Distal Edge Research Articles

Comparison of quantitative measurements between two different intravascular ultrasound catheters and consoles: in vitro and in vivo studies

Previous studies suggested possible discordant quantitative measurements between different IVUS catheters and/or systems. The purpose of this study was to assess compatibility of two different IVUS catheters and consoles for quantitative measurements of coronary arteries. (1). In vitro study: IVUS imaging was performed in a concentric cylindrical phantom with 6 sections of known, cross-sectional diameter ranging from 3.0 to 8.0 mm. The lumen diameter (LD) and lumen cross-sectional area (LA) were measured and compared. To compare between 2 different IVUS consoles, IVUS images were obtained using a single IVUS catheter (catheter 1) connected to 2 different IVUS consoles (console 1 and 2). To compare between 2 different IVUS catheters, IVUS imaging was obtained using 2 different IVUS catheters (catheter 1 and 2) connected to a single IVUS console (console 2). (2). In vivo study: IVUS imaging was performed in 40 stented coronary arterial segments from 40 patients. The maximal stent diameter (Max SD), minimal stent diameter (minSD), and stent area (SA) were measured at both distal and proximal stent edges and compared between the two IVUS consoles (console 1 and 2) connected to a single IVUS catheter (catheter 1) (n = 20). IVUS imaging was also performed to compare between catheter 1 and 2 connected to IVUS console 2 (n = 20). Both in vitro and in vivo studies showed good correlation between the two IVUS consoles as well as two IVUS catheters. In conclusion, two IVUS catheters and consoles provide comparable IVUS measures both in vitro and in vivo.

Evaluation of Dental Golden Ratio in Terms of Facial Esthetics

Aim and Objectives: This cross-sectional study examined the Bolton index of 6 maxillary anterior teeth and the facial esthetic ratios in the Turkish population with healthy facial appearance. Materials and Methods: Face photographs of the subjects, taken using a DSLR camera, were fixed in the Frankfort horizontal plane. The measurements were made on the images using ImageJ 1.52a software and certain ratios of face and teeth were calculated such as Bolton index (BI). Differences between genders were evaluated and comparisons with golden ratio of 1.618 were conducted on SPSS. Results: Males had significantly higher upper, middle, lower, and total facial height compared to females ( P < .001, P = 0.0257, P = .0243, P < .001, respectively). Right to left distance of labial commissure (LC)/distance from the distal edge of right canine to the distal edge of left canine ratio had golden proportion. Ratio of naso-menton length to facial width showed golden ratio only in males. The ratio of the width of upper middle incisor to the width of canine tooth also showed golden ratio in both genders. Conclusions: The present study presents noteworthy data about facial and teeth ratios of the young adult Turkish population that will guide plastic surgeons and orthodontists in clinical practice.

Development and validation of an optimal GATE model for double scattering proton beam delivery

Proton therapy (PT) is an emerging external beam radiation therapy characterized by superior dose distribution compared to conventional modalities. In the present study, an optimal GATE model was developed and then validated for a double scattering proton nozzle based on the previously constructed model. To this aim, a double scattering treatment nozzle was modeled in the GATE platform. To accelerate the GATE simulations, a virtual range modulation wheel (vRMW) and a variance reduction technique (VRT) were implemented. Proton beam flatness, symmetry, and delivery efficiency, secondary neutron dose, and dosimetric performance were characterized through a set of GATE simulations. The findings show that range cutoff value of 0.075 mm provides the best compromise between the simulation accuracy and speed for the simulated geometry. A proton beam flatness of 98.6% was observed at the downstream of the aperture for a 7 × 7 cm2 field size. The beam flatness deteriorates at the edge of the treatment field for the single scattering model while it remains approximately constant for the double scattering one. In comparison to the single scattering delivery, the second scattering model results in a 1.28 times increase in neutron dose for the nickel, as the optimal collimator/aperture material. Furthermore, a flat beam modulation width of 3.50 cm is formed with a distal edge at 7.86 cm in water using both GATE and MCNPX codes. The GATE model agreed with the MCNPX results with a maximum difference of ±6.3% in absorbed dose estimation. The findings demonstrate that the constructed GATE model of double scattering proton nozzle results in a fast and accurate simulation of passive scattering PT.

