Lesion Coverage Research Articles

What affects detectability of lesion-deficit relationships in lesion studies?

Elucidating the brain basis for psychological processes and behavior is a fundamental aim of cognitive neuroscience. The lesion method, using voxel-based statistical analysis, is an important approach to this goal, identifying neural structures that are necessary for the support of specific mental operations, and complementing the strengths of functional imaging techniques.Lesion coverage in a population is by nature spatially heterogeneous and biased, systematically affecting the ability of lesion–deficit correlation methods to detect and localize functional associations. We have developed a simulator that allows investigators to model parameters in a lesion–deficit study and characterize the statistical bias in lesion deficit detection coverage that will result from specific assumptions. We used the simulator to assess the signal detection properties and localization accuracy of standard lesion–deficit correlation methods, under a simple truth model — that a critical region of interest (CR), when damaged, gives rise to a deficit. We considered voxel-based lesion-symptom mapping (VLSM) and proportional MAP-3 (PM3). Using regression analysis, we examined if the pattern of outcome statistics can be explained by simulation parameters, factors that are inherent to anatomic parcels, and lesion coverage of the population, which consisted of a representative sample of 351 subjects drawn from the Iowa Patient Registry. We examined the effect of using nonparametric versus parametric statistics to obtain thresholded maps and the effect of correcting for multiple comparisons using false discovery rate or cluster-based correction.Our results, which are derived from samples of realistic lesions, indicate that even a simple truth model yields localization errors that are systematic and pervasive, averaging 2 cm in the standard anatomic space, and tending to be directed towards areas of greater anatomic coverage. This displacement positions the center of mass of the detected region in a different anatomical region 87% of the time. This basic result is not affected by the choice of PM3 vs VLSM as the fundamental approach, nor is localization error ameliorated by incorporation of lesion size as a covariate in the VLSM approach, or by data distribution-driven approaches to controlling multiple spatial comparisons (false discovery rate or cluster-based correction approaches).Our simulations offer a quantitative basis for interpreting lesion studies in cognitive neuroscience. We suggest ways in which lesion simulation and analysis frameworks could be productively extended.

Comparison of Full Lesion Coverage versus Spot Drug-Eluting Stent Implantation for Coronary Artery Stenoses

PurposeThe aim of this study was to evaluate and compare the long-term clinical outcomes of the spot drug-eluting stent (DES) implantation strategy, which is used to minimize implanted stent length and the number of stents, versus full lesion coverage for treatment of coronary artery stenoses.Materials and MethodsWe evaluated 1-year clinical outcomes of 1619 patients with stent implantation for a single coronary lesion. They were divided into two groups: those treated by full lesion coverage (n=1200) and those treated with the spot stenting strategy (n=419). The combined occurrence of 1-year target vessel failure (TVF), including cardiac death, target-vessel related myocardial infarction, or ischemia-driven target-vessel revascularization was evaluated.ResultsThe spot DES implantation group had a shorter stent length (23.14±9.70 mm vs. 25.44±13.24 mm, respectively; p<0.001) and a fewer number of stents (1.09±0.30 vs. 1.16±0.41, respectively; p<0.001), even though the average lesion length was similar to the full lesion coverage group (21.36±10.30 mm vs. 20.58±10.97 mm, respectively; p=0.206). Spot DES implantation was superior to full DES coverage with respect to 1-year TVF (1.4% vs. 3.3%, p=0.044). Cox proportional hazard model analysis showed that the risk for 1-year TVF was almost 60% lower among patients who received spot DESs compared to those who received full DES coverage after adjustment for other risk factors (HR=0.40, 95% confidence interval=0.17-0.98; p=0.046).ConclusionMinimizing stent length and the number of stents with overlapping by spot DES implantation may result in reduced rates of 1-year TVF, compared with full DES coverage.

CT PERFUSION IN ACUTE ISCHAEMIC STROKE: DO WE COVER THE LESION AND WHAT DOES IT MEAN?

IntroductionIdentifying and quantifying infarct core and penumbra in acute ischaemic stroke patients may improve patient selection for thrombolysis. Although CT Perfusion (CTP) imaging has several potential advantages over multimodal MRI,...

