Biopsychosocial Characteristics of Community‐Dwelling Older Adults with Limited Ability to Walk One‐Quarter of a Mile

OBJECTIVES: To establish nationally representative estimates of the prevalence of self‐reported difficulty and inability of older adults to walk one‐quarter of a mile and to identify the characteristics independently associated with difficulty or inability to walk one‐quarter of a mile. DESIGN: Cross‐sectional analysis of data from the 2003 Cost and Use Medicare Current Beneficiary Survey. SETTING: Community. PARTICIPANTS: Nine thousand five hundred sixty‐three community‐dwelling Medicare beneficiaries aged 65 and older, representing an estimated total population of 34.2 million older adults. MEASUREMENTS: Self‐reported ability to walk one‐quarter of a mile, sociodemographics, chronic conditions, body mass index, smoking, functional status. RESULTS: In 2003, an estimated 9.5 million older Medicare beneficiaries had difficulty walking one‐quarter of a mile, and 5.9 million were unable to do so. Of the 20.2 million older adults with no difficulty in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), an estimated 4.3 million (21%) had limited ability to walk one‐quarter of a mile. Having difficulty or being unable to walk one‐quarter of a mile was independently associated with older age, female sex, non‐Hispanic ethnicity, lower educational level, Medicaid entitlement, most chronic medical conditions, current smoking, and being overweight or obese. CONCLUSION: Almost half of older adults and 20% of those reporting no ADL or IADL limitations report limited ability to walk one‐quarter of a mile. For functionally independent older adults, reported ability to walk one‐quarter of a mile can identify vulnerable older adults with greater medical problems and fewer resources and may be a valuable clinical marker in planning their care. Future work is needed to determine the association between ability to walk one‐quarter of a mile walk and subsequent functional decline and healthcare use.     

Pharmacokinetics of Carboplatin in a One‐Year‐Old Anuric Boy Undergoing Hemodialysis and a Review of the Literature

There have been few reports of carboplatin‐based chemotherapy for anuric infants. As we had a chance to treat a one‐year‐old anuric hepatoblastoma patient with carboplatin, we performed a pharmacokinetic analysis and examined the optimal treatment strategy. A one‐year‐old anuric boy under peritoneal dialysis was diagnosed with hepatoblastoma. Surgical resection was performed, and administration of carboplatin was scheduled postoperatively aiming at 5 mg·min/mL of the area under the curve from the time of dosing to the time of the last observation (AUC_0‐t). We set the initial dose at 50 mg, higher than that calculated by the Calvert formula (34 mg); the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h; and the hemodialysis duration at 24 h. The actual AUC_0‐t was 3.05 mg·min/mL because the elimination half‐lives before and during hemodialysis were shorter than expected. The AUC_0‐t after the second dose (100 mg) and the third dose (80 mg) were 7.00 and 4.68 mg·min/mL, respectively. The Calvert formula is not suitable for hemodialysis patients because removal of platinum by hemodialysis is not taken into account. It appears that extrarenal clearance in anuric infants is different from that in adults. We obtained an optimal AUC_0‐t using a dose of 80 mg (200 mg/m²), setting the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h, and performing 8‐h hemodialysis. Further accumulation of the pharmacokinetic data of carboplatin is necessary for anuric children.     

One‐step,simultaneous triple endoscopic nasobiliary drainage for hilar biliary stricture

The management of advanced hilar malignant and benign biliary strictures remains difficult regardless of the advances in endoscopic biliary stenting. Endoscopic nasobiliary drainage (ENBD) is suitable for the management, but the number of ENBD tubes is limited by the diameter of the accessory channel of the duodenoscope. In the present study,we demonstrated the feasibility and safety of one‐step simultaneous triple ENBD insertion to manage hilar biliary strictures. A therapeutic duodenoscope with a 4.2‐mm accessory channel was advanced into the duodenum. Three guidewires were advanced into three different intrahepatic bile ducts, none of which communicated with the others.Then, the three 5‐Fr ENBD tubes were simultaneously inserted alongguidewire, one at a time. Three patients with hilar biliary stricture who suffered from acute cholangitis due to stent occlusion were successfully managed by one‐step, simultaneous triple ENBD insertion.There were no procedure‐related complications. One‐step simultaneous triple ENBD is the most suitable drainage method for patients with advanced hilar biliary obstruction, especially in the setting of acute cholangitis due to occlusion of the previously placed stent.     