Influencia de cuerpos discordantes de distinta cohesión en la geometría estructural de fajas plegadas y corridas: aproximación sobre la base de un modelamiento analógico

Lithological heterogeneities in a rock series deformed by the development of a fold-and-thrust belt (FTB) affects the pattern of the resulting structures. We present a series of analogue experiments to determine the effect caused on the deformation pattern of a FTB by the presence of cohesive bodies, like plutons or basement blocks that oppose greater resistance than the host rocks to contractional deformation. The influence of these bodies on the deformation pattern of the FTB was studied by incorporating discordant bodies with different cohesions within a stratified granular sequence with negligible cohesion. We describe two sets of experiments in which the inserted body presents low (Co1) and high (Co2) cohesion respectively. The experiments show a tendency of the structural pattern to curve around the inserted body and to migrate towards the deformation front or the foreland, even when the cohesive body is not exposed. In the first case (Co1) the thrusts cut across the cohesive body, while in the second one (Co2) the cohesive body is not faulted, but transferred towards the deformation front along a basal detachment. Comparison of these results with natural examples at different scales shows a high degree of coincidence in the structural patterns recognized in both cases. Two of the main characteristics of these patterns are the tendency of the thrust faults traces to avoid the cohesive body and adopt the geometry of its distal edge. In order to explain curvatures in natural structural patterns in fold-and-thrust belts, we suggest consider the presence of unexposed bodies with higher strength than their environment.

Technique for Reconstruction of Nasal Alar Defects in Asian Patients with a Modified Bilobed Nasolabial Flap

Introduction: The Oriental nose differs from the Caucasian nose in terms of size, subunit definition, texture, and thickness of the skin [1]. Zitelli’s bilobed flap enables aesthetic reconstruction in Caucasian noses but in smaller Oriental noses the outcomes are less desirable with nasal alar retraction commonly seen [2]. Hence, we describe a modification of Zitelli’s bilobed flap incorporating nasolabial skin for a single stage nasal reconstruction with reduced nasal alar retraction [3]. Methods: We modified the bilobed flap based on Zitelli’s bilobed flap and the aesthetic subunit principle, as modified for Orientals by Yotsuyanagi in 2000 [4]. The primary lobe was located between the defect and the cheek and the second lobe was located on the cheek, above the nasolabial fold. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. Results: Satisfactory alar reconstruction was achieved from the viewpoint of the patient and surgeon. There was good nasal contour and appropriate symmetry of the nasal tip with reduced nasal alar retraction. Conclusion: The modification of Zitelli’s bilobed flap to have a longer primary lobe and include nasolabial skin, results in reduced nasal alar retraction.

Inhibition of edge stenosis of endografts in swine iliac arteries by a novel endograft with biodegradable coating at both ends