Uso da terapia por pressão subatmosférica em feridas traumáticas agudas

To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287 procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.

Premiere use of Integra™ artificial skin to close an extensive fetal skin defect during open in utero repair of myelomeningocele

There are fetuses demonstrating very large myelomeningocele lesion which can not be covered with autochothonous skin. We use Integra™ artificial skin for intrauterine coverage of the back lesion. A reverse latissimus dorsi flap was used postnatally to reinforce the repair site. Integra™ appears to be a suitable coverage for large soft tissue defects in utero. Moreover, a postnatal reverse latissimus dorsi flap appears to markedly strengthen tissue coverage over a spinal cord rescued in utero.

Radiofrequency–Intravascular Ultrasound Assessment of Lesion Coverage After Angiography-Guided Emergent Percutaneous Coronary Intervention in Patients With Non–ST Elevation Myocardial Infarction

Using radiofrequency-intravascular ultrasound (VH-IVUS), we have previously demonstrated that in 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with optimal angiographic result, the stent does not fully cover the whole VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) related to the culprit lesion. Presently, we set out to extend these findings to 20 patients with non-STEMI with Thrombolysis In Myocardial Infarction flow 3 in the infarct-related artery before intervention who were then treated with angiography-guided direct stent implantation. The lesion was imaged with VH-IVUS before and after intervention, but the results were blinded to the operator. Plaque rupture site was identified in 8 lesions (40%), all proximal to the minimum lumen area (MLA) site. The maximum necrotic core site was found proximal to MLA in 18 lesions and at the MLA in 2 lesions. Although the plaque rupture site was fully covered with the stent in all lesions, an uncovered VH-TCFA was found in 7 lesions (35%), 4 in the proximal reference segment, 1 in the distal reference segment, and 2 in both the proximal and distal reference segments. In conclusion, in 35% of patients with non-STEMI undergoing angiography-guided emergent percutaneous coronary intervention, the stent does not fully cover a VH-TCFA related to the culprit lesion.

One-Year Outcomes of Percutaneous Coronary Intervention With the 38-mm Resolute Zotarolimus-Eluting Stent

This study was designed to prospectively evaluate the safety and efficacy of the 38-mm Resolute zotarolimus-eluting stent (R-ZES). Drug-eluting stents with long lengths are needed to ensure coverage of long lesions in some patients. Patients recruited from the RESOLUTE US and RESOLUTE Asia studies were implanted with at least one 38-mm R-ZES. Up to 2 lesions (in separate vessels) could be implanted with length ≤35 mm and a reference vessel diameter of 3.0 to 4.2 mm. The primary end point was 1-year target lesion failure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. The 1-year target lesion failure rate using 1 vessel per patient was compared with a performance goal (19%) derived from historical data. There were 223 patients enrolled (n = 269 lesions). The mean age was 60.9 ± 10.9 years, 79% were men, and 38% had diabetes. Target lesion failure rate using a single-vessel analysis was 4.5%, and the upper limit of the 1-sided 95% confidence interval (7.5%) was less than the performance goal of 19%. A secondary analysis using all lesions resulted in a target lesion failure rate of 5.4% (upper limit of 1-sided 95% confidence interval, 8.6%). Baseline characteristics and clinical outcomes were similar between patients with and without diabetes. The rate of probable or definite stent thrombosis was 0.9%. In conclusion, the 38-mm length of the R-ZES was found to be safe and effective with a low rate of target lesion failure and stent thrombosis and no differences in outcomes between patients with and without diabetes.

Does optical coherence tomography-guided angioplasty yield additional clinical information and modify physician strategy?

