The essentials of guide wires for CTOs
Masahisa Yamane, Sayama City, Japan
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Microcatheters for antegrade and retrograde approachEuro CTO Club
Microcatheters for antegrade and retrograde approach
George Sianos, Thessaloniki, Greece
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Microcatheters for antegrade and retrograde approachEuro CTO Club
Microcatheters for antegrade and retrograde approach
George Sianos, Thessaloniki, Greece
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Kambis Mashayekhi: Microcatheter selection and manipulation- How to make the ...Euro CTO Club
14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
Main Session - Lunch Symposium by Asahi:
Road to CTO expert 2022 – how to build your CTO toolkit
Microcatheter selection and manipulation- How to make the right choice
Kambis Mashayekhi, Lahr, Germany
Room:
Guteberg Hall (Auditorium) - Saturday 13:30
Speaker:
Gerald Werner, Darmstadt, Germany;
Kambis Mashayekhi, Lahr, Germany;
Jo Dens, Genk, Belgium;
Gregor Leibundgut, Bâle, Suisse
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Kambis Mashayekhi: Microcatheter selection and manipulation- How to make the ...Euro CTO Club
14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
Main Session - Lunch Symposium by Asahi:
Road to CTO expert 2022 – how to build your CTO toolkit
Microcatheter selection and manipulation- How to make the right choice
Kambis Mashayekhi, Lahr, Germany
Room:
Guteberg Hall (Auditorium) - Saturday 13:30
Speaker:
Gerald Werner, Darmstadt, Germany;
Kambis Mashayekhi, Lahr, Germany;
Jo Dens, Genk, Belgium;
Gregor Leibundgut, Bâle, Suisse
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse
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Discover Infineon‘s first double sided cooling power module for automotive.
More information on that report at https://www.i-micronews.com/category-listing/product/infineon-ff400r07a01e3-double-side-cooled-igbt-module.html
1200V Silicon IGBT vs SiC MOSFET Comparison 2018system_plus
Technology and cost analysis of thirteen silicon IGBTs and eight SiC MOSFETs from eight different manufacturers shows their potential.
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Similar to The essentials of guide wires masahisa yamane 9 13 2019 (20)
15th Experts Live CTO - Carlo Di Mario: ConclusionsEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Francesco Burzotta: Wrap up Gemelli CasesEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Jonathan Hill: Role of mechanica support in CTO recanalizationEuro CTO Club
10:42
Role of mechanica support in CTO recanalization
Jonathan Hill (London - UK)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Gregor Leibundgut: Role of DEB in CTO-PCIEuro CTO Club
10:35 Role of DEB in CTO-PCI
Gregor Leibundgut (Basel - CH)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Euro CTO Club
AUDITORIUM ZUBIN MEHTA
08/09/2023 04:30 - 05:20
PLENARY SESSION - INTERVENTIONAL CTO & CHIP RESEARCH Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Euro CTO Club
16:33
EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions
Mario Iannaccone (Turin)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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The essentials of guide wires masahisa yamane 9 13 2019
1. EuroCTO club, 9 13-14 2019, Berlin, Germany
The essentials of guide wires for CTOs
Masahisa Yamane, MD, FACC
Sayama City, Japan
2. EuroCTO club, 9 13-14 2019, Berlin, Germany
Conflict of Interest
MasahisaYamane,MD, FACC
I have a financial interest/arrangement or affiliation with one or more
organizations that could be perceived as a real or apparent conflict of interest
in the context of the subject of this presentation.