One‐Year Clinical Outcome of a Randomized Trial of Polymer‐Free Paclitaxel‐Eluting Stents Versus Biodegradable Polymer‐Based Rapamycin‐Eluting Stents in Patients with Coronary Heart Disease

Background: More widespread use of drug‐eluting stents (DES) to treat coronary heart disease (CHD) has recently generated more attention to thrombosis, which was relative to the polymer. Polymer‐free and biodegradable polymer‐based stents are more frequently studied, but their efficacy on preventing detrimental clinical events is unclear. Methods and Results: To assess whether polymer‐free paclitaxel‐eluting stent (YINYI stent) was noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents (EXCEL stent) in preventing detrimental clinical cardiovascular events, a total of 167 consecutive CHD patients requiring DES implantation were randomly divided into the YINYI group (n = 82) and the EXCEL group (n = 85). The primary end‐point was major adverse cardiac events (MACE). The secondary end‐points included stent thrombosis events, all‐cause mortality, and rehospitalization. The study was designed to test the noninferiority or equivalence of the YINYI stent compared with the EXCEL stent with respect to one‐year MACE according to a noninferiority or equivalence margin of 0.1. One‐year MACE was 6.10% in the YINYI group versus 5.88% in the EXCEL group. The lower limit of the one‐sided 95% confidence interval was ?0.0582 (P = 0.002 from the test for noninferiority). The 95% confidence interval for the equivalence test was [?0.0698, 0.0742] (P₁=0.004 and P₂=0.007 from 2 times the 1‐sided test for equivalence). There was no statistically significant difference in thrombosis events, all‐cause death, and rehospitalization (all P > 0.05). Conclusions: In this small randomized trial, polymer‐free paclitaxel‐eluting stents appear to be noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents. (J Interven Cardiol 2012;25:604–610)     

One‐stop‐shop totally percutaneous approach for severe aortic and mitral regurgitation in cardiogenic shock

Patients presenting with cardiogenic shock and severe combined aortic and mitral regurgitation represent a major clinical challenge. Therapeutic options are limited in this setting as they are often deemed inoperable due to prohibitive risk for surgery, while mechanical circulatory support is usually contraindicated or technically challenging. Medical therapy, on the other hand, is associated with high‐mortality rates. Therefore, percutaneous therapies may represent an appealing alternative. Here, we present a “one‐stop‐shop” totally percutaneous approach for severe aortic and mitral regurgitation in a patient with cardiogenic shock.     

Challenge of One‐incision Midurethral Sling for Female Stress Urinary Incontinence: Current Results

As a result of the understanding of the pathogenesis of stress urinary incontinence in females, a tension‐free vaginal tape procedure has been introduced based on integral theory and is now widely used because of its minimal invasiveness and high success rate. Modifications over the last 10 years include changes to mesh type, technique and route of insertion of sling materials. Long‐term efficacy and quality of life data of the different midurethral sling (MUS) procedures are available. However, complications, such as bladder and urethral injury, persistent groin pain, vascular and nerve injury, and voiding difficulty can occur. Recently, one‐incision MUS procedures without tape outlets have been developed to reduce surgical invasiveness and lower the risk of complications. However, few studies have reported the outcomes following one‐incision MUS procedures. The present report reviews studies of one‐incision MUS procedures to determine whether this technique can be used in the place of older techniques. It appears that while one‐incision MUS procedures may be associated with lower complication rates, success rates may also be lower, although the latest results are promising. It takes a long time for the surgeon to become an expert in performing the technique. Proper sling tension and correct surgical plane are very important. At the moment it seems that the one‐incision sling cannot replace older slings. We need to wait for and review the long‐term prospective results of the new and minimally invasive one‐incision sling for the treatment of female stress urinary incontinence.     

Long‐Term Clinical Outcomes of the One‐Stent Technique versus the Two‐Stent Technique for Non‐Left Main True Coronary Bifurcation Disease in the Era of Drug‐Eluting Stents

Background

Few studies have compared the long‐term major adverse cardiac events (MACEs) between the one‐stent technique (stenting only the main branch) and the two‐stent technique (stenting of both the main and side branches) for the treatment of true coronary bifurcation lesions in the drug‐eluting stent era. Therefore, we investigated this issue using the large nationwide coronary bifurcation registry.

Methods

The 1,147 patients with non‐left main coronary true bifurcation lesions underwent percutaneous coronary intervention in the Korea Coronary Bifurcation Stent (COBIS) registry. All patients were stratified based on the stent placement technique: one stent (n = 898) versus two stents (n = 249). MACE, including death, nonfatal myocardial infarction (MI), and repeat vessel and lesion revascularization (TVR and TLR), were evaluated.