ObjectiveThis study evaluated the effectiveness and safety of a novel endograft with a biodegradable coating at both ends in preventing edge stenosis in swine iliac arteries. The biodegradable coating was composed of polylactide and paclitaxel. MethodsFour types of endograft were implanted in the iliac arteries of healthy swine: an endograft without coating (control group) and endografts with polylactide and paclitaxel coating containing 0.1, 0.3, or 3.6 μg/mm2 of paclitaxel. The edge stenosis of these endografts in swine iliac arteries was assessed using angiographic image data at 30, 90, and 180 days after the operation. After terminal angiography, histologic evaluation of the treated arteries was performed. The treated sections of iliac arteries and blood samples were obtained at 1, 7, 30, 90, and 180 days for pharmacokinetic analysis. ResultsThe results of angiographic and histologic evaluation demonstrated that intimal hyperplasia contributed to edge stenosis and polylactide-paclitaxel coating effectively inhibited edge stenosis. At 30 days, edge stenosis was observed at both the proximal and distal edges of the endograft without coating. At 90 days, edge stenosis was detected for the endograft coated with 0.1 μg/mm2 paclitaxel, and ectasia dilation occurred at the proximal and distal edges of the endograft coated with 3.6 μg/mm2 paclitaxel. No edge stenosis or other adverse effects were observed at 90 and 180 days for the endograft coated with 0.3 μg/mm2 paclitaxel. In addition, for the endograft coated with 0.3 μg/mm2 paclitaxel, a pharmacokinetic analysis showed that the paclitaxel concentration of treated segments decreased from 14 264 ± 1020 ng/g at day 1 to 80 ± 70 ng/g at day 90, and 20 ± 40 ng/g at day 180. The plasma paclitaxel concentration was low at day 1 and no longer detected after 7 days. ConclusionsPolylactide and paclitaxel coating containing 0.3 μg/mm2 paclitaxel at both ends of endografts effectively and safely inhibits edge stenosis in swine iliac arteries.

Effect of branch length and tortuosity on the outcomes of branched endovascular repair of thoracoabdominal aneurysms using self-expandable bridging stent graft

ObjectiveWe investigated the effect of the length and tortuosity of directional branches on the mid-term outcomes of branched endovascular aneurysm repair (BEVAR) for thoracoabdominal aortic aneurysms (TAAA). MethodsWe retrospectively reviewed single-center data of consecutive patients who had undergone BEVAR for TAAA from 2015 to 2019. Three-dimensional computed tomography angiogram reconstructions (Aquarius iNtuition software; TeraRecon, Durham, NC) of the first postoperative imaging studies were used to measure the branch total length (TL), branch vertical length (VL), and branch tortuosity index (TI). The branch TL was measured as the centerline distance between the branch proximal radiopaque marker and the distal edge of the bridging stent. The VL was measured as the centerline distance between the branch distal radiopaque marker and the origin of the target artery. The TI was measured in accordance with the Society for Vascular Surgery reporting standard. The primary end point was freedom from branch instability, defined as any branch-related death, occlusion, or rupture and any reintervention for stenosis, endoleak, or disconnection. Cox proportional hazards were used to identify predictors of branch instability. A penalized spline function was used to identify the relationship between branch instability and the branch TL and VL. ResultsPostimplantation analysis was conducted on 32 TAAAs (extent I-III, n = 18 [56%]; extent IV, n = 14 [44%]), with 123 arteries included through a directional branch. A covered self-expanding bridging stent was used in all cases. Intraoperative reinforcement with an additional bare metal stent was performed in 85 cases (69%). The overall freedom from branch instability at 3 years was 88% (95% confidence interval [CI], 81%-94%). Five cases of occlusion and eight cases of branch-related endoleak occurred. A concomitant endoleak and severe stenosis requiring intervention developed in three cases. The Cox model with splines showed that the minimal risk of branch instability was achieved with a branch TL of 60 to 100 mm (P = .002) and a branch VL of 25 to 50 mm (P = .038). A TI of >1.15 was a predictor of branch complications (hazard ratio [HR], 8.6; 95% CI, 2.4-31.4; P < .001). After multivariate analysis, aneurysm diameter (HR, 1.08; 95% CI, 0.03-1.15; P = .003), TI >1.15 (HR, 6.81; 95% CI, 2.17-27.33; P < .001), and TL <60 or >100 mm (P = .002) were significantly associated with branch instability. ConclusionsThe branch length and TI seemed to play an important role in BEVAR outcomes. The lowest branch instability rates were obtained with a branch TL of 60 to 100 mm, and this should be considered during planning and implantation. A branch TI >1.15 might require a more strict monitoring to prevent mid- and long-term complications.

