Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p \u3c 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p \u3c 0.001) and diabetes mellitus (50% vs. 42%, p \u3c 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p \u3c 0.001), moderate/severe calcification (68% vs. 40%, p \u3c 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p \u3c 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p \u3c 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p \u3c 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p \u3c 0.001) and procedural (88% vs. 96%, p \u3c 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p \u3c 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?

Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging

Minimal information for studies of extracellular vesicles 2018 (MISEV2018):a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines

The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points

Assessment of the menstrual problems among teenage girls: A tertiary care center study

Introduction: Due to shame over discussing menstruation and fear of illness, many adolescent girls with monthly problems never visit their family doctor or gynecologist. The presentation can be delayed as a result. The current study's goal was to assess the sociodemographic characteristics of adolescent females experiencing menstruation issues and the nature of those problems, and how they were handled. Materials and Methods: The problems faced by the adolescent girls attending the Department of Obstetrics and Gynecology were analyzed retrospectively, and all their study characteristics and conditions were evaluated. The descriptive demographics are only represented in the current study. Results: Two hundred-two teenage girls with menstruation issues visited our hospital overall. 64% of them were late adolescents, 96% lived in cities, 89 were unmarried, and 50% belonged to the middle class socioeconomically. Amenorrhea, dysmenorrhea, and irregular menstrual periods affected 86 (61%) people, 38 (27%) people, and 17 (12%) people, respectively. Patients were treated with appropriate counseling and medicinal and/or surgical care. Conclusion: Most of the teenage girls in our study had anemia. Therefore, it is essential to educate people on the importance of nutrition, different menstrual disorders, normal physiology, and the prevention and management of anemia. Adolescent-friendly health care has been attempted and partially developed in India's governmental and private systems. As a result, counseling and management of adolescent menstrual difficulties must be offered in the current health and medical care systems

Distribution of active tectonics in the Himalayan piedmont (Darjeeling, Eastern India) inferred from Horizontal-to-Vertical Spectral Ratio analysis of passive seismic records

International audienceActive tectonics necessitate to select key zones for detailed studies. In the Himalaya, and specially in its piedmont, the quality of natural outcrops is poor due to strong weathering, heavy vegetation and/or anthropogenic influence. In this paper, we show that the HVSR (Horizontal-to-Vertical Spectral Ratio) method allows exploring the structures beneath the 2-Active tectonics in the Darjeeling piedmont Terra Nova plain south of the Himalayan mountain front. This method is easy to apply in any context and we show that it has allowed revealing the subsurface structures down to 600 meters even in jungle areas. We have correlated geomorphologic scarps evidenced by geomorphologic profiles but nearly invisible in the jungle, to thrust structures evidenced at depth. Two of these scarps of about ten meters affect the 3.7 ± 0.7 ka old surface and imply that about half of the convergence is expressed south of the Himalayan front in this zone