Background: It is unclear whether optical coherence tomography (OCT) can optimise percutaneous coronary intervention and stenting. We evaluated whether OCT-guided angioplasty would provide useful clinical information beyond that obtained by angiography, and if this would modify physician behaviour & treatment choices. Methods: Prospective study of patients (pts) undergoing coronary angiography for ST and non-ST elevation myocardial infarction (STEMI, NSTEMI), stable angina (SA) or silent ischemia (SI). In all pts, 1 OCT run was performed (OCT-pre) after initial angiography (angio-pre); and a 2nd run after angioplasty (OCT-post). We compared thrombus burden, calcifications & plaque dissection between OCT-pre and angio-pre. After angioplasty, we compared stent malapposition, suboptimal stent deployment or lesion coverage, and edge dissection as identified by OCT-post vs post-angioplasty fluoroscopy alone. Results: 69 pts were included (13 STEMI, 23 NSTEMI, 27 SA, 6 SI); 46% multivessel disease; 10% had atheroma without significant lesions. Results are shown in the Table. OCT-pre and post-angioplasty revealed significantly more procedural information than angiography alone. This led to a change in treatment strategy in 35/69 (51%), namely thromboaspiration in 2 (2.9%), rotational atherectomy in 4 (5.8%), additional stenting in 13 (18.8%), additional balloon inflation in 20 (29%), GPIIb/IIIa inhibitors in 8/69 (11.6%). Conclusion: Our results indicate that OCT performed before and after angioplasty provides useful information beyond that obtained by angiography alone, and modifies treatment strategy in more than half of pts. It remains to be determined whether this translates into improved outcomes in the longer term.

Stenting of a left main coronary artery compressed by dilated pulmonary artery

A 54-year-old obese man without comorbidity presented with dyspnea associated with typical angina. Physical examination revealed jugular venous distension, systolic murmur at left parasternal border with a prominent pulmonary component of S2 and S3 gallop. He had ST depression throughout the precordial leads and troponin level of 8. Coronary angiography showed 95% narrowing in the proximal left main coronary artery (LMCA) with TIMI grade 3 flow (Image A, B, C). Echocardiography showed a markedly dilated pulmonary. CT angiography demonstrated compression of the LMCA by the severely enlarged Main pulmonary artery (MPA) (9.8×9.0 cm). Right heart catheterization revealed right ventricle pressure of 69/10 mmHg with mean pressure of 33 mmHg and right pulmonary artery pressure of 66/28 mmHg with mean pressure of 40 mmHg. Work up for the cause of pulmonary hypertension was consistent with primary pulmonary arterial hypertension (PPAH). Stent of the LMCA was performed with 4.5×12 mm bare metal Veriflex™ stent (Boston Scientific Company, Minneapolis, MN) with post-dilation diameter of 5mm.(Image D) Subsequently IVUS revealed adequate expansion of the stent and complete coverage of the lesion.(Image E) After the procedure, the patient reported immediate relief of symptoms. Optimal medical management was continued. Follow-up coronary angiography at 3 months showed a nonstenosed stent (Image F) and at 1 year, he remained asymptomatic. ![Figure][1] Figure 1. Angiographic and IVUS images LMCA compression by dilated MPA in PAH may not be uncommon as previously thought. It is a reversible cause of chest pain associated with PPAH. Traditionally, LMCA stenosis treatment involves coronary bypass graft surgery. However, LMCA stenosis secondary to compression by dilated MPA has been increasingly treated by angioplasty with promising outcome [1]: pending:yes

Comparison of imaging-based gross tumor volume and pathological volume determined by whole-mount serial sections in primary cervical cancer

ObjectiveTo investigate the accuracy of imaging-based gross tumor volume (GTV) compared with pathological volume in cervical cancer.MethodsTen patients with International Federation of Gynecology and Obstetrics stage I–II cervical cancer were eligible for investigation and underwent surgery in this study. Magnetic resonance imaging (MRI) and fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) scans were taken the day before surgery. The GTVs under MRI and 18F-FDG PET/CT (GTV-MRI, GTV-PET, GTV-CT) were calculated automatically by Eclipse treatment-planning systems. Specimens of excised uterine cervix and cervical cancer were consecutively sliced and divided into whole-mount serial sections. The tumor border of hematoxylin and eosin-stained sections was outlined under a microscope by an experienced pathologist. GTV through pathological image (GTV-path) was calculated with Adobe Photoshop.ResultsThe GTVs (average ± standard deviation) delineated and calculated under CT, MRI, PET, and histopathological sections were 19.41 ± 11.96 cm3, 12.66 ± 10.53 cm3, 11.07 ± 9.44 cm3, and 10.79 ± 8.71 cm3, respectively. The volume of GTV-CT or GTV-MR was bigger than GTV-path, and the difference was statistically significant (P < 0.05). No significant difference was observed between GTV-PET and GTV-path (P > 0.05). Spearman correlation analysis showed that GTV-CT, GTV-MRI, and GTV-PET were significantly correlated with GTV-path (P < 0.01). There was no significant difference in the lesion coverage factor among the three modalities.ConclusionThe present study showed that GTV defined under 40% of maximum standardized uptake value in PET images was very similar to the pathological volume of cervical cancer. This result should be replicated in a larger number of patients with cervical cancer in a future study of ours.

