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Novel method for extraction of a massive refractory coronary thrombus after stent implantation.

Percutaneous treatment of thrombotic coronary lesions is associated with an increased incidence of complications. In particular, management of massive coronary thrombus refractory to traditional methods of removal may be especially problematic. We report a novel application of the FilterWire distal protection device to retrieve a massive refractory native coronary thrombus present after drug-eluting stent implantation.

Adult↗

Pivotal, randomized U.S. study of the Symbiottrade mark covered stent system in patients with saphenous vein graft disease: eight-month angiographic and clinical results from the Symbiot III trial.

OBJECTIVES: The purpose of this study was to evaluate the clinical and angiographic outcomes of the Symbiot ePTFE covered stent versus bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease. BACKGROUND: The Symbiot stent was developed to reduce periprocedural complications, by potentially preventing distal embolization, and to serve as a possible barrier to cell migration, thus reducing restenosis. METHODS: Symbiot III is a prospective, randomized trial of 400 patients at 45 US sites, with 201 patients in the Symbiot group and 199 in the BMS group. Randomization was stratified based on the intended use of embolic protection devices and glycoprotein IIb/IIIa inhibitors. The primary endpoint was percent diameter stenosis (%DS) as measured by quantitative coronary angiography at 8 months. Secondary endpoints included MACE (cardiac death, MI, TVR). RESULTS: The groups were well matched for all baseline clinical and lesion characteristics. At 8 months, %DS was comparable between groups (30.9% Symbiot, 31.9% BMS, P = 0.80). Although the rates of binary restenosis in the stented segment were similar (29.1% Symbiot, 21.9% BMS, P = 0.17), more patients in the Symbiot group had binary restenosis at the proximal edge (9.0% Symbiot, 1.8% BMS, P = 0.0211). There was no difference in the incidence of MACE between groups (30.6% Symbiot, 26.6% BMS, P = 0.43). CONCLUSIONS: This study failed to show an advantage for the Symbiot stent in the treatment of degenerated SVGs. This PTFE covered stent does not appear to act as a barrier to prevent restenosis.

Adult↗

Update of carotid stent trials.

As is the case in many vascular territories, endovascular treatment of extracranial carotid artery disease is becoming a rival alternative to surgery. Results of carotid artery stenting (CAS) are improving with the introduction of embolic protection devices, improved technology, and increasing operator experience. Multiple clinical studies have shown results in favor of CAS as opposed to carotid endarterectomy (CEA) in patients considered at high risk for surgery. Current ongoing trials are examining both treatment options in low and intermediate risk patients in prospective randomized protocols. With the recent FDA approval of carotid stent systems, we are entering a new era in the treatment of carotid artery disease. An update of modern carotid stent studies, as well as stent versus surgery studies in the current era is needed.

Blood Vessel Prosthesis Implantation↗

Mechanical thrombectomy options in complex percutaneous coronary interventions.

Percutaneous coronary interventions (PCI) of thrombus-containing lesions are associated with an increased risk of acute complications and poorer long term vessel patency. Dealing with these vessels provides many technical challenges, especially with the significant risk of coronary no reflow and distal embolization. Pharmacological strategies, including intravenous and intracoronary glycoprotein IIbIIIa inhibitors reduce intracoronary thrombus propagation, improve TIMI flow and are associated with a reduction in adverse event rates. Mechanical strategies (particularly embolic protection and thrombectomy catheters) help to improve coronary blood flow and myocardial perfusion. However, their impact on clinical outcomes is less clear. The use of embolic protection devices is associated with better perfusion, blood flow, and clinical outcomes among patients undergoing saphenous vein graft (SVG) PCI. However, the role for these devices in primary PCI and native coronary artery interventions is uncertain. This study examines the current approaches to manage thrombotic lesions during PCI and reviews the evidence in support of the different mechanical thrombectomy options that are available to the interventional cardiologist.

Angioplasty, Balloon, Coronary↗

Near ultraviolet DNA damage induces the SOS responses in Escherichia coli.

