3rd vp symposium jang
•Download as PPT, PDF•
1 like•279 views
This document summarizes research on using optical coherence tomography (OCT) to characterize coronary plaques. OCT uses near-infrared light to generate high-resolution cross-sectional images of tissue microstructure. Researchers studied 357 arterial segments ex vivo using OCT and validated plaque types (fibrous, calcific, lipid-rich) against histology with high accuracy. A pilot clinical study of 10 patients found OCT feasible and safe for examining plaques before and after percutaneous coronary intervention, identifying various pathologies and stent placements. While promising, OCT imaging in patients requires overcoming challenges like blood obstruction and motion artifacts. Further research may establish OCT as an "optical biopsy" tool for vulnerable plaque detection.
Report
Share
Report
Share
Recommended
Syntax ii, innovación científica en investigación biomédica con el stent farm...
Syntax ii, innovación científica en investigación biomédica con el stent farm...SHCI - Sección de Hemodinámica y Cardiología Intervencionista
- SYNTAX II is a single-arm international study comparing outcomes of contemporary PCI using the Synergy stent to the PCI arm of the original SYNTAX trial.
- The study aims to evaluate how improvements in stent platform/design, polymer coatings, and ischemia-guided revascularization impact outcomes compared to earlier generation DES.
- Preliminary data from one center shows physiological assessment with FFR/iFR may reclassify a significant portion of multivessel patients originally thought to require multi-vessel PCI based on angiography alone.PULMONARY THROMBOEMBOLISM IN CANCER PATIENTS AFTER SURGERY
Bakulina L.A.
Chief: M.D. Shepet`ko M.N.
PULMONARY THROMBOEMBOLISM IN CANCER PATIENTS AFTER SURGERY
Miklik R - AIMRADIAL 2014 - Radial artery injury
Miklik R - AIMRADIAL 2014 - Radial artery injuryInternational Chair on Interventional Cardiology and Transradial Approach
Incidence of radial artery injury after PCI for nonSTEMI ACS and 9-month follow-up re-catheterization assessed by optical coherence tomography (OCT)NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENT...
NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENT...Eurasian Federation of Oncology
M.Y. Myasnyankin
NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENTS WITH CUTANEOUS MELANOMA
17:15 Serra - BVS in CTO PCI
1) The document describes a prospective study assessing the safety and performance of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs).
2) 35 patients with CTOs underwent PCI with BVS implantation and were followed clinically and with imaging for 6-8 months.
3) Preliminary results found excellent mid-term patency and safety with no deaths, myocardial infarctions, or scaffold thromboses at 6-8 months follow-up.
Friday 1653 – karmpalotis – stent patency post cto pci
1) Stent type, crossing technique, and patient factors influence stent patency after CTO PCI. Drug-eluting stents are superior to bare metal stents in reducing restenosis and reocclusion.
2) Techniques involving extensive subintimal dissection and re-entry are associated with higher restenosis rates, especially if outflow and final TIMI flow are poor.
3) Patient factors like diabetes are also important determinants of stent patency, with diabetics having higher restenosis risks.
4) The role of routine angiographic follow-up after CTO PCI remains controversial.
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
Kanovsky J - AIMRADIAL 2013 - OCT for radial injury
Kanovsky J - AIMRADIAL 2013 - OCT for radial injuryInternational Chair on Interventional Cardiology and Transradial Approach
This study used optical coherence tomography (OCT) to assess radial artery injuries after percutaneous coronary intervention (PCI) in 40 patients. OCT imaging found only two minor injuries (5% of patients) and abnormal vessel wall structure in 5 patients (12.5%). This represents a major difference from a previous 2010 study that found a high number of intimal tears and medial dissections using time-domain OCT. The authors conclude that transradial access for coronary angiography and intervention carries a low risk of acute radial artery injuries, and that sheath length is an important factor affecting injury rates. Follow-up imaging will further examine any chronic changes in the radial artery.Recommended
Syntax ii, innovación científica en investigación biomédica con el stent farm...
Syntax ii, innovación científica en investigación biomédica con el stent farm...SHCI - Sección de Hemodinámica y Cardiología Intervencionista
- SYNTAX II is a single-arm international study comparing outcomes of contemporary PCI using the Synergy stent to the PCI arm of the original SYNTAX trial.
- The study aims to evaluate how improvements in stent platform/design, polymer coatings, and ischemia-guided revascularization impact outcomes compared to earlier generation DES.
- Preliminary data from one center shows physiological assessment with FFR/iFR may reclassify a significant portion of multivessel patients originally thought to require multi-vessel PCI based on angiography alone.PULMONARY THROMBOEMBOLISM IN CANCER PATIENTS AFTER SURGERY
Bakulina L.A.
Chief: M.D. Shepet`ko M.N.
PULMONARY THROMBOEMBOLISM IN CANCER PATIENTS AFTER SURGERY
Miklik R - AIMRADIAL 2014 - Radial artery injury
Miklik R - AIMRADIAL 2014 - Radial artery injuryInternational Chair on Interventional Cardiology and Transradial Approach
Incidence of radial artery injury after PCI for nonSTEMI ACS and 9-month follow-up re-catheterization assessed by optical coherence tomography (OCT)NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENT...
NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENT...Eurasian Federation of Oncology
M.Y. Myasnyankin
NEOADJUVANT PHOTODYNAMIC THERAPY IN THE SURGICAL TREATMENT OF PATIENTS WITH CUTANEOUS MELANOMA
17:15 Serra - BVS in CTO PCI
1) The document describes a prospective study assessing the safety and performance of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs).
2) 35 patients with CTOs underwent PCI with BVS implantation and were followed clinically and with imaging for 6-8 months.
3) Preliminary results found excellent mid-term patency and safety with no deaths, myocardial infarctions, or scaffold thromboses at 6-8 months follow-up.
Friday 1653 – karmpalotis – stent patency post cto pci
1) Stent type, crossing technique, and patient factors influence stent patency after CTO PCI. Drug-eluting stents are superior to bare metal stents in reducing restenosis and reocclusion.
2) Techniques involving extensive subintimal dissection and re-entry are associated with higher restenosis rates, especially if outflow and final TIMI flow are poor.
3) Patient factors like diabetes are also important determinants of stent patency, with diabetics having higher restenosis risks.
4) The role of routine angiographic follow-up after CTO PCI remains controversial.
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
Kanovsky J - AIMRADIAL 2013 - OCT for radial injury
Kanovsky J - AIMRADIAL 2013 - OCT for radial injuryInternational Chair on Interventional Cardiology and Transradial Approach
This study used optical coherence tomography (OCT) to assess radial artery injuries after percutaneous coronary intervention (PCI) in 40 patients. OCT imaging found only two minor injuries (5% of patients) and abnormal vessel wall structure in 5 patients (12.5%). This represents a major difference from a previous 2010 study that found a high number of intimal tears and medial dissections using time-domain OCT. The authors conclude that transradial access for coronary angiography and intervention carries a low risk of acute radial artery injuries, and that sheath length is an important factor affecting injury rates. Follow-up imaging will further examine any chronic changes in the radial artery.090 carotid atherosclerotic lesion model
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow indexing of reference sites. Documentation is provided on the models' composition and standardized MRI acquisition parameters to enable reproducible imaging as an internal standard over long periods.
