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ApPropriateness of myocaRdial RevascularizatiOn assessed by the SYNTAX score II in a coUntry without cardiac Surgery faciliTies; PROUST study. Int J Cardiol 2017; 227:478-484. [DOI: 10.1016/j.ijcard.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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A simplified and reproducible method to size the mitral annulus: implications for transcatheter mitral valve replacement. Eur Heart J Cardiovasc Imaging 2016; 18:697-706. [DOI: 10.1093/ehjci/jew132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/01/2016] [Indexed: 01/02/2023] Open
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Video densitometric assessment of aortic regurgitation after transcatheter aortic valve implantation: results from the Brazilian TAVI registry. EUROINTERVENTION 2016; 11:1409-18. [DOI: 10.4244/eijv11i12a271] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Clinical outcomes in 995 unselected real-world patients treated with an ultrathin biodegradable polymer-coated sirolimus-eluting stent: 12-month results from the FLEX Registry. BMJ Open 2016; 6:e010028. [PMID: 26888727 PMCID: PMC4762083 DOI: 10.1136/bmjopen-2015-010028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate, in the FLEX Registry, clinical outcomes of an ultrathin (60 µm) biodegradable polymer-coated Supraflex sirolimus-eluting stent (SES) for the treatment of coronary artery disease. Additionally, to determine the vascular response to the Supraflex SES through optical coherence tomography (OCT) analysis. SETTING Multicentre, single-arm, all-comers, observational registry of patients who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. PARTICIPANTS 995 patients (1242 lesions) who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. A total of 47 participants underwent OCT analysis at 6 months' follow-up. INTERVENTIONS Percutaneous coronary intervention with Supraflex SES, PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint-the rate of major adverse cardiac events (defined as a composite of cardiac death, myocardial infarction (MI), target lesion revascularisation (TLR))-was analysed during 12 months. RESULTS At 12 months, the primary endpoint occurred in 36 (3.7%) of 980 patients, consisting of 18 (1.8%) cardiac deaths, 16 (1.6%) MI, 7 (0.7%) TLR and 2 (0.2%) cases of non-target lesion target vessel revascularization. In a subset of 47 patients, 1227 cross-sections (9309 struts) were analysed at 6 months by OCT. Overall, a high percentage of struts was covered (98.1%), with a mean neointimal thickness of 0.13 ± 0.06 µm. CONCLUSIONS The FLEX Registry evaluated clinical outcomes in real-world and more complex cohorts and thus provides evidence that the Supraflex SEX can be used safely and routinely in a broader percutaneous coronary intervention population. Also, the Supraflex SES showed high percentage of stent strut coverage and good stent apposition during OCT follow-up.
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The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation. EUROINTERVENTION 2016; 11 Suppl V:V115-9. [PMID: 25983143 DOI: 10.4244/eijv11sva26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Unprotected left main coronary artery (ULMCA) stenosis has relatively high prevalence and exposes patients to a high risk for adverse cardiovascular events. The optimal revascularisation strategy (coronary artery bypass surgery [CABG] or percutaneous coronary intervention [PCI]) for patients with complex coronary artery disease is a topic of continuing debate. The introduction of the newer-generation drug-eluting stents (DES) -with documented improvements in both safety and efficacy- has prompted the interventional community to design two new dedicated randomised trials comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials. The aims of the present review are to describe the similarities and contrasts between these two trials as well to explore their future implications in ULMCA treatment.
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Impact of the Everolimus-eluting Bioresorbable Scaffold in Coronary Atherosclerosis. ACTA ACUST UNITED AC 2015; 69:109-16. [PMID: 26739828 DOI: 10.1016/j.rec.2015.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Absorb bioresorbable vascular scaffold has been shown to decrease total plaque areas in the treated segment. However, it is unknown whether plaque size is modified in scaffolded segments only or whether the modification extends to other coronary segments. METHODS Absorb Cohort A is a single-arm, prospective study, with safety and imaging endpoints, in which 30 patients underwent percutaneous coronary intervention with the first generation Absorb bioresorbable vascular scaffold. Noninvasive multislice computed tomography imaging was performed in 18 patients at 18 months and 5 years of follow-up. The present study was an intrapatient comparison of matched segments (normalized by the segment length) of the scaffolded region with nonintervened segments for lumen volume, vessel volume, plaque volume, plaque burden, and percent change in plaque atheroma volume. RESULTS All 18 scaffolded segments could be analyzed. In the nonintervened segments, 1 of 72 segments had a motion artifact and was excluded. Serial comparison showed that the scaffolded segments showed no significant change in the mean plaque burden, total atheroma volume, total lumen volume, or vessel volume between 18 months and 5 years. Conversely, the untreated segments showed a significant increase in plaque burden (2.7 ± 6.5%; P < .01) and normalized plaque volumes (8.0 ± 22.8mm(3); P < .01). This resulted in a significant difference in plaque burden between scaffolded and nonintervened segments (P = .03). CONCLUSIONS In this small series, the Absorb bioresorbable vascular scaffold showed the potential to provide an additional benefit to pharmacological therapy in locally reducing progression of percent plaque burden. These findings need to be confirmed in larger studies.