The influence of the growth delay induced by near u.v. radiation on the SOS response was monitored by comparing the level of sfiA expression by means of a sfiA::lacZ fusion in both a nuvA+ cell and an isogenic nuvA mutant. The mutant lacks 4-thiouridine in its tRNA and does not exhibit the near u.v.-induced growth delay. Although the two strains exhibit similar sfiA induction levels after 254 nm irradiation, their behaviour is different after illumination with near u.v. light, including solar u.v. Inducibility is 10-20 times higher in the nuvA mutant than in the parent strain. Furthermore, pre-illumination with broad band near u.v. light does not affect the 254 nm-induced sfiA response in the mutant but reduces it by a factor of 3-4 in the parent strain. The kinetics of sfiA induction in near u.v.-illuminated nuvA+ cells, whether treated with 254 nm light or not, is unusual and follows the growth curve: only after 50 min is sfiA derepression observed. It can be concluded that (i) near u.v.-induced DNA lesions are able to trigger the SOS response and (ii) the growth delay effect reduces this response, whether triggered by u.v. or near u.v. light. Hence 4-thiouridine in tRNA acts as a built-in antiphotomutagenic 'device' protecting Escherichia coli cells against mutagenesis and the induction of the SOS response by near u.v. light and sunlight.

DNA Repair↗

The foot at risk: identification and prevention of skin breakdown.

This article presents the major predisposing factors and measures associated with preventing nosocomial foot lesions. The combination of nursing interventions and the appropriate use of protective devices can markedly reduce the incidence of foot lesions acquired in the hospital. Patient and family education is another important aspect in preventing skin breakdown of the foot at risk.

Foot Diseases↗

Importance of bone-conducted sound transmission on patient hearing in the MR scanner.

PURPOSE: to evaluate the influence of bone-conduction in the MR environment compared to a standardized acoustic environment. MATERIALS AND METHODS: Acoustic noise is an unwanted side effect of MRI that is commonly tackled with passive hearing protection. In an MR scanner, however, with the patient completely surrounded by the MR sounds and in close contact with the vibrating MR table and gantry, bone-conduction may increase subjective sound levels, restricting the efficacy of passive protection that reduces air-conducted noise only. A total of 10 volunteers were subjected to pure MR tones, covering the frequency range relevant for hearing and at 60 dB, generated through the MR system's gradient coils. Bone-conduction was determined for various passive damping conditions in an MR scanner and was compared to that acquired in an acoustically-calibrated environment. The contribution of mechanical vibrations to bone-conduction was determined. Also, with a microphone in the ear canal, the objective efficacy of the passive protection was measured. RESULTS: We found no difference between the bone-conduction experiments executed inside the imager and in the acoustically-controlled environment. The overall insertion loss of the passive hearing protectors was over 20 dB with strongest effects at 0.4 and 2.5 kHz. CONCLUSION: As bone-conduction is not more pronounced inside the MR scanner than outside, the previous reports on the subjective evaluation of protection devices in MRI hold their validity.

Bone Conduction↗

Patterns of retinal light absorption related to retinitis pigmentosa mutants from in silico model structures of rhodopsin.

Changes induced by mutations in rhodopsin that are associated with the degenerative visual disease retinitis pigmentosa result in an altered pattern of light absorption according to quantum mechanical simulations and reference experimental works. Eleven single-point mutations associated with retinitis pigmentosa at and in the proximity to the retinal binding pocket of rhodopsin have been modeled in silico and their spectra calculated with the NDOL (Neglect of Differential Overlap accounting L azimuthal quantum number) a priori method. The altered pattern of absorption found would lead to cumulative consequences in energy dissipation with aging. Different energy balances in the case of mutants at the very molecular level, compared to native nonmutated rhodopsin, can cause permanent cellular stress and would play a role in the progression of the retine degenerative process. It could explain the worsening of the pathological condition mostly in adults and suggests the probable beneficial effects of using quenching drugs and protection devices against excess of light in the early stages of life for avoiding or reducing potential damage.

Absorption↗

Sperm protection and mate assessment in the bushcricket Coptaspis sp. 2.

Several adaptive explanations regarding the function of lengthy copulations in insects have been proposed. They may represent a form of mate guarding, where the male physically prevents the female from copulating with rival males. Alternatively, they may function to ensure full insemination of the male's sperm when copulation duration covaries with the amount of sperm transferred and male fertilization success. Finally, lengthy copulations may serve to allow males to assess female quality in terms of mating status and body weight. In this study I examine these hypotheses for the function of lengthy copulations in the Australian bushcricket Coptaspis sp. 2 (Orthoptera: Tettigoniidae). Unlike most other bushcrickets, males of this species do not produce a large spermatophylax that the female feeds on during insemination, but remain attached to the female's genitals up to 6 h after spermatophore attachment. Experimental manipulation of the duration of spermatophore attachment showed it to be related to the amount of sperm transferred. This suggests that the main function of copulation duration is to ensure complete transfer of the male's ejaculate. Males also discriminated between females, and provided mated females with more sperm which resulted in longer copulations than with virgin females. It is possible that possession of a large spermatophylax has been lost evolutionarily in this species, with males themselves acting as a sperm protection device during insemination.Copyright 1998 The Association for the Study of Animal Behaviour

Journal Article↗

Cataphoric devices in spoken discourse.

