Short Tip Research Articles

First record of a deep-sea tardigrade from the South China Sea, Halechiniscus janus sp. nov. (Arthrotardigrada: Halechiniscidae).

The knowledge of marine tardigrades in the South China Sea (Western Pacific Ocean) is very scarce, with only four species from shallow waters recorded until now. The first deep-sea (15301624 m bsl) tardigrade species from this sea, Halechiniscus janus sp. nov. (Arthrotardigrada: Halechiniscidae), is described here. Specimens of the new species have four wrinkled digits without peduncles on each leg, terminated by simple crescent-shaped claws, and primary clavae clearly shorter than cirri A, both inserted on a common cirrophore, as typical for the genus Halechiniscus Richters, 1908. The new species differs from all other Halechiniscus species by its cylindrical body and conical head; by the presence of semispherical secondary clavae, and by sensory organs on legs IV consisting of a short cirrophore followed by a short papilla terminated in a peculiar short bipartite tip. The discovery of this new bathyal species, with its peculiar morphological traits, brings new insights not only to the biogeography and ecology of tardigrades, but also to the understanding of the only partially resolved systematics of the diversified family Halechiniscidae.

The use of a novel short dilator tip on the distal bifurcated component during fenestrated aortic repair to avoid reno-visceral bridging stents.

The aim of this study was to evaluate the feasibility and efficacy of a modified delivery system of the distal bifurcated FEVAR component where the dilator tip was shortened to prevent damage to the renovisceral bridging stents. All consecutive patients from a tertiary referral center that underwent a FEVAR with a custom delivery system of the distal bifurcated endograft with a short tip between November 2017 and July 2019 were retrospectively analyzed. Only patients with complete fluoroscopic loops of the insertion and deployment of the distal endograft were included. The primary study endpoint was the degree of crossing of the fenestration bridging stent-grafts, that was graded as 'not crossing', 'partial crossing' and 'complete crossing' relative to the lowermost placed fenestration. Secondary endpoints included fenestration related adverse events, secondary interventions, changes in renal function, aneurysm related mortality and overall mortality. 23 patients were included (21 (91%) juxta-renal aneurysms, 2 TAAA type IV (9%). The lowermost fenestration was crossed in 4 (17.3%), partially crossed in 9 (39.1%) and not crossed in 10 (43.4%) cases. Partial compression or inadequate flaring of a fenestration stent-graft was identified in the intraoperative cone beam CT in 6 (26.0%) patients and corrected peri-operatively. Technical success was 100%. Median follow-up was 34 (27-38) months with two non-aneurysm related deaths during this period. Four patients (17.3%) underwent a secondary intervention related to a fenestration bridging stent-graft. The use of a custom short dilator introducer tip on the bifurcated device during FEVAR reduces the need to cross the fenestration bridging stent-grafts and may result in less fenestration related adverse events. However, the reno-visceral segment is still frequently crossed by the iliac extension which may lead to adverse events. This could likely be avoided by a similar adaptation on the iliac extension delivery system.

Novel cryoballoon system for pulmonary vein isolation: multicenter assessment of efficacy and safety - The ANTARCTICA study

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) either by balloon devices or point by point radiofrequency (RF) and 3D mapping based catheter ablation forms the cornerstone of invasive atrial fibrillation (AF) treatment and has demonstrated high procedural success and encouraging long-term outcomes. Although equally effective cryoballoon (CB) based PVI offers shorter procedure duration as well as lower complication rates compared to RF based PVI. Beside the worldwide established Arctic Front Advance (AFA) cryoablation system a novel CB ablation system, POLARx was recently introduced. The POLARx CB incorporates unique features which may translate into improved efficacy and safety of CB based PVI. However, multicenter assessment of periprocedural efficacy and safety is lacking up to date. Methods From August 5th to october 12th 2020, a total of 317 patients with paroxysmal or persistent atrial fibrillation (AF) underwent POLARx CB based PVI in 5 centers from Germany and Italy. Acute efficacy and safety were assessed. Results In 317 patients (mean age 64±12 years, 209/317 (66%) paroxysmal AF) a total of 1256 pulmonary veins (PV) were identified and 1252 (99,7%) PVs were successfully isolated utilizing the mainly the short tip POLARx CB (82%). The mean minimal cryoballoon temperature was -57.9±7 °C. Real-time PVI was visualized in 72% of PVs. The mean procedure time 92±41 minutes with a mean fluoroscopy time of 15±10 minutes. Concerning periprocedural complications 1 (0.3%) cardiac tamponade successfully treated by pericardial puncture and 4 (1.3%) pericardial effusion without any intervention were detected. A total of 13 phrenic nerve injuries (4.1%) occurred during treatment of the right superior PV (9/13) and right inferior PV (4/13). Phrenic nerve injury recovered in 3/13 (23%) patients until discharge. Two minor bleeding of the groin (0.6%), 1 (0.3%) severe bleeding with intervention, 5 transient air embolism (1.6%) and 3 (0.9%) stroke / TIA has been observed. Conclusions In this large multicenter assessment the novel POLARx CB shows a promising efficacy and safety profile. Further studies are necessary to draw final conclusion.

