Dedicated bifurcation stents or regular drug eluting stents in distal left main stenosis: A retrospective study

  Background: In the distal left main (LM) atherosclerosis mainly develops within bifurcation or trifur­cation. The aim of this study was to analyze the strategy of distal LM stenosis treatment and associated clinical outcomes in a large hospital in Northern Poland. Methods: The study population consisted of consecutive patients with stable coronary artery disease or acute coronary syndrome (ACS) and distal LM stenosis who were hospitalized between June 2012 and June 2013. Patients were treated with regular drug-eluting stents (rDES), including bioresorbable vascular scaffolds, or dedicated bifurcation stents (BiOSS LIM®). Clinical outcomes were analyzed at 12, 24 and 36 months. Primary endpoint was cumulative major adverse cardiovascular events (MACE) inducing rate of cardiac death, myocardial infarction, and target lesion revascularization (TLR) after 36 months. Results: One hundred and two patients were identified, 90 of whom were treated with percutaneous coronary intervention (56 rDES, including 9 Absorb, and 34 BiOSS) with no stent implantation fail­ure. In 15 (16.7%) patients rDES was required within side branch (SB). After 36 months MACE rate was 19.0% (BiOSS: 18.8% vs. rDES 19.2%), whereas TLR rate was 10.7% (BiOSS 12.5% vs. rDES 9.6%). In logistic regression for 36-month TLR rate proximal optimization technique (OR 0.311, 95% CI 0.211–0.644) was a prognostic factor of better clinical outcome, whereas non-ST-elevation ACS (OR 2.211, 95% CI 1.642–5.110), ST-elevation myocardial infarction (OR 2.771, 95% CI 1.325–7.209) and SB stenting (OR 1.141, 95% CI 1.002–1.881) were risk factors of poor outcome. Conclusions: Regular drug-eluting stents as well as dedicated bifurcation BiOSS LIM® stents enabled a simple and fast distal LM treatment option with a single stent. Both resulted in comparable MACE and TLR rates

Relationships between body weight and percentage body fat in the body and the development of osteopenia and osteoporosis

Obesity nowadays is a significant problem in developing countries and developed ones. Both the percentage of adipose tissue in the body and the proportion of muscle tissue affect the condition of the skeletal system. The common origin of adipose tissue and muscle tissue shows that overweight and obesity are not indifferent to the metabolism of bone tissue. Both malnutrition and obesity can lead to unfavorable health effects, contributing to the development of bone disorders and the occurrence of osteopenia, osteopenia with sarcoidosis, osteoporosis or osteoarthritis. Increased percentage of adipose tissue and/or muscle tissue during menopause may have an osteoprotective effect and thus prevent or relieve the effects of menopause in women or andropause in men. Research aimed at measuring the content of adipose tissue as a supplement to other diagnostic tests may contribute to the early detection and even prevention of osteoporosis. Key words: BMI, obesity, osteoporosis, osteopeni

New methods of varicose veins treatment

Chronic venous disease may affect even 60% of the population. Manifestation of this condition may vary from no symptoms to an active venous ulcer. The treatment of this disease may improve patient’s quality of life. A large number of new studies have been carried out since the guidelines publication of the Society for Vascular Surgery, American Venous Forum and European Society for Vascular Surgery considering chronic venous disease treatment. There is also available a 2 year follow-up of the study described in the guidelines. New non- thermal techniques like Mechanochemical ablation (MOCA) and Cyanoacrylate closure (CAC) are very effective, less painful and safe. The use of endovenous non- thermal ablation techniques doesn’t require tumescent anaesthesia which works as a heat sink protecting surrounding tissues from damage in thermal techniques. This eliminates the risk of bleeding and pain associated with multiple needle injections along the vein section to be treated. New studies show that MOCA and CAC techniques have high closure rates directly after the procedure and in the follow-up periods

Vitamin D and hypertension

Introduction: Current epidemiological studies indicate, that insufficiency of vitamin D affects 50% of the population worldwide. 1α,25(OH)2D – active form of vitamin D affects tissues and organs through vitamin D receptor (VDR). Attention to the role of vitamin D deficiency in hypertension development has been continuously increased during recent decades. The aim of the study: The purpose of this narrative systemic review was to analyse and summarize available data on role of vitamin D deficiency in hypertension development. Material and method: Standard criteria were used to review the literature data. The search of articles in the PubMed and Google Scholar database was carried out using the following keywords: hypertension, calcitriol, vitamin D, 25-hydroxyvitamin D. Description of the state of knowledge: Vitamin D influence blood pressure level through renin-angiotensin-aldosterone system (RAAS) and parathormon regulation. Studies conducted on animal model could explain possible mechanism of vitamin D influence on blood pressure control. However, clinical trial results are equivocal due to differences in sample size, heterogeneity of patient baseline characteristics, different vitamin D doses and study duration. Summary: Further research is needed to confirm the role of vitamin D in hypertension development