We propose that speakers mark key words with cataphoric devices. Cataphoric devices are counterparts to anaphoric devices: Just as anaphoric devices enable backward reference, cataphoric devices enable forward reference. And just as anaphoric devices mark concepts that have been mentioned before, cataphoric devices mark concepts that are likely to be mentioned again. We investigated two cataphoric devices: spoken stress and the indefinite this. Our experiments demonstrated three ways that concepts marked by cataphoric devices gain a privileged status in listeners' mental representations: Cataphoric devices enhance the activation of the concepts that they mark; cataphoric devices suppress the activation of previously mentioned concepts; and cataphoric devices protect the concepts that they mark from being suppressed by subsequently mentioned concepts.

Communication↗

Prevention of noise-induced hearing loss.

Sounds of sufficient loudness and duration will damage the human ear resulting in temporary or permanent hearing loss, often accompanied by tinnitus. Irreversible inner ear damage from repeated sound overstimulation can occur at any age, including early infancy, resulting in permanent noise-induced hearing loss. A typical noise-induced hearing loss impairs the understanding of speech sounds, which could degrade performance in the classroom and on the job. Utilizing current knowledge about ear protection, noise-induced-hearing loss is entirely preventable except in cases of accidental exposure. Unfortunately, widespread and consistent use of appropriate ear protection devices by individuals at risk has been an elusive public health goal.

Adolescent↗

Benefit and risk of organic ultraviolet filters.

Modern sunscreen products provide broad-spectrum UV protection and may contain one or several UV filters. A modern UV filter should be heat and photostable, water resistant, nontoxic, and easy to formulate. Identification of a substance that meets these criteria is as difficult as discovering a new drug; hundreds of new molecules are synthesized and screened before a lead candidate is identified. The most important aspect in the development of a new UV filter is its safety. In our laboratories, the safety of new ultraviolet filters is assessed by an initial in vitro screen including photostability, cytotoxicity, photocytotoxicity, genotoxicity, and photogenotoxicity tests. These tests are performed in mammalian, yeast, and bacterial cell systems. Skin penetration potential is measured in vitro using human skin or, when required by regulations, in vivo. Because modern sunscreens are selected on the basis of their retention on and in the stratum corneum and are formulated as poorly penetrating emulsions, they generally have very low to negligible penetration rates. The safety and efficacy of UV filters are regulated and approved by national and international health authorities. Safety standards in the European Union, United States, or Japan stipulate that new filters pass a stringent toxicological safety evaluation prior to approval. The safety dossier of a new UV filter resembles that of a new drug and includes acute toxicity, irritation, sensitization, phototoxicity, photosensitization, subchronic and chronic toxicity, reproductive toxicity, genotoxicity, photogenotoxicity, carcinogenicity, and, in the United States, photocarcinogenicity testing. The margin of safety of new UV filters for application to humans is estimated by comparing the potential human systemic exposure with the no-effect level from in vivo toxicity studies. Only substances with a safe toxicological profile and a margin of safety of at least 100-fold are approved for human use. Finally, prior to marketing, new UV filters undergo stringent human testing to confirm their efficacy as well as the absence of irritation, sensitization, photoirritation, and photosensitization potential in man. UV filters not only protect against acute skin injury, such as sunburn, but also against long-term and chronic skin damage, including cellular DNA damage, photoinduced immune suppression, and, by extension, skin cancer. The protection provided by modern sunscreens against UV-induced skin cancer was shown in animal photocarcinogenicity studies and confirmed by numerous in vitro, animal, and human investigations: UV filters protect the p53 tumor suppressor gene from damage and prevent UV-induced immune suppression. Recent studies suggest that sunscreens protect against precursor lesions of skin cancer, such as actinic keratoses. Additional benefits of ultraviolet filters include prevention of photodermatoses, such as polymorphic light eruption, and, possibly, photoaging. Modern sunscreens are safe for children and adults. Percutaneous penetration and irritation rates of topically applied substances in children and adults are similar. The principal protective measure is to keep children out of the sun and/or to cover them with protective clothes; however, sunscreens are a safe and effective and often the only feasible defense of children against UV radiation. In conclusion, sunscreens are safe protective devices that undergo stringent safety and efficacy evaluation.