Сравнительный анализ вариантов применения наконечников калибра 25G к постоянному магниту при удалении вгит из заднего сегмента глаза

Purpose. To compare the options for applying a 25G caliber tip to a permanent magnet when removing the VGIT from the posterior segment of the eye. Material and methods. The analysis of the results of treatment of 60 patients of the Ophthalmology Clinic of the Kirov Medical Institute was performed. The localization of the entrance opening, localization of the IOFB in the intraocular space, features of the use of 25G caliber tips, intraoperative complications were analyzed and the advantages of removing the IOFB in a combined way with the use of a 25G tip to a permanent magnet were evaluated. Results. According to the localization of the entrance opening, patients were distributed as follows: zone I – 16 (27 %), zone II – 34 (57 %), zone III – 10 (17 %). In all patients, IOFB was located in the posterior segment of the eyeball. During the operation, the following methods of IOFB removal were used: forceps – forceps (45 %), magnet–forceps (33 %), magnet–magnet (22%). When removing the IOFB according to the first and second technique, in several cases it was necessary to intercept the IOFB for more reliable fixation in the branches of the forceps. In the case of the use of the third technique, reliable fixation of the IOFB with a 25G tip was noted, however, for its implementation, it was necessary to have another magnet with a larger and shorter tip. After the treatment, all patients received an increase in visual acuity and in most cases (48%) at the time of discharge from the hospital, it was in the range from 0.05 to 0.1. Conclusions. Removal of magnetic IOFB using 25G caliber tips to a permanent magnet allows you to reliably fix the IOFB, significantly reduce the risks of intraoperative complications and shorten the duration of the operation, and the option with the use of two magnets allows you to completely eliminate the risks of falling IOFB on the fundus. Keywords: open globe injury, intraocular foreign body, 25G tips, permanent eye magnet

Re-Examining the Cochlea in Branchio-Oto-Renal Syndrome: Genotype-Phenotype Correlation.

Temporal bone imaging plays an important role in the work-up of branchio-oto-renal syndrome. Previous reports have suggested that the unwound or offset cochlea is a highly characteristic marker for branchio-oto-renal syndrome. Our goals were to examine the prevalence of this finding in a branchio-oto-renal syndrome cohort and analyze genetic-phenotypic associations not previously established. This multicenter retrospective study included 38 ears in 19 unrelated individuals with clinically diagnosed branchio-oto-renal syndrome and confirmed mutations in the EYA1 or SIX1 genes. Two blinded neuroradiologists independently reviewed and documented temporal bone imaging findings in 13 categories for each ear. Imaging phenotypes were correlated with genotypes. There was excellent interrater agreement for all 13 phenotypic categories (κ ≥ 0.80). Of these, 9 categories showed statistically significant differences between patients with EYA1-branchio-oto-renal syndrome and SIX1-branchio-oto-renal syndrome. Cochlear offset was present in 100% of patients with EYA1-branchio-oto-renal syndrome, but in only 1 ear (12.5%) among patients with SIX1-branchio-oto-renal syndrome. A short thorny appearance of the cochlear apical turn was observed in most patients with SIX1-branchio-oto-renal syndrome. An offset cochlea is associated with the EYA1-branchio-oto-renal syndrome genotype. The SIX1-branchio-oto-renal syndrome genotype is associated with a different cochlear phenotype that almost always is without offset and has a short thorny tip as the apical turn. Therefore, cochlear offset is not a characteristic marker for all patients with branchio-oto-renal syndrome. The lack of a cochlear offset in a patient with clinically suspected branchio-oto-renal syndrome does not exclude the diagnosis and, in fact, may be predictive of the SIX1 genotype.