Results

The median follow‐up duration was 20 months. The MACEs did not differ between the 2 groups. Findings from the one‐stent group were similar to those of the two‐stent group in composite of death, MI, or TVR, based on analysis by crude, multivariate Cox hazard regression model, inverse‐probability‐of‐treatment weighting (hazard ratio [HR] 0.911, 95% confidence interval (CI) 0.614–1.351; HR 0.685 95% CI 0.381–1.232; HR 1.235, 95% CI 0.331–4.605, respectively). In further analysis with propensity score matching, the overall findings were consistent.

Conclusions

The findings of the present study indicate that the one‐stent technique was not inferior to the two‐stent technique for the treatment of non‐left main true coronary bifurcation lesions in terms of long‐term MACEs. (J Interven Cardiol 2013;26:245–253)

     

Transradial Coronary Angiography—Insights to the One‐Catheter Concept

Transradial coronary angiography (TRC) can be performed applying only one catheter fitting into the right and left coronary ostia (R/LCO). In this bicentric study (n = 2953), we analyzed the ostial performance of the Tiger_II_catheter widely used in TRC. Compared to Judkins catheters, the Tiger_II is frequently associated with ostial instability within the LCO but fits better into the RCO—irrespective of tube size. Judkins catheters generally need more peri‐procedural contrast and radiation exposure. TRC may be started using a 5F_Tiger_II on the right side in order to be switched to 5F Judkins in case of propable LCO instability. (J Interven Cardiol 2016;29:113–116)

     

One‐stop shop: Simultaneous direct mitral annuloplasty and percutaneous mitral edge‐to‐edge repair in a patient with severe mitral regurgitation

Percutaneous edge‐to‐edge repair of severe mitral regurgitation has been established as an alternative treatment option for patients at high risk for cardiac surgery. More recently, the introduction of the Cardioband system enabled percutaneous direct annuloplasty. Here, we present a case of simultaneous percutaneous direct annuloplasty with edge‐to‐edge repair. Moreover, annuloplasty did facilitate clip implantation bei approximating the anterior and posterior mitral leaflet. In conclusion, the combination of direct annuloplasty with edge‐to‐edge repair is feasible in a single procedure.     

One‐year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re‐entry techniques

We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re‐entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer‐term outcomes are unknown, particularly in relation to dissection and re‐entry techniques. Data were collected for consecutive CTO PCIs performed by hybrid‐trained operators from 7 United Kingdom (UK) centres between 2012 and 2014. The primary endpoint (death, myocardial infarction, unplanned target vessel revascularization) was measured at 12 months along with angina status. One‐year follow up data were available for 96% of successful cases (n = 805). In total, 85% of patients had a CCS angina class of 2–4 prior to CTO PCI. Final successful procedural strategy was antegrade wire escalation 48%; antegrade dissection and re‐entry (ADR) 21%; retrograde wire escalation 5%; retrograde dissection and re‐entry (RDR) 26%. Overall, 47% of CTOs were recanalized using dissection and re‐entry strategies. During a mean follow up of 11.5 ± 3.8 months, the primary endpoint occurred in 8.6% (n = 69) of patients (10.3% (n = 39/375) in DART group and 7.0% (n = 30/430) in wire‐based cases). The majority of patients (88%) had no or minimal angina (CCS class 0 or 1). ADR and RDR were used more frequently in more complex cases with greater disease burden, however, the only independent predictor of the primary endpoint was lesion length. CTO PCI in complex lesions using the hybrid approach is safe, effective and has a low one‐year adverse event rate. The method used to recanalize arteries was not associated with adverse outcomes. © 2017 Wiley Periodicals, Inc.     

One‐stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high‐risk foot

Aims

To evaluate the feasibility of a one‐stop microvascular screening service for the early diagnosis of diabetic distal symmetrical polyneuropathy, painful distal symmetrical polyneuropathy and the at‐risk diabetic foot.

Methods

People with diabetes attending retinal screening in hospital and community settings had their feet examined by a podiatrist. Assessment included: Toronto Clinical Neuropathy Score evaluation; a 10‐g monofilament test; and two validated, objective and quick measures of neuropathy obtained using the point‐of‐care devices ‘DPN‐Check’, a hand‐held device that measures sural nerve conduction velocity and amplitude, and ‘Sudoscan’, a device that measures sudomotor function. The diagnostic utility of these devices was assessed against the Toronto Clinical Neuropathy Score as the ‘gold standard’.