SU‐E‐T‐591: Geometry‐Based Non‐Coplanar Beam Selection for Intensity Modulated Robotic Radiotherapy

Purpose: The MLC‐based CyberKnife system has been shown promising in treatment‐time reduction and plan‐quality improvement, comparing with the cone‐based models. The improved treatment efficiency can be attributed to the enhanced coverage of larger lesions and the capability of realizing high‐quality plans with less beams due to improved target conformity. The purpose of this study is to develop an efficient non‐coplanar beam selection program for CyberKnife‐based IMRT. Methods: The candidate beam‐set consists of 94 non‐coplanar beams, each defined by a vector connecting a CyberKnife node and a target point. The MLC leaves are configured to approximate a circle, whose radius R at 80cm SSD can be chosen such that the beam cross‐sections fully covers the PTV. We aim to choose an adequate number of beams that will cover as much body surface area as possible, considering the facts that to deliver a certain dose to the PTV, the larger the total covered surface area is, the lower the surface dose will be and that the more the beams are, the longer the treatment time will be. A beam‐selection program was developed based on the constraint on the body surface overlap. To evaluate its effectiveness, several IMRT plans with the selected beams for different treatment sites were generated using the Varian Eclipse treatment‐planning‐system. Results: Our program efficiently selected much less number of beams without compromising the desired surface coverage. For example, a set of 17 beams were selected for a pancreas case, covering 92.5% of the surface area covered by the 94 beams for R=5cm with 20% maximal overlap. The IMRT plans with the selected beams show superior quality with dramatically improved critical structure sparing, comparing with the clinically approved IMRT plans. Conclusion: One can efficiently select effective sets of non‐coplanar beams with our program, which allow the generation of high‐quality plans for MLC‐based robotic radiotherapy.

3. Gamma knife surgery in hypothalamic hamartoma: An effective treatment of refractory epilepsy with good outcome on quality of life and cognition

Hypothalamic hamartomas (HHs) are intrinsically epileptogenic congenital lesions typically presenting with drug resistant epilepsy. Patients affected also suffer from progressive cognitive deficits. Based upon previous studies, Gamma-knife surgery for HHs seems to be effective regarding epilepsy outcome with minimal side effects. Little data is available on the neurocognitive effect of this procedure. At the Centre Hospitalier Universitaire de Sherbrooke, we have undertaken a prospective observational study of patients who underwent radiosurgery for HHs, evaluating the response rate of seizures and the impact on cognition and quality of life. Patients were included in the study if they had an HH, refractory epilepsy, and no other suspected seizure focus. After radiosurgery, seizure status was assessed every three months and reported using the Engel Classification. Neuropsychological evaluation and quality of life evaluation using a standardized questionnaire (QOLIE-89) was performed at baseline and annually thereafter. Twelve patients with refractory epilepsy have been included so far in the study. Age ranged from 14 to 57 years. Margin doses ranged from 14 to 20 Gy. Nine patients had smaller hamartomas (Régis classification Grade I–III) and underwent treatment of the entire lesion. Three patients had larger lesions (Grade IV–VI) for which a radiosurgical disconnection was attempted. One of them had a second treatment with full lesion coverage. Among the seven patients treated with full lesion coverage with more than two years of follow-up, five (70%) are seizure free (Engel I). One patient has only rare seizure (Engel II), and one did not improve (Engel IV). Mean time to seizure freedom was twelve months (range 4–22). Disconnection led to no or little improvement in epilepsy (Engel IV in two patients and Engel IIIa in one). Nine patients had an abnormal cognitive profile at baseline. Four of them had a second evaluation after two years, and marked improvement in multiple domains of cognition occurred in three patients, and one remained stable. We observed a tendency toward improvement of quality of life evaluated with QOLIE-89, with a median result of 53% before treatment compared to 84% one or two years after treatment ( p = 0.068). Three patients had transient psychiatric disturbances after treatment (major depression with psychotic features requiring hospitalization in two, and impulsive behavior in one). In this prospective study of patients with refractory epilepsy associated with HHs, radiosurgery was effective in most patients when the entire lesion could be targeted. Some encouraging effects were also observed for cognition and quality of life, but this needs to be further evaluated in larger series of patients. Radiosurgical disconnection of large lesions was ineffective. Psychiatric disturbances as a possible side effect of this procedure need to be investigated further. For small HHs, radiosurgery with full lesion coverage should be a first line surgical therapy.