Carotid atherosclerotic lesion models for mri endpoints insull
Carotid atherosclerotic lesion models for mri endpoints insullSociety for Heart Attack Prevention and Eradication
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes designed to closely resemble real carotid arteries, including gross structure, composition, and all stages of atherosclerotic lesions. The models are housed in holders compatible with MRI and have defined reference sites to allow for standardized imaging and comparison over time. Documentation is provided on the composition and imaging of the models to serve as standards for intra- and inter-laboratory quality control in multicenter trials.248 carotid atherosclerotic lesion models
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow indexing of reference sites. Documentation is provided on the models' composition and standardized MRI acquisition parameters to enable reproducible imaging as an internal standard over long periods.
Morrisett
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow imaging of indexed sites for reproducible measurements over time. Documentation is provided on the composition and imaging of the models to serve as standards for intra- and inter-laboratory comparisons.
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivas
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivasSociedad Española de Cardiología
Focus en el diagnóstico y tratamiento de las enfermedades coronarias. Utilidad de las nuevas técnicas de imagen invasivasЛечение пациентов с поражением ствола ЛКА, преимущества коронарной хирургии. ...
This randomized trial compared percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease over 5 years. At 5 years, the cumulative rate of major adverse cardiac and cerebrovascular events was not significantly different between PCI and CABG. However, ischemia-driven revascularization was significantly higher with PCI. Mortality and rates of myocardial infarction were similar with both treatments. PCI may be considered an alternative to CABG for select left main coronary artery disease patients when performed at high-volume centers.
Plnd athens 2011
Robotic-assisted extended pelvic lymphadenectomy (ePLND) during radical prostatectomy can achieve a comparable nodal yield to open surgery. A study of 99 patients who underwent robotic-assisted ePLND found a median nodal yield of 19 nodes removed, ranging from 8 to 53 nodes. Other studies on ePLND for bladder cancer also found comparable nodal yields between robotic and open surgery. Performing an ePLND is currently indicated at the O.L.V. Robotic Surgery Institute for prostate cancer patients with a biopsy Gleason score of 4+3 or higher, or 3+4 with a PSA over 10 ng/mL or more than 50% positive cores.
Wyniki leczenia przezskónego asd - prof. Jacek Białkowski
This document summarizes the results of percutaneous closure of atrial septal defects (ASDs) in patients. It finds that:
1) Transcatheter closure is now the treatment of choice for most ASD Type II cases, with over 90% able to be closed this way.
2) The author's center has performed over 1,000 ASD closures since 1997, mostly using the Amplatzer device, with low rates of complications like embolization.
3) While generally safe, complications like erosion of the atrial wall are still possible even after months and close follow-up is needed after the procedure.
CT Colonography for Osteoporosis Assessment
A new study found that CT colonography used for colorectal cancer screening can also provide information about bone health and detect osteoporosis. Researchers evaluated 136 women who underwent both CT colonography and DXA bone density tests within six months. Biomechanical analysis of CT images was highly correlated with and as effective as DXA for assessing osteoporosis, detecting it with 100% sensitivity and 98.4% specificity. The study concluded CT colonography can provide a comprehensive osteoporosis assessment without changing imaging protocols.
BVS IN STEMI
The document discusses the use of bioresorbable vascular scaffolds (BVS) in patients with ST-segment elevation myocardial infarction (STEMI). It summarizes that while BVS have shown efficacy and safety in trials so far, their use in STEMI patients remains uncertain due to challenges such as improper vessel sizing in acute settings, risk of distal embolization, and limited data on dual antiplatelet therapy duration. More studies are needed to fully evaluate the risks and benefits of deploying BVS in patients with acute MI.
062 pathologic study of the effect of spio injection
This document reports on a pathologic study examining the effects of injecting superparamagnetic iron oxide (SPIO) nanoparticles and analyzing the contribution of angiogenesis versus macrophage accumulation. Sections were taken from tissue without SPIO injection and stained with H&E or iron staining, as well as tissue with SPIO injection and stained with H&E, iron staining, or CD68 to identify macrophages.
Blc developing online courses 071614v2
This document discusses key elements and challenges of online course design. It identifies questions about adapting face-to-face content online and engaging students interactively in the online environment. The document outlines the agenda, which includes exploring online activities, courses, and sharing resources to support learning effective design. Standards and frameworks for online course quality are listed. Groups explored an online course to discuss benefits of online learning design, backwards design, and differences between face-to-face and online/blended courses. Effective design elements like content organization, navigation and interactivity were applied.
052 non invasive high resolution detection
1) The document discusses a study using magnetic resonance imaging (MRI) to detect active atherosclerotic plaque in mice after injection of superparamagnetic iron oxide (SPIO) nanoparticles.
2) The study found that SPIO nanoparticles were taken up by macrophages within atherosclerotic plaques, darkening the plaques on post-injection MRI scans.
3) Histological analysis confirmed iron particle presence within plaques that correlated with macrophage density, supporting MRI's ability to detect plaque inflammation.
Sreb March 2010 5
Presentation on large-scale e-Learning for Educators online professional development program and research with online training and courses by EdTech Leaders Online at EDC.
087 mri of atherosclerotic plaque in apo e ko mice
The document discusses using MRI and USPIO particles to study atherosclerotic plaques in Apo E knockout mice. Apo E knockout mice are commonly used as a model for human atherosclerosis because they develop lesions similar to humans. The study aims to determine if USPIO particles can be used to visualize plaques and evaluate stabilization of plaques with hyperthermia treatment. Preliminary experiments will involve serial MRI and pathology studies of Apo E mice before and after USPIO injection to see particle localization in plaques over time. The goal is to non-invasively stabilize atherosclerotic plaques using USPIO and hyperthermia.
032 hossein eftekhari,md
This document discusses animal models for studying vulnerable plaque and atherosclerosis. It describes how the chicken, pig, mouse, and rabbit models each have advantages and disadvantages for replicating different aspects of human disease. The mouse has been genetically modified to better model plaque development. No single animal model fully captures the human condition, but they provide insights into disease mechanisms. The document also notes that no current animal model replicates the plaque rupture seen in human heart attacks.
Online Learning to Support Educators
Online professional development (PD) for educators provides flexibility, access to experts, opportunities for reflection, and potential cost savings. Effective online PD is interactive, personalized, and data-driven. It requires careful attention to design, facilitation, and building learning communities. Research shows online PD can improve teacher practice and student learning when developed using collaborative models and incorporating feedback over time. Choosing the right technologies and providing training are also important for success.
3rd vulnerable plaque rumberger 3 16-02 4
The document discusses that less obstructive plaques pose a greater risk of coronary occlusion than severely obstructed plaques due to their greater numbers. It also states that the aggregate risk of rupture from many non-significant lesions exceeds that of fewer significant lesions, so a myocardial infarction is more likely to originate from a non-significant lesion. Additionally, it explains that while electron beam tomography (EBT) cannot identify vulnerable plaques directly, it can identify vulnerable patients based on their coronary artery calcium (CAC) scores and percentile ranks, as risk increases with higher scores. EBT is also useful for estimating prognosis and tracking changes in plaque in response to treatment over time.
084 biodistribution of spio in apo e mouse
The document reports on histopathological results from an experiment studying the bio-distribution of superparamagnetic iron oxide nanoparticles in ApoE mice over 3 and 5 days after injection. Images show H&E staining of the aorta and liver in mice at both timepoints, revealing the presence of iron-containing nanoparticles (Pearl's staining) in various tissues.
