Summary Background Percutaneous coronary intervention (PCI) is most commonly guided by angiography alone. Intravascular ultrasound (IVUS) guidance has been shown to reduce major adverse ...cardiovascular events (MACE) after PCI, principally by resulting in a larger postprocedure lumen than with angiographic guidance. Optical coherence tomography (OCT) provides higher resolution imaging than does IVUS, although findings from some studies suggest that it might lead to smaller luminal diameters after stent implantation. We sought to establish whether or not a novel OCT-based stent sizing strategy would result in a minimum stent area similar to or better than that achieved with IVUS guidance and better than that achieved with angiography guidance alone. Methods In this randomised controlled trial, we recruited patients aged 18 years or older undergoing PCI from 29 hospitals in eight countries. Eligible patients had one or more target lesions located in a native coronary artery with a visually estimated reference vessel diameter of 2·25–3·50 mm and a length of less than 40 mm. We excluded patients with left main or ostial right coronary artery stenoses, bypass graft stenoses, chronic total occlusions, planned two-stent bifurcations, and in-stent restenosis. Participants were randomly assigned (1:1:1; with use of an interactive web-based system in block sizes of three, stratified by site) to OCT guidance, IVUS guidance, or angiography-guided stent implantation. We did OCT-guided PCI using a specific protocol to establish stent length, diameter, and expansion according to reference segment external elastic lamina measurements. All patients underwent final OCT imaging (operators in the IVUS and angiography groups were masked to the OCT images). The primary efficacy endpoint was post-PCI minimum stent area, measured by OCT at a masked independent core laboratory at completion of enrolment, in all randomly allocated participants who had primary outcome data. The primary safety endpoint was procedural MACE. We tested non-inferiority of OCT guidance to IVUS guidance (with a non-inferiority margin of 1·0 mm2 ), superiority of OCT guidance to angiography guidance, and superiority of OCT guidance to IVUS guidance, in a hierarchical manner. This trial is registered with ClinicalTrials.gov , number NCT02471586. Findings Between May 13, 2015, and April 5, 2016, we randomly allocated 450 patients (158 35% to OCT, 146 32% to IVUS, and 146 32% to angiography), with 415 final OCT acquisitions analysed for the primary endpoint (140 34% in the OCT group, 135 33% in the IVUS group, and 140 34% in the angiography group). The final median minimum stent area was 5·79 mm2 (IQR 4·54–7·34) with OCT guidance, 5·89 mm2 (4·67–7·80) with IVUS guidance, and 5·49 mm2 (4·39–6·59) with angiography guidance. OCT guidance was non-inferior to IVUS guidance (one-sided 97·5% lower CI −0·70 mm2 ; p=0·001), but not superior (p=0·42). OCT guidance was also not superior to angiography guidance (p=0·12). We noted procedural MACE in four (3%) of 158 patients in the OCT group, one (1%) of 146 in the IVUS group, and one (1%) of 146 in the angiography group (OCT vs IVUS p=0·37; OCT vs angiography p=0·37). Interpretation OCT-guided PCI using a specific reference segment external elastic lamina-based stent optimisation strategy was safe and resulted in similar minimum stent area to that of IVUS-guided PCI. These data warrant a large-scale randomised trial to establish whether or not OCT guidance results in superior clinical outcomes to angiography guidance. Funding St Jude Medical.
Providing reliable and affordable wastewater treatment in rural areas is a challenge in many parts of the world, particularly in developing countries. The problems and limitations of the centralized ...approaches for wastewater treatment are progressively surfacing. Centralized wastewater collection and treatment systems are costly to build and operate, especially in areas with low population densities and dispersed households. Developing countries lack both the funding to construct centralized facilities and the technical expertise to manage and operate them. Alternatively, the decentralized approach for wastewater treatment which employs a combination of onsite and/or cluster systems is gaining more attention. Such an approach allows for flexibility in management, and simple as well as complex technologies are available. The decentralized system is not only a long-term solution for small communities but is more reliable and cost effective. This paper presents a review of the various decentralized approaches to wastewater treatment and management. A discussion as to their applicability in developing countries, primarily in rural areas, and challenges faced is emphasized all through the paper. While there are many impediments and challenges towards wastewater management in developing countries, these can be overcome by suitable planning and policy implementation. Understanding the receiving environment is crucial for technology selection and should be accomplished by conducting a comprehensive site evaluation process. Centralized management of the decentralized wastewater treatment systems is essential to ensure they are inspected and maintained regularly. Management strategies should be site specific accounting for social, cultural, environmental and economic conditions in the target area.
The recovery of enriched Zn-68 is extremely important in the production of short-lived isotope (Ga-67) in the Cyclotron because of its high price. A high amount of Zn-68 is produced during the ...production of Ga-67 from its target (Zn-target) by a solvent extraction technique. In this investigation, we successfully prepared poly(vinyl alcohol-t-acrylamide), P(VA-t-AM) resin using the gamma radiolysis technique. The characterization of pristine PVA and synthesized P(VA-t-AM) was performed to confirm their structures. The produced polymer was tested for the elimination of Zn
2+
ions from simulated liquid waste as produced during the production of the Ga-67. To get the highest uptake of Zn
2+
ions on the polymer, various parameters such as solution pH, polymer weight, and contact time were applied. The loading Zn
2+
ions were studied at optimum conditions of the Batch approach. Then, the retrieval of Zn
2+
ions from the packed chromatographic column was tested using different parameters such as flow rates, bed depths, and initial concentration of Zn
2+
. The results indicated that the percentages of loaded Zn
2+
ions on the packed column were 96.94% at the best operational conditions. Moreover, different eluents were applied to the retrieval of Zn
2+
ions from the P(VA-t-AM) column, and the data confirmed that the retrieval percentage of Zn
2+
ions from P(VA-t-AM) was 98.43% at the optimum. The reusability of the working polymer was examined for eight cycles. This paper recommended that the synthesized P(VA-t-AM) can be utilized for the retrieval of Zn
2+
ions from the spent Zn-68 target in the Cyclotron.