Perancangan E-Magazine sebagai Referensi Program untuk Perpustakaan Sekolah Menengah Atas (Design and Development di Perpustakaan Sekolah Negeri se-Kota Bandung)

The Covid-19 pandemic has made school libraries unable to provide their services, plus there is still a lack of school library programs to respond to the way of learning from offline to online. Even though libraries can use technology to continue to provide services for their users. The purpose of this research is to design library e-magazines at High School Libraries in Bandung city as a form of innovation for school library programs that can be run in the midst of the Covid-19 pandemic. This research can be used as an e-magazine blueprint that can be used at other school libraries. The research using a design and development model. The design of the e-magazine consists of three processes: 1) pre-production, which includes determining the theme, searching for articles, writing articles and correcting the text; 2) production, including magazine design, proofreading of design results, and trial printing; and 3) post-production, including printing and marketing. The results of the needs analysis show that suitable content in e-magazine are light reading types such as short stories, tips and tricks, various recommendations such as food, tourist attractions, movies, and books, as well as light like crossword puzzles. The response of librarians and students to the e-magazine is very good in terms of theme selection, material and language, and appearance. It is stated that the chosen theme is very relevant to the conditions and needs that occur. The responses obtained can then be used as an illustration and evaluation material for the next e-magazine design.

Langmuir probe array for the small angle slot divertor in DIII-D.

The DIII-D small angle slot (SAS) divertor is designed for divertor physics studies with enhanced neutral confinement and special target geometries in a closed divertor. The closed nature of the SAS makes optical diagnostic measurements difficult, so a specially designed, multipurpose array of Langmuir probes has been implemented to study the plasma conditions in and around the slot. The probes are spaced to provide at least 2mm resolution (shorter than the energy decay length) of the near scrape-off layer when mapped to the outer mid-plane. Due to space limitations at the bottom of the slot, a novel spring-loaded probe and tile design was developed to clamp several short rooftop probe tips and insulators to the cooled baseplate. Initial probe measurements revealed tile to tile edge shadowing, especially where magnetic field line surface angles were less than 1°. Additionally, it was found, using three Langmuir probes (at 90°, 180°, and 270°), that the strike point variation of ±5mm radially around the torus was not well aligned with the circular slot geometry [Watkins et al., Nucl. Mater. Energy 18, 46 (2019)]. These issues were resolved by (1) designing tiles with all probes mounted near the tile center instead of near the edges and (2) aligning these new custom tiles to the measured strike point toroidal surface with a very accurate laser scanning alignment tool. Post-alignment Langmuir probe measurements and plasma behavior demonstrated close agreement at two separate toroidal locations that were 45° apart.

Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

Procedural Effectiveness With a Focused Force Scoring Angioplasty Catheter: Procedural and Clinical Outcomes From the Scoreflex NC Trial

BackgroundThe Scoreflex NC scoring angioplasty catheter is designed with a short rapid-exchange tip distal to a non-compliant, high-pressure balloon and an integral wire outside of the balloon, such that the guidewire and the integral wire act as scoring elements during balloon inflation. The external scoring elements enable a focal stress pattern facilitating expansion of resistant lesions at lower pressures using a focused force angioplasty effect. MethodsPatients undergoing elective percutaneous coronary intervention (PCI) were enrolled in a prospective, single-arm study conducted at 12 centers in the United States. The primary endpoint was device procedural success, defined as the composite of successful device delivery to the target lesion with balloon inflation and deflation; absence of vessel perforation, flow-limiting dissection or reduction in TIMI flow from baseline; and achievement of final TIMI 3 flow. ResultsAmong 200 patients (234 lesions), lesion complexities included: bifurcation disease (37.6%), moderate/severe calcification (36.6%), and total occlusions (5.0%). Successful delivery to the target lesion, inflation and removal of the balloon catheter was achieved in 95.5% of patients (191/200). Procedural success was achieved in 93.5% (187/200) of patients, and final TIMI 3 flow was observed in 99.0% of cases (198/200). No unanticipated device-related events occurred. In-hospital major adverse events were reported in 4.5% of patients (9/200), related to periprocedural myocardial infarction (8/200, 4.0%) and target lesion revascularization (1/200, 0.5%). ConclusionsAmong patients undergoing elective PCI and with varied lesion complexity, these results support the safety and effectiveness of a dilation strategy using the Scoreflex NC scoring catheter.

