BACKGROUND: Coronary artery target lesion calcification may be an important determinant of the arterial response to catheter therapy for coronary arterial disease. The excimer laser coronary angioplasty(ELCA) has been reported to be a promising treatment for complex coronary artery disease. However, the effects of ELCA is not well known against the calcified target lesion. METHODS: To assess the arterial and plaque remodeling in calcified lesions after excimer laser coronary angioplasty, we used a comprehensive intravascular ultrasound(IVUS) imaging system(25MHz rotation transducer, 3.9 Fr monorail imaging sheath, motorized transducer pull back at 0.5mm/sec and quantification) to study 23 patients(1 left main, 10 LAD, 4 LCX, 6 RCA, 2 SVG) before and immediately after ELCA(the AIS 308nm XeCl excimer laser, pulse width >200nsec, pulse frequency 20Hz, energy density 35-65mJ/mm2). Paired before and after ELCA image slices were analysed ; and extermal elastic membrane, lumen, plaque+media(P+M) and calcium cross-sectional area(CSA) measured; and their differences after ELCA calculated. RESULTS: The IVUS results about the therapeutic effects of ELCA showed the enlargement of lumen CSA from 1.5+/-0.4 to 3.2+/-0.9mm2(p<0.001) and decreased of P+M CSA from 14.6+/-3.8 to 13.4+/-3.6mm2(p<0.001) without arterial expansion. The decrease of calcium CSA from 1.8+/-0.7 to 1.5+/-0.6mm2(p<0.001) and the formation of small, superficial fissures within the calcified plaque(15/23 lesions) were noted. The number of small fissures correlate with the calcium CSA significantly(r=0.61, p<0.001). CONCLUSION: The plaque and calcium ablation is the main effects of ELCA in calcified lesion, and the calcium ablation and fissure formation after ELCA may contribute to decrease the dissection and improve the success after ajunctive PTCA.
Angioplasty* ; Calcium ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Lasers, Excimer* ; Membranes ; Transducers ; Ultrasonography*

BACKGROUND: The Cordis coronary stent is a flexible, balloon expandable, radiopaque tantalum stent. Previous reports have shown excellent initial clinical outcomes. To our knowledge, there is no report of the long-term clinical outcomes. The intensely radiopaque tantalum may interfere with the angiographic assessment. We intended to evaluate long-term clinical and angiographic restenosis rates after successful implantation of the Cordis tantalum coronary stent. METHOD: Two hundred and eighty-five consecutive patients with 300 lesions were treated with 366 Cordis stents. An angiographic follow-up substudy was performed in 190 lesions ; 6 month follow-up angiograms were available in 167(88%). At follow-up, intravascular ultrasound(IVUS) was performed to (1) determine the pattern of restenosis and (2) to validate the quantitative coronary angiographic(QCA) caliper measurements. RESULTS: IVUS and QCA caliper measurement of minimal luminal diameter correlated reliably (r=0.767, p<0.001). The QCA analysis detected diffuse in-stent restenosis more reliably than focal in-stent restenosis(p<0.01). The overall angiographic restenosis rate was 19%, The factors affecting angiographic restenosis were post-stent minimum lumen diameter, type C lesion, and reference vessel size. CONCLUSION: We concluded 1) The angiographic restenosis rate of Cordis stent was comparable to that of other slotted-tube stent. 2) The QCA caliper method is reliable for the assessment of Cordis in-stent restenosis, especially in the detection of diffuse in-stent restenosis. However, QCA may miss focal in-stent restenosis only detectable by IVUS
Coronary Artery Disease ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Tantalum*

BACKGROUND: Recently, several reports regarding the protected and/or unprotected left main stenting suggested the possibility of percutaneous intervention for this prohibited area. We intented to evaluate immediate and long-term outcomes after elective stenting of unprotected left main coronary artery in selected patients. METHOD: Forty eight consecutive patients with unprotected left main coronary artery stenosis and normal left ventricular function were treated with stents implantation. The poststent antithrombotic regimen were aspirin, ticlopidine with warfarin in 14 pateints or without warfarin in 34 patients. The stents for left main coronary artery stenosis were Palmaz-Schatz stent in 25, NIR stent in 8, Multi-link stent in 3, Cordis stent in 7, Palmaz stent in 2, Gianturco-Roubin stent II in 2, and Microstent in 1 patient. Intravascular ultrasound was performed in selected patients before predilation and after stenting at late stage of this study. RESULTS: The procedural success rate was 100%. Regardless of anticoagulation, the in hospital complication including stent thrombosis, myocardial infarction, emergency bypass surgery and death did not occur. Six-months follow-up angiography was performed in 31 patients(82%) of 38 eligible patients. The angiographic restenosis occurred in 7 patients(22%) who subsequently underwent elective coronary bypass surgery in 5 patients and rotational atherectomy/balloon angioplasty in 2 patients. The target lesion revascularization rate was 18%. One death(3%) occurred 2 days after elective coronary bypass surgery during follow-up period. CONCLUSION: Stenting of unprotected left main coronary artery stenosis might be a safe and effective alternative to bypass surgery in carefully selected patients with normal left ventricular function. However, further clinical study should be needed for the late outcomes with larger numbers of patients.
Angiography ; Angioplasty ; Aspirin ; Coronary Stenosis* ; Coronary Vessels* ; Emergencies ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Ventricular Function, Left ; Warfarin