香港六合彩
王老的香港六合彩眼睛一直瞪得大大地老看着我，我的香港六合彩话说完了一会儿，他才回过神来，一把拉住我进到香港六合彩里屋，也不理睬那些香港六合彩目瞪口呆的人。
王老忙不迭地把他的得意之作全搬出来给香港六合彩我看，我的目光一下子被三条鱼的画作吸引住了。香港六合彩画面上的鱼是湖北独有的品种，颜色黄黄的，背上长着香港六合彩很尖的刺，不知叫什么鱼。真是画得活灵活现，不论格调和用笔都堪称佳作，直追八香港六合彩大山人。我不由得惊叹：“这张最好！”
当然，对一些香港六合彩画作我都如实地提出我的意见，实话实讲。这时的香港六合彩王老和坐在藤椅上抽烟的王老判若两人，他亲切地抚摸着我的脑袋，不停地点着头。香港六合彩接着，他从我手里抽过我带来的画作，轻轻地铺展香港六合彩在桌面上，笑着说：“让我也看看你的画。”
他一张一张香港六合彩地看过，嘴里不停地说着：“不错。”
他还把我画香港六合彩的一张松树挑出来，近看看，远看看，然后对我说：“我给你改一下试试看。”
看来香港六合彩王老画画有个习惯，老是喜欢把毛笔尖放在嘴边，用口水润香港六合彩湿再画。他含着毛笔，站在那里思索的时候，就像一位入定的老僧，神情肃穆，颇有香港六合彩司马相如“含笔而腐毫”之势，令人更添了几分景仰。他改完画，收了笔，一动不动地香港六合彩思忖了片刻，突然对我说：“你找我学香港六合彩画画，不行
Helping Educators Transform their Classroom Practice: Sedta Leadership Instit...
This document discusses how to help educators transform their classroom practice through effective professional development that leverages technology. It argues that teachers must "unlearn" outdated practices and embrace new technologies and tools. Two examples of successful online professional development programs are provided: (1) a 10-state consortium that built state-level online teacher PD programs focused on content, pedagogy and student achievement; and (2) an online algebra program for Louisiana teachers seeking additional certification. The document emphasizes that effective professional development must be intensive, ongoing, connected to practice and build strong relationships among teachers.
Co sn commoncore 2013
The document discusses how technology and online tools can support the implementation of Common Core State Standards (CCSS) in schools. It explains that the CCSS emphasize deeper learning goals and integrate media and technology standards. It also describes how online professional development courses for teachers through EdTech Leaders Online can help educators understand how to align their teaching with the CCSS, with a focus on how technology enables deeper learning and allows teachers to explore resources for the classroom. The courses provide opportunities for reflection, trying new strategies, and receiving feedback to help implement the mathematics and English language arts CCSS.
More Related Content
What's hot
090 carotid atherosclerotic lesion model
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow indexing of reference sites. Documentation is provided on the models' composition and standardized MRI acquisition parameters to enable reproducible imaging as an internal standard over long periods.
Carotid atherosclerotic lesion models for mri endpoints insull
Carotid atherosclerotic lesion models for mri endpoints insullSociety for Heart Attack Prevention and Eradication
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes designed to closely resemble real carotid arteries, including gross structure, composition, and all stages of atherosclerotic lesions. The models are housed in holders compatible with MRI and have defined reference sites to allow for standardized imaging and comparison over time. Documentation is provided on the composition and imaging of the models to serve as standards for intra- and inter-laboratory quality control in multicenter trials.248 carotid atherosclerotic lesion models
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow indexing of reference sites. Documentation is provided on the models' composition and standardized MRI acquisition parameters to enable reproducible imaging as an internal standard over long periods.
Morrisett
This document describes models of human carotid arteries that can be used for quality control in clinical trials evaluating atherosclerotic lesions with MRI endpoints. The models are made from cadaveric human carotid arteries and have attributes that closely resemble real carotid arteries, including different stages of atherosclerotic lesions. The models are housed in holders that are compatible with MRI and allow imaging of indexed sites for reproducible measurements over time. Documentation is provided on the composition and imaging of the models to serve as standards for intra- and inter-laboratory comparisons.
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivas
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivasSociedad Española de Cardiología
Focus en el diagnóstico y tratamiento de las enfermedades coronarias. Utilidad de las nuevas técnicas de imagen invasivasЛечение пациентов с поражением ствола ЛКА, преимущества коронарной хирургии. ...
This randomized trial compared percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease over 5 years. At 5 years, the cumulative rate of major adverse cardiac and cerebrovascular events was not significantly different between PCI and CABG. However, ischemia-driven revascularization was significantly higher with PCI. Mortality and rates of myocardial infarction were similar with both treatments. PCI may be considered an alternative to CABG for select left main coronary artery disease patients when performed at high-volume centers.
Plnd athens 2011
Robotic-assisted extended pelvic lymphadenectomy (ePLND) during radical prostatectomy can achieve a comparable nodal yield to open surgery. A study of 99 patients who underwent robotic-assisted ePLND found a median nodal yield of 19 nodes removed, ranging from 8 to 53 nodes. Other studies on ePLND for bladder cancer also found comparable nodal yields between robotic and open surgery. Performing an ePLND is currently indicated at the O.L.V. Robotic Surgery Institute for prostate cancer patients with a biopsy Gleason score of 4+3 or higher, or 3+4 with a PSA over 10 ng/mL or more than 50% positive cores.
Wyniki leczenia przezskónego asd - prof. Jacek Białkowski
This document summarizes the results of percutaneous closure of atrial septal defects (ASDs) in patients. It finds that:
1) Transcatheter closure is now the treatment of choice for most ASD Type II cases, with over 90% able to be closed this way.
2) The author's center has performed over 1,000 ASD closures since 1997, mostly using the Amplatzer device, with low rates of complications like embolization.
3) While generally safe, complications like erosion of the atrial wall are still possible even after months and close follow-up is needed after the procedure.
CT Colonography for Osteoporosis Assessment
A new study found that CT colonography used for colorectal cancer screening can also provide information about bone health and detect osteoporosis. Researchers evaluated 136 women who underwent both CT colonography and DXA bone density tests within six months. Biomechanical analysis of CT images was highly correlated with and as effective as DXA for assessing osteoporosis, detecting it with 100% sensitivity and 98.4% specificity. The study concluded CT colonography can provide a comprehensive osteoporosis assessment without changing imaging protocols.
BVS IN STEMI
The document discusses the use of bioresorbable vascular scaffolds (BVS) in patients with ST-segment elevation myocardial infarction (STEMI). It summarizes that while BVS have shown efficacy and safety in trials so far, their use in STEMI patients remains uncertain due to challenges such as improper vessel sizing in acute settings, risk of distal embolization, and limited data on dual antiplatelet therapy duration. More studies are needed to fully evaluate the risks and benefits of deploying BVS in patients with acute MI.
What's hot (10)
Carotid atherosclerotic lesion models for mri endpoints insull
Carotid atherosclerotic lesion models for mri endpoints insull
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivas
Dr. Alexander Parkhomenko. Utilidad de las nuevas técnicas de imagen invasivas
Лечение пациентов с поражением ствола ЛКА, преимущества коронарной хирургии. ...
Лечение пациентов с поражением ствола ЛКА, преимущества коронарной хирургии. ...
Wyniki leczenia przezskónego asd - prof. Jacek Białkowski
Wyniki leczenia przezskónego asd - prof. Jacek Białkowski
Viewers also liked
062 pathologic study of the effect of spio injection
This document reports on a pathologic study examining the effects of injecting superparamagnetic iron oxide (SPIO) nanoparticles and analyzing the contribution of angiogenesis versus macrophage accumulation. Sections were taken from tissue without SPIO injection and stained with H&E or iron staining, as well as tissue with SPIO injection and stained with H&E, iron staining, or CD68 to identify macrophages.