Results

A total of 236 consecutive people attending the retinal screening service, 18.9% of whom had never previously had their feet examined, were evaluated. The prevalence of distal symmetrical polyneuropathy, assessed using the Toronto Clinical Neuropathy Score, was 30.9%, and was underestimated by 10‐g monofilament test (14.4%). The prevalence of distal symmetrical polyneuropathy using DPN‐check was 51.5% (84.3% sensitivity, 68.3% specificity), 38.2% using Sudoscan foot electrochemical skin conductance (77.4% sensitivity, 68.3% specificity), and 61.9% using abnormality in either of the results (93.2% sensitivity, 52.8% specificity). The results of both devices correlated with Toronto Clinical Neuropathy Score (P<0.001). A new diagnosis of painful distal symmetrical polyneuropathy was made in 59 participants (25%), and 56.6% had moderate‐ or high‐risk foot. Participants rated the service very highly.

Conclusions

Combined, eye, foot and renal screening is feasible, has a high uptake, reduces clinic visits, and identifies painful distal symmetrical polyneuropathy and the at‐risk foot. Combined large‐ and small‐nerve‐fibre assessment using non‐invasive, quantitative and quick point‐of‐care devices may be an effective model for the early diagnosis of distal symmetrical polyneuropathy.     

One‐hour fast for water and six‐hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort

Background and Aim: Current guidelines for upper gastrointestinal endoscopy (UGIE) advise at least 6–8 h fasting for solids and 4‐h fasting for liquids. We aimed to determine whether a 6‐h fast for solids and one‐hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. Methods: 128 patients referred for UGIE were given a standard meal 6 h before endoscopy, and then randomized to either nil by mouth for 6 h (group A, n = 65) or allowed to drink water for up to one hour prior to endoscopy (group B, n = 63). Before endoscopy patients were requested to indicate discomfort due to fasting on a visual analog scale. Fluid in the gastric fundus was aspirated, when present, for volume and pH measurements, and endoscopic vision was graded. Results: 53 patients in group A and 43 patients in group B completed the study. Discomfort was significantly lower in group B than group A (P < 0.0001). Endoscopic vision was good in all 53 patients in group A and 40 in group B, and average in 3 patients in group B. Fluid in the gastric fundus was noted in 11 patients in group A and 16 in group B, but there were no significant differences in volume or pH between groups. There were no complications attributable to endoscopy in either group. Conclusions: A 6‐h fast for solids and a 1‐h fast for water prior to UGIE gives good endoscopic vision, and causes minimum patient discomfort.     

One‐year results of the INSPIRE trial with the novel MGuard stent: Serial analysis with QCA and IVUS

Background : The newly developed balloon‐expandable Mguard stent system, a combination of an ultra‐thin polymer mesh sleeve attached to the external surface of a BMS, was conceived to provide embolic protection during PCI of SVG and thrombus‐containig lesions. Although the acute results (<30 days) have pointed to the efficacy of this novel device, few is known about its long‐term performance. Methods : The present article address the 1‐year clinical results of a cohort of 30 patients enrolled in the INSPIRE trial. Inclusion critiria was de novo lesions in SVG or native vessels with angiographic evidence of instability with potential to provoke flow disturbances and/or distal embolization. The primary endpoint (incidence of MACE‐composite of cardiac death, nonfatal MI, and TLR) up to 30 days of the procedure has already been published. Secondary endpoints here presented included in‐stent late lumen loss (QCA), % of stent obstruction (IVUS) at 6 months and combined MACE at 1 year. QCA and IVUS were performed by independent corelabs. Results : Mean population age was 63 years with 38% of diabetics. Overall, 55% presented with ACS and 57% of lesions were located in SVG. Most lesions had complex morphology including the presence of thrombus (26%) and ulceration (20%). Distal/proximal protection devices were not used. Preprocedural QCA data showed lesion length and reference vessel diameter of 12.0 ± 4.5 mm and 3.0 ± 0.5 mm. The MGuard stent was successfully delivered in all cases and final TIMI‐3 was achieved in 100% with no MACE up to 30 days. At 6 months, in‐stent late loss and % of stent obstruction were 1.0 ± 0.4 mm and 28.5 ± 15.6%. Up to 1 year there was no case of cardiac death, two MI (one Q‐wave and one non‐Q‐wave) and six cases of ischemia‐driven TLR. Of note, there was no case of definite/probable stent thorombosis. Conclusions : In this series of patients treated with MGuard stent, the novel device showed no midterm efficacy and safety concerns. © 2011 Wiley Periodicals, Inc.     

