The Initial Extent of Malapposition in ST-Elevation Myocardial Infarction Treated with Drug-Eluting Stent: The Usefulness of Optical Coherence Tomography

PURPOSE: The aim of this study is to identify the extent of initial malapposition using optical coherence tomography (OCT) in ST-elevation myocardial infarctions (STEMI) treated with different types of drug-eluting stents (DES). MATERIALS AND METHODS: Twenty four STEMI patients that underwent primary percutaneous coronary intervention (PCI) were enrolled. The OCT and intravascular ultrasound (IVUS) were performed within 72 hours after the primary PCI. Distances between the endo-luminal surface of the strut reflection and the vessel wall and the extent of malapposition were measured and analyzed. RESULTS: Sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES) were deployed in 7 patients (29%), 7 patients (29%) and 10 patients (42%). In total, 4951 struts in 620 mm single-stent segments were analyzed (1463 struts in SES, 1522 in PES, and 1966 in ZES). In strut analysis by OCT, the incidence of malapposition was 17 % (860/4951) and in stent analysis by IVUS, malapposition rate was 21% (5/24). The malapposition rate of strut level using OCT in 5 patients who had malapposition in IVUS was significantly higher than the 19 of those who had not (32 +/- 5% vs. 12 +/- 6%, p = 0.001). In addition, the frequency of malapposition was also significantly different (28% in SES, 11% in PES, 10% in ZES, p = 0.001). The use of SES was an independent predictor of malapposed struts. CONCLUSION: The incidence of malapposition using OCT was quite prevalent in STEMI after primary PCI with DES implantation and SES has especially higher rates of malapposition compared to other DESs.ope

Is patients’ rurality associated with in-hospital sepsis death in US hospitals?

BackgroundThe focus of this study was to explore the association of patients’ rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals.MethodsThe National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients’ rurality is associated with in-hospital death.FindingsDuring the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds.ConclusionRurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors

The effect of instruction on the acquisition of Japanese discourse marker ndesu

The present study investigated the effects of explicit pragmatic instruction on the acquisition of the Japanese discourse marker ndesu by second language (L2) learners enrolled in third- and fourth-year Japanese courses at the university level. The research was based on a quasi-experimental, pretest-posttest, and delayed posttest design using an experimental group (pragmatically-oriented) and a control group (textbook-based). The present study was specifically designed to examine the effect of a pragmatically-oriented intervention introducing a unified concept of ndesu in which the pragmatic aspect was emphasized (e.g., specific context, speaker’s intention) by comparing it to a textbook-based approach offering several representative functions of ndesu with no mention of how each function is related to each other. The study aimed not only to determine how much the pedagogical intervention facilitated learners’ ability to apply the unified concept of ndesu to the functions they had learned, but also to access their ability to understand the functions not yet introduced. Furthermore, this study explored whether certain critical demographic factors (e.g., course level, duration of stay in Japan, hours of exposure to Japanese culture, and contact hours with native speakers) affected students’ knowledge of ndesu. To investigate the effect and applicability of a pedagogical intervention of ndesu, and the relationship between various factors and knowledge relating to ndesu, two groups were compared to examine the effect of the pedagogical intervention providing a unified concept of ndesu. The pragmatically-oriented group received instruction providing a unified concept of ndesu, whereas the textbook-based group was instructed by following the textbook Nakama (Hatasa, Hatasa, & Makino, 2009) that provided an explanation of each ndesu function. The results showed that both groups had a positive, immediate effect for learning ndesu, that is, explicit ndesu instruction was effective regardless of the type of instruction. Moreover, the pragmatically-oriented instruction group performed better than the textbook-based group in the posttest. Although a short-term effect was shown, a long-term effect was not retained as indicated on the delayed posttest for both groups. For each item type, both groups performed similarly on test items they were familiar with. However, the pragmatically-oriented groups performed significantly better on the items where ndesu should not be used. The result also showed that among the demographic factors (e.g., course level, duration of stay in Japan, hours of exposure to Japanese culture, and contact hours with native speakers), only general proficiency (i.e., course level, pretest score) affected the participants’ previous knowledge and learning of ndesu

Persuasion Intent And Advertising Skepticism In Health Advertorials: An Information Processing Approach Using Lexical Decision Tasks

Advertorials, advertisements disguised as an editorial, often mislead readers into perceiving the advertisement as an objective source. Two experiments examined whether health advertorials, which typically start with useful health information and promote a product in the end, circumvent the triggering of advertising schema relative to regular advertisements. In Study 1, response time in a Lexical Decision task (LDT) for persuasion-related words (e.g., promote) was shorter after viewing a regular advertisement compared to an advertorial, suggesting that advertising schemas had lower levels of activation after viewing advertorials relative to typical advertisements (H1). Labels on the advertorials, however, reduced the LDT response time, suggesting that labels may be effective for activating advertising schema (H2). Advertorials were most successful at circumventing advertising schema activation when the reader had low prior knowledge of advertorials (H3). Regardless of the type of advertisement, the more negative their category affect toward health advertisements, the more likely participants noticed the persuasive intent of the message (H4). Participants with longer LDT responses showed positive message attitudes and increased behavioral intention to adopt suggested behaviors. Study 2 examined the impact of structural aspects of advertorials by comparing infofirst with ad-first advertorials. Participants who viewed info-first advertorials showed longer latency responses toward skepticism related words on an LDT than those who viewed regular advertisements (H1). When people know about advertorials, LDT latency responses were significantly longer after reading info-first advertorials but shorter after reading ad-first advertorials. People with positive category affect toward health advertisements tend to have longer LDT latency responses toward skepticism related words. The SEM in Study 2 reported that behavioral intention was predicted by message attitudes, positive category affect, and low prior knowledge about advertorials, but there were no indirect or direct effects from LDT latency responses. The LDT latency responses were predicted by experimental conditions and positive category affect. Taken together these results suggest that advertorials enhance persuasion, compared to regular advertisements, because they reduce a reader's typical response to advertising, especially by obscuring the persuasive intent towards the advertisement. i

Percutaneous Cardiopulmonary Support in Refractory No-Reflow with Cardiogenic Shock after Coronary Stenting in Acute Myocardial Infarction

Coronary no-reflow is defined as inadequate myocardial perfusion of a given coronary segment without angiographic evidence of mechanical vessel obstruction. No-reflow is visualized angiographically as a reduction in thrombolysis in myocardial infarction (TIMI) flow grade and is typically accompanied by chest pain, electrocardiographic changes with ST-segment shift and possible hemodynamic compromise. No-reflow during primary percutaneous coronary intervention (PCI) results in increasing mortality and morbidity. Therefore, treatment of noreflow is associated with improved clinical outcomes. Generally, the treatment of no-reflow is based on pharmacotherapy. In this case, despite maximal pharmacotherapy and intraaortic balloon pump (IABP), refractory no-reflow accompanied with cardiogenic shock was successfully treated with percutaneous cardiopulmonary support (PCPS)