Blc developing online courses 071614v2
This document discusses key elements and challenges of online course design. It identifies questions about adapting face-to-face content online and engaging students interactively in the online environment. The document outlines the agenda, which includes exploring online activities, courses, and sharing resources to support learning effective design. Standards and frameworks for online course quality are listed. Groups explored an online course to discuss benefits of online learning design, backwards design, and differences between face-to-face and online/blended courses. Effective design elements like content organization, navigation and interactivity were applied.
052 non invasive high resolution detection
1) The document discusses a study using magnetic resonance imaging (MRI) to detect active atherosclerotic plaque in mice after injection of superparamagnetic iron oxide (SPIO) nanoparticles.
2) The study found that SPIO nanoparticles were taken up by macrophages within atherosclerotic plaques, darkening the plaques on post-injection MRI scans.
3) Histological analysis confirmed iron particle presence within plaques that correlated with macrophage density, supporting MRI's ability to detect plaque inflammation.
Sreb March 2010 5
Presentation on large-scale e-Learning for Educators online professional development program and research with online training and courses by EdTech Leaders Online at EDC.
087 mri of atherosclerotic plaque in apo e ko mice
The document discusses using MRI and USPIO particles to study atherosclerotic plaques in Apo E knockout mice. Apo E knockout mice are commonly used as a model for human atherosclerosis because they develop lesions similar to humans. The study aims to determine if USPIO particles can be used to visualize plaques and evaluate stabilization of plaques with hyperthermia treatment. Preliminary experiments will involve serial MRI and pathology studies of Apo E mice before and after USPIO injection to see particle localization in plaques over time. The goal is to non-invasively stabilize atherosclerotic plaques using USPIO and hyperthermia.
032 hossein eftekhari,md
This document discusses animal models for studying vulnerable plaque and atherosclerosis. It describes how the chicken, pig, mouse, and rabbit models each have advantages and disadvantages for replicating different aspects of human disease. The mouse has been genetically modified to better model plaque development. No single animal model fully captures the human condition, but they provide insights into disease mechanisms. The document also notes that no current animal model replicates the plaque rupture seen in human heart attacks.
Online Learning to Support Educators
Online professional development (PD) for educators provides flexibility, access to experts, opportunities for reflection, and potential cost savings. Effective online PD is interactive, personalized, and data-driven. It requires careful attention to design, facilitation, and building learning communities. Research shows online PD can improve teacher practice and student learning when developed using collaborative models and incorporating feedback over time. Choosing the right technologies and providing training are also important for success.
3rd vulnerable plaque rumberger 3 16-02 4
The document discusses that less obstructive plaques pose a greater risk of coronary occlusion than severely obstructed plaques due to their greater numbers. It also states that the aggregate risk of rupture from many non-significant lesions exceeds that of fewer significant lesions, so a myocardial infarction is more likely to originate from a non-significant lesion. Additionally, it explains that while electron beam tomography (EBT) cannot identify vulnerable plaques directly, it can identify vulnerable patients based on their coronary artery calcium (CAC) scores and percentile ranks, as risk increases with higher scores. EBT is also useful for estimating prognosis and tracking changes in plaque in response to treatment over time.
084 biodistribution of spio in apo e mouse
The document reports on histopathological results from an experiment studying the bio-distribution of superparamagnetic iron oxide nanoparticles in ApoE mice over 3 and 5 days after injection. Images show H&E staining of the aorta and liver in mice at both timepoints, revealing the presence of iron-containing nanoparticles (Pearl's staining) in various tissues.
香港六合彩
王老的香港六合彩眼睛一直瞪得大大地老看着我，我的香港六合彩话说完了一会儿，他才回过神来，一把拉住我进到香港六合彩里屋，也不理睬那些香港六合彩目瞪口呆的人。
王老忙不迭地把他的得意之作全搬出来给香港六合彩我看，我的目光一下子被三条鱼的画作吸引住了。香港六合彩画面上的鱼是湖北独有的品种，颜色黄黄的，背上长着香港六合彩很尖的刺，不知叫什么鱼。真是画得活灵活现，不论格调和用笔都堪称佳作，直追八香港六合彩大山人。我不由得惊叹：“这张最好！”
当然，对一些香港六合彩画作我都如实地提出我的意见，实话实讲。这时的香港六合彩王老和坐在藤椅上抽烟的王老判若两人，他亲切地抚摸着我的脑袋，不停地点着头。香港六合彩接着，他从我手里抽过我带来的画作，轻轻地铺展香港六合彩在桌面上，笑着说：“让我也看看你的画。”
他一张一张香港六合彩地看过，嘴里不停地说着：“不错。”
他还把我画香港六合彩的一张松树挑出来，近看看，远看看，然后对我说：“我给你改一下试试看。”
看来香港六合彩王老画画有个习惯，老是喜欢把毛笔尖放在嘴边，用口水润香港六合彩湿再画。他含着毛笔，站在那里思索的时候，就像一位入定的老僧，神情肃穆，颇有香港六合彩司马相如“含笔而腐毫”之势，令人更添了几分景仰。他改完画，收了笔，一动不动地香港六合彩思忖了片刻，突然对我说：“你找我学香港六合彩画画，不行
Helping Educators Transform their Classroom Practice: Sedta Leadership Instit...
This document discusses how to help educators transform their classroom practice through effective professional development that leverages technology. It argues that teachers must "unlearn" outdated practices and embrace new technologies and tools. Two examples of successful online professional development programs are provided: (1) a 10-state consortium that built state-level online teacher PD programs focused on content, pedagogy and student achievement; and (2) an online algebra program for Louisiana teachers seeking additional certification. The document emphasizes that effective professional development must be intensive, ongoing, connected to practice and build strong relationships among teachers.
Co sn commoncore 2013
The document discusses how technology and online tools can support the implementation of Common Core State Standards (CCSS) in schools. It explains that the CCSS emphasize deeper learning goals and integrate media and technology standards. It also describes how online professional development courses for teachers through EdTech Leaders Online can help educators understand how to align their teaching with the CCSS, with a focus on how technology enables deeper learning and allows teachers to explore resources for the classroom. The courses provide opportunities for reflection, trying new strategies, and receiving feedback to help implement the mathematics and English language arts CCSS.
Online Professional Development and Web 2.0
This document discusses the use of online tools to support effective professional development for educators. It outlines several principles of effective professional development, such as being intensive, ongoing, focused on student learning and curriculum. It then describes different types of online tools like course management, voice/content, collaboration, and communication tools that can help implement these principles. Examples of tools discussed include blogs, social bookmarking, and learning management systems. The document concludes that online professional development, if done well, can help address issues like extending training over time and building learning communities.
香港六合彩
我们一帮香港六合彩画友经常相聚，都希望在笔墨香港六合彩功夫上有所突破，不由得萌生了拜访名师学艺的香港六合彩念头。
记不得是谁提起，在1967年秋，我和香港六合彩辛石、刘子铸、刘一原等一些在外面画国画有点名气的人邀在一块，去拜访号称湖北香港六合彩画坛龙头老大的王霞宙先生。像是统一布置好了似的，大家每个人手上拿着一卷自己的香港六合彩得意之作，围在王老的身边，你一言我一语地说着香港六合彩什么“久慕大名”、“如雷贯耳”、“不吝赐教”等等香港六合彩好听的恭维话，争着要拜王老为师。
我从不习惯这个场面，也不会说客套话，香港六合彩一个人远远地站在旁边，端详着墙上挂着的香港六合彩国画。
王老坐在一把旧藤椅上，真可谓老态龙钟，香港六合彩深深浅浅的皱纹十分夸张地布满国字脸上，斑白的香港六合彩长发，杂乱的胡须，可能很少梳理。眼睛很大，却老是半睁半闭着。他一个香港六合彩劲地吸着烟，也不吭声，好像什么都没听见。等到把一支烟香港六合彩吸完，他开腔了，仿佛和李可染先生的口音差不多：“我香港六合彩身体不好，你们去找张老。”
他所说的香港六合彩张老，就是张肇铭，也是武汉名气很大的画家，论水平排在香港六合彩第三位。但大伙儿不听这话，还是围住他央求。
3rd vulnerable plaque rumberger 3 16-02 3
1) Clinical data confirms that coronary calcium detected by electron beam computed tomography (EBT) is found in 96% of patients presenting with or developing acute coronary syndromes, and that these patients have significantly greater coronary artery calcium (CAC) at baseline compared to asymptomatic matched individuals.
