant impact. However the (182)W/(184)W of the Moon has not been determined precisely enough to identify signatures of a late veneer or the giant impact. Here, using more-precise measurement techniques, we show that the Moon exhibits a (182)W excess of 27 ± 4 parts per million over the present-day bulk silicate Earth. This excess is consistent with the expected (182)W difference resulting from a late veneer with a total mass and composition inferred from HSE systematics. Thus, our data independently show that HSE abundances in the bulk silicate Earth were established after the giant impact and core formation, as predicted by the late veneer hypothesis. But, unexpectedly, we find that before the late veneer, no (182)W anomaly existed between the bulk silicate Earth and the Moon, even though one should have arisen through the giant impact. The origin of the homogeneous (182

  20. Ideal kingship in the late medieval world: The Ottoman case

    OpenAIRE

    Yelçe, Zeynep Nevin; Yelce, Zeynep Nevin

    2003-01-01

    The aim of this study is to examine the characteristics of the ideal ruler as seen through the eyes of the members of late medieval societies. Throughout the study, main features attributed to the ideal ruler in various cultures have been pursued. Comparing the concepts and attributes apparent in these cultures, it has become possible to talk about a single ideal of kingship as far as the "Christian" and "Muslim" realms of the late medieval era is concerned. The early Ottoman enterprise has b...

  1. Partial diagenetic overprint of late jurassic belemnites from New Zealand

    DEFF Research Database (Denmark)

    Ullmann, Clemens Vinzenz; Campbell, Hamish J.; Frei, Robert

    2013-01-01

    composition have been preserved or can be extrapolated from the measured values. The δ18O and δ13C values as well as Sr/Ca and Mn/Ca ratios were analysed along two profiles. In addition, 6 samples were analysed for 87Sr/86Sr, Sr/Ca and Mn/Ca ratios. Five samples from the same specimen and 2 from...... for pristine Late Jurassic (~155-148 Ma) belemnites is +27 ± 1 ‰, which points to a Late Jurassic seawater δ7Li of ~29-32 ‰, compatible with the modern value of 31 ‰....

  2. Late effects of ionizing radiations on vulva, vagina and uterus

    International Nuclear Information System (INIS)

    Mazeron, J.J.; Gerbaulet, A.

    1997-01-01

    Reporting and scoring complications after radiotherapy of gynaecological cancers is difficult because of the variety of treatment techniques involved. Use of an international classification is necessary to compare results obtained in series of patients treated in different institutions. An international group of experts designed in the early nineties the so-called French-Italian glossary. This classification of late effects is now completed with the new LENT SOMA scales. This paper contains details of these late changes, including their pathophysiology, clinical syndromes, potential treatment, and prevention. (authors)

  3. Functional interchangeability of late domains, late domain cofactors and ubiquitin in viral budding.

    Directory of Open Access Journals (Sweden)

    Maria Zhadina

    2010-10-01

    Full Text Available The membrane scission event that separates nascent enveloped virions from host cell membranes often requires the ESCRT pathway, which can be engaged through the action of peptide motifs, termed late (L- domains, in viral proteins. Viral PTAP and YPDL-like L-domains bind directly to the ESCRT-I and ALIX components of the ESCRT pathway, while PPxY motifs bind Nedd4-like, HECT-domain containing, ubiquitin ligases (e.g. WWP1. It has been unclear precisely how ubiquitin ligase recruitment ultimately leads to particle release. Here, using a lysine-free viral Gag protein derived from the prototypic foamy virus (PFV, where attachment of ubiquitin to Gag can be controlled, we show that several different HECT domains can replace the WWP1 HECT domain in chimeric ubiquitin ligases and drive budding. Moreover, artificial recruitment of isolated HECT domains to Gag is sufficient to stimulate budding. Conversely, the HECT domain becomes dispensable if the other domains of WWP1 are directly fused to an ESCRT-1 protein. In each case where budding is driven by a HECT domain, its catalytic activity is essential, but Gag ubiquitination is dispensable, suggesting that ubiquitin ligation to trans-acting proteins drives budding. Paradoxically, however, we also demonstrate that direct fusion of a ubiquitin moiety to the C-terminus of PFV Gag can also promote budding, suggesting that ubiquitination of Gag can substitute for ubiquitination of trans-acting proteins. Depletion of Tsg101 and ALIX inhibits budding that is dependent on ubiquitin that is fused to Gag, or ligated to trans-acting proteins through the action of a PPxY motif. These studies underscore the flexibility in the ways that the ESCRT pathway can be engaged, and suggest a model in which the identity of the protein to which ubiquitin is attached is not critical for subsequent recruitment of ubiquitin-binding components of the ESCRT pathway and viral budding to proceed.