The Ideal Insertion Site for the Flexor Digitorum Profundus Tendon in Jersey Finger Repair: A Biomechanical Analysis

Most jersey finger repair techniques involve reattaching the tendon to an approximate location corresponding to the tendon's native attachment. This study aimed to determine the biomechanical effect on the distal interphalangeal joint flexion forces and range of motion when the flexor digitorum profundus (FDP) tendon attachment site on the distal phalanx is altered within its broad footprint. We fixed 14 fresh-frozen cadaveric fingers to a wooden block with an attached pulley and weights system. A pressure mapping sensor placed under the fingertip measured the contact force and area in response to FDP tendon loading for the intact tendon and 3 repair sites along the FDP footprint. Two-way repeated-measures analysis of variance test using mixed-effect model was performed to test the influences of attachment location (intact, proximal, central, and distal) and digit (index, middle, and ring) on the outcomes. Mean ± SD contact force under 45 N tendon loading force was 43.5 ± 7.2 N for the intact tendon, 34.6 ± 7.4 N for the proximal insertion, 38.0 ± 7.1 N for the central insertion, and 43.1 ± 6.3 N for the distal insertion. Compared with the intact tendon, the proximal group generated notably less contact force. No significant difference was detected between the intact tendon and the central or distal repairs. Comparisons among the 3 repair groups show that the distal group generated significantly higher force than the proximal group. There was no difference between contact areas across all groups. The FDP tendon inserted at the distal edge of its footprint conferred significantly greater distal interphalangeal joint flexion force compared with the proximal insertion site and most closely resembled the intact FDP tendon. Biomechanically, distal reattachment of the FDP most closely approximates the contact force of the native anatomy and may help guide intraoperative placement of the repair footprint.

Community succession in phototrophic shell-degrading endoliths attacking intertidal mussels

ABSTRACT Intertidal mussels are important ecosystem engineers that increase habitat complexity and provide shelter, substratum and food to associated communities. They thus play a key role in the maintenance of local biodiversity. Intertidal mussels are frequently parasitized by endolithic cyanobacteria that erode and significantly weaken their shells. We examined succession of cyanobacterial infestation in the shells of the mussels Perna perna and Mytilus galloprovincialis on the south coast of South Africa. We examined variations in species composition of the endolithic cyanobacterial community across regions of mussel shells of different ages (variation in space) and by exposing non-infested shells in field experiments for known periods (variation in time). The results on the spatial distribution of endolith species within a shell supported those from the field experiment evaluating temporal succession. Endolithic species that were early colonists of clean shells were similar to those that were found at the distal edge, the new and growing region of the shell. These species were also found near the umbo, the oldest region of the shell, but cyanobacterial communities near the umbo also included species that appeared late in time. Thus, succession when viewed in either time or space involved the accumulation, rather than the replacement of species. Species that arrived late in the succession were similar to endolithic species found near the umbo, the oldest region of the shell. Overall, the study shows clear patterns of endolithic cyanobacterial succession within mussel shells.

Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial

The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named “Castor” was designed and a clinical trial conducted to investigate its suitability. From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48–72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.

A proof-of-concept study of an in-situ partial-ring time-of-flight PET scanner for proton beam verification.