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Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective. Heart 2015; 101:1980-8. [PMID: 26552756 DOI: 10.1136/heartjnl-2015-307578] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 10/05/2015] [Indexed: 11/04/2022] Open
Abstract
AIMS Recent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective. We, therefore, used individual patient-level data from the SYNTAX trial to evaluate the cost-effectiveness of PCI versus CABG from a European (Dutch) perspective. METHODS AND RESULTS Between 2005 and 2007, 1800 patients with three-vessel or left main coronary artery disease were randomised to either CABG (n=897) or PCI with drug-eluting stents (DES; n=903). Costs were estimated for all patients based on observed healthcare resource usage over 5 years of follow-up. Health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on Dutch life-tables was used to extrapolate the 5-year in-trial data to a lifetime horizon. Although initial procedural costs were lower for CABG, total initial hospitalisation costs per patient were higher (€17 506 vs €14 037, p<0.001). PCI was more costly during the next 5 years of follow-up, due to more frequent hospitalisations, repeat revascularisation procedures and higher medication costs. Nevertheless, total 5-year costs remained €2465/patient higher with CABG. When the in-trial results were extrapolated to a lifetime horizon, CABG was projected to be economically attractive relative to DES-PCI, with gains in both life expectancy and quality-adjusted life expectancy. The incremental cost-effectiveness ratio (ICER) (€5390/quality-adjusted life year (QALY) gained) was favourable and remained <€80 000/QALY in >90% of the bootstrap replicates. Outcomes were similar when incorporating the prognostic impact of non-fatal myocardial infarction and stroke, as well as across a broad range of assumptions regarding the effect of CABG on post-trial survival and costs. However, DES-PCI was economically dominant compared with CABG in patients with a SYNTAX Score ≤22 or in those with left main disease. In patients for whom the SYNTAX Score II favoured PCI based on lower predicted 4-year mortality, PCI was also economically dominant, whereas in those patients for whom the SYNTAX Score II favoured surgery, CABG was highly economically attractive (ICER range, €2967 to €3737/QALY gained). CONCLUSIONS For the broad population with three-vessel or left main disease who are candidates for either CABG or PCI, we found that CABG is a clinically and economically attractive revascularisation strategy compared with DES-PCI from a Dutch healthcare perspective. The cost-effectiveness of CABG versus PCI differed according to several anatomic factors, however. The newly developed SYNTAX Score II provides enhanced prognostic discrimination in this population, and may be a useful tool to guide resource allocation as well. TRIAL REGISTRATION NUMBER Clinical trial unique identifier: NCT00114972 (http://www.clinical-trials.gov).
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TCT-343 Post-procedural geometrical parameters and their impact on adverse cardiovascular events: insights from the ABSORB II trial. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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TCT-368 Natural history of coronary calcification: A 5-year serial optical coherence tomography study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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61
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Reasonable incomplete revascularisation after percutaneous coronary intervention: the SYNTAX Revascularisation Index. EUROINTERVENTION 2015; 11:634-42. [DOI: 10.4244/eijy14m10_05] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Impact of the Orbital Atherectomy System on a Peripheral Calcified Lesion: Quantitative Analysis by Intravascular Echogenicity. JACC Cardiovasc Interv 2015; 8:e205-6. [PMID: 26386765 DOI: 10.1016/j.jcin.2015.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/05/2015] [Indexed: 11/18/2022]
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Abstract
Elevated levels of phospholipase A2 have been linked to atherosclerotic plaque progression, instability via promoting inflammation and subsequent acute coronary events. Epidemiological studies have demonstrated the correlation between elevated levels associated phospholipase A2 and cardiovascular events. Therefore, specific inhibition of lipoprotein-associated phospholipase A2 with darapladib has been tested as a therapeutic option for atherosclerosis. The aim of this profile is to review the physiologic aspects of lipoprotein-associated phospholipase A2 and to revisit the clinical evidence of darapladib as therapeutic option for atherosclerosis.