Numerical analysis of vibration modes of a qPlus sensor with a long tip.

We study the oscillatory behavior of qPlus sensors with a long tilted tip by means of finite element simulations. The vibration modes of a qPlus sensor with a long tip are quite different from those of a cantilever with a short tip. Flexural vibration of the tungsten tip will occur. The tip can no longer be considered as a rigid body that moves with the prong of the tuning fork. Instead, it oscillates both horizontally and vertically. The vibration characteristics of qPlus sensors with different tip sizes were studied. An optimized tip size was derived from obtained values of tip amplitude, ratio between vertical and lateral amplitude components, output current, and quality factor. For high spatial resolution the optimal diameter was found to be 0.1 mm.

Synthesis, properties and functionalization of gold nanostars for medical diagnostics

Th e aim of the research. To evaluate two approaches to colloidal synthesis using two diff erent non-toxic surfactants (PVP and Triton X-100) and their properties for future use. Material and methods. (PVP) Th e solution of GNSs with short tips was prepared in 200 ml vial. 20 mg of PVP (Polyvinylpyrrolidone, 1-ethenylpyrrolidin-2-one) were dissolved in the 200 mL of DMF (N,N-Dimethylmethanamide) (with the sonication to dissolve well). (Triton X-100) In a typical preparation of GNSs with long tips, the seed solution was prepared in a 20mL vial: 5mL of HAuCl4 5∙10-4M in water are added to 5mL of an aqueous solution of TritonX-100 0.1M. To examinate the shape and properties of prepared gold nanostars Cary 100 Bio Spectrophotometer using quartz cuvettes was used to taken on UV-Vis spectra. Transmission Electron Microscopy (TEM) was used to obtain shape and size of prepared GNSs. Results. Microscopy analysis shows that the obtained GNSs have completely diff erent shapes. Th e GNSs fabricated using synthesis approach with PVP have shorter tips and the cores are larger than the GNSs synthesized with Triton X-100 synthesis approach. TEM-images of the second ones show smaller size nanoparticles with the longer and thinner tips. Optical properties of the synthesized GNSs were analyzed using UV-vis-NIR absorbtion spectra, which shows maximum plasmon existence at 800 nm for GNSs synthesized with PVP and at 850 nm for GNSs synthesized with Triton X-100. Conclusion. In summary, we developed GNSs using two colloidal synthesis approaches with the use of two diff erent non-toxic surfactants (PVP and Triton X-100). In the future, gold nanostars are planned to be used to develop highly sensitive methods of medical diagnostics.

Preparation of Low Invasive Type Glucose Sensor for Continuous Glucose Monitoring

Implantable glucose sensors for a continuous glucose monitoring (CGM) system are getting more attractive, since it not only provide an instant glucose value but also its continuous value trend, which help to provide an effective medical treatment. However, the current commercialized or presented conventional CGM sensor devise are required to have about an length of 1.0 cm to be inserted inside the skin. Therefore, it is desirable to develop a lower invasive type glucose sensor to improve the quality of life of diabetic patients.We have previously proposed an unique glucose sensor, which has a sensing region at the tip of a fine tapered needle. Therefore, it only require a short tip of the sensor devise to be implanted to perform as an CGMS sensor. We attempted to implant this sensor device for a length of 1.0 mm in the skin, and the glucose monitoring was performed. As a result, we could obtain sensor response, which had a good correlation with blood glucose value trend. This result indicate that the glucose measurement in a lighter region than subcutaneous tissue, which might be in dermis, may also provide valuable information for diabetes patients’ blood glucose management. Nevertheless, low-invasive sensor, which is essential with miniaturization of sensing region, leads to a decrease of glucose response current. Therefore, the improvement of sensor sensitivity is also indispensable. In this study, we prepared glucose sensors in various procedures to develop a sensor with high sensor sensitivity.

A Novel Technique for the Removal of Elastic Intramedullary Nail in Pediatric Long Bones: A Technical Note.

Elastic stable intramedullary nails have been commonly used to treat unstable long bone fractures in children. The nail tip at the insertion site can cause problems. The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems. If the nail tip is short, nail removal after fracture union can be difficult and may pose challenges. A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail. Few techniques have been suggested in the past for removing elastic nail with the short tip, but all these techniques need special instruments. We describe a surgical technique using a metallic suction cannula to aid elastic nail removal. This method utilizes an easily available instrument in the operating room and does not need any special equipment.