Asahi Intec Consultant
Terumo Cooperation Consultant
Abbott vascular Honorarium
Boston Scientific Honorarium
Nippro Company Honorarium
3. EuroCTO club, 9 13-14 2019, Berlin, Germany
Guide wire in CTO PCI
1) Essential tool for crossing occlusion
2) No single wire fits the whole sequence of PCI
3) Difference of Non-CTO PCI wires are small (
overlapping), but significant in dedicated wires
4) Cross CTO safely, it is imperative to understand
the characteristics of each wire
5) Use of micro catheter and trapping is essential
6) Focus on 3-4 broad categories will foreshorten
learning process
4. EuroCTO club, 9 13-14 2019, Berlin, Germany
Basic Structure of the Guide wire
1. Core Material
2. Core Shape ( Tapering)
3. Outer sleeve
4. Tip (shape)
5. Coating ( none, hydrophobic, hydrophilic, polymer jacket)
(sleeve)
5. EuroCTO club, 9 13-14 2019, Berlin, Germany
Guide wire basic structure
Difference in the core
Round core and conventional flat core design
Avoid whipping phenomenon
Better maneuverability even in
complex vessel anatomy
Conventional flat coreRound core
✔ Whip motion depends on core wire design
stress
high
low
7. EuroCTO club, 9 13-14 2019, Berlin, Germany
FIGHTER™ Guidewire
PTFE Coating3.5 cm
radiopaque
18 cm hydrophilic
coating
18 cm polymer jacket
over spring coil
0.009”
Diameter*
Compound taper
stainless steel core
0.014”
Diameter*
Compatible w/ STRETCH
Extension Wire
Clear Polymer Jacket
PTFE Coating3.5 cm
radiopaque
15 cm hydrophilic
coating
15 cm
spring coil
0.008”
Diameter*
Compound taper
stainless steel core
0.014”
Diameter*
Compatible w/ STRETCH
Extension Wire
Wire
Tip Load
(gf)
Penetration Force
(gf/mm2)
HORNET 10 10.0 308
HORNET 14 14.0 432
HORNET™ Guidewire
8. EuroCTO club, 9 13-14 2019, Berlin, Germany
Structure of the wires
0.009” Fielder XT
Fielder FC11cm Spring Coil
3cm Radio-opaque Coil
0.014”
20cm Polymer Sleeve & SLIP COAT®
PTFE Coating
Stainless Steel Core
16cm Radio-opaque spring coil
16cm Polymer Sleeve & SLIP COAT®
0.014”
PTFE Coating
Stainless Steel Core
More controllable & safe collateral channel tracking; Tip load = 0.6g with Superb torque
response “No whip” and Durable tip
0.010”
“W coil structure”
Polymer jacket with hydrophilic coating ;16cm
Fielder XT-R
9. EuroCTO club, 9 13-14 2019, Berlin, Germany
Composite guide wire structure
Composite guide wire
Outer coil
Core wire (round / flat)
ACT ONE (inner coil)
Twist wire (runs parallel to the core wire)
ACT ONE: Patented
ASAHI brand multi wire coil
provides torque force, torque
response, durability and flexibility.
10. EuroCTO club, 9 13-14 2019, Berlin, Germany
Terminology & Definition summary
<Primary wires & Coils>
Primary wire
Coil formation
(General name)
Coil name
(ASAHI original
name)
Picture
Wire type
Amount of
wires
Wire
Single
Single wire coil
Multi
Multi wire coil
ACT ONE
construction
Wire
rope Single
Single wire rope
coil
Multi
Multi wire rope
coil XTRAND
11. EuroCTO club, 9 13-14 2019, Berlin, Germany
Characteristics of Outer sleeves
Definition and name
Flexibilit
y
Torque
force
Single wire coil
i.x) Same as the outer coil of
conventional guide wires 2nd 3rd
Multi wire coil
i.x) Same as the inner coil, ACT ONE,
In composite guide wires 4th 1st
Single wire rope coil
i.x) Same as the outer coil
of SUOH 03 1st 4th
Multi wire rope coil
i.x) Same as the outer coil
of Gaia Next
3rd 2nd
Ranking shows the
comparison of 4 kinds
of coils with 2 different
features
Condition:
Outer diameter of
the primary wire
(wire / wire rope) is
the same.
Same amount of
wires in multiple
numbers.
12. EuroCTO club, 9 13-14 2019, Berlin, Germany
The above data was obtained by company standardized test, which may differ from industry standardized tests.
The above data does not prove that all devices have exactly the same performance with the samples used for these tests.
Conventional coil
(single wire coil)
ACT ONE
(Multi wire coil)
Same torque force input by hand, but
different output at the wire tip.
* ACT ONE
*Compared to our company’s coil
New technology that overcomes the trade-off:
ACT ONE
13. EuroCTO club, 9 13-14 2019, Berlin, Germany
Total Length 1900mm
SLIP-COAT® Coating Length 400mm
Coil Length 150mm
0.36mm
(0.014inch) PTFE coat
First： 0.26mm (0.010inch)
Second：0.28mm (0.011inch)
Third： 0.30mm (0.012inch)
Diameter ：0.26mm (0.010”) - 0.36mm (0.014”)
Tip load ：1.7gf
Diameter ：0.28mm (0.011”) - 0.36mm (0.014”)
Tip load ：3.5gf
Diameter ：0.30mm (0.012”) - 0.36mm (0.014”)
Tip load ：4.5gf
ASAHI Gaia First
ASAHI Gaia Second
ASAHI Gaia Third
Gaia™ Guidewire
14. EuroCTO club, 9 13-14 2019, Berlin, Germany
The ball tip has been sharpened to provide the necessary penetration ability
to enter hard occlusions, while the tip flexibility is still maintained.