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Four-year clinical follow-up of the first-in-man randomized comparison of a novel sirolimus eluting stent with abluminal biodegradable polymer and ultra-thin strut cobalt-chromium alloy: the INSPIRON-I trial. Cardiovasc Diagn Ther 2015; 5:264-70. [PMID: 26331110 DOI: 10.3978/j.issn.2223-3652.2015.07.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/07/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The Inspiron™ sirolimus-eluting stent (SES) is a low-dose, ultra-thin-strut cobalt-chromium stent abluminally coated with biodegradable polymers (BP). Previous results from the INSPIRON-I trial, a first-in-man study, have proven the efficacy of the novel stent in reducing neointimal proliferation. The present report aims at evaluating the long-term clinical outcomes of patients enrolled into the INSPIRON-I trial (Clinical Trials Gov. identifier: NCT01093391). METHODS A total of 57 patients (60 lesions) were randomly allocated in a 2:1 ratio to treatment with the Inspiron™ SES vs. its equivalent Cronus™ bare metal stent (BMS, both by Scitech Medical™, Aparecida de Goiânia, Goiás, Brazil), in four tertiary centers. The primary endpoint of the present analysis was the occurrence of major adverse cardiac events (MACE) [death, myocardial infarction (MI), target vessel revascularization (TVR) and/or target lesion revascularization (TLR)] at 4 years. RESULTS Baseline clinical and angiographic characteristics of both groups were similar. After 4 years, the primary endpoint occurred in 7.9% vs. 23.5% of patients in Inspiron and control groups respectively (P=0.11). The rate of death/MI was similar between the groups, but there was a significant decrease in the risk of repeat revascularization in the Inspiron group compared to the control arm TLR (0.0% vs. 23.5% respectively, P=0.02). There were no stent thromboses in the study population. CONCLUSIONS The novel Inspiron™ SES showed a sustained safe and effective clinical profile after 4-year of follow-up, with very low adverse events and null stent thrombosis (ST) occurrence.
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Validation of the SYNTAX revascularization index to quantify reasonable level of incomplete revascularization after percutaneous coronary intervention. Am J Cardiol 2015; 116:174-86. [PMID: 25983123 DOI: 10.1016/j.amjcard.2015.03.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 01/17/2023]
Abstract
Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument-the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (ΔSS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (ΔSS/bSS]) × 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to <100%, and <50%). The Youden index for the SRI was computed to identify the best cutoff for 5-year all-cause mortality. The mean bSS was 28.4 ± 11.5, and after PCI, the mean ΔSS was 23.8 ± 10.9 and the mean residual SYNTAX score was 4.5 ± 6.9. The mean SRI was 85.3 ± 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI ≥70% representing a "reasonable" goal for patients with complex coronary artery disease.
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Short- and Long-term Evaluation of Bioresorbable Scaffolds by Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:333-349. [PMID: 28581949 DOI: 10.1016/j.iccl.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The analysis of bioresorbable scaffolds (BRSs) by optical coherence tomography (OCT) requires a dedicated methodology, as the polymeric scaffold has a distinct appearance and undergoes dynamic structural changes with time. The high resolution of OCT allows for the detailed assessment of scaffold implantation, rupture, discontinuity, and strut integration. OCT does not provide reliable information on the extent of scaffold degradation, as it cannot differentiate between polylactide polymer and the provisional matrix of proteoglycan formed by connective tissue. Three-dimensional OCT reconstruction can aid in the evaluation of BRS in special scenarios such as overlapping scaffold segments and bifurcations.