Development of a PET system capable of in-situ imaging requires a design that can accommodate the proton treatment beam nozzle. Among the several PET instrumentation approaches developed thus far, the dual-panel PET scanner is often used as it is simpler to develop and integrate within the proton therapy gantry. Partial-angle coverage of these systems can however lead to limited-angle artefacts in the reconstructed PET image. We have previously demonstrated via simulations that time-of-flight (TOF) reconstruction reduces the artifacts accompanying limited-angle data, and permits proton range measurement with 1-2 mm accuracy and precision. In this work we show measured results from a small proof-of-concept dual-panel PET system that uses TOF information to reconstruct PET data acquired after proton irradiation. The PET scanner comprises of two detector modules, each comprised of an array of 4×4×30 mm3 lanthanum bromide scintillator. Measurements are performed with an oxygen-rich gel-water, an adipose tissue equivalent material, and in vitro tissue phantoms. For each phantom measurement, 2 Gy dose was deposited using 54 - 100 MeV proton beams. For each phantom, a Monte Carlo simulation generating the expected distribution of PET isotope from the corresponding proton irradiation was also performed. Proton range was calculated by drawing multiple depth-profiles over a central region encompassing the proton dose deposition. For each profile, proton range was calculated using two techniques (a) 50% pick-off from the distal edge of the profile, and (b) comparing the measured and Monte Carlo profile to minimize the absolute sum of differences over the entire profile. A 10 min PET acquisition acquired with minimal delay post proton-irradiation is compared with a 10 min PET scan acquired after a 20 min delay. Measurements show that PET acquisition with minimal delay is necessary to collect 15O signal, and maximize 11C signal collection with a short PET acquisition. In comparison with the 50% pick-off technique, the shift technique is more robust and offers better precision in measuring the proton range for the different phantoms. Range measurements from PET images acquired with minimal delay, and the shift technique demonstrate the ability to achieve <1.5 mm accuracy and precision in estimating proton range.

Dose quantification in carbon ion therapy using in-beam positron emission tomography

This work presents an iterative method for the estimation of the absolute dose distribution in patients undergoing carbon ion therapy, via analysis of the distribution of positron annihilations resulting from the decay of positron-emitting fragments created in the target volume. The proposed method relies on the decomposition of the total positron-annihilation distributions into profiles of the three principal positron-emitting fragment species - 11C, 10C and 15O. A library of basis functions is constructed by simulating a range of monoenergetic 12C ion irradiations of a homogeneous polymethyl methacrylate phantom and measuring the resulting one-dimensional positron-emitting fragment profiles and dose distributions. To estimate the dose delivered during an arbitrary polyenergetic irradiation, a linear combination of factors from the fragment profile library is iteratively fitted to the decomposed positron annihilation profile acquired during the irradiation, and the resulting weights combined with the corresponding monoenergetic dose profiles to estimate the total dose distribution. A total variation regularisation term is incorporated into the fitting process to suppress high-frequency noise. The method was evaluated with 14 different polyenergetic 12C dose profiles in a polymethyl methacrylate target: one which produces a flat biological dose, 10 with randomised energy weighting factors, and three with distinct dose maxima or minima within the spread-out Bragg peak region. The proposed method is able to calculate the dose profile with mean relative errors of 0.8%, 1.0% and 1.6% from the 11C, 10C, 15O fragment profiles, respectively, and estimate the position of the distal edge of the SOBP to within an average of 0.7 mm, 1.9 mm and 1.2 mm of its true location.

Radio-luno-triquetral bone-ligament transfer as an additional stabilizer in scapholunate-instability

IntroductionReconstruction of the scapho-lunate (SL) ligament is still challenging. Many different techniques, such as capsulodesis, tendon graft and bone-ligament-bone graft have been described to stabilize reducible SL dissociation. If primary ligament repair alone is not possible, an additional stabilizer is needed to achieve scapho-lunate stability. A new local bone-ligament transfer using half of the radio-luno-triquetral ligament is performed. The direction of traction of the transposed ligament is very similar to the original ligament. Ideal tension can be attained by fixation of the bone block at the dorsal ridge of the scaphoid. The biomechanical stability of this bone-ligament transfer shall be examined biomechanically.Material and methodsComputed tomography imaging was performed using eight cadaveric forearms with a defined position of the wrist. Axial load was accomplished with tension springs attached to the extensor and flexor tendons. Three series ([a] native, [b] divided SL ligament and [c]) after reconstruction with bone-ligament transfer] were reconstructed three-dimensionally to determine the angles between radius, scaphoid and lunate. The radial distal part including a bone fragment of the radio-luno-triquetral ligament was transferred from its insertion at the distal edge of the radius to be attached to the dorsal ridge of the scaphoid.ResultsSL gap was widened after its transection. Average SL distance was 6.6 ± 1.6 mm. After ligament reconstruction, the gap could be narrowed significantly to 4.2 mm (± 0.7 mm). The movement of the scaphoid and lunate showed significant changes, especially in wrist flexion, fist closure and radial deviation. These deviations could be corrected by the bone ligament transfer.ConclusionReconstruction of a transected SL ligament with a bone-ligament transfer from the radio-luno-triquetral ligament reduces SL dissociation under axial load. The described surgical technique causes low donor-side morbidity and can be considered in addition to improve stability if SL ligament suture alone does not appear sufficient.Level of evidenceLevel II, therapeutic investigating experimental study.