P420Improved real time recordings using the third generation cryoballoon technology - detection of dual fascicle electrograms

Abstract Introduction The third-generation cryoballoon has been designed with a 40% shortened tip length compared with the former second-generation CB device. Ideally, a shorter tip could result with an improved visualization of real-time (RT) recordings in the pulmonary vein (PV) due to a more proximal positioning of the inner lumen mapping catheter. Beside the high incidence of RT recordings, for the first time, we observed dual fascicle electrograms with different isolation time for each fascicle, when using the new device. Purpose We sought to analyze the rate of visualization of RT recordings and dual fascicle electrograms in our first series of patients with the third generation cryoballoon device. Methods All consecutive patients having undergone CB ablation using the third generation technology were analyzed. Procedures were performed under conscious sedation. A single transeptal puncture was preformed guided by intracardial ultrasound and a 28 mm cryoballoon was used. A single 180 seconds freeze strategy was employed. Results A total of 80 consecutive patients (77.5% male, 60.3 ± 10.8 years) were evaluated. Real-time recordings were detected in 275 of 320 PVs (85.9%). Specifically, RT recordings could be visualized in 68 left superior PVs (85%), 69 left inferior PVs (86.2%), 73 right superior PVs (91.2%), and 65 right inferior PVs (81.2%). Furthermore, in 14 of 320 PVs (4.3%) two different fascicles electrograms were detected. A distinctive isolation time for each fascicle could be observed both in sinus rhythm and in atrial fibrillation (Picture). Most commonly, dual fascicles were observed in left superior PV (7.5%) and right inferior PV (6.3%). In the rest of the veins this phenomenon was not so frequent. In 2.5% of right superior PV and in only 1.2% of left inferior PV dual fascicles could be observed. Conclusion The rate of visualization of RT recordings is significantly high during third generation CB ablation. Real-time recordings can be visualized in 85.9% of veins with this novel cryoballoon. Furthermore, for the first time, isolation of two different fascicles during a single cryoballoon lesion could be observed. Other that more proximal mapping catheter position, there is second possible explanation for the visualization of dual fascicles with this novel balloon. Shorter tip could result with poorer cryoballoon stability and weaker contact with the atrium wall, hence non-uniform freezing and isolation of different fascicles in different times. Abstract Figure.

Preparation of Low Invasive Type Glucose Sensor for Continuous Glucose Monitoring

Implantable glucose sensors for a continuous glucose monitoring (CGM) system are getting more attractive, since it not only provide an instant glucose value but also its continuous value trend, which help to provide an effective medical treatment. However, the current commercialized or presented conventional CGM sensor devise are required to have about an length of 1.0 cm to be inserted inside the skin. Therefore, it is desirable to develop a lower invasive type glucose sensor to improve the quality of life of diabetic patients. We have previously proposed an unique glucose sensor, which has a sensing region at the tip of a fine tapered needle. Therefore, it only require a short tip of the sensor devise to be implanted to perform as an CGMS sensor. We attempted to implant this sensor device for a length of 1.0 mm in the skin, and the glucose monitoring was performed. As a result, we could obtain sensor response, which had a good correlation with blood glucose value trend. This result indicate that the glucose measurement in a lighter region than subcutaneous tissue, which might be in dermis, may also provide valuable information for diabetes patients’ blood glucose management. Nevertheless, low-invasive sensor, which is essential with miniaturization of sensing region, leads to a decrease of glucose response current. Therefore, the improvement of sensor sensitivity is also indispensable. In this study, we prepared glucose sensors in various procedures to develop a sensor with high sensor sensitivity.

Pycnodysostosis presented with tibial shaft fracture.

Pycnodysostosis is rare autosomal recessive lysosomal storage disorder of bone in which the enzyme Cathepsin K is mutated which maps on chromosome 1q21 causing osteoclast dysfunction. It is characterized by short stature, craniofacial dysmorphias, osteosclerosis, and brittle bones. Recognition of these signs is important in order to make the diagnosis and prevent possible complications. A 13-year old male patient of 130 cm height presented to the emergency with pathological fracture in shaft of left tibia. On the basis of clinical and radiological findings, he was diagnosed as a case of pycnodysostosis. The patient had history of pathological fracture in shaft of right tibia. With normal bone healing, open fontanelles, short stature, short finger tips, flat and grooved nails, micrognathia, and irregular teeth with hypodontia. Radiological evaluation of patient revealed generalized osteopetrosis, short distal phalanges, obtuse angle of mandible and open fontanelles. He was managed conservatively and showed normal bone healing pattern. No specific treatment options exist, so treatment is supportive, with fracture prevention and management constituting the most important aspects of clinical care. Dental hygiene and regular checkups are also helpful in preventing complications.

