This document discusses several studies on the use of intracoronary imaging and physiology techniques. It summarizes guidelines on using these techniques from 2014 and discusses studies showing their value in better understanding prognosis, simplifying assessment, and their potential value in STEMI. Specific studies discussed include ones analyzing FFR as a continuous risk marker, evaluating iFR and other techniques, comparing FFR and contrast injection, co-registering angiography with intracoronary imaging, using physiology mapping, and exploring the use of physiology techniques to anticipate microvascular injury after PCI for STEMI.
A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches In Women Undergoing Percutaneous Coronary Intervention: The Study of Access Enhancement of PCI for Women (SAFE-PCI for Women) Trial
A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches In Women Undergoing Percutaneous Coronary Intervention: The Study of Access Enhancement of PCI for Women (SAFE-PCI for Women) Trial
Presentación "Estenosis aórtica riesgo moderado" del Lino Patricio durante la Mesa Redonda Hispano-Lusa sobre Controversias de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
Ann Emerg Med. 2015;65:32-42
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
Presentación "Estenosis aórtica riesgo moderado" del Lino Patricio durante la Mesa Redonda Hispano-Lusa sobre Controversias de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
Ann Emerg Med. 2015;65:32-42
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
Austin Journal of Cerebrovascular Disease & Stroke is a peer reviewed, open access, academic journal that brings ground breaking investigations and progression in stroke research. This open access journal concentrates on the basic, translational and clinical aspects of stroke and cerebrovascular disease - areas include but not limited to stroke causes, epidemiology, signs and symptoms, Pathophysiology, diagnosis, prevention, management and rehabilitation. Austin Journal of Cerebrovascular Disease & Stroke is ardent to promote, pragmatic, rigorous reproducible research and scientific progress through open access platform.
Austin Journal of Cerebrovascular Disease & Stroke accepts manuscripts on areas of basic, translational and clinical aspects of stroke and cerebrovascular disease - areas include but not limited to stroke causes, epidemiology, signs and symptoms, Pathophysiology, diagnosis, prevention, management and rehabilitation for researches who are working as a basic scientists, cardiologists Neurologists, internists, interventionalists, neurosurgeons, and physiatrists.
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Ponencia presentada por el Dr. José Manuel García Pinilla en el directo online ‘Highlights del congreso HFA 2018: una mirada a Europa’, realizado el 15 de junio de 2018 en la XV Reunión Anual de la Sección de Insuficiencia Cardiaca de la SEC en Toledo.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Reunion Anual Madeira 2015 Imagen y análisis funcional intracoronarios
1. Imagen y análisis funcional intracoronarios
Javier Escaned MD PhD
Hospital Clínico San Carlos
Madrid
2. Physiology and imaging: selected areas of
contributions
• Clinical practice guidelines 2014
• Better understanding of prognostic FFR information
• Symplifying assessment with imaging and physiology
to increase adoption
• Potential value of physiology in STEMI
3. Recommendations for the clinical value of
intracoronary diagnostic techniques
ESC CPGs on Myocardial Revascularization
Windecker S et al. Eur Heart J 2014
4. Recommendations for the clinical value of
intracoronary diagnostic techniques
ESC CPGs on Myocardial Revascularization
Windecker S et al. Eur Heart J 2014
• … new methods and indices (including instantaneous
wavefree ratio [iFR] that do not rely on the concept
of maximal hyperemia have been proposed, in order
to simplify studies and facilitate a wider adoption of
physiological assessment.
• Further studies will need to confirm the value of
these new indices in clinical decision-making
5. Physiology and imaging: selected areas of
contributions
• Clinical practice guidelines 2014
• Better understanding of prognostic FFR information
• Symplifying assessment with imaging and physiology
to increase adoption
• Potential value of physiology in STEMI
6. Johnson N et al. JACC. 2014;64(16):1641-1654
FFR envisaged as a continuous marker of risk
A meta-analysis of 51 FFR studies with clinical patient follow up
7. FFR envisaged as a continuous marker of risk
A meta-analysis of 51 FFR studies with clinical patient follow up
Johnson N et al. JACC. 2014;64(16):1641-1654
8. Supplementary data of FAME II study
Stratified analysis of the primary endpoint
PCI better Medical Tx better
9. Post PCI FFR and long-term outcome
Johnson N et al. JACC. 2014;64(16):1641-1654
10. Reclassification of treatment with FFR
interrogation of all stentable vessels (RIPCORD)
Curzen N et al . Circ Cardiovasc Interv. 2014
200 stable patients undergoing coronary angiography.
11. Reclassification of treatment with FFR
interrogation of all stentable vessels (RIPCORD)
Curzen N et al . Circ Cardiovasc Interv. 2014
12. Routine pressure wire assessment during diagnostic angiography in stable
patients leads to a change in treatment strategy in 26% of the cases.