2) Histologic studies show that CAC occurs in all types of coronary plaques, including stable plaques (43%), ruptured plaques (77%), and eroded plaques (54%), indicating that calcium is not a marker of plaque stability or instability.
3) Because all plaque types exhibit considerable overlap in the presence of calcium, CAC detected by EBT is not a marker of either stable or unstable plaque.
192 pericardioscopy and pericardial biopsy
Pericardioscopy and pericardial biopsy can provide a minimally invasive method for diagnosing pericardial diseases. A study compared the diagnostic value of 3 approaches: fluoroscopic guidance with 3-6 samples, pericardioscopy guidance with 3-6 samples, and pericardioscopy with extensive sampling of 18-20 samples. Pericardioscopy provided excellent visualization and significantly improved sampling efficiency and diagnostic value compared to fluoroscopy. Extensive sampling via pericardioscopy further enhanced diagnostic accuracy by reducing false negatives from 58.3% to 6.7%.
100 non enhancement mri of rabbit
The document summarizes two MRI scans of a rabbit aorta. The first scan used a superficial coil but lacked penetration, so a volume coil was used for the second scan. While imaging was attempted on a New Zealand rabbit, it was injured during intubation so a WHHL rabbit was scanned instead, using spin echo, fat suppressed spin echo, and 3D imaging sequences. Further work is needed to improve fat suppression and identify artifacts.
Ten Tip for Effective Online Facilitation
This document summarizes a webinar on keys to successful online and blended learning facilitation. It provides 10 tips for effective online facilitation, including making all participants feel welcome, establishing clear goals and expectations, providing behind-the-scenes support, fostering communication between participants, modeling participation techniques, keeping discussion alive and on topic, guiding participants through content, ensuring audience and content are in sync, and bringing closure to each topic before moving on. The webinar encouraged continuing the conversation on these facilitation tips online at an EdTech Leaders Online forum.
096 mri imaging of atherosclerosis using spio
Schmitz et al studied the use of ultrasmall superparamagnetic iron oxide (USPIO) particles to enhance MRI imaging of atherosclerosis in rabbits. They administered different doses of USPIO to rabbits and imaged them at various time points up to 48 hours later. Their results demonstrated contrast enhancement of atherosclerotic plaques on MRI scans after USPIO injection.
Viewers also liked (20)
062 pathologic study of the effect of spio injection
062 pathologic study of the effect of spio injection
087 mri of atherosclerotic plaque in apo e ko mice
087 mri of atherosclerotic plaque in apo e ko mice
Helping Educators Transform their Classroom Practice: Sedta Leadership Instit...
Helping Educators Transform their Classroom Practice: Sedta Leadership Instit...
Similar to 3rd vp symposium jang
Ilumienation of lightening - 4final.pptx
This randomized controlled trial compared OCT-guided PCI to angiography-guided PCI. The OCT group had a larger minimum stent area post-PCI but no difference in target vessel failure at 2 years. While OCT guidance reduced stent thrombosis and complications, it did not decrease major adverse cardiac events due to the low rate of ischemia-driven revascularization in both groups. The results demonstrate the benefits of OCT for optimization but need longer term follow-up to assess clinical outcomes fully.
Nanotechnology in Cancer - Dr. Cote
Dr. Richard Cote of Sylvester Comprehensive Cancer Center presented "New Technologies That Will Have an Impact on Cancer" at the 2011 WellBeingWell Conference in Miami.
Multi-modal CT scanning in the evaluation of cerebrovascular disease patients
Multi-modal CT scanning in the evaluation of cerebrovascular disease patientsCardiovascular Diagnosis and Therapy (CDT)
This document discusses the use of multi-modal CT scanning in evaluating patients with cerebrovascular disease. It begins by introducing ischemic stroke as a leading cause of disability and mortality. It then discusses how CT has evolved as a non-invasive imaging tool to evaluate carotid artery pathology and intracranial vessels. In particular, it describes the use of CT angiography (CTA) to assess vessel lumen and plaque characteristics, and CT perfusion (CTP) to provide information on brain vascular physiology and identify ischemic penumbra. The document provides details on CT protocols for CTA and CTP, and discusses how findings from these techniques can predict stroke risk and guide treatment decisions. It focuses on how CTA allows evaluation ofAMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh
Ultrasound shows promise as a diagnostic tool for giant cell arteritis (GCA) that could reduce the need for temporal artery biopsies. A large study found ultrasound had higher sensitivity (54%) than biopsy (39%) for GCA diagnosis, though lower specificity. Using ultrasound first and only doing biopsies for high-risk cases could avoid 87-98% of biopsies while maintaining high sensitivity for GCA detection. Follow-up ultrasounds may help monitor disease activity and detect relapses in GCA patients treated with steroids.
OCT in coronary PCI
This document discusses optical coherence tomography (OCT) in coronary artery disease. It provides an overview of OCT, including its history and clinical evidence. It then outlines how to perform an OCT study and presents an algorithmic approach to interpreting OCT images, including assessing plaque morphology, stent sizing and apposition. The document discusses several clinical applications of OCT, such as evaluating acute coronary syndrome, plaque vulnerability, and stent failure. It also reviews limitations and future directions of OCT, including hybrid OCT/IVUS catheters and the use of artificial intelligence.
Lecture vienna september 16 2005
This document summarizes the use of noninvasive MDCT imaging of the coronary arteries. It discusses the challenges of imaging small, rapidly moving coronary vessels. MDCT allows for successful coronary imaging with temporal resolution of 330-400ms, spatial resolution of 0.4-0.75mm, coverage of the heart in a single breath hold of 8-14 seconds. Sensitivity for detecting coronary stenosis is 80-86% for 4-16 slice MDCT and specificity is 90-97%. Potential clinical applications include decreasing invasive angiograms, improving risk assessment, detecting anomalies, and evaluating bypass grafts. Larger clinical trials are still needed to determine the impact on patient management.
Ivancev 2
The document discusses fenestrated endovascular aneurysm repair (FEVAR) for juxtarenal abdominal aortic aneurysms. It summarizes studies comparing outcomes of open surgery, FEVAR, and chimney EVAR. FEVAR had lower mortality and complications than open surgery. The Zenith Fenestrated graft and a new preloaded P-Branch device were presented. The P-Branch aims to improve precision and reduce planning/production time but may have limitations from imperfect vessel alignment. Overall, FEVAR improves outcomes over open repair for juxtarenal aneurysms.
Elective Nodal Irradiation #radonc
These slides are from versions of a talk I gave at ESTRO in 2014 and again in Lille in 2015.
The talk aims to explain the importance of correctly defining the CTV with respect to nodes in curative radiotherapy planning.
The lecture makes some important points about the function of lymph glands and their potential to act as stem cell 'rests' for malignant cells: this fact might explain whilst lymph node failure rates don't necessarily equate to disease failure rates.