Abstract 138: Treatment of Atherosclerosis by Systemic Protease Inhibition

Background Elevated activity of urokinase plasminogen activator (uPA) and matrix metalloproteases (MMPs) in human arteries is associated with accelerated atherosclerosis (athero), aneurysms, and plaque rupture. Apoe -null mice with macrophage-targeted uPA overexpression (SR-uPA mice) have elevated vascular uPA and MMP activity, accelerated athero, dilated aortic roots, and increased histologic features of plaque rupture. SR-uPA mice are therefore a useful experimental setting for beginning to investigate whether inhibition of uPA or MMPs can prevent athero progression, aortic dilation, and plaque rupture. Hypothesis Treatment with a murine monoclonal antibody inhibiting mouse uPA (mU1), or a limited-spectrum synthetic MMP inhibitor (XL784) will reduce athero in SR-uPA mice. Methods SR-uPA mice were fed a high-fat diet for 10 wk beginning at 5 - 6 wk of age. Fat-fed mice were injected with mU1 or control antibody twice per wk (for 10 wk), or were given either XL784 (125, 250, or 500 mg/kg) or vehicle by daily oral gavage. Mice were then anesthetized, formalin-perfused, and athero was measured in isolated aortic roots and pinned aortas. Groups were compared by t-test and ANOVA. Results None of the treatments altered peripheral blood monocyte counts or plasma cholesterol. mU1 reduced aortic root intimal lesion area by 20% ( P &lt; 0.05) and aortic root circumference by 12% ( P = 0.01). All 3 doses of XL784 significantly decreased oil-red O-positive lesion area (36 - 42%; P &lt; 0.05 for all). All XL784 doses also reduced aortic root intimal lesion area (22 - 29%; P &lt; 0.05 for low dose only). The highest XL784 dose also reduced total macrophage-positive lesion area (33%; P &lt; 0.05). All XL784 doses yielded trends towards decreased aortic root circumference (5 - 10%). Neither mU1 nor XL784 significantly altered percent aortic surface lesion coverage. Conclusions In SR-uPA mice, pharmacologic inhibition of either uPA or selected MMPs significantly decreased aortic root athero and limited aortic dilation. Differential effects of both agents on aortic root versus surface athero suggest prevention of athero progression rather than initiation. These approaches to protease inhibition show promise for preventing the progression and complications of established athero.

Spot Stenting is Preferable in Long Diffuse Coronary Lesions: Possible Incremental Value of Physiologic and Intracoronary Imaging Modalities