BACKGROUND: Emerging reports suggest the potential for adverse health effects from exposure to emissions from some additive manufacturing (AM) processes. There is a paucity of real-world data on emissions from AM machines in industrial workplaces and personal exposures among AM operators. METHODS: Airborne particle and organic chemical emissions and personal exposures were characterized using real-time and time-integrated sampling techniques in four manufacturing facilities using industrial-scale material extrusion and material jetting AM processes. RESULTS: Using a condensation nuclei counter, number-based particle emission rates (ERs) (number/min) from material extrusion AM machines ranged from 4.1×1010 (Ultem filament) to 2.2×1011 [acrylonitrile butadiene styrene and polycarbonate filaments). For these same machines, total volatile organic compound ERs (mg/min) ranged from 1.9×104 (acrylonitrile butadiene styrene and polycarbonate) to 9.4×104 (Ultem). For the material jetting machines, the number-based particle ER was higher when the lid was open (2.3×1010 number/min) than when the lid was closed (1.5–5.5×109 number/min); total volatile organic compound ERs were similar regardless of the lid position. Low levels of acetone, benzene, toluene, and m,p-xylene were common to both AM processes. Carbonyl compounds were detected; however, none were specifically attributed to the AM processes. Personal exposures to metals (aluminum and iron) and eight volatile organic compounds were all below National Institute for Occupational Safety and Health (NIOSH)-recommended exposure levels. CONCLUSION: Industrial-scale AM machines using thermoplastics and resins released particles and organic vapors into workplace air. More research is needed to understand factors influencing real-world industrial-scale AM process emissions and exposures.
Acetone ; Benzene ; Humans ; Metals ; National Institute for Occupational Safety and Health (U.S.) ; Styrene ; Toluene ; Volatile Organic Compounds

Objective: To determine the utility of a highly sensitive troponin assay when utilized in the emergency department. Methods The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician’s clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic definitions were determined by a pair of cardiologists reviewing two separate data sets; one that included all local troponin testing results and a second that excluded troponin testing so that diagnosis was based solely on clinical grounds. By this method, a statistically valid head-to-head comparison of contemporary and high sensitivity troponin testing is obtainable. Finally, because of a significant delay in sample processing, a unique ability to define the molecular stability of various troponin assays is possible.Trial registration ClinicalTrials.gov Identifier NCT00880802

PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.
Adrenal Cortex Hormones* ; Anti-Asthmatic Agents ; Asthma ; Cohort Studies ; Comparative Effectiveness Research ; Diethylpropion ; Disease Progression ; Gastroesophageal Reflux ; Hospitalization ; Humans ; Odds Ratio ; Prevalence ; Rhinitis

<b>BACKGROUNDb>Durable polymers used for first-generation drug-eluting stents (DES) potentially contribute to persistent inflammation and late DES thrombosis. We report the first in human experience with the rapamycin-eluting biodegradable polymer coated cobalt-chromium FIREHAWK stent with abluminal groove.

<b>METHODSb>A total of 21 patients with stable or unstable angina, or prior myocardial infarction, with single de novo native coronary stenoses < 30 mm in length in vessel sizes ranging from 2.25 to 4.0 mm were enrolled. The primary endpoint was major adverse cardiac events (MACE) at 30 days defined as the composite of cardiac death, myocardial infarction (Q and non-Q), or ischemia-driven target lesion revascularization. Secondary endpoints include device, lesion, and clinical success rates, 4-month in-stent late lumen loss by quantitative coronary angiography (QCA), proportion of uncovered or malapposed stent struts by optical coherence tomograpphy (OCT) at 4 months, and MACE at 4, 12, 24 and 36-month follow-up.

<b>RESULTSb>Device success was 95.7%, lesion and clinical success was 100.0%. There were no MACE events at 30 days. One patient died of non-cardiac hemorrhagic stroke 5 days after index procedure. At 4 months, in-stent late loss was (0.13 ± 0.18) mm, and complete strut coverage was 96.2% by OCT with 0.1% strut malapposition. At 4-month follow-up there was no additional MACE events, and a single target vessel (non-target lesion) revascularization.