Blunt tip
Plain ball tip
Micro-cone tip
--- Conventional guidewire
--- Gaia, Gaia Next
--- Miracle Neo 3
Non Tapered
Tapered guide wire
Tip end design Cross section area
ULTIMATE bros3 , etc
Tip design / Cross section
15. EuroCTO club, 9 13-14 2019, Berlin, Germany
Micro-cone tip vs. plain ball tip
Difference of penetration ability at CTO entry
Gaia Next 1
Plain ball tipMicro-cone tip
Tentative model
for test
Tentative model of Gaia Next 1 with plain ball tip failed to enter the
lesion as the tip could not stick onto the diagonal entry
ETOSS model
Tip end design CTO entry×
16. EuroCTO club, 9 13-14 2019, Berlin, Germany
Gaia Next 3
with Micro cone tip
Miracle 6
with plain ball tip
Miracle 6 vs. Gaia Next 3 (ETOSS 6000)
CTO body×Tip end design
Blunt tip
--- Miracle Neo 3
Micro-cone tip
--- Gaia, Gaia Next
17. EuroCTO club, 9 13-14 2019, Berlin, Germany
Penetration force and tip load
0 100 200 300 400 500 600 700 800 900 1000
Gaia Next 3
Gaia 3rd
Conquest Pro
Miracle 12
Conquest Pro 8-20
Conqeust Pro 12
Penetration force [gf/mm2]
0 5 10 15 20 25
Gaia Next 3
Gaia 3rd
Conquest Pro
Miracle 12
Conquest Pro 8-20
Conqeust Pro 12
Tip load
18. EuroCTO club, 9 13-14 2019, Berlin, Germany
High
Silicone on Coil
Hydrophilic on Coil
Hydrophilic on Polymer jacket
Coating on CTO wiresLubricity
Tactile Feedback
19. EuroCTO club, 9 13-14 2019, Berlin, Germany
Lesion diameter：4 mm
Without coating vs. coating XT-A
Abrupt and smooth entry (ETOSS 8000)
Lubricity × CTO entry
XT-A without coating XT-A
In the case with abrupt and smooth lesion entry, XT-A, after wiping off the coating, could
penetrate the lesion as the tip caught at the entry like a hook. However, it failed to go
further due to heavy resistance because of the uncoated tip within the lesion. On the
other hand, for conventional XT-A, it slipped and was not able to penetrate the lesion.
20. EuroCTO club, 9 13-14 2019, Berlin, Germany
LAD Os CTO
Confianza Pro with a larger curveAfter micro , Gaia 2 into the distal
21. EuroCTO club, 9 13-14 2019, Berlin, Germany
CTO Guide wire
• Microchannel tracking or Probing for a Short distance
Tapered, low gram force polymer-jacket wires, Fielder XT-A,XT-R, GaiaNext1
• Blunt Cap penetration/ Crossing unknown vessel course
Non-tapered, moderate gram wires without polymer-jacket for complex
long lesion crossing and tortuosity, Pilot 200, Gladius MG, Miracle Neo3g,
Uitimate bross 3g
• Blunt or Calcified cap puncture with IVUS/MDCTA guide, known vessel
course
Tapered, high gram, hydrophilic wires for penetration and cap puncture ,
Confienza Pro 12g, Hornet 14, Astato 8-20, Progress 200, GaiaNext2, 3
25. EuroCTO club, 9 13-14 2019, Berlin, Germany
Long LAD CTO (incl ISR)
• Ambiguous Proximal Cap
• More than 20mm CTO
• Poor distal landing
• Poor collaterals
• J CTO 3
Gaia Next 2Gaia Next 2 over Asahi SasukeGaia Next 3Stepdown to SionAdditional angled Gaia Next 3Pre-shaped Gaia Next 3
26. EuroCTO club, 9 13-14 2019, Berlin, Germany
CTO Guide wire
• Crossing known vessel course
Tapered, high gram, hydrophilic wires for penetration and cap puncture ,
Confienza Pro 12g, Hornet 14, Astato 8-20, Progress 200, GaiaNext2, 3
• Crossing unknown vessel course
Non-tapered, moderate gram wires with /without polymer-jacket for
complex long lesion crossing and tortuosity, Pilot 200, Gladius MG, Miracle
Neo3g, Uitimate bross 3g
27. EuroCTO club, 9 13-14 2019, Berlin, Germany
Guide Wires for collatéral crossing
Sion Sionblack XT-R Suoh 03
Septal CC STD AP Limited AP
Epicardial CC AP limited Very limited STD
Atrial or
marginal
AP limited Very limited STD
CC 1 or 2 STD AP AP AP
CC 0 AP limited AP STD
Unvisualized CC limited ? limited AP
Corkscrew limited limited
Risk of
perforation
AP
Rigid Epicardial
or AM
limited limited Risk of injury AP
STD : Standard AP: Applicable
34. EuroCTO club, 9 13-14 2019, Berlin, Germany
ASAHI Conquest Pro8-20
Anti trapping performance
*The above data was obtained by company standardized test, which may differ from industry standardized tests.