Reclassification of treatment with FFR
interrogation of all stentable vessels (RIPCORD)
Curzen N et al . Circ Cardiovasc Interv. 2014
13. Physiology and imaging: selected areas of
contributions
• Clinical practice guidelines 2014
• Better understanding of prognostic FFR information
• Symplifying assessment with imaging and physiology
to increase adoption
• Potential value of physiology in STEMI and ACS
14. Diagnosis efficiency of hybrid iFR/FFR approach
(ADVISE II)
Escaned J et al JACC C Intvn 2015
15. Diagnosis efficiency of Pd/Pa
(An ADVISE II post hoc analysis)
Echavarría-Pinto M J et al JACC C Intvn 2015
16. Can contrast injection better approximate FFR compared
to pure resting physiology? (CONTRAST)
Johnson N et al EuroPCR 2015
750 subjects (prospective) with 1 lesion/patient enrolled in 15 centres
17. Can contrast injection better approximate FFR compared
to pure resting physiology? (CONTRAST)
contrast = 85.5% accuracy
iFR = 79.6% accuracy
Pd/Pa = 78.4% accuracy
superior accuracy (p<0.001)
Optimal binary cutoff for contrast Pd/Pa ≤0.83
Johnson N et al EuroPCR 2015
19. Aim of the study:
To investigate if co-
registration had the
potential for improving
positioning of stents
compared to operator
mind mapping of OCT to
angiography during PCI.
n=22
Co-registration of OCT and X-ray angiography in PCI:
the DOCTOR study
Hebsgaard et al. Int J Cardiol 2015; 182: 272–278
20. Co-registration of OCT and X-ray angiography in PCI:
the DOCTOR study
Hebsgaard et al. Int J Cardiol 2015; 182: 272–278
Without access to the computer-based
co-registration, segments of the target
lesion indicated on OCT were left
uncovered by stent in 14 patients (70%)
21. FFR 0.58
Intracoronary FFR mapping during i.v. adenosine
Case performed at Hospital Clinico San Carlos / Madrid
22. Adenosine-free iFR pressure mapping
DES 2.25 x 15
Pre
Post
Case performed at Hospital Clinico San Carlos / Madrid
23. Nijjer S et al. JACC Cardiol Intv. 2014
iFR coronary mapping and virtual PCI simulations
Pre
PCI
Post
PCI
24. Nijjer S et al. JACC Cardiol Intv. 2014
iFR coronary mapping and virtual PCI simulations
26. Influence of pressure pullback derived patterns of
diffuse disease on IMA-CABG outcome
Follow-up with MSCT
IMA failure: 9% 31%p=0.020
Shiono Y et al EuroPCR 2015
27. Physiology and imaging: selected areas of
contributions
• Clinical practice guidelines 2014
• Better understanding of prognostic FFR information
• Symplifying assessment with imaging and physiology
to increase adoption
• Potential value of physiology and imaging in STEMI
28. STEMI and multivessel disease:
what to do and when?
PRAMI / Wald et al. NEJM 2013 CVLPRIT / Gershlick et al. ESC 2014
Pivotal studies supporting the value of complete revascularization in patients with
STEMI and MVD (PRAMI and CVLPRIT) used angiographic guidance alone.
29. MACE(primaryendpoint)
DANAMI 3-PRIMULTI: staged FFR-guided
management of non-culprit stenoses
Complete FFR guided revascularisation of MVD STEMI patients, staged within the index
admission, reduced the primary endpoint. This reduction was driven by repeat
revascularisations and not by hard endpoints
Engstrøm T et al ACC 2015
N=313
N=314
30. Modification of thrombus burden by aspiration in the
TOTAL trial assessed with OCT
Bhindi et al Eur Heart J 2015
31. Modification of thrombus burden by aspiration in the
TOTAL trial assessed with OCT
• No impact of thrombectomy vs. PCI-alone on pre-stent thrombus burden.
• Both interventions were associated with a low level of culprit lesion thrombus
in the majority of patients, and with similar thrombus burden after stenting.
Bhindi et al Eur Heart J 2015
32. End or the paradigm of
thrombus embolization as
major determinant of
outcome (TOTAL trial)
Growing evidence of the
prognostic role of
intramyocardial
haemorrage in STEMI
Improving outcomes in STEMI
35. PREDICT-MVI: Anticipating the development of
microvascular injury after primary PCI in STEMI
In PREDICT-MVI
Doppler-pressure
interrogation was
performed in 60 pts
immediately after
PCI to investigate
whether MVI can be
anticipated in the
cath lab
Teunissen PF et al Circulation C Intv 2015
36. PREDICT-MVI: Anticipating the development of
microvascular injury after primary PCI in STEMI
Post-analysis with
pressure-velocity
loops allowed
calculation of
resistance,
conductance and
zero flow pressure
(compression of the
microcirculation)
Teunissen PF et al Circulation C Intv 2015
37. PREDICT-MVI: Anticipating the development of
microvascular injury after primary PCI in STEMI
MRI and PET were
performed to assess
the predictive value
of indices that could
be measured in the
cath lab during PPCI
Teunissen PF et al Circulation C Intv 2015
38. PREDICT-MVI: role of microcirculatory compression (zero
flow pressure, Pzf)
Teunissen PF et al Circulation C Intv 2015
39. From an strictly personal point if view:
which was the publication in 2015 that has
influenced me most?
40. 50 chapters and more than 30 clinical cases
Available at the PCR Bookshop at prconline.com
Coronary Stenosis: Imaging, Structure and Physiology
Javier Escaned and Patrick Serruys, editors