Time course of vascular response after an a priori strategy of bare metal stent implantation post-dilated with a paclitaxel-coated balloon: Implementation of a three-dimensional analysis algorithm with optical coherence tomography

Background: An a priori combined therapy of a bare metal stent post-dilated with a paclitaxel- -coated balloon (PCB) was investigated with optical coherence tomography (OCT) at 2 and 6 months regarding vessel response. Previous studies have shown inconsistent results and the time course of vessel healing after such an interventional strategy is unknown. Methods: Thirty-three de novo lesions in 32 patients were electively treated. Six-month OCT analysis was available in 24 lesions. Two-month OCT follow-up was obtained in 16 lesions. Sequential OCT at 2 and 6 months was available in 7 patients. A novel 3-dimensional picture of vessel segments as spread outs was implemented. Results: Severe incomplete stent apposition (ISA) accompanied by significantly lower strut coverage were found at 2-month compared with 6-month follow-up (ISA struts: 11.4 ± 11.8% vs. 1.8 ± 4.8%, p = 0.001; uncovered struts: 14.5 ± 14.8% vs. 2.0 ± 5.3%, p = 0.001). ISA size diminished over time and the possibly observed phenomenon of positive vessel remodeling (remodeling volume: 4.9 ± 5.9 mm3 at 2-months vs. 2.0 ± 2.6 mm3 at 6-months; p = 0.042) was largely reversible in most lesions. Conclusions: Bare metal stenting with adjunctive application of paclitaxel by a coated bal­loon shows transient severe incomplete strut apposition, most likely due to focal positive ves­sel remodeling. Thus, caution is needed in bailout situations following a PCB angioplasty. A novel illustration of OCT parameters as “carpet views” enables a comprehensive analysis of investigated stents.

Acute mountain sickness.

Acute mountain sickness (AMS) is a clinical syndrome occurring in otherwise healthy normal individuals who ascend rapidly to high altitude. Symptoms develop over a period ofa few hours or days. The usual symptoms include headache, anorexia, nausea, vomiting, lethargy, unsteadiness of gait, undue dyspnoea on moderate exertion and interrupted sleep. AMS is unrelated to physical fitness, sex or age except that young children over two years of age are unduly susceptible. One of the striking features ofAMS is the wide variation in individual susceptibility which is to some extent consistent. Some subjects never experience symptoms at any altitude while others have repeated attacks on ascending to quite modest altitudes. Rapid ascent to altitudes of 2500 to 3000m will produce symptoms in some subjects while after ascent over 23 days to 5000m most subjects will be affected, some to a marked degree. In general, the more rapid the ascent, the higher the altitude reached and the greater the physical exertion involved, the more severe AMS will be. Ifthe subjects stay at the altitude reached there is a tendency for acclimatization to occur and symptoms to remit over 1-7 days

Optimierung von Methoden zur Standortcharakterisierung anhand passiver seismischer Messungen am Beispiel der Weserterrassen bei Hameln

Passive seismische Messungen des Umgebungsrauschens sind effektive und nicht-invasive Methoden, um die Struktur des lokalen Untergrunds und mögliche Verstärkungen seismischer Bodenbewegungen zu ermitteln. Liegt beispielsweise Lockersediment auf Festgestein auf, so kann dies bei seismischen Ereignissen eine verstärkende Wirkung auf die seismische Beanspruchung darüberliegender Gebäude haben. Um einen ersten Überblick über den Standort zu bekommen, wird mithilfe von Einzelstationsmessungen die Fundamentalfrequenz, mit welcher der Untergrund schwingt, ermittelt (H/V-Kurven). Liegt diese in einem ähnlichen Bereich wie die Resonanzfrequenzen von Gebäuden (ca. 1 - 10 Hz) wirkt dies verstärkend, sodass auch seismische Ereignisse mit geringer Magnitude eine erhöhte Einwirkung in Bezug auf Fühlbarkeit und Schäden zur Folge haben. Des Weiteren werden zur Erstellung eines Geschwindigkeit-Tiefen-Profils mehrere Stationen zu einem Array kombiniert. Aus den gemessenen Daten werden mittels einer hochauflösenden Frequenz-Wellenzahl-Analyse (hrFK) und einer räumlichen Autokorrelation (SPAC) Dispersionskurven ermittelt, welche die Phasengeschwindigkeiten von Oberflächenwellen in Abhängigkeit der Frequenz angeben. Die resultierenden Dispersionskurven werden am Ende invertiert, um das Geschwindigkeits-Tiefen-Profil für den lokalen Untergrund zu erhalten. Insgesamt wurden auf den Flussterrassen der Weser drei Array-Messungen an unterschiedlichen Standorten, sowie mehrere H/V-Messungen durchgeführt. Ziel ist es, eine bestmögliche Strategie sowohl für die Vorgehensweise bei den Messungen, als auch für die Auswertung der Daten zu entwickeln und eine bessere Eingrenzung der Tiefenprofile der S-Wellengeschwindigkeiten zu erreichen. So wurde bei der Auswertung der Daten unter anderem eine Trennung in Love- und Rayleigh-Wellen vorgenommen, um die Geschwindigkeitsprofile besser bestimmen zu können. In Zukunft sind zudem Tests mit Variationen der Array-Geometrien geplant, um zukünftige Messungen hinsichtlich Logistik, Messdauer und Personaleinsatz zu optimieren.poste

BSZ Infotag Sachsen 24.10.2023

Begrüßung (Susanne Kandler, UB Freiberg / Frank Aurich, SMWK Sachsen / Dr. Ralf Goebel, BSZ) - K10plus (Silke Horny, BSZ) - Fernleihe: Elektronische Lieferung an Endnutzer (Volker Conradt, BSZ) - Aktuelle Projekte (LastCopies, Digitaler Assistent) (Dr. Ralf Goebel, BSZ / Silke Horny, BSZ) - FOLIO (Peter-Paul Kloppenborg, BSZ / Björn Muschall, UB Leipzig

Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation

Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system

Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19

The newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a pandemic respiratory disease. Moreover, thromboembolic events throughout the body, including in the CNS, have been described. Given the neurological symptoms observed in a large majority of individuals with COVID-19, SARS-CoV-2 penetrance of the CNS is likely. By various means, we demonstrate the presence of SARS-CoV-2 RNA and protein in anatomically distinct regions of the nasopharynx and brain. Furthermore, we describe the morphological changes associated with infection such as thromboembolic ischemic infarction of the CNS and present evidence of SARS-CoV-2 neurotropism. SARS-CoV-2 can enter the nervous system by crossing the neural–mucosal interface in olfactory mucosa, exploiting the close vicinity of olfactory mucosal, endothelial and nervous tissue, including delicate olfactory and sensory nerve endings. Subsequently, SARS-CoV-2 appears to follow neuroanatomical structures, penetrating defined neuroanatomical areas including the primary respiratory and cardiovascular control center in the medulla oblongata.Peer Reviewe