*The above data does not prove that all devices have exactly the same performance with the samples used for these tests.
ASAHI Gaia Next
35. EuroCTO club, 9 13-14 2019, Berlin, Germany
0.0
200.0
400.0
2 5 10 15 20 25 30
Gaia Third Gaia next 3rd
Conquest Pro Conquest Pro12
Conquest Pro8-20 Miracle 12
35
Tip flexibility
[mm]
Guide wire
[mN]
36. EuroCTO club, 9 13-14 2019, Berlin, Germany
Corsair Pro
Suoh 03 on Caravel 150 cmCorsair Pro 150 cmGaia Next 2 for Cap punctureXT Knuckle
Post CABG long bending Calcified RCA CTO
Ant Gaia Next 3
39. EuroCTO club, 9 13-14 2019, Berlin, Germany
Amplitude + Direction = Vector *
Force ( longitudinal) Amplitude
Direction tip curve, tip-stiffness, tissue characteristics
Deflection above mentioned + tip bend + torque transmission
40. EuroCTO club, 9 13-14 2019, Berlin, Germany
1-< 2mm tip
Angle 30-45°
mild 2 nd curve
1-< 2mm tip
Bend ~90o
How to create the tip curve ?
1-2mm tip
Bend >90o
CTO Probing Wire
After Micro catheter
Advancement to the
proximal cap
CTO Wire for
intraplaque
puncture from
Subintimal
CTO Wire intended
to knuckle, push
without rotation, XT
FFC, PL200, Gaia2
41. EuroCTO club, 9 13-14 2019, Berlin, Germany
41
How to re-enter by Stingray system
Subintimal Space
Intimal Plaque
Stick-and-swap technique
Stingray wire, GaiaNext 3, CP12, Hor14
43. EuroCTO club, 9 13-14 2019, Berlin, Germany
• Cap puncture ( both ant & ret) is a key for success
• Trade off in increased penetrability and flexibility
• Parallel wiring and Step-Up or Down remain key strategies
and require specific wires
• Faster and efficient wiring possible in a limited loop knuckle
in crossing the resistant segment safely
• Deflection control is now possible even in moderate-heavy
calcified occlusion in the CTO body
• Adoption of new wire technology needs hands-on experience.
CTO Guide wire in Essence
Figure 29. Specifications of Fighter and Hornet Family wires
Figure 26, Specifications of Fielder XT, and XT-R
Figure 30. Specifications of Gaia wires
Tip loadが同じ６ｇのMiracle6とGaia Next３ですが、Tip end design の違いによって、閉塞病変内でのルート変更し易さが大きく違う事が分かります。
一度ガイドワイヤーが通過した後にはスペースが出来てしまいます。先端がシャープなMicro cone tipは、スペース内の壁に先端が引っ掛かりやすく、
引っ掛かることでデフレクションを伴い方向を変えることが出来ますが、Miracle６では一度出来てしまったスペース内（ルート）から違う方向へ向きを変える事ができません。
つまり、狙った場所にGWの最先端が引っ掛かるか、引っ掛からないかで方向のコントロール可否が決まります。
Figure 33.
Figure 33. Contnd Active Wire Control, based upon anatomical landmarks
Gaia Next 2 was deflected from a diagonal direction (1) to a septal (2) counterclockwise torque, while from (2) to diagonal (3), clockwise torque, and counterclockwise beyond(3) to reach a distal lumen.
Figure 31. Specifications of Gaia Next wires
Figure 21.
Figure 9g. Measure to decide the shape of the wire tip curve.
Even the same size of tip curve, the shape is a key factor of penetration efficiency. Curve A (small 1st curve with second curve) is recommended as 1st step.
If re-wiring (penetration of target plaque) is difficult with curve A, then Curve B (large one curve) can be recommended.