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Comparison between MDCT and Grayscale IVUS in a Quantitative Analysis of Coronary Lumen in Segments with or without Atherosclerotic Plaques. Arq Bras Cardiol 2015; 104:315-23. [PMID: 25993595 PMCID: PMC4415868 DOI: 10.5935/abc.20140211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022] Open
Abstract
Background The diagnostic accuracy of 64-slice MDCT in comparison with IVUS has been poorly
described and is mainly restricted to reports analyzing segments with documented
atherosclerotic plaques. Objectives We compared 64-slice multidetector computed tomography (MDCT) with gray scale
intravascular ultrasound (IVUS) for the evaluation of coronary lumen dimensions in
the context of a comprehensive analysis, including segments with absent or mild
disease. Methods The 64-slice MDCT was performed within 72 h before the IVUS imaging, which was
obtained for at least one coronary, regardless of the presence of luminal stenosis
at angiography. A total of 21 patients were included, with 70 imaged vessels
(total length 114.6 ± 38.3 mm per patient). A coronary plaque was diagnosed
in segments with plaque burden > 40%. Results At patient, vessel, and segment levels, average lumen area, minimal lumen area,
and minimal lumen diameter were highly correlated between IVUS and 64-slice MDCT
(p < 0.01). However, 64-slice MDCT tended to underestimate the lumen size with
a relatively wide dispersion of the differences. The comparison between 64-slice
MDCT and IVUS lumen measurements was not substantially affected by the presence or
absence of an underlying plaque. In addition, 64-slice MDCT showed good global
accuracy for the detection of IVUS parameters associated with flow-limiting
lesions. Conclusions In a comprehensive, multi-territory, and whole-artery analysis, the assessment of
coronary lumen by 64-slice MDCT compared with coronary IVUS showed a good overall
diagnostic ability, regardless of the presence or absence of underlying
atherosclerotic plaques.
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Precise vessel sizing: a trivial but crucial issue during left main stenting. Catheter Cardiovasc Interv 2015; 84:359-60. [PMID: 25142420 DOI: 10.1002/ccd.25605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 11/06/2022]
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Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAXII trial. Catheter Cardiovasc Interv 2015; 86:E229-38. [DOI: 10.1002/ccd.25907] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/27/2015] [Accepted: 02/26/2015] [Indexed: 11/09/2022]
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Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: A patient-level pooled analysis of 5433 patients enrolled in contemporary coronary stent trials. Int J Cardiol 2015; 187:111-5. [DOI: 10.1016/j.ijcard.2015.03.248] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 01/08/2023]
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Comparison between two- and three-dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: A subanalysis of the TRYTON pivotal IDE coronary bifurcation trial. Catheter Cardiovasc Interv 2015; 86:E140-9. [DOI: 10.1002/ccd.25925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/08/2015] [Indexed: 11/06/2022]
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Anatomic Characteristics and Clinical Implications of Angiographic Coronary Thrombus. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002279. [DOI: 10.1161/circinterventions.114.002279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bioresorbable vascular scaffolds: novel devices, novel interpretations, and novel interventions strategies. Catheter Cardiovasc Interv 2015; 84:46-7. [PMID: 24975261 DOI: 10.1002/ccd.25541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/06/2014] [Accepted: 05/11/2014] [Indexed: 11/06/2022]
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Smoking Is Associated With Adverse Clinical Outcomes in Patients Undergoing Revascularization With PCI or CABG. J Am Coll Cardiol 2015; 65:1107-15. [DOI: 10.1016/j.jacc.2015.01.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/26/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
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Ex vivovalidation of 45 MHz intravascular ultrasound backscatter tissue characterization. Eur Heart J Cardiovasc Imaging 2015; 16:1112-9. [DOI: 10.1093/ehjci/jev039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/14/2022] Open
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Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II. Eur Heart J 2015; 36:1231-41. [PMID: 25583761 DOI: 10.1093/eurheartj/ehu518] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/22/2014] [Indexed: 12/15/2022] Open
Abstract
AIMS To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. METHODS AND RESULTS Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). CONCLUSION The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
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First-in-man randomised comparison of a novel sirolimus-eluting stent with abluminal biodegradable polymer and thin-strut cobalt-chromium alloy: INSPIRON-I trial. EUROINTERVENTION 2014; 9:1380-4. [PMID: 24755382 DOI: 10.4244/eijv9i12a234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The INSPIRON-I trial is a first-in-man evaluation of the safety and efficacy of the Inspiron drug-eluting stent, a sirolimus-eluting stent with abluminal biodegradable polymer coating and thin cobalt-chromium alloy. METHODS AND RESULTS This is a randomised, multicentre comparison between Inspiron and a stent with the same metallic structure but without polymer coating or drug elution (Cronus). The primary objective was to evaluate the in-segment late loss (LLL) at six months. Secondary endpoints included percent in-stent obstruction as measured by intravascular ultrasound (IVUS) at six months and major adverse cardiac events (MACE). Fifty-eight patients were enrolled (60 lesions), 39 for Inspiron and 19 for Cronus. Baseline clinical and angiographic characteristics of both groups were similar. At six months, the in-segment LLL was reduced in the Inspiron group compared to the control group (0.19±0.16 mm vs. 0.58±0.4 mm, respectively; p<0.001), as well as the percent neointimal obstruction (7.8±7.1% vs. 26.5±11.4%; p<0.001). At two-year follow-up, incidence of MACE was similar between groups (7.9 vs. 21.1%, respectively; p=0.20), with lower target lesion revascularisation for Inspiron (0 vs. 21.1%, respectively; p=0.01) and no stent thrombosis. CONCLUSIONS Sirolimus eluted from an abluminal biodegradable polymer on a cobalt-chromium alloy proved effective in reducing restenosis at six months.