The lecture then goes on to emphasise the utility of the best imaging technologies may more accurately identify involved nodes.
Shrinking fields with confidence may be the best way to reduce radiation toxicity.
Ruzsa Z - AIMRADIAL 2015 - Angioplasty of the hand
Ruzsa Z - AIMRADIAL 2015 - Angioplasty of the handInternational Chair on Interventional Cardiology and Transradial Approach
1) Percutaneous angioplasty is a feasible treatment for critical hand ischemia, with a technical success rate of 88-96% and clinical success rate of 85-100% based on a study of 75 patients.
2) Complications occurred in 6-16% of patients and included perforation, distal embolization, dissection, and access site issues.
3) Long term follow up showed a high rate of major adverse events (22.6% at 1 year) and target lesion revascularization (16%).Interpretable Spiculation Quantification for Lung Cancer Screening
Spiculations are spikes on the surface of pulmonary nodule and are important predictors of malignancy in lung cancer. In this work, we introduced an interpretable, parameter-free technique for quantifying this critical feature using the area distortion metric from the spherical conformal (angle-preserving) parameterization. The conformal factor in the spherical mapping formulation provides a direct measure of spiculation which can be used to detect spikes and compute spike heights for geometrically-complex spiculations. The use of the area distortion metric from conformal mapping has never been exploited before in this context. Based on the area distortion metric and the spiculation height, we introduced a novel spiculation score. A combination of our spiculation measures was found to be highly correlated (Spearman's rank correlation coefficient ρ = 0.48) with the radiologist's spiculation score. These measures were also used in the radiomics framework to achieve state-of-the-art malignancy prediction accuracy of 88.9% on a publicly available dataset.
Radiomics and Deep Learning for Lung Cancer Screening
The document summarizes research on using radiomics and deep learning approaches for lung cancer screening. It describes:
1) Using radiomic features like shape, texture, and intensity from lung nodules on CT scans and an SVM-LASSO model to classify nodules with 87.9% sensitivity and 78.2% specificity, outperforming the Lung-RADS system.
2) A deep learning model developed for a Kaggle competition that achieved 67.4% accuracy on nodule classification but only ranked 99th due to overfitting issues without enough data.
3) Future work could integrate quantification of nodule characteristics like spiculation with plasma biomarkers to improve diagnostic accuracy.
Temporal artery biopsy
A review of the indications , technique and complication of temporal artery biopsy, the gold standard test to diagnose Giant Cell Arteritis.
Poster vienne ecr
This study assessed the feasibility of reducing radiation exposure during coronary CT angiography (CCTA) using only modified acquisition parameters on a 64-slice CT scanner. Over 85% of patients were able to undergo prospective CCTA, which significantly reduced radiation dose compared to historical levels and conventional angiography. Image quality remained high, with over 97% of coronary segments evaluated as having either excellent, good, or fair quality. The study demonstrated that very low dose CCTA is possible using standard equipment by optimizing acquisition settings.
Clinical papers on TAVR
Clinical trials Discussed in the PPT
VitaFlow™ Clinical trial data
TAVR vs SAVR in low risk Patients
TAVR in Bicuspid Patient
POPular Trial
Hofer ct teaching manual - a systematic approach to ct reading, 2nd ed.
This document provides an overview of computed tomography (CT) scanning. It discusses the general principles of how CT works, including how x-rays pass through the body and are measured by detectors. It compares conventional CT, which acquires images sequentially, to spiral CT, which acquires a continuous stream of data as the patient passes through the scanner. Spiral CT can image areas more quickly and is better for assessing contrast enhancement. The document also discusses technical aspects like spatial resolution, reconstruction algorithms, and multi-detector CT systems.
Flex Registry
Clinical Outcomes in 995 Unselected Real-world Patients Treated With an Ultra-thin Biodegradable Polymer-coated
Sirolimus-eluting Stent:
12 Months Results from the FLEX Registry
Role of CT Urography in bladder cancer. Cambridge lecture.
Role of CT Urography in bladder cancer. Cambridge lecture.Complexo Hospitalario Universitario de Vigo
CT urography (CTU) is highly accurate for detecting bladder cancer in high-risk patients. A retrospective study of 45 high-risk patients found that CTU had a 97% sensitivity and 80% specificity for bladder cancer detection compared to flexible cystoscopy. Multivariate analysis showed that positive CTU findings were highly significant predictors of bladder cancer diagnosis. The study suggests that in high-risk patients with positive CTU findings, flexible cystoscopy could be omitted and patients referred directly for rigid cystoscopy and potential biopsy or resection. However, the study had some limitations due to the small sample size.ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fib...
ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fib...Salvatore Ronsivalle
Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fibrin Glue Injection
Trattamento dello pseudoaneurisma iatrogeno mediante iniezione coguidata di colla di fibrina-
XXXIII° Congresso Nazionale della Società Italiana di Cardiologia Invasiva Porto Antico di Genova, Centro Congressi-3 ottobre 2012 Treatment of iatrogenic artery pseudoaneurysm by ultrasound guided fibrin glue injection: a single center experience Francesca Faresin; Francesca Franz; Marco Zennaro; Enrico Favaretto; Luigi Pedon; Salvatore Ronsivalle; Division of Vascular Surgery,Division of Cardiology, Cittadella Hospital, Padua, Italy-
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
- Endeavor IV was a randomized trial comparing the zotarolimus-eluting Endeavor stent to the paclitaxel-eluting Taxus stent.
- The primary endpoint was target vessel failure at 9 months, with a pre-specified non-inferiority margin of 3.8%.
- 1,548 patients at 80 sites in the US were randomized 1:1 to receive either the Endeavor or Taxus stent. Follow-up was planned through 5 years.
Carotid surgery 2014
The document discusses the case of a 62-year-old man who experienced a transient ischemic attack. It summarizes the diagnostic workup, including imaging and vascular testing, to determine if the patient had a stroke and the location of any blockages. The document then reviews the evidence and guidelines for treatment of carotid artery disease, including whether the patient is a surgical candidate. Overall, the key information provided is on evaluating and treating patients who experience transient ischemic attacks or minor strokes due to carotid artery disease.
Similar to 3rd vp symposium jang (20)
Multi-modal CT scanning in the evaluation of cerebrovascular disease patients
Multi-modal CT scanning in the evaluation of cerebrovascular disease patients
AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh
AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh
Ruzsa Z - AIMRADIAL 2015 - Angioplasty of the hand
Ruzsa Z - AIMRADIAL 2015 - Angioplasty of the hand
Interpretable Spiculation Quantification for Lung Cancer Screening
Interpretable Spiculation Quantification for Lung Cancer Screening
Radiomics and Deep Learning for Lung Cancer Screening
Radiomics and Deep Learning for Lung Cancer Screening
Hofer ct teaching manual - a systematic approach to ct reading, 2nd ed.
Hofer ct teaching manual - a systematic approach to ct reading, 2nd ed.
Role of CT Urography in bladder cancer. Cambridge lecture.
Role of CT Urography in bladder cancer. Cambridge lecture.
ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fib...
ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fib...
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
Endeavor IV-A Randomized Comparison of a Zotarolimus-Eluting Stent Endeavor...
More from SHAPE Society
Barth imt
This document provides background on Jacques Barth, an expert in cardiovascular imaging and risk assessment. It discusses the evolution of ultrasound technology for measuring intima-media thickness (IMT) from 1986 to 2005. IMT is an early marker of atherosclerosis and cardiovascular risk. The document also addresses issues around vulnerable plaques, reporting IMT measurements, and assessing cardiovascular risk in children and adolescents.