Zero-contrast percutaneous coronary intervention for chronic total occlusions guided by intravascular ultrasound with ChromaFlo mode: a case report.

BackgroundContrast agent allergy may result in severe adverse events that prevent the use of percutaneous coronary intervention (PCI) in some patients, especially for those with complex lesions.Case summaryWe describe a 59-year-old man who presented with the multi-vessel disease and suffered from contrast allergy. The patient refused to have coronary artery bypass grafting surgery, thus two-stage PCI procedures without iodinated contrast media were performed after a detailed discussion with the heart team, including a chronic total occlusion (CTO) lesion in the proximal left anterior descending artery. The intravascular ultrasound (IVUS) was used for finding the entry point of the proximal fibre cap, and assessing the lesion, thereby marking the positions of the proximal and distal edges of the stent. After PCI, stent expansion and subtle edge dissection or incomplete apposition were confirmed by IVUS and ChromaFlo imaging. Zero-contrast PCI was done successfully without any complication.DiscussionThis case report illustrates the feasibility and safety of performing CTO-PCI without contrast agent in carefully and well prepared selected patients.

Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial

The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). The technical success rate was 97% (n=71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n=4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n=4/73) within one year and 7% within six years (n=5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n=63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.

Impact of hinge motion on stent edge restenosis after new generation drug-eluting-stent implantation in RCA

Abstract Background Edge restenosis still occurs after stent implantation, even by using new generation drug-eluting stents (DES) considered to have favorable biomechanical properties. Mechanical stress imposed on the stent edge are thought to be aggravated by hinge motion at a point between the stented and unstented segments, inducing chronic local inflammation and neointimal overgrowth. Purpose The aim of this study was to investigate the association between the development of edge restenosis and hinge motion in right coronary artery (RCA) where the excessive vessel movement is commonly observed. Methods Among consecutive 650 lesions in RCA where new generation DESs were implanted between 2009 and 2019, 427 serial lesions with sets of angiographies at baseline and follow-up (6–18 month) were included. In addition to conventional quantitative angiography analysis, hinge angle at stent edges was measured (Fig. 1). All the appropriate data for intravascular imaging were analyzed for both stent edges and reference segments. Results Binary restenosis occurred in 43 lesions, and 39 of them were referred to re-intervention. Fifty five percent of them were related to stent edges (15 at proximal and 9 at distal edges). Classical risk factors including diabetes and hemodialysis were more prevalent in the restenosis group (p&amp;lt;0.05). Hinge angle was statistically larger in edge restenosis group than body restenosis or no restenosis group (17.3° vs 11.6° vs 10.6°, p&amp;lt;0.001, Fig. 2). In per-edge analysis, hinge angle, dissection and residual plaque ratio were the independent predictors for binary restenosis (Table 1) with the optimal cut-off value of hinge angle 11.5°. The coexistence of excessive hinge angle and residual plaque burden had an amplified effect on the angiographic stenotic progression at stent edge (p for interaction &amp;lt;0.001) and the incidents of binary restenosis (16.7% vs 1.7% p&amp;lt;0.01, Figs. 3,4). Conclusion Substantial stress determined by angulation at the stent edge and its interaction with residual plaque can be considered as one of the plausible mechanisms for edge restenosis. For tortuous RCA lesions, it would be important to decide the stent-landing zone for minimizing hinge motion and optimize the future stent design. Funding Acknowledgement Type of funding source: None