Adult↗

Combined brachial root and plexus lesions--typical sequelae of motor-bike accidents.

A total of 20 patients with severe post-traumatic arm paralysis was examined using electromyography and sensory neurography to evaluate the type and localization of the lesion; 19 patients had been involved in a motor-bike accident. In more than 80% the brachial roots were involved. In 65% a combined radicular and plexus lesion was found. The poor prognosis of these injuries indicates the need for additional protective devices.

Accidents, Traffic↗

UV-mediated cataractogenesis: a radical perspective.

A number of epidemiologic and experimental studies indirectly support the idea that solar ultraviolet radiation may be cataractogenic. However, the physical and cellular processes which might be involved in such cataractogenesis are by no means clear. Because a major consequence of the UV irradiation of oxygenated organic matter is the production of activated oxygen species, the involvement of oxidants has been suspected to be of importance. However, because the lens may normally exist in an hypoxic or even anoxic environment, the extent of availability of oxygen for such reactions is presently unknown. So also are the possible mechanism through which putative UV damage of the lens might eventuate in cataract. In addition to possible rapid and direct lethal damage to lens epithelium, possible cumulative damage to both lenticular DNA and proteins may occur. Furthermore, UV radiation has the potential to photolytically destroy light-sensitive nutrients and to generate damaging oxidants through interaction with ferruginous compounds. Given that Nature has probably provided the lens with substantial protective devices to ward off damaging effects of UV light, it is still an open question as to whether solar radiation contributes to cataract formation and, if so, by what mechanisms.

Animals↗

Anesthesia systems. Part 1: Operating principles of fundamental components.

This article is the first in a two-part series on the operation of principal components within Narkomed anesthesia systems. Part 1 illustrates the structure and function of various sections of the machine's internal piping, including components of the pneumatic circuit and the oxygen flush valve, and several safety features, such as the oxygen supply pressure alarm, oxygen failure protection device, and oxygen ratio monitor controller. The article progresses to other basic components of the anesthesia system. Topics include the function of the absorber unit and the flow of gas through it, the principle of operation of the positive end-expiratory pressure valve, the function and mechanics of the adjustable pressure limiter valve, and the open reservoir scavenger system. Part 1 is a valuable tool in understanding the function and pneumatics of the primary components of the anesthesia system.

Anesthesia, Inhalation↗

Sexually transmitted disease prevention services for female chronically mentally ill patients.

Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill women for STDs. When female chronically mentally ill patients are at risk of STDs, barriers to the exercise of their autonomy must be identified and clinically treated. Preventive clinical interventions can also be usefully augmented by educational strategies and facilitate patients' communication and behavioral skills, particularly in order to enable them to abstain from unwanted sex or to make prospective male partners wear a condom. Outreach efforts to the male partners of female patients and to the homeless mentally ill may also be required. Preventive services could be integrated and coordinated with STD clinics, substance abuse treatment programs and family planning programs.

Acquired Immunodeficiency Syndrome↗

Assessment of mass properties of human head using various three-dimensional imaging modalities.

Better methods are needed to analyse personal protective devices, such as helmets or facemasks, before they are used in practice. Software tools to quantify three-dimensional craniofacial mass properties are developed to improve our understanding of craniofacial impact biomechanics, supplement existing knowledge of osseous structure and provide a comprehensive description of human head morphology. The application of state-of-the-art imaging systems, solid modelling and other software tools are studied to determine the associated errors in mass property estimation by spiral computed tomography, three-dimensional magnetic resonance and optical surface scanning using phantoms and cadaver head studies. Volume, centre of gravity and principal moments of inertia are determined from solid mathematical models for each scanning modality. Landmark-based registration is used to register scans of the same object obtained from the three imaging modalities to a common reference co-ordinate system. Physically and analytically determined mass properties are used as the standard for truth. Although this comparative study does not lend itself to statistical analysis owing to the small sample size, results indicate that any of the three imaging modalities can be used to predict mass properties within the uncertainty of existing methods. Applying these techniques in vivo is practical and feasible.

Cephalometry↗