One‐Year Results of the CRISTAL Trial,a Randomized Comparison of Cypher Sirolimus‐Eluting Coronary Stents versus Balloon Angioplasty for Restenosis of Drug‐Eluting Stents

Objectives: We compared the efficacy of the Cypher Select? (Cordis Corporation, Bridgewater, NJ, USA) sirolimus‐eluting stent (SES) versus balloon angioplasty (BA) in in‐stent restenosis (ISR) of Taxus? or Taxus Liberté? paclitaxel‐eluting stents (PES; Boston Scientific, Natick, MA, USA) or Cypher/Cypher Select SES. Background: Optimal treatment strategies have not been identified for drug‐eluting stent (DES) ISR. Methods: Patients with a native coronary artery SES or PES ISR were randomized to SES or BA. In addition, a control group included BMS ISR treated with SES. Angiographic control was performed at 12 months. Results: 281 patients were enrolled. Significant differences favoring SES over BA were noted in immediate and net gain (1.39 ± 0.51 vs. 0.97 ± 0.54 mm, P < 0.0001 and 1.07 ± 0.69 vs. 0.49 ± 0.67 mm, P < 0.0001), 12‐month mean luminal diameter (MLD; 2.14 ± 0.62 vs. 1.71 ± 0.55 mm, P < 0.0001) and percent diameter stenosis (%DS; 21 ± 19.24 vs. 29.82 ± 18.47, P = 0.001). There was no significant difference at 12 months between SES and BA in the primary end‐point late lumen loss (LLL; 0.37 ± 0.57 vs.0.41 ± 0.63, P = 0.73) and in in‐stent binary restenosis (11.1% vs. 14%, P = 0.59). Target‐lesion revascularization (TLR) was numerically lower in patients treated with SES (5.9% vs. 13.1%, P = 0.097). There was no difference according to the initial DES. In contrast, significantly higher immediate and net gains and MLD were noted in the BMS control group treated by SES. Conclusions: In this angiographic randomized trial comparing SES and BA in SES or PES restenosis, 12 month MLD, immediate and net gain, and %DS favored SES whereas no difference was noted in LLL. Condensed Abstract Optimal treatment strategies have not been identified for sirolimus‐ (SES) or paclitaxel‐eluting stent (PES) in‐stent restenosis (ISR). We randomized patients with a native coronary artery SES or PES ISR to SES or BA. In addition, a control group included BMS ISR treated with SES. There was no difference in the primary end‐point, late lumen loss (LLL) at 12 months between the SES and BA groups. However, follow‐up MLD and immediate and net gain favored SES. (J Interven Cardiol 2012;25:586–595)     

Posttraumatic Stress Disorder and One‐Year Outcome in Methadone Maintenance Treatment

Background: Although opiate use may be associated with posttraumatic stress disorder (PTSD), it is not clear whether PTSD is associated with retention in methadone maintenance. Objectives: To evaluate among those receiving methadone maintenance at an urban methadone maintenance clinic the frequency of life‐time traumatic experiences, the predictors and prevalence of current PTSD, and whether PTSD affects retention at 1 year. Methods: Eighty‐nine people participated in the study. The Post Traumatic Diagnostic Scale was used to determine the prevalence of PTSD. The Life Stressor Checklist Revised was used to evaluate trauma history. Logistic regression analyses examined associations between demographic characteristics, substance use, trauma‐related variables, and PTSD. Similar logistic regression analyses were used to examine retention in methadone maintenance at 1 year. Results: The mean number of reported lifetime stressful events was 8.0 (SD = 3.7). Twenty‐seven percent were diagnosed with PTSD. Nearly 92% of those with PTSD had co‐occurring depressive symptoms. Female gender (adjusted odds ratio [AOR][95% CI]; 3.89 [1.07–14.01]), number of traumatic events (AOR [95% CI]; 1.34 [1.13–1.61]), and less education (AOR [95% CI]; 4.13 [1.14–14.98]) were significantly associated with PTSD. Those with a toxicology positive screen were 80% less likely to remaine in methadone maintenance at 1 year (OR [95% CI]; 0.20 [0.07–0.52]). PTSD diagnosis was not significantly associated with treatment retention at 1 year (OR [95% CI]; 0.61 [0.23–1.64]). Conclusions and Scientific Significance: Future studies are needed to determine if treatment of PTSD that is integrated into methadone maintenance programs may impact continued substance abuse use and thereby improve retention in care. (Am J Addict 2012;21:524–530)     