A novel therapeutic approach for coronary inflammation and lymphatic vessels using non-invasive low-intensity pulsed ultrasound in a porcine model with DES-induced coronary hyperconstricting responses

Abstract Background The coronary adventitia harbors lymphatic vessels (LVs). We previously demonstrated that coronary adventitial inflammation and LV dysfunction play important roles in the pathogenesis of coronary artery spasm, including drug-eluting stent (DES)-induced coronary hyperconstricting responses, in pigs and humans. However, a direct therapeutic approach to the coronary adventitia remains to be developed. Purpose In this study, we aimed to examine whether our novel and non-invasive therapy with low-intensity pulsed ultrasound (LIPUS) ameliorates DES-induced coronary hyperconstricting responses, and if so, what mechanisms are involved. Methods An everolimus-eluting stent (EES) was implanted into the left anterior descending (LAD) coronary artery in normal male pigs. They were randomly assigned to the LIPUS or the sham therapy groups. After EES implantation, in the LIPUS group, LIPUS (32 cycles, 193 mW/cm2) was applied to the heart at 3 different levels (proximal and distal stent edges and middle portion of the stent) through X-ray fluoroscopy for 20 min at each level for every other day for 2 weeks (6 days in total) (Fig. 1A, B). The sham therapy group was treated in the same manner but without LIPUS. At 4 weeks after the procedure, we performed coronary angiography to examine coronary vasoconstricting responses to intracoronary serotonin in vivo. Finally, stented coronary vessels were harvested for immunohistochemistry of vasa vasorum (vWF), LVs (LYVE-1), vascular inflammation (CD68-positive macrophages and IL-1β expression), vascular endothelial growth factor A (VEGF-A, angiogenesis marker), VEGF-C and VEGF receptor 3 (VEGFR3, lymphangiogenesis markers). Results Coronary vasoconstricting responses to intracoronary serotonin at the DES edges in the LAD were significantly enhanced in the sham group but were significantly suppressed in the LIPUS group, while those responses were comparable at the non-DES implanted left circumflex (LCx) coronary artery between the 2 groups (Fig. 1C, D). In addition, in vivo lymph transport speed was significantly faster in the LIPUS group than in the sham group (Fig. 1E–G). In histological analysis, the number of LVs was significantly increased in the LIPUS group compared with the sham group, whereas those of CD68 and IL-1β expressions were significantly reduced in the LIPUS group compared with the sham group. In contrast, the density of vasa vasorum was comparable between the 2 groups. Mechanistically, the extents of VEGF-C and VEGFR3 expressions were increased in the LIPUS group, whereas that of VEGF-A was comparable between the 2 groups (Fig. 1G–K). Importantly, there were significant correlations among the LV-related changes and enhanced coronary vasoconstricting responses. Conclusion These results provide the first evidence that the LIPUS therapy ameliorates DES-induced coronary hyperconstricting responses in pigs in vivo through structural and functional alterations of LVs (Fig. 1L). Figure 1 Funding Acknowledgement Type of funding source: None

Stratigraphy and Sedimentology of the Morrison Formation in the Western Panhandle of Oklahoma with Reference to the Historical Stovall Dinosaur Quarries

New investigations of the Morrison Formation in the western Oklahoma panhandle reveal that the formation is approximately 60 m thick near Kenton, considerably less than historical measurements. We provide a new isopach map of the Morrison Formation at the basin margin and divide the formation into three new members based on geological, geochemical, petrographic, and paleontological characteristics. Each member is defined by unique depositional facies recording a variable climatic signal and the eventual progradation of the distributive fluvial system to the basin margin. Analogous depositional facies and lithologies of these units suggest they are lateral facies successions of the well-established members of the Colorado Plateau. The Cimarron Member is composed of numerous small, ephemeral, clastic lakes at the distal margin of the alluvial braid plain of the Tidwell Member. The Boise Member consists of numerous perennial limestone lakes at the distal edge of the Salt Wash Member distributive fluvial system. At the top of the member, the lake coalesced into a large lake, herein termed Lake Stovall. The Kenton Member records the progradation of the Brushy Basin Member distributive fluvial system to the basin margin in Oklahoma. Kenton Member fluvial deposition was by small, isolated, anastomosing fluvial channels and their associated splays. The gradual progradation of facies to the basin margin signifies that deposition in the foreland basin was geographically extensive and protracted. Dinosaur fossils excavated during the 1930s are placed into a stratigraphic framework. All quarries lie in the basal 6 m of the Kenton Member. Depositional facies and taphonomic data imply the dinosaurs died during a series of severe droughts. Bone dispersal and burial resulted from ephemeral flood splay events.