<b>CONCLUSIONSb>The FIREHAWK abluminal groove biodegradable polymer rapamycin-eluting stent demonstrated feasibility, safety and efficacy in this first in human experience. OCT findings indicated excellent stent strut coverage 4 months after implantation. Larger studies are required to confirm whether the early FIREHAWK stent results translate into longer term restenosis and thrombosis benefits.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Polymers ; administration & dosage ; Sirolimus ; administration & dosage ; Tomography, Optical Coherence

Objective: To determine a normative value for the nasopharyngeal depth from the anterior nasal spine (ND-ANS) among normal adult Filipinos using Computed Tomography scans. Methods: Design: Cross-sectional study. Setting: Tertiary National University Hospital. Participants: Of 516 adult patients that underwent facial, neck and temporal bone CT scans in our hospital between January 1 to June 30, 2019, 100 cases were randomized to be included in the study and 91 CT scans were analyzed. Results: The mean nasopharyngeal depth from the anterior nasal spine among Filipino adults is 7.17 ± 0.42. There was a significant difference between sexes with a mean measurement of 7.23 cm ± 0.44 in males and 7.09 ± 0.37 cm in females. There was no statistically significant difference in mean nasopharyngeal depth across age groups. Conclusion A statistically significant difference was observed between sexes in our study sample. Our study provides initial normative values of nasopharyngeal depth among adult Filipinos, and additional studies may use this as a basis for further research.
Nasopharynx ; Adult ; Anthropometry

Background and Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital and community-acquired infections, showing antimicrobial resistance (AMR), which is an increasing public health concern. One of the commonly-used methods to evaluate resistance include the Kirby-Bauer disk diffusion method. However, this test is found to be time-consuming, lacking in terms of mechanization and automation, alongside its non-applicability to certain antibiotics such as vancomycin. Thus, the Clinical Laboratory Standards Institute (CLSI) recommends using the broth microdilution method in the evaluation of antibacterial activities against S. aureus. A rapid laboratory identification of MRSA is important in the treatment of patients. Therefore, this study aims to optimize and evaluate the effectiveness of a rapid microplate assay using resazurin dye as a colorimetric indicator in determining antibacterial activity against clinical isolates of MRSA and methicillin-susceptible S. aureus (MSSA). Methods: Clinical isolates of MRSA and MSSA were obtained from the Philippine General Hospital (PGH) Microbiology Section, and American Type Culture Collection (ATCC) controls of both strains (ATCC 25923 and ATCC 43300) were acquired. These were then subjected to identification and confirmation procedures. A standardization of bacterial inoculum was performed by comparing its 24-hr growth in Mueller Hinton Broth to 0.5 McFarland Standard. The resazurin microplate assay (REMA) was set-up using two-fold serial dilution of control antibiotics such as oxacillin, vancomycin, and cefoxitin. Each plate was inoculated with standardized bacterial growth of controls and clinical isolates. To determine the time needed for the reduction of the resazurin dye, a qualitative assessment was conducted by comparing the reaction time between a 6.75 mg/mL dye with a 0.01 mg/mL dye. The plates were also subjected to different incubation times and dye concentrations, and the optical densities of the plates were compared using a microplate reader. Results: Results showed that there were no significant differences between the optical densities of the wells of those incubated for 5 hours and for 24 hours (p >0.05). Furthermore, there was a significant reduction in the reaction time of the dye (from 18 hours to 1 hour) when the dye concentration was reduced from 6.75 mg/mL to 0.01 mg/mL. The optimized REMA showed a significant difference between the minimum inhibitory concentrations (MICs) of the different antibiotics against the control and isolate strains of MRSA and MSSA, showing a W of -2.98 (p <0.05) using the Wilcoxon Rank-Sum non-parametric test. Furthermore, the REMA has shown better illustration of anti-MRSA and anti-MSSA activities as compared to the Kirby Bauer disk diffusion method. Conclusion Based on the results presented, the researchers determined the optimal condition for the resazurin microtiter assay, which was 0.01 g/mL concentration of resazurin dye, at a 5-hour incubation period. This study has shown that an optimized REMA is an efficient and fast method to determine the antimicrobial activities of oxacillin, cefoxitin, and vancomycin against MRSA and MSSA.
Methicillin Resistant Staphylococcus aureus

The coronavirus disease 2019 (COVID-19) pandemic has affected all Canadian families, with some impacted differently than others. Our study aims to: (1) determine the prevalence and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among Canadian families, (2) identify predictors of infection susceptibility and severity of SARS-CoV-2, and (3) identify health and psychosocial impacts of the COVID-19 pandemic. This study builds upon the CHILD Cohort Study, an ongoing multi-ethnic general population prospective cohort consisting of 3,454 Canadian families with children born in Vancouver, Edmonton, Manitoba, and Toronto between 2009 and 2012. During the pandemic, CHILD households were invited to participate in the CHILD COVID-19 Add-On Study involving: (1) brief biweekly surveys about COVID-19 symptoms and testing; (2) quarterly questionnaires assessing COVID-19 exposure and testing, vaccination status, physical and mental health, and pandemic-driven life changes; and (3) in-home biological sampling kits to collect blood and stool. In total, 1,462 households (5,378 participants) consented to the CHILD COVID-19 Add-On Study: 2,803 children (mean±standard deviation [SD], 9.0±2.7 years; range, 0-17 years) and 2,576 adults (mean±SD, 43.0±6.5 years; range, 18-85 years). We will leverage the wealth of pre-pandemic CHILD data to identify risk and resilience factors for susceptibility and severity to the direct and indirect pandemic effects. Our short-term findings will inform key stakeholders and knowledge users to shape current and future pandemic responses. Additionally, this study provides a unique resource to study the long-term impacts of the pandemic as the CHILD Cohort Study continues.