  4. Late lessons from early warnings: science, precaution, innovation

    DEFF Research Database (Denmark)

    Hansen, Steffen Foss

    2013-01-01

    The 2013 Late lessons from early warnings report is the second of its type produced by the European Environment Agency (EEA) in collaboration with a broad range of external authors and peer reviewers. In all 26 case study chapters have been peer reviewed from a broad range of perspectives.PART A:...

  5. impact of fungicide applications for late blight management on ...

    African Journals Online (AJOL)

    IMPACT OF FUNGICIDE APPLICATIONS FOR LATE BLIGHT. MANAGEMENT ON HUCKLEBERRY YIELDS IN CAMEROON. D. A. FONTEM, A.T. SONGWALANG, J.E. BERINYUY and R.R. SCHIPPERS l. Faculty of Agriculture, University of Dschang, Box 208, Dschang, Cameroon l~orticultural Development Services LLP, ...

  6. Rejection Sensitivity in Late Adolescence: Social and Emotional Sequelae

    Science.gov (United States)

    Marston, Emily G.; Hare, Amanda; Allen, Joseph P.

    2010-01-01

    This study used longitudinal, multireporter data, in a community sample, to examine the role of rejection sensitivity in late adolescents' social and emotional development. Rejection sensitivity was linked to a relative increase in adolescent depressive and anxiety symptoms over a 3-year period, even after accounting for teens' baseline level of…

  7. Childhood and Adolescent Predictors of Late Onset Criminal Careers

    Science.gov (United States)

    Zara, Georgia; Farrington, David P.

    2009-01-01

    This study explores the emergence of a criminal career in adulthood. The main hypothesis tested is that late criminal onset (at age 21 or later) is influenced by early factors that delay antisocial manifestations. The Cambridge Study in Delinquent Development (CSDD) was used to examine early determinants of criminal behavior. 400 Inner London…

  8. Sphere sovereignty in late-modern society and social theory

    NARCIS (Netherlands)

    van Putten, R.J.

    2016-01-01

    This paper analyses to which extent the concept of sphere sovereignty, as developed by Kuyper and Dooyeweerd, is relevant for the understanding of late modern society. The central topic therefore is sphere sovereignty as view on social order. Firstly, I argue the urgency of studying the

  9. The economic benefits of political connections in late Victorian Britain

    NARCIS (Netherlands)

    Braggion, F.; Moore, L.

    2013-01-01

    The late Victorian era was characterized by close links between politicians and firms in the United Kingdom, with up to half of all members of Parliament serving as company directors. We analyze 467 British companies over the period 1895 to 1904. An analysis of election results shows that the

  10. The Economic Benefits of Political Connections in Late Victorian Britain

    NARCIS (Netherlands)

    Braggion, F.; Moore, L.

    2011-01-01

    The late-Victorian era was characteristed by especially close links between politicians and firms in the UK. Roughly half of all members of Parliament served as company directors, many as directors of multiple firms. We analyze 467 British companies over the period 1895 to 1904 to investigate the

  11. Prevalence and factors associated with late antenatal care visit ...

    African Journals Online (AJOL)

    The objective of this study was to determine the prevalence and factors associated with late antenatal booking among pregnant women in Lushoto district of north-eastern Tanzania. Methods: This hospital based cross sectional study involved pregnant women and was conducted in August-September 2015. A standardized ...

  12. Late-onset CMV disease following CMV prophylaxis.

    LENUS (Irish Health Repository)

    Donnelly, C

    2012-02-01

    BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplantation, increasing morbidity and mortality. Three months of oral valganciclovir have been shown to provide effective prophylaxis. Late-onset CMV disease, occurring after the discontinuation of prophylaxis, is now increasingly recognised. AIMS: To investigate the incidence and the time of detection of CMV infections in liver transplant recipients who received CMV prophylaxis. METHODS: Retrospective review of 64 high- and moderate-risk patients with 1 year of follow-up. RESULTS: The incidence of CMV infection was 12.5%, with 4.7% disease. All cases of symptomatic CMV disease were of late-onset. CONCLUSIONS: The incidence of CMV infections in this study was low compared with literature reports; however, the late-onset disease is an emerging problem. Detection of late-onset disease may be delayed because of less frequent clinic follow-up visits. Increased regular laboratory monitoring may allow earlier detection at the asymptomatic infection stage.