Intravascular imaging to guide lithotripsy in concentric and eccentric calcific coronary lesions

Abstract Background Calcified coronary lesions still represent a challenge for coronary angioplasty, with sub-optimal acute PCI results causing more frequent late stent failure. Purpose The study aimed at the evaluation of the immediate procedural outcome of a novel treatment algorithm based on IVUS and/or OCT and including lithotripsy into a real-world consecutive based on intravascular imaging assessment by IVUS or OCT. Methods and results Thirty-one calcified stenoses (28 patients) out of a total of 455 lesions in 370 patients treated between November 2018 and May 2019 met the clinical and angiographic criteria for treatment with IVL under intravascular imaging guidance. Patients were divided into two subgroups depending on the calcium arc measured with intravascular imaging. Twenty lesions showed a calcium arc greater than 180 degrees (289±53 degrees) and 11 lesions smaller than 180 (140±24 degrees). The following parameters were assessed with OCT and/or IVUS: post stent minimal lumen area (MLA) and area stenosis (AS), incomplete strut apposition (ISA), eccentricity index, strut fracture, and edge dissection. After optimization a satisfactory lumen enlargement (acute gain 1.28±0.46 mm; minimal stent area 7.09±2.77 mm2) was observed with good stent expansion (residual area stenosis &amp;lt;20% in 29 lesions, 93.5%) and OCT calcium fractures in 71% of cases. Peri-procedural complications were limited to one dissection at the distal edge requiring an additional stent and 3 peri-procedural myocardial infarctions. There were no in-hospital coronary perforations, no pericardial effusions, no stent failure or thrombosis, no deaths. Conclusions A standardized algorithm applying multimodality imaging to guide selection and application of IVL facilitated second generation DES implantation with final post-dilatation delivers excellent immediate procedural results and patient outcome, both in concentric or eccentric calcifications. Funding Acknowledgement Type of funding source: None

Tactics of treatment of the inflow varico-thrombophlebitis

Objective. To substantiate the indications for surgical treatment of the inflow thrombophlebitis, depending on state of venous hemodynamics in the large subcutaneous vein basin.&#x0D; Materials and methods. Analysis of the examination and treatment results was conducted in 23 patients, suffering the inflow varico-thrombophlebitis in the large subcutaneous vein basin.&#x0D; Results. Localization, length, borders, level of proximal and distal edges of thrombotic occlusion, and the thrombotic masses character were estimated in a case of the inflow thrombophlebitis diagnosis. Establishment of an acute inflow varico-thrombophlebitis diagnosis have had served the indication for performance of an urgent operation. At the same time, taking into account of the ultrasonographic investigation results obtained, it became possible to elaborate a differentiated tactics for the inflow varico-thrombophlebitis in the large subcutaneous vein basin present.&#x0D; Conclusion. Following an active surgical tactics for the inflow varico-thrombophlebitis have permitted to prevent effectively the spread of thrombtotic process on the large subcutaneous vein trunk and insufficient perforant veins, as well as to prevent the development of thrombosis in deep veins and venous thromboembolism morbidity. At the same time the operation volume reduction due to the inflow thrombophlebitis presence in the patient gave a chance to preserve the intact subcutaneous vein for possible further reconstructive interventions and to prevent the chronic venous insufficiency development as well.