Since the late 1990s, there has been a steady decline in cancer-related mortality, in part related to the introduction of so-called targeted therapies. Intended to interfere with a specific molecular ...pathway, these therapies have, paradoxically, led to a number of effects off their intended cancer tissue or molecular targets. The latest examples are tyrosine kinase inhibitors targeting the Philadelphia Chromosome mutation product, which have been associated with progressive atherosclerosis and acute vascular events. In addition, agents designed to interfere with the vascular growth factor signaling pathway have vascular side effects ranging from hypertension to arterial events and cardiomyocyte toxicity. Interestingly, the risk of cardiotoxicity with drugs such as trastuzumab is predicted by preexisting cardiovascular risk factors and disease, posing the question of a vascular component to the pathophysiology. The effect on the coronary circulation has been the leading explanation for the cardiotoxicity of 5-fluorouracil and may be the underlying the mechanism of presentation of apical ballooning syndrome with various chemotherapeutic agents. Classical chemotherapeutic agents such as cisplatin, often used in combination with bleomycin and vinca alkaloids, can lead to vascular events including acute coronary thrombosis and may be associated with an increased long-term cardiovascular risk. This review is intended to provide an update on the evolving spectrum of vascular toxicities with cancer therapeutics, particularly as they pertain to clinical practice, and to the conceptualization of cardiovascular diseases, as well. Vascular toxicity with cancer therapy: the old and the new, an evolving avenue.
High-voltage pulse-generators can be used effectively for bacterial decontamination in water treatment applications. Applying a pulsed electric field to the infected water sample guarantees killing ...of harmful germs and bacteria. In this paper, a modular high-voltage pulse-generator with sequential charging is proposed for water treatment via underwater pulsed streamer corona discharge. The proposed generator consists of series-connected modules similar to an arm of a modular multilevel converter. The modules' capacitors are charged sequentially from a relatively low-voltage dc supply, then they are connected in series and discharged into the load. Two configurations are proposed in this paper, one for low repetitive pulse rate applications, and the other for high repetitive pulse rates. In the first topology, the equivalent resistance of the infected water sample is used as a charging resistance for the generator's capacitors during the charging process. While in the second topology, the water resistance is bypassed during the charging process, and an external charging resistance with proper value is used instead. In this paper, detailed designs for the proposed pulse-generators are presented and validated by simulation results using MATLAB. A scaled down experimental setup has been built to show the viability of the proposed concept.
Objectives
We investigated the results of T and small protrusion (TAP) versus a novel modification of TAP (mTAP) stenting by multimodality imaging in bench testing and in patients with coronary ...bifurcation lesions (CBL).
Background
TAP stenting is a suboptimal technique for bailout side branch (SB) stenting.
Methods
In a bench model, optical coherence tomography (OCT), microscopic examinations (ME), and computational fluid dynamics (CFD) were performed after TAP and mTAP stenting. In 20 patients with CBL, 80 intravascular ultrasound (IVUS) examinations were performed during mTAP stenting in which the SB stent was pulled‐back to indent the inflated main vessel (MV) balloon and deployed while deflating it. For TAP stenting, the tip of the SB stent was positioned in the MV and deployed.
Results
In bench testing, OCT showed neocarina length (NL) was shorter and minimum stent area (MSA) was larger after mTAP versus TAP stenting (2.84 ± 0.70 vs. 4.80 ± 020 mm; 6.75 ± 1.50 vs. 4.5 ± 2.2 mm2; respectively; p < 0.05). By ME, NL was shorter and shear rate trended lower after mTAP versus TAP stenting. In patients, IVUS showed MSA was larger after versus before mTAP stenting (6.32 ± 0.58 vs. 5.21 ± 0.56 mm2; p < 0.01); NL was 1.43 ± 0.22 mm with SB ostium coverage. The Seattle Angina questionnaire (SAQ) score was higher at 6 months versus baseline (85 ± 4.0 vs. 48 ± 6.0, respectively; p < 0.001).
Conclusions
This multimodality imaging study showed, for the first time, mTAP stenting resulted in larger stent area and shorter neocarina than TAP stenting in bench testing. In patients with CBL, mTAP stenting led to larger stent area, short neocarina with complete SB ostium coverage, and improved the SAQ score at follow‐up.
...this is an inpatient sample and outpatient FFR procedures are likely to have been missed particularly "deferred cases" not undergoing PCI. ...all deferred PCIs cannot be attributed to nonischemic ...FFR results alone, as some patients with positive FFR could have been referred for surgical revascularization.
Graphene oxide (GO) was synthesized by modified Hummers method and was characterized using HR-TEM, FTIR, XRD and zeta potential. The antibacterial activity of GO towards gram-positive bacteria such ...as
Staphylococcus aureus
was investigated in vitro. Different parameters were used to study the GO labeling by
99m
Tc. Under optimum conditions, the labeling yield of
99m
Tc-GO complex is 91%. Biodistribution studies in Swiss Albino rats were carried out in experimentally induced infection in the left lateral thigh using
Staphylococcus aureus
. The biodistribution study revealed that the optimum accumulation of
99m
Tc-GO at the infection sites is 4.21 ± 0.32 at 60 min.
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