The treatment of long and diffuse coronary lesions with percutaneous coronary intervention (PCI) has been problematic since the era of plain balloon angioplasty. With the advent of bare-metal stents (BMS), long and multiple stents were used to completely cover the diseased segments in order to improve outcomes. Lesion length has been proven to be a factor related to higher rates of restenosis and target lesion revascularization (TLR) and the risk was further increased by the multiplicity of implanted stents. Covering the lesion with the least number of non-overlapping stents might reduce the risk of restenosis. This strategy, called spot stenting , was initially tested in the BMS era to treat discrete high-grade disease within moderately diseased vessel segments and has been shown to significantly reduce restenosis rates. Drug-eluting stents (DES) have been consistently shown to reduce restenosis and the need for TLR and thus provide improved clinical efficacy compared with BMS. However, even with DES, diffuse disease and long lesions are still associated with an increased risk of restenosis, need for TLR and major adverse cardiac events (MACE). A major long-term concern regarding DES is the potential for stent thrombosis which is increased after complex procedures with implantation of longer, multiple and overlapping stents. Data are limited but recent reports suggest that even when DES are used, selective stenting of only the severely narrowed areas of long lesions reduces the risk of MACE compared to full lesion coverage. The data supporting the spot stenting approach along with some considerations regarding the technique are presented herein.

One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries.

BackgroundIn recent years, stents are increasingly used in variety of coronary lesions. Ostial lesion of left anterior descending coronary artery (LAD) however remains a challenge area because of the invariable involvement of distal left main coronary artery (LMCA). This study was designed to evaluate the clinical and angiographic outcomes of everolimus-eluting stent (EES) implantation for ostial LAD.MethodsEESs were implanted in 45 consecutive patients with ostial LAD stenoses. For complete lesion coverage, stent positing was extended into the distal LMCA in 6 patients (13.3%) with intermediated LMCA narrowing. We assess MACE during one-year follow-up.ResultsIn-hospital success rate was 100%; neither cardiac death nor stent thrombosis in our patients, but two patients had myocardial infarction in non-related coronary artery during follow-up. Two patients had angiographic restenosis and underwent TLR. The cumulative MACE-free survival rate was 95.6% at one year.ConclusionEES was in ostial LAD lesions with complete lesion coverage achieving high procedural success rate and acceptable clinical outcomes during one-year follow-up period.

Dynamic and Segmental Methods of Intensity Modulated Radiation Therapy Delivery in Head-and-Neck Cancer—Analysis of Volumetric and Dosimetric Parameters

The use of intensity-modulated radiation therapy (IMRT) is widely advocated for the treatment of head and neck cancers to increase the therapeutic ratio. IMRT is delivered with a multileaf collimator (MLC) either in dynamic mode (DMLC or sliding window) or in segmental mode (SMLC or step-and-shoot).This report aims to compare the volumetric and dosimetric parameters between the two methods of IMRT delivery. Objectives: To compare conformality index, homogeneity index, quality of coverage, lesion coverage factor, conformation number and integral dose between DMLC and SMLC IMRT plans; To compare the mean parotid dose, maximum spinal cord dose, beam-on time (MU or monitor units), treatment delivery time and the fluence dosimetric parameters.

Attenuation of Early Atherogenesis in Low-Density Lipoprotein Receptor–Deficient Mice by Proteasome Inhibition

Low and nontoxic proteasome inhibition has anti-inflammatory, antiproliferative, and antioxidative effects on vascular cells in vitro and in vivo. We hypothesized that low-dose inhibition of the proteasome could provide antiatherogenic protection. The present study investigated the effect of low-dose proteasome inhibition on early lesion formation in low-density lipoprotein receptor-deficient mice fed a Western-type diet. Male low-density lipoprotein receptor-deficient mice, 10 weeks old, were fed a Western-type diet for 6 weeks with intraperitoneal injections of bortezomib or solvent. Bortezomib was injected at a dose of 50 μg/kg body weight. Cholesterol plasma levels were not affected by bortezomib treatment. En face Oil Red O staining of aortae and aortic root cryosections demonstrated significant reduction of atherosclerotic lesion coverage in bortezomib-treated animals. Bortezomib significantly reduced vascular cellular adhesion molecule-1 expression and macrophage infiltration as shown by histological analysis. Bortezomib treatment resulted in a significant reduction of superoxide content, lipid peroxidation and protein oxidation products, serum levels of monocyte chemoattractant protein-1, and interleukin-6. Gene expression microarray analysis showed that expressional changes induced by Western-type diet were attenuated by treatment with low-dose bortezomib. Low-dose proteasome inhibition exerts antioxidative and anti-inflammatory effects and attenuates development of atherosclerotic lesions in low-density lipoprotein receptor-deficient mice.