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Scaffold and edge vascular response following implantation of everolimus-eluting bioresorbable vascular scaffold: a 3-year serial optical coherence tomography study. JACC Cardiovasc Interv 2014; 7:1361-9. [PMID: 25457053 DOI: 10.1016/j.jcin.2014.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 06/19/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study sought to investigate the in-scaffold vascular response (SVR) and edge vascular response (EVR) after implantation of an everolimus-eluting bioresorbable scaffold (BRS) using serial optical coherence tomography (OCT) imaging. BACKGROUND Although studies using intravascular ultrasound have evaluated the EVR in metal stents and BRSs, there is a lack of OCT-based SVR and EVR assessment after BRS implantation. METHODS In the ABSORB Cohort B (ABSORB Clinical Investigation, Cohort B) study, 23 patients (23 lesions) in Cohort B1 and 17 patients (18 lesions) in Cohort B2 underwent truly serial OCT examinations at 3 different time points (Cohort B1: post-procedure, 6 months, and 2 years; B2: post-procedure, 1 year, and 3 years) after implantation of an 18-mm scaffold. A frame-by-frame OCT analysis was performed at the 5-mm proximal, 5-mm distal edge, and 2-mm in-scaffold margins, whereas the middle 14-mm in-scaffold segment was analyzed at 1-mm intervals. RESULTS The in-scaffold mean luminal area significantly decreased from baseline to 6 months or 1 year (7.22 ± 1.24 mm(2) vs. 6.05 ± 1.38 mm(2) and 7.64 ± 1.19 mm(2) vs. 5.72 ± 0.89 mm(2), respectively; both p < 0.01), but remained unchanged from then onward. In Cohort B1, a significant increase in mean luminal area of the distal edge was observed (5.42 ± 1.81 mm(2) vs. 5.58 ± 1.53 mm(2); p < 0.01), whereas the mean luminal area of the proximal edge remained unchanged at 6 months. In Cohort B2, the mean luminal areas of the proximal and distal edges were significantly smaller than post-procedure measurements at 3 years. The mean luminal area loss at both edges was significantly less than the mean luminal area loss of the in-scaffold segment at both 6-month and 2-year follow-up in Cohort B1 or at 1 year and 3 years in Cohort B2. CONCLUSIONS This OCT-based serial EVR and SVR evaluation of the Absorb Bioresorbable Vascular Scaffold (Abbott Vascular, Santa Clara, California) showed less luminal loss at the edges than luminal loss within the scaffold. The luminal reduction of both edges is not a nosologic entity, but an EVR in continuity with the SVR, extending from the in-scaffold margin to both edges. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).
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Assessing Bioresorbable Coronary Devices. JACC Cardiovasc Imaging 2014; 7:1130-48. [DOI: 10.1016/j.jcmg.2014.06.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/11/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022]
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Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. JACC Cardiovasc Interv 2014; 7:1287-93. [PMID: 25326742 DOI: 10.1016/j.jcin.2014.05.024] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast. METHODS A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months. RESULTS The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI. CONCLUSIONS Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [MOZART]; NCT01947335).
