When one won't do it, use two-double "buddy" wiring to facilitate stent advancement across a highly calcified artery.

Percutaneous coronary intervention (PCI) of heavily calcified vessels poses several problems including difficulty in delivering stents to the target lesion. Effective strategies include rotational atherectomy and the use of a "buddy" wire, the latter acting as a track that directs the stent away from the vessel wall. There are no reports in the literature of using a second "buddy" wire when one fails. We report on a case of a second "buddy" wire saving the day during PCI of a highly calcified right coronary artery wherein the stent failed to reach the lesion until the second wire was deployed.     

Tracheobronchopathia osteochondroplastica in a 9-year-old girl

Tracheobroncopathia osteochondroplastica (TO) is a rare disease of adult males characterized by osteocartilagious submucosal nodules protruding into the airway lumen, causing variable degrees of airway obstruction. Here we describe a case of TO in a 9-year-old girl patient presenting with chronic cough, along with a brief review of this rare benign condition.     

Efficacy of extracorporal shock-wave treatment for calcific tendinitis of the shoulder: experimental and clinical results

The effects of various extracorporal shock wave energy levels and impulse rates were investigated using an in vitro model. In addition, we performed a controlled, randomized study to examine the clinical outcome after treatment for calcific tendinitis of the shoulder. Two groups of 40 patients each received 2000 impulses twice with an energy flux density of 0.23mJ/mm² and then 0.42mJ/mm². The results were evaluated by the Constant and Murley score. Disintegration of the implanted deposits requires an energy of at least 0.42mJ/mm² and 2000 impulses. The clinical trial showed resorption of calcific deposits in 37.5% (0.23mJ/mm²) and 55.0% (0.42mJ/mm²). After 1 year the Constant and Murley score increased from 46 to 68 at 0.23mJ/mm² and from 48 to 73 points at 0.42mJ/mm². Based on our experimental and clinical results it is evident that disintegration of calcific deposits is dose-dependent. Because of the time that elapses until changes became evident on the radiographs, an instant and sole mechanical effect on the calcific deposits is unlikely. Therefore, a combined mechanical and cellular mechanism for absorption of the calcific deposits must be presumed.     

人参皂苷Rb1对体外培养人脂肪干细胞增殖与成骨分化的影响

背景：脂肪干细胞成骨分化受多种因素的影响,中药成骨诱导活性因子在脂肪干细胞研究中有重要意义。目的：观察人参皂苷Rb1在体外培养条件下对人脂肪干细胞增殖和成骨分化的影响。方法：体外分离培养人脂肪干细胞,传至第3代后,按2×103/孔接种至96孔板,分别加入0.5,1.0,2.0,4.0,6.0μmol/L人参皂苷Rb1培养基200μL进行培养;设立对照组,仅加入等量普通DMEM培养基。采用XTT比色法测定大鼠脂肪干细胞的生长增殖曲线。通过碱性磷酸酶试剂盒测定细胞碱性磷酸酶活性,放射免疫法检测骨钙素含量,茜素红染色观察钙化结节形成能力。结果与结论：0.5μmol/L人参皂苷Rb1可明显促进人脂肪干细胞增殖;随着人参皂苷Rb1浓度的增加,促细胞增殖活性降低,6.0μmol/L人参皂苷Rb1表现为明显的抑制细胞增殖作用。人参皂苷Rb1呈剂量依赖性促进人脂肪干细胞碱性磷酸酶活性和骨钙素表达。4.0,6.0μmol/L人参皂苷Rb1诱导钙化结节形成能力优于0.5,1.0和2.0μmol/L人参皂苷Rb1,对照组人脂肪干细胞未见钙化结节形成。提示人参皂苷Rb1在一定浓度范围内对体外培养条件下的人脂肪干细胞具有促生长增殖作用,但在高浓度时,人参皂苷Rb1对人脂肪干细胞的成骨分化具有促进作用,因此可作为一种良好的成骨诱导活性因子。     

Predictive value of the coronary artery calcium score and advanced plaque characteristics: Post hoc analysis of the PREDICT registry

BackgroundWhether coronary plaque characteristics assessed in coronary computed tomography angiography (CCTA) in association with the coronary artery calcium score (CACS) have predictive value for coronary events is unclear. We aimed to examine the predictive value of the CACS and plaque characteristics for the occurrence of coronary events.MethodsAmong 2802 patients who were analyzed in the PREDICT registry, 2083 with suspected coronary artery disease (CAD) were studied using post hoc analysis. High-risk plaques were defined as having ≥2 adverse characteristics, such as low computed tomographic attenuation, positive remodeling, spotty calcification, and napkin-ring sign. An adjudicative composite of coronary events (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization ≥3 months after indexed CCTA) were analyzed.ResultsSeventy-three (3.5%) patients had coronary events and 313 (15.0%) had high-risk plaques. Multivariate Cox proportional hazard analysis showed that high-risk plaques remained an independent predictor of coronary events (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.13–3.34, P ?= ?0.0154), as well as the log-transformed CACS (adjusted HR 1.24, 95% CI 1.11–1.39, P ?= ?0.0002) and the presence of obstructive stenosis (adjusted HR 5.63, 95% CI 3.22–10.12, P 0.0001). In subgroup analyses, high-risk plaques were independently predictive only in the low CACS class (<100).ConclusionThis study shows that assessment of adverse features by coronary plaque imaging independently predicts coronary events in patients with suspected CAD and a low CACS. Our findings suggest that the clinical value of high-risk plaques to CACS and stenosis assessment appears marginal.     

Litoplastia coronaria en lesiones calcificadas: registro multicéntrico de la práctica clínica

Introduction and objectivesCoronary lithoplasty (CL) is a balloon-based technique used to treat calcified lesions. This study reports the initial experience of treatment of calcified lesions with CL in an unselected and high-risk population.MethodsThis was a prospective, multicenter registry, which included all consecutive cases with calcified coronary lesions that underwent CL between August, 2018 and August, 2019. Exclusion criteria consisted of a target lesion located in a small vessel (< 2.5 mm) and the presence of dissection prior to CL. Quantitative coronary angiography and intravascular ultrasound/optical coherence tomography analysis were completed by an independent central core laboratory.ResultsThis registry included 57 patients (66 lesions). The population was elderly (72.6 ± 9.4 years) with high proportions of patients with diabetes (56%), chronic kidney disease (35%), and multivessel disease (84%). All lesions were classified as type B/C. More than 75% of lesions were predilated with noncompliant/semicompliant balloons or cutting-balloon. Rotablator was used in 5 lesions (7.6%) prelithoplasty. On average, CL required 1.17 balloons delivering a mean of 60 pulses. Successful CL was achieved in 98%. In 13% of cases, lithoplasty balloon was broken during therapy. There were few procedural complications: 2 cases of significant dissections (none related to lithoplasty balloon rupture) were successfully treated with drug-eluting stent implantation. One patient experienced stent thrombosis 2 days after successfully undergoing target lesion revascularization.ConclusionsThis is a real-world multicenter registry, which supports the feasibility, safety, and short-term efficacy of PCI for calcified coronary lesions using CL in an unselected and high-risk population with promising results.