To continue or discontinue aspirin? The risk of perioperative complications

Acetylsalicylic acid (aspirin) is a noncompetitive irreversible antagonist of the enzyme cyclooxygenase 1 (COX1). This drug is commonly used in prevention of cardiovascular and cerebrovascular events due to inhibition of platelet function. Because of the risk of surgical hemorrhage it is recommended to cessation aspirin intake couple days before the surgical intervention. However, discontinuation of aspirin treatment may results in increased risk of thrombotic events and perioperative complications. Antithrombotic Trialist's Collaboration proved that low dose of aspirin intake before surgery reduces the risk of nonfatal myocardial infarction by 33%, vascular events by 17% and nonfatal stroke by 25%. However, some studies showed the increased risk of perioperative bleeding in patients continuing aspirin treatment. The position of experts is not unambiguous and there have been doubts about the necessity of discontinuation or continuation this drug before surgery

3D PET image reconstruction based on Maximum Likelihood Estimation Method (MLEM) algorithm

Positron emission tomographs (PET) do not measure an image directly. Instead, they measure at the boundary of the field-of-view (FOV) of PET tomograph a sinogram that consists of measurements of the sums of all the counts along the lines connecting two detectors. As there is a multitude of detectors build-in typical PET tomograph structure, there are many possible detector pairs that pertain to the measurement. The problem is how to turn this measurement into an image (this is called imaging). Decisive improvement in PET image quality was reached with the introduction of iterative reconstruction techniques. This stage was reached already twenty years ago (with the advent of new powerful computing processors). However, three dimensional (3D) imaging remains still a challenge. The purpose of the image reconstruction algorithm is to process this imperfect count data for a large number (many millions) of lines-of-responce (LOR) and millions of detected photons to produce an image showing the distribution of the labeled molecules in space.Comment: 10 pages, 7 figure

TOF-PET detector concept based on organic scintillators

In this contribution we present a new concept of the large acceptance detector systems based on organic scintillators which may allow for simultaneous diagnostic of large fraction of the human body. Novelty of the concept lies in employing large blocks of polymer scintillators instead of crystals as detectors of annihilation quanta, and in using predominantly the timing of signals instead of their amplitudes

Plastic scintillators for positron emission tomography obtained by the bulk polymerization method

This paper describes three methods regarding the production of plastic scintillators. One method appears to be suitable for the manufacturing of plastic scintillator, revealing properties which fulfill the requirements of novel positron emission tomography scanners based on plastic scintillators. The key parameters of the manufacturing process are determined and discussed.Comment: 7 pages, 4 figure

Application of the compress sensing theory for improvement of the TOF resolution in a novel J-PET instrument

Nowadays, in positron emission tomography (PET) systems, a time of fl ight (TOF) information is used to improve the image reconstruction process. In TOF-PET, fast detectors are able to measure the difference in the arrival time of the two gamma rays, with the precision enabling to shorten signifi cantly a range along the line-of-response (LOR) where the annihilation occurred. In the new concept, called J-PET scanner, gamma rays are detected in plastic scintillators. In a single strip of J-PET system, time values are obtained by probing signals in the amplitude domain. Owing to compressive sensing (CS) theory, information about the shape and amplitude of the signals is recovered. In this paper, we demonstrate that based on the acquired signals parameters, a better signal normalization may be provided in order to improve the TOF resolution. The procedure was tested using large sample of data registered by a dedicated detection setup enabling sampling of signals with 50-ps intervals. Experimental setup provided irradiation of a chosen position in the plastic scintillator strip with annihilation gamma quanta

Multiple scattering and accidental coincidences in the J-PET detector simulated using GATE package

Novel Positron Emission Tomography system, based on plastic scintillators, is developed by the J-PET collaboration. In order to optimize geometrical configuration of built device, advanced computer simulations are performed. Detailed study is presented of background given by accidental coincidences and multiple scattering of gamma quanta