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Prognostic Value of Site SYNTAX Score and Rationale for Combining Anatomic and Clinical Factors in Decision Making. J Am Coll Cardiol 2014; 64:423-32. [DOI: 10.1016/j.jacc.2014.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
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Differential impact of five coronary devices on plaque size: insights from the ABSORB and SPIRIT trials. Int J Cardiol 2014; 175:441-5. [PMID: 25017907 DOI: 10.1016/j.ijcard.2014.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/11/2014] [Accepted: 06/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary plaque size modification, by either local (device) or systemic treatments, has been the target for many years. METHODS From ABSORB Cohort A (Absorb BVS 1.0), ABSORB Cohort B (Absorb BVS 1.1), SPIRIT FIRST (Multi-Link Vision vs. Xience V) & SPIRIT II (Xience V vs. Taxus), we calculated the total plaque area (vessel minus lumen area - thus it comprises both compartments - the plaque behind struts and the neointima.) changes by IVUS. RESULTS A total of 313 patients were included. Comparison-at-6-month follow-up: All devices induced an increase in the total plaque area. The largest increase occurred with Vision and Taxus stents as compared to other devices [Absorb BVS (1.0 and 1.1) and Xience V], (p=0.0002). Comparison-at-2-year follow-up: Absorb BVS 1.1 had a larger increase from post procedure in total plaque compared to Absorb BVS 1.0, Xience V and Taxus (p=0.0499). However, in Absorb BVS 1.1 total plaque showed a reduction of 2.2% from 1 to 3 years. Specifically, the total plaque in the sequential cohorts of Absorb BVS 1.1 increased 16.2% from baseline to 2 years (Cohort B1) while at 3 years this increase is only 5% compared to baseline (Cohort B2). CONCLUSIONS Local devices affect coronary plaque size differently and it depends on the platform (metallic vs. polymeric) and on whether it is a bare - or drug eluting stent. Coronary scaffolds appear to be a promising alternative to metallic stents since they allow plaque regression at long-term follow-up.
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Predicting 3-Year Mortality After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2014; 7:464-70. [DOI: 10.1016/j.jcin.2014.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/04/2014] [Accepted: 02/24/2014] [Indexed: 11/27/2022]
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Impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 16 randomized trials. J Cardiol 2014; 64:185-93. [PMID: 24560821 DOI: 10.1016/j.jjcc.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents. METHODS We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between EES and other rapamycin derivative-eluting stents. Safety endpoints were stent thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac events (MACE), target lesion revascularization (TLR), and target vessel revascularization (TVR). RESULTS We identified 16 randomized controlled trials with 23,481 patients and a weighted mean follow-up of 18 months. Compared with other rapamycin derivative-eluting stents, EES were associated with a significant reduction in definite ST [relative risk (RR): 0.45; 95% confidence interval (CI): 0.30-0.69; p<0.001] and TLR (RR: 0.87; 95% CI: 0.77-0.99; p=0.03). EES also showed a non-significant trend toward reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p=0.06). However, both groups had similar rates of mortality (RR: 0.95; 95% CI: 0.82-1.09; p=0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p=0.43), and MACE (RR: 0.94; 95% CI: 0.87-1.02; p=0.35). The stratified analysis of the included trials showed that EES was associated with significantly lower rate of definite ST compared with either zotarolimus-eluting stent (p=0.012) or sirolimus-eluting stent (p=0.006), but not biolimus-eluting stent (p=0.16). In longer follow-up (>1 year) stratification, EES was associated with a significant reduction in risk of definite ST (p<0.001). CONCLUSIONS EES is associated with a significant reduction in definite ST and TLR for treating patients with coronary artery disease, compared with a pooled group of other rapamycin derivative-eluting stents. Biolimus-eluting stent had similar safety and efficacy for treating patients with coronary artery disease, compared with the EES.
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Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease. Circ J 2014; 78:1942-9. [DOI: 10.1253/circj.cj-14-0204] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Temporal Evolution of Strut Light Intensity After Implantation of Bioresorbable Polymeric Intracoronary Scaffolds in the ABSORB Cohort B Trial. Circ J 2014; 78:1873-81. [DOI: 10.1253/circj.cj-14-0143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ecology of the parasitic endohelminth community of Piaractus mesopotamicus (Holmberg, 1887) (Characiformes) from Aquidauana and Miranda Rivers, Pantanal, state of Mato Grosso do Sul, Brazil. BRAZ J BIOL 2009; 69:87-91. [PMID: 19347149 DOI: 10.1590/s1519-69842009000100010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 05/16/2008] [Indexed: 11/22/2022] Open
Abstract
In this study the structure and diversity of the endohelminth community, as well as its interactions with 73 specimens of Piaractus mesopotamicus are described. The fish were caught in Aquidauana and Miranda rivers, both located in the Pantantal region, in the state of Mato Grosso do Sul. A total of 608,788 specimens of helminthes were found, representing five species: Dadaytrema oxycephala, Chabaudinema americanum, Spectatus spectatus, Rondonia rondoni and Echinorhynchus jucundum. D. oxycephala was more prevalent (91.78%) followed by R. rondoni (73.97%). Simpson's index indicated dominance in the endohelminth infracommunities (C = 0.396) and D. oxycephala was considered central species. A total of 54 hosts had between 2 and 3 species of helminthes. The pairs of the species R. rondoni/D. oxycephala and S. spectatus/D. oxycephala showed significant positive correlation between abundances. There was a significant positive correlation between total length and abundance of S. spectatus (rs = -0.2467 and p = 0.0353). Abundance of R. rondoni between the periods of 1/2003 and 2/2003 (p = 0.0356) and 1/2003 and 4/2004 (p = 0.0009) was significantly different. There was significant prevalence of E. jucundum in the female hosts.