Braunwald
This document outlines an approach to identifying and managing coronary risk. It recommends that prevention must be the primary goal through intensive global risk factor reduction for all patients with clinically apparent heart disease. It also recommends identifying asymptomatic high-risk individuals through testing like the Framingham Risk Score so they can receive prevention. It proposes a risk stratification approach from low to very high risk based on annual risk levels and corresponding testing and treatments, with very high risk patients receiving the most intensive treatments like invasive detection of unstable plaques and procedures like CABG or multiple drug-eluting stents.
Acc vp-org 3-02 stone
This document describes a study that uses intravascular ultrasound (IVUS), biplane coronary angiography, and blood flow measurements to characterize endothelial shear stress (ESS) in coronary arteries. It found that over 6 months, areas of low ESS demonstrated plaque progression, areas of normal ESS remained stable, and areas of high ESS developed outward remodeling. The technology allows in vivo determination of intracoronary flow velocity and ESS, which has not previously been possible. This provides a method to predict progression of atherosclerosis and vascular remodeling. A pilot study applied this technique in 8 patients at baseline and 6 months to analyze changes in native coronary artery disease and in-stent restenosis while taking candesartan vs fel
101205 shape aha 2005 f
Zahi A. Fayad is an Associate Professor who studies molecular imaging of atherosclerosis using MRI. His research focuses on developing targeted contrast agents to noninvasively detect unstable plaque. Some agents under investigation include annexin A5 labeled with a radioisotope to detect apoptosis, FDG-PET to assess plaque activity, and fibrin-targeted and MMP-targeting Gd-based contrasts. Additional work involves lipid-based particulate agents using reconstituted HDL or iron oxide nanoparticles. The goal is to improve MRI detection sensitivity and specificity for high-risk plaque characterization.
Acc v porg becker
This document discusses the use of coronary CT angiography (CTA) to detect and characterize coronary atherosclerosis beyond just detecting coronary stenoses. CTA can identify calcified plaques, non-calcified plaques, mixed plaques, atheromas, thrombi, and myocardial infarction scars. CTA provides information on plaque composition and distribution that can help understand coronary artery disease and be used to follow patients under therapy. The limitations of CTA include artifacts from cardiac motion, breathing, blooming effect, and poor contrast opacification of small vessels. Advances in multislice CT technology are helping to address some of these limitations.
Acc 2005-1, v pl-vp
This document discusses approaches to cardiovascular disease (CVD) and the need for new approaches. It summarizes that the emphasis is shifting from high risk plaques to high risk symptomatic patients, and from high risk asymptomatic to intermediate and low risk patients. It discusses diagnostic tools like magnetic resonance imaging to identify high risk asymptomatic patients and computed tomography to identify intermediate risk patients using coronary artery calcium scoring and CRP biomarkers. It also discusses prevention and treatment strategies like a polypill for acute coronary syndrome patients and those with chronic atherothrombosis.
Acc presentation macrophage (1)
This document proposes a non-invasive method using SPIO (super paramagnetic iron oxide) nanoparticles to image macrophage infiltration and inflammation in vulnerable atherosclerotic plaques. Rabbits and mice were injected with SPIO, which accumulated in inflamed plaque areas correlated with macrophage density. SPIO-enhanced MRI then successfully identified these inflamed plaques non-invasively in vivo. This technique could provide a way to detect rupture-prone plaques and better understand plaque vulnerability.
Acc v porg
This document discusses the use of coronary CT angiography (CTA) to detect and characterize coronary atherosclerosis beyond just detecting coronary stenoses. CTA can identify calcified plaques, non-calcified plaques, and mixed plaques. It can detect atheromas and characterize plaque density. CTA can also identify intracoronary thrombi and myocardial infarction scars. The document outlines the CTA scanning parameters and techniques used to minimize motion artifacts and optimize image quality for plaque detection and characterization.
Acc presentation (1)
This document describes a study that introduces a non-invasive method for imaging macrophage infiltration in inflamed atherosclerotic plaques using superparamagnetic iron oxide (SPIO) nanoparticles and MRI. The researchers injected SPIO into hypercholesterolemic and normal rabbits and found that SPIO profoundly accumulated in areas of macrophage infiltration in the atherosclerotic plaques, as confirmed by histology. SPIO-enhanced MRI was able to identify these inflamed plaques non-invasively. The results suggest SPIO-enhanced MRI can be a novel method for detecting rupture-prone inflamed plaques associated with heart attacks and strokes.
Ac cculprit
The document discusses several factors that are considered predictors of plaque vulnerability, including luminal narrowing, plaque volume and composition, fibrous cap thickness, and plaque inflammation. It reviews studies that show myocardial infarction can develop from previously non-severe lesions and that lipid content, cap thickness, inflammation, and stress factors like circumferential stress are correlated with plaque stability and vulnerability. In conclusion, the size and composition of the lipid core, thickness and composition of the fibrous cap, and inflammation are well-established predictors of plaque rupture.
Acc presentation lipid coated(2)
This document discusses a novel tracer for MRI imaging of macrophage infiltration in atherosclerotic plaque. It summarizes research into lipid-coated superparamagnetic iron oxide nanoparticles (SPIOs) that are phagocytosed by macrophages. The researchers tested various SPIO coatings and sizes to maximize macrophage uptake while minimizing oxidative stress. Lipid-coated SPIOs combined with certain aminoglycans showed the highest uptake and lowest induction of reactive oxygen species. The goal is to develop an MRI contrast agent that can noninvasively image vulnerable, inflamed plaques by detecting macrophage presence.
Acc 2002 microarray mehran for print
This document discusses the use of DNA microarrays in vulnerable plaque research. It provides background on atherosclerosis and identifies DNA microarrays as a tool that can be used to investigate the molecular mechanisms underlying plaque vulnerability. The document outlines the basic steps of a DNA microarray experiment and discusses considerations for experimental design, data analysis, and validation of results. It also summarizes several studies that have used DNA microarrays or related techniques to examine gene expression in atherosclerosis.
Acc booth inventory
The document provides details about AEHA's booth at the ACC/AEHA Exhibition from March 30 to April 1, 2003. It lists the booth equipment and inventory, proposed activities like an Ecode on Friday morning and a VP Symposium. Giveaways include Magellan GPS devices in a raffle and Dove chocolates. It also discusses the need for an immediate membership sign-up page on the AEHA website and a vision for the future of AEHA.
Acc 04 vuln pt
This document discusses approaches to identifying and managing coronary risk. It states that the primary goal should be preventing acute cardiac events through intensive risk factor reduction for all patients with clinically apparent heart disease. Additionally, it notes that one third of sudden cardiac deaths and heart attacks occur in previously asymptomatic individuals with undiagnosed risk factors or pre-clinical disease. The document proposes identifying high-risk asymptomatic individuals through testing to provide prevention. It presents a risk stratification approach using testing like CRP, cholesterol, glucose and imaging to guide different levels of risk factor reduction and management.
Acc 2002 mehran for print
This document discusses the use of DNA microarrays in studying vulnerable atherosclerotic plaques. It provides background on atherosclerosis and plaque rupture. DNA microarrays allow high-throughput analysis of gene and protein expression, which can provide insights into molecular mechanisms underlying plaque vulnerability. One study used microarrays to analyze gene expression differences between ruptured and stable plaques, identifying perilipin as upregulated in ruptured plaques. However, microarray analysis of atherosclerosis is still in its early stages with many technical challenges to address.
Acc2002 thermography
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors. It also explores using infrared thermography to identify vulnerable plaques by detecting heat from macrophage inflammation. Studies in animal models and humans found temperature heterogeneity in atherosclerotic arteries that correlated with plaque vulnerability features. Further research aims to develop non-invasive thermography techniques to accurately detect vulnerable plaques and help predict heart attack risk.