Non-invasive Production of Multi-Compartmental Biodegradable Polymer Microneedles for Controlled Intradermal Drug Release of Labile Molecules.

Transdermal drug delivery represents an appealing alternative to conventional drug administration systems. In fact, due to their high patient compliance, the development of dissolvable and biodegradable polymer microneedles has recently attracted great attention. Although stamp-based procedures guarantee high tip resolution and reproducibility, they have long processing times, low levels of system engineering, are a source of possible contaminants, and thermo-sensitive drugs cannot be used in conjunction with them. In this work, a novel stamp-based microneedle fabrication method is proposed. It provides a rapid room-temperature production of multi-compartmental biodegradable polymeric microneedles for controlled intradermal drug release. Solvent casting was carried out for only a few minutes and produced a short dissolvable tip made of polyvinylpyrrolidone (PVP). The rest of the stamp was then filled with degradable poly(lactide-co-glycolide) (PLGA) microparticles (μPs) quickly compacted with a vapor-assisted plasticization. The outcome was an array of microneedles with tunable release. The ability of the resulting microneedles to indent was assessed using pig cadaver skin. Controlled intradermal delivery was demonstrated by loading both the tip and the body of the microneedles with model therapeutics; POXA1b laccase from Pleurotus ostreatus is a commercial enzyme used for the whitening of skin spots. The action and indentation of the enzyme-loaded microneedle action were assessed in an in vitro skin model and this highlighted their ability to control the kinetic release of the encapsulated compound.

‘Blinking’ and ‘gliding’ eigenfrequencies of oscillations of elastic bodies with blunted cuspidal sharpenings

The spectrum of a two-dimensional problem in elasticity theory is investigated for a body with a cuspidal sharpening with a short tip of length that is broken off. It is known that when the tip is in place, the spectrum of the problem for has a continuous component with positive cut-off point . We show that each point is a ‘blinking’ eigenvalue, that is, it is an actual eigenvalue of the problem in ‘almost periodically’ in the scale of . Among families of eigenvalues , which continuously depend on , we discover ‘gliding’ eigenvalues, which fall down along the real axis at a great rate, , but then land softly on the threshold . This reveals a new way of forming the continuous spectrum of the problem for a cuspidal body from the system of discrete spectra of the problems in the , . In addition, there may be ‘hardly movable’ eigenvalues, which remain in a small neighbourhood of a fixed point for all small , in contrast to ‘gliding’ eigenvalues. Bibliography: 30 titles.

P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

Abstract Background The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring. Objective We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS. Method We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times. Result The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04). Conclusion The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

The Effective and Safe Way to Use Crusade Microcatheter-Facilitated Reverse Wire Technique to Solve Bifurcated Lesions with Markedly Angulated Target Vessel.

Objectives We aim to present a new way to introduce reverse wire in crusade microcatheter-facilitated reverse wire technique to solve markedly angulated bifurcated lesions. Background Markedly angulated coronary bifurcation lesions are still one of the considerable challenges of treatment with percutaneous coronary intervention especially with severe proximal stenosis. Microcatheter-facilitated reverse wire technique improved the efficacy of crossing a guide wire to such an extremely angulated complex targeted vessel. However, there has been a debate regarding what kind of curve was the best to introduce reverse guide wire in this technique. Methods We analyzed 7 patients who were admitted to Fuwai Hospital and underwent antegrade wiring which failed. Crusade microcatheter-facilitated reverse wire technique with simple short tip one round curve was used successfully to solve in all 7 bifurcation lesions. We investigated the bifurcation lesion's characteristics and details of the reverse wire technique procedures. Results All 7 bifurcations exhibit both a smaller take-off angle and a larger carina angle and severe proximal significant stenosis. After having suitable size of balloon predilation, reverse wire with simple short distal one curve was delivered to distal segment of targeted vessel successfully. We performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. Conclusions In solving markedly angulated bifurcated lesions, especially with severe proximal stenosis, crusade microcatheter-facilitated reverse wire technique with simple short tip one curve is an effective and safe way of wiring.