Whole Brain Irradiation With Hippocampal Sparing and Dose Escalation on Multiple Brain Metastases: A Planning Study on Treatment Concepts

To develop a new treatment planning strategy in patients with multiple brain metastases. The goal was to perform whole brain irradiation (WBI) with hippocampal sparing and dose escalation on multiple brain metastases. Two treatment concepts were investigated: simultaneously integrated boost (SIB) and WBI followed by stereotactic fractionated radiation therapy sequential concept (SC). Treatment plans for both concepts were calculated for 10 patients with 2-8 brain metastases using volumetric modulated arc therapy. In the SIB concept, the prescribed dose was 30 Gy in 12 fractions to the whole brain and 51 Gy in 12 fractions to individual brain metastases. In the SC concept, the prescription was 30 Gy in 12 fractions to the whole brain followed by 18 Gy in 2 fractions to brain metastases. All plans were optimized for dose coverage of whole brain and lesions, simultaneously minimizing dose to the hippocampus. The treatment plans were evaluated on target coverage, homogeneity, and minimal dose to the hippocampus and organs at risk. The SIB concept enabled more successful sparing of the hippocampus; the mean dose to the hippocampus was 7.55±0.62 Gy and 6.29±0.62 Gy, respectively, when 5-mm and 10-mm avoidance regions around the hippocampus were used, normalized to 2-Gy fractions. In the SC concept, the mean dose to hippocampus was 9.8±1.75 Gy. The mean dose to the whole brain (excluding metastases) was 33.2±0.7 Gy and 32.7±0.96 Gy, respectively, in the SIB concept, for 5-mm and 10-mm hippocampus avoidance regions, and 37.23±1.42 Gy in SC. Both concepts, SIB and SC, were able to achieve adequate whole brain coverage and radiosurgery-equivalent dose distributions to individual brain metastases. The SIB technique achieved better sparing of the hippocampus, especially when a10-mm hippocampal avoidance region was used.

COMPARISON OF OSTIAL AND CROSSOVER DRUG-ELUTING STENT IMPLANTATION TECHNIQUE FOR MEDINA (0,1,0) OR (0,0,1) BIFURCATED LESION

Background: For Medina (0,1,0) and (0,0,1) lesion, stent implantation at ostium of bifurcation may finish with incomplete coverage of lesion and may cause proximal edge restenosis. But if we crossover other branch with stent, additional balloon dilatation for healthy vessels through jailed strut to maintain access route for other branch with single balloon or kissing balloon technique may be needed. So this study was aimed to investigate the outcomes of ostial and crossover stent implantation for Medina (0,1,0) and (0,0,1) bifurcated lesion.

Virtual Histology-Intravascular Ultrasound Assessment of Lesion Coverage After Angiographically-Guided Stent Implantation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

An occlusion or severe stenosis (angiographic culprit lesion) of the infarct-related artery is frequently located at the site of the maximum thrombus burden, whereas the origin of the plaque rupture (the true culprit) can be situated proximal or distal to it. The aim of this study was to examine stent coverage of true culprit lesions in 20 patients who underwent primary percutaneous coronary intervention and had Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow restored in the infarct-related artery by angiographically guided direct stenting. Images of lesions were obtained using virtual histology-intravascular ultrasound before and after intervention (blinded to the operator). Plaque rupture sites were identified by intravascular ultrasound in 12 lesions (60%), 11 proximal and 1 distal to the minimum luminal area (MLA). Maximum necrotic core sites were found proximal to the MLA in 16 lesions, at the MLA in 3 lesions, and distal to the MLA in 1 lesion. Plaque rupture sites were fully covered by stents in 11 lesions. Virtual histology-intravascular ultrasound-derived thin-cap fibroatheroma longitudinal geographic misses were found in 10 lesions, 7 in the proximal reference segment and in 3 patients in the proximal and distal reference segments. In conclusion, in about 50% of patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction with optimal angiographic results, the stent does not fully cover the maximum necrotic core site related to the culprit lesion.