A20 gene
The document presents findings on the A20 gene, which encodes a zinc finger protein that inhibits NF-kB activity and TNF-induced apoptosis. The study found that C57 and FVB mouse strains have a coding difference in A20 that generates a phosphorylation site in C57 mice. C57-A20 was less effective at shutting down TNF-induced NF-kB activity and C57 cells were less susceptible to TNF-induced apoptosis compared to FVB cells. This suggests less active A20 in C57 mice leads to increased inflammation and reduced apoptosis, while more active A20 in FVB mice decreases inflammation and increases apoptosis, contributing to differences in atherosclerosis susceptibility between the strains.
#1 killer of human beings in the 21st century
Vulnerable plaque refers to dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis, disrupting blood flow. The document discusses the history and research around vulnerable plaque, including pioneers in the field and emerging techniques to detect vulnerable plaque such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging. It summarizes that vulnerable plaques are typically characterized by a thin fibrous cap, large lipid core, and presence of macrophages.
A20 is an atherosclerosis
The document presents findings on the A20 gene, which encodes a zinc finger protein that inhibits NF-kB activity and TNF-induced apoptosis. The study found that C57 and FVB mouse strains have a coding difference in A20 that generates a putative phosphorylation site in C57 mice. Experiments showed the C57 version of A20 is less effective at shutting down NF-kB activity and C57 cells are less susceptible to TNF-induced apoptosis. This suggests the A20 variation could contribute to differences in atherosclerosis susceptibility between C57 and FVB strains by affecting inflammation and apoptosis.
103100
This progress report discusses ongoing near-infrared (NIR) spectroscopy studies. It notes that a new probe design is being developed to improve signal detection in the NIR range. Characterization of a new light source and additional tissue phantom studies are needed. The report identifies ongoing difficulties with depth penetration studies and experimental setup issues. Priorities include analyzing existing data to inform probe redesign, characterizing the new light source, conducting depth penetration and tissue phantom studies, and addressing experimental setup challenges.
More from SHAPE Society (20)
Recently uploaded
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
PGx Analysis in VarSeq: A User’s Perspective
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Foundation of Yoga, YCB Level-3, Unit-1
Unit -1 of Yoga certification board, level 3, all topics covered. An exam conducted by ministry of Ayush for yoga enthusiastic students.
What is Obesity? How to overcome Obesity?
Obesity is a chronic complex disease defined by excessive fat deposits that can impair health.
Microbiology & Parasitology Exercises Parts of the Microscope
Exercise 1 of Microbiology and Parasitology which is the parts of the microscope and their uses
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Helminthiasis or Worm infestation in Children for Nursing students
Brief description worm infestation/Helminthiasis for Basic B.Sc Nursing students
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
cosmetics and cosmeceuticals
Muskan
mpharm
2nd semester
Guru Gobind Singh college of pharmacy, yamunanagar, haryana
Ageing, the Elderly, Gerontology and Public Health
Challenges associated with ageing from a public health perspective
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
This quiz was conducted as a promotional event for the 2024 Annual Meet of Kerala Chapter of API.
More than 20 participants took part everyday !
KENT'S REPERTORY by dr niranjan mohanty.pptx
its a presentation on Dr kents Repertory by Dr niranjan Mohanty
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PG in India
Pharmacology of Drugs for Congestive Heart Failure
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Recently uploaded (20)
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Microbiology & Parasitology Exercises Parts of the Microscope
Microbiology & Parasitology Exercises Parts of the Microscope
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
Ageing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public Health
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptx
Pharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart Failure
3rd vp symposium jang
- 1. Optical Coherence Tomography: Optical Biopsy with a Short Photonic Needle? I.K. Jang, MD Massachusetts General Hospital Harvard Medical School The 3rd Vulnerable Plaque Symposium Atlanta, March 16, 2002
- 2. Optical Coherence Tomography • Optical analog of ultrasound • Cross-sectional imaging • 10 µm resolution • 2 mm penetration depth Low signal High signal
- 3. MGH OCT System Technical Data Optical wavelength : Image acquisition rate : Catheter: Axial Resolution : Transverse Resolution : Data storage : 1300 nm 4-8 images / sec 3.0 F 10 µm 25 µm Digital
- 4. Ex Vivo Study Aim Establish OCT criteria for plaque characterization Materials and Methods • 357 arterial segments from 90 cadavers – 78 Coronary; 86 Carotid; 143 Aorta • training set, n=50 validation set, n = 307 • Specimen registration • OCT imaging • Histology processing • Correlation of OCT with histology
- 5. Ex Vivo Study Type Number Fibrous 11 (22%) Calcific 27 (54%) Lipid pool 12 (24%) Type Number Fibrous 67 (22%) Calcific 167 (54%) Lipid pool 73 (24%) Validation Set (n = 307)Training Set (n = 50) Histologic Diagnoses
- 6. OCT Characteristics lp lp Homogeneous, Signal-rich Fibrous Lipid Echolucent, Diffuse Borders Echolucent, Sharp Borders Calcific 500 µm
- 7. Intimal Hyperplasia Low signal High signal
- 11. Ex Vivo Study Results SENS .87 PPV .88 SPEC .97 NPV .96 SENS .95 PPV 1.0 SPEC 1.0 NPV .95 SENS .92 PPV .81 SPEC .94 NPV .97 Accuracy Statistics Fibrous Calcific Lipid pool Interobserver κ = 0.88, Intraobserver κ = 0.91
- 12. Clinical Study 1 Feasibility and Safety: Pre and Post PCI
- 13. Pilot Human Study Aim: Test feasibility and safety of OCT in patients Methods • 10 patients (average age 59, 8M/2F) • Coronary angiogrpahy • IVUS + OCT imaging (3.2 F catheter) • PCI • Repeat IVUS + OCT Imaging
- 14. Fibrous Plaque
- 15. Fibrous Plaque
- 17. Lipid Rich Plaque g lplp f g 2x m a i iel eel f OCT IVUS
- 18. Fibrous Plaque with Calcium
- 19. Fibrous Plaque with Calcium
- 21. Cutting balloon
- 22. Stent
- 23. Stent
- 24. Stent
- 25. Pilot Human Study Results No OCT related complications Variety of pathology imaged and compared with IVUS • 10 patients with 28 plaque segments • 8 dissections • 13 stent locations Problems • Obstruction by blood • Motion artifacts
- 26. Acknowledgements Massachusetts General Hospital Cardiology Division H. Yabushita, B. MacNeill, H. Lowe, M. Hayashi, S. Clarke, E. Pomerantsev, D. DeJoseph, I.K. Jang Wellman Laboratories of Photomedicine B.E. Bouma, M. Shishkov, C. Kauffman, N. Iftima, G.J. Tearney Dept. of Pathology S. Houser, H.T. Aretz CIMIT J. Muller, T. Brady, J. Rosen Guidant Corporation D. Kilpatrick, J. Ellis, R. Jones, T. Linnemeier
Editor's Notes
- To date, there are two MGH prototype systems, with another under construction. All optics and electronics reside within a portable enclosure that can easily be transported to the clinical site. A photograph of one the the MGH OCT systems is shown in the upper right hand corner of this slide. A videoendoscopy image, present in the lower right hand corner of this slide, shows the typical view of the OCT catheter protruding through the accessory port. Light emanates from the OCT catheter in a direction that is perpendicular to the axis of the endoscope. The beam scans along the side of the hollow organ in a linear fashion.