  13. Views and attitudes of pregnant women regarding late termination of ...

    African Journals Online (AJOL)

    To study the views and attitudes of pregnant women with severe fetal anomalies regarding late termination of pregnancy (LTOP). Methods. Data were ... Detection of severe congenital fetal abnormalities after ..... diagnosis and abortion for fetuses with severe genetic disorder: Type 1 spinal muscular atrophy. Ann Saudi Med ...

  14. 7 CFR 1260.175 - Late-payment charge.

    Science.gov (United States)

    2010-01-01

    ... Board pursuant to § 1260.172 shall be increased 2.0 percent each month beginning with the day following... 7 Agriculture 10 2010-01-01 2010-01-01 false Late-payment charge. 1260.175 Section 1260.175 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING...

  15. Julius Caesar's late onset epilepsy: a case of historic proportions.

    Science.gov (United States)

    McLachlan, Richard S

    2010-09-01

    This is a case report of Julius Caesar's epilepsy that onset when he was 54-years-old. The differential diagnosis of late onset epilepsy is discussed and the rationale presented for concluding from the clinical presentation that the cause was neurocysticercosis. That this man's disease and its consequences altered the course of history is a very real possibility.

  16. Late-Onset Startle Syndrome and Obsessive Compulsive Disorder

    Directory of Open Access Journals (Sweden)

    Alejandro Gonzalez

    1998-01-01

    Full Text Available A case of late onset sporadic startle syndrome in a patient with a right posterior fossa brain tumour is reported. The exaggerated startle response did not respond to treatment with clonazepam. In addition to anxiety and depression, the patient developed obsessive- compulsive symptoms which responded to behavioural therapy. The possible mechanisms for this unique pattern of symptoms are discussed.

  17. Geomorphic expression of late Quaternary sea level changes along ...

    Indian Academy of Sciences (India)

    Geomorphic expression of land-sea interaction is preserved in the form of abandoned cliffs, marine terraces,shore platforms and marine notches along the southern Saurashtra coast. These features have been used to ascertain the magnitude of sea level changes during late Quaternary.Notch morphology and associated ...

  18. Exploring Career Success of Late Bloomers from the TVET Background

    Science.gov (United States)

    Omar, Zoharah; Krauss, Steven Eric; Sail, Rahim M.; Ismail, Ismi Arif

    2011-01-01

    Purpose: The purpose of this paper is to explore objective and subjective career success and to identify factors contributing to career success among a sample of technical and vocational education and training (TVET) "late bloomers" working in Malaysia. Design/methodology/approach: Incorporating a mixed method design, the authors…

  19. The Leporid Datum: a late Miocene biotic marker

    Czech Academy of Sciences Publication Activity Database

    Flynn, L. J.; Winkler, A. J.; Erbaeva, M.; Alexeeva, N.; Anders, U.; Angelone, Ch.; Čermák, Stanislav; Fladerer, F. A.; Kraatz, B.; Ruedas, L. A.; Ruf, I.; Tomida, Y.; Veitschegger, K.; Zhang, Z.

    2014-01-01

    Roč. 44, 3/4 (2014), s. 164-176 ISSN 0305-1838 R&D Projects: GA ČR GA205/09/0184 Institutional support: RVO:67985831 Keywords : dispersal * immigration * late Neogene * molecular tree * palaeoecology Subject RIV: EG - Zoology Impact factor: 4.256, year: 2014

  20. factors associated with late antenatal care attendance in selected

    African Journals Online (AJOL)

    Esem

    delivery and ensuring that they deliver in a suitably. 5 equipped facility . ntenatal care attendance and ..... Table 4: Predictors of Late ANC attendance in Mpongwe and Ndola-logistic regression. Predictors. Mpongwe. Ndola. AOR .... transport systems were also hindrance factors to. 21 maternity service utilization . Univariate ...