Intravascular OCT tissue type imaging by automated optical attenuation analysis

We developed attenuation imaging in OCT for atherosclerotic tissue characterization and validated the method ex and in-vivo. We introduced an en-face map of attenuation in the whole artery for plaque visualization. We quantified the attenuation derived from OCT and derived an index for the plaques. A single centre clinical study (OC3T study) was conducted to validate the index to identify thin cap fibroatheromas. We also demonstrated the utility of the attenuation maps and the index in clinical studies as corresponding well with a visual assessment of LCP in the OCT data by expert readers

A new technique for lipid core plaque detection by optical coherence tomography for prevention of peri-procedural myocardial infarction

Rationale: Percutaneous coronary intervention (PCI) provides effective revascularization of atherosclerotic coronary arteries but the invasive nature of treatment can result in complications. Patient concerns: A 53-year old man underwent coronary angiography due to chest pain with minimal ST-segment elevation in the inferior leads of the electrocardiogram. Diagnosis: We proceeded directly to coronary angiography and delineated a moderate stenosis with haziness in the mid right coronary artery (RCA). Interventions: Expert analysis of the pre-intervention OCT imaging demonstrated a large lipid core plaque (LCP), upstream of the culprit site, with minimal thrombus burden. Subsequent implantation of a bioresorbable vascular scaffold, protected with distal deployment of a filter protection device provided an excellent result with retrieval of plaque material. Post-hoc attenuation analysis confirmed the presence of large LCP. Outcomes: A post-procedural transthoracic echocardiogram confirmed good left ventricular function with no regional wall motion abnormality. An excellent clinical outcome was achieved. Lessons: Optical coherence tomography (OCT) derived attenuation analysis can provide with qualitative and quantitative detailed evaluation of the underlying plaque substrate. Our case shows OCT can provide the interventionist with qualitative and qualitative assessment of large LCP for prevention of periprocedural complications, which may improve outcome for PCI

OCT assessment of the long-term vascular healing response 5 years after everolimus-eluting bioresorbable vascular scaffold

AbstractBackgroundAlthough recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response.ObjectivesThis study assessed the in vivo vascular healing response using optical coherence tomography (OCT) 5 years after elective first-in-man BVS implantation.MethodsOf the 14 living patients enrolled in the Thoraxcenter Rotterdam cohort of the ABSORB A study, 8 patients underwent invasive follow-up, including OCT, 5 years after implantation. Advanced OCT image analysis included luminal morphometry, assessment of the adluminal signal-rich layer separating the lumen from other plaque components, visual and quantitative tissue characterization, and assessment of side-branch ostia “jailed” at baseline.ResultsIn all patients, BVS struts were integrated in the vessel and were not discernible. Both minimum and mean luminal area increased from 2 to 5 years, whereas lumen eccentricity decreased over time. In most patients, plaques were covered by a signal-rich, low-attenuating layer. Minimum cap thickness over necrotic core was 155 ± 90 μm. One patient showed plaque progression and discontinuity of this layer. Side-branch ostia were preserved with tissue bridge thinning that had developed in the place of side-branch struts, creating a neo-carina.ConclusionsAt long-term BVS follow-up, we observed a favorable tissue response, with late luminal enlargement, side-branch patency, and development of a signal-rich, low-attenuating tissue layer that covered thrombogenic plaque components. The small size of the study and the observation of a different tissue response in 1 patient warrant judicious interpretation of our results and confirmation in larger studies

Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. Methods: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. Results: Seventeen studies were included with 278 QIs (original, adapted or newly developed). The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR): 11%-35%), depression (IQR: 27%-41%), osteoporosis (IQR: 34%-43%) and osteoarthritis (IQR: 29-41%) were notably low. Medication management and use (range: 81%-90%), hearing loss (77%-79%) and continuity of care (76%-80%) scored higher than other conditions. Out of the 278 QIs, 141 (50%) had mean pass rates below 50% and 121 QIs (44%) had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. Conclusions: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively lo

In vitro antibacterial activity of diterpene and benzoxazole derivatives from Excoecaria agallocha L.

The in vitro antibacterial activity of column chromatographic fractions of n-hexane, benzene, chloroform, acetone, ethanol and water extracts of Excoecaria agallocha L. were determined against 24 localized and common bacterial pathogens. Antibacterial assay was performed by agar diffusion method against 4 specialized urinary tract pathogens, 10 antibiotic sensitive ophthalmic bacterial pathogens, 5 antibiotic resistant bacterial pathogens and 5 fish pathogens. It was found that the 11th fraction of chloroform extract and the 30th fraction of water extract exhibited broad spectrum of antibacterial activity. These 2 active fractions were further investigated through UV-Visible, NMR and FT-IR and were characterized as benzoate and diterpenes and their derivatives viz., 2,3-secoatisane type diterpene and 3,4,5-trihydroxy methyl benzoate.Keywords: 2,3-secoatisane, 3,4,5-trihydroxy methyl benzoate, Diterpenes, Mangroves

Isolation, identification and metal tolerance of halobacteial strains

402-408Present study is to identify the halo tolerant strains and their toxic metal tolerance. A total of 126 isolates were isolated from solar salt pan sediment sample. Among them 96 isolates were identified as metal resistance. MIC values suggested that, the maximum concentration of Ni2+ (200 ppm), Al2+ (600 ppm), Cd2+ (50 ppm), Zn2+ (400 ppm), Hg2+ (25 ppm) and As3+ (200 ppm) inhibitory activity was identified 6 isolates. Maximum percentage of metal tolerant was identified with Ni2+ (22%) and minimum percentage of tolerant was identified with the Hg2+ (8%). None of the selected isolates were showed the presence of plasmids. It is concluded from the present findings that, the halobacterial strains which isolated from the solar salt pan showed wide range of metal tolerance. </span