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Ecology of the parasitic endohelminth community of Pseudoplatystoma fasciatum (Linnaeus, 1776) (Siluriformes: Pimelodidae) from the Aquidauana River, Pantanal, State of Mato Grosso do Sul, Brazil. BRAZ J BIOL 2009; 69:93-9. [PMID: 19347150 DOI: 10.1590/s1519-69842009000100011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 05/09/2008] [Indexed: 11/22/2022] Open
Abstract
This study investigated the structure and diversity of the endohelminth community and its interactions with Pseudoplatystoma fasciatum, caught in the Aquidauana River, in the State of Mato Grosso do Sul, Brazil. Ten helminth species were represented in 1,228 specimens of parasites found in the intestine and mesentery of 33 specimens of P. fasciatum. Cestodes were observed in the intestine, while nematodes Cucullanus sp. in the mesentery. Contracaecum sp. Type 1, Spatulifer rugosa and Choanoscolex abscisus showed the highest mean intensity and mean abundance and Nomimoscolex sudobin showed the highest prevalence. Simpson's index indicated dominance in the endohelminth infracommunities (C = 1.0792) and Choanoscolex abscisus was considered the central species. A clumped pattern of dispersion according to Green's index was related. 69.69% of hosts analyzed had between 2 and 5 species of endohelminths. Mean diversity was H = 0.5517 (SD = 0.4209). Two pairs of species showed significant positive association and four pairs presented significant positive correlation among abundance data. Significant negative correlations between total length and prevalence and abundance of Peltydocotyle rugosa and Nomimoscolex sudobim were found. However, no significant correlation was observed between condition factor and abundance, as well as total length and diversity. There was significant prevalence of Harriscolex kaparari in male hosts.
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Abstract
This is an essay about the nursing working process in mental health. Several conceptions have substantiated the psychiatric assistance, as well as the proposals of reorientation of those practices; nursing practices have been related to that process. The professionals' standpoint determines the choice of a tendency and the understanding of the health-illness process. The need of reviewing the nursing working object, as well as its practice in view of the transformations in mental health assistance, has pointed towards new professional attitudes regarding the person with psychic disorders, as well as towards the acquisition of knowledge besides that one obtained at college courses.
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Abstract
A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis.
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Abstract
Skin contact with caterpillars of Lonomia moths causes haemostatic disorders that may evolve into a haemorrhagic syndrome. Replacement therapy has been shown to exacerbate the clinical symptoms of this envenoming. In this study it is shown that horses immunized with a bristle extract of L. obliqua caterpillars produced IgG antibodies that completely neutralized, in vitro, the toxin(s) responsible for the blood incoagulability observed in rats. This antivenom offers the possibility of specific treatment for envenoming caused by contact with caterpillars of Lonomia moths.
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Abstract
Rat-bite fever results from an infection with the organism Spirillum minus. The authors report a symptomatic patient with fever, malaise, and ulcer in forehead after a rodent exposure. The organism was identified in darkfield examination of the ulcer exudate. Penicillin was the drug used with clinical improvement of symptoms.
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[Intradermal paracoccidioidin and histoplasmin reactions in urban inhabitants of Bragança Paulista, State of São Paulo, Brazil]. Rev Inst Med Trop Sao Paulo 1978; 20:289-92. [PMID: 725429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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[Late complications of valvular prosthesis. Mitral valve thrombosis]. Arq Bras Cardiol 1970; 23:147-54. [PMID: 5470967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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