One‐stage and chromogenic FVIII:C assay discrepancy in mild haemophilia A and the relationship with the mutation and bleeding phenotype

Summary. The discrepancy of the levels of factor VIII activity (FVIII:C) by different assays in some mild and moderate haemophilic A patients has been long known. Specific mutations affecting FVIII:C discrepancies have been described. No consensus exit as to which method most accurately represents the FVIII cofactor function in vivo and which has a better correlation with the haemorrhagic clinical expression. We studied 163 mild A haemophiliacs, and detected discrepancies in 20% of the patients, most of whom presented higher levels of FVIII:C with the one‐stage assay. In nine families, the FVIII mutation was found, while three showed mutations not previously described (Leu1978Phe and Ser1791Pro associated with higher levels of FVIII:C by one‐stage method; Arg1639His in a patient with low level of FVIII:C by the one‐stage, but normal, chromogenic assay). Assessing the level of FVIII:C by different methods could help to learn the possible haemorrhagic expressions of patients.     

Single‐operator double‐balloon endoscopy (DBE) is as effective as dual‐operator DBE

Background and Study Aims: Double‐balloon endoscopy (DBE) is a new device that allows diagnosis and treatment throughout the entire small intestine. Although the originally described method requires two operators, we have recently developed a method to perform DBE by a single operator. We here assessed the clinical usefulness of this one‐person method in comparison to the conventional two‐person DBE. Patients and Methods: One hundred sixty‐two patients (102 men and 60 women, mean age 59 years) underwent 303 DBE procedures. Total observation time, completion rate of total intestinal and colonic observation, lesion‐discovery rate, and complication rate were retrospectively compared between the one‐person method and the conventional two‐person method of DBE. The one‐person method consists of the Grip and Pinch technique and Keep (or Hold) and Slide technique. Results: The total observation times were 95.5 ± 35.1 min and 96.7 ± 47.5 min by one‐person and two‐person antegrade DBE, respectively, and 103 ± 29.8 min and 111 ± 30.1 min by one‐person and two‐person retrograde DBE, respectively. The completion rate for examination of the entire small intestine was 74.2% in one‐person DBE and 76.5% in two‐person DBE, respectively. The lesion‐discovery rate was 69.0% in one‐person DBE and 65.5% in two‐person DBE, respectively. No significant differences between two methods were found in all measures. Also, no difference was observed in complication rate of the two methods. Conclusions: The single‐operator method for DBE was as efficient as the dual‐operator DBE without any higher risk of complications and, therefore, could replace the conventional dual‐operator method in the future.     

Transition from Acenocoumarol to Warfarin in a 12‐year‐old Child

The types of coumadin anticoagulants registered and available for use differ between countries. Most frequently used coumadin anticoagulants are warfarin and acenocoumarol. Under several specific conditions, transition from one coumarin to another is required. Because of different pharmacokinetic and pharmacodynamic characteristics, the transition from one type of coumarol to another type can be challenging. There are no studies that address this issue in children. We present the case report of transition treatment between acenocoumarol and warfarin in a 12‐year‐old child with prosthetic mitral valve.     

Lectin‐like Oxidized Low‐density Lipoprotein Receptor‐1, a New Promising Target for the Therapy of Atherosclerosis?

Endothelial activation and dysfunction induced by oxidized modified low‐density lipoprotein (ox‐LDL) is one of the key steps in the initiation of atherosclerosis. Recent studies have shown that a new lectin‐like oxidized low‐density lipoprotein receptor‐1 (LOX‐1) mediates the recognition and internalization of ox‐LDL. LOX‐1 is the main receptor for ox‐LDL and may play an important role in the pathogenesis of hypertension, diabetes, and, especially, of atherosclerosis. The potential role of LOX‐1 in the pathogenesis of atherosclerosis includes: endocytosis of ox‐LDL, expression co‐location with atherosclerosis enhanced by atherosclerosis‐related risk factors, elevated LOX‐1 protein in cardiovascular disease, effects related to atherosclerosis and eliminated by antiatherosclerotic drugs. Identification and regulation of LOX‐1 and understanding its signal transduction pathways might improve our insight toward the pathogenesis of atherosclerosis and provide a selective treatment approach. LOX‐1 might be a potential and promising target for the development of novel antiatherosclerotic drugs. However, due to limited knowledge about LOX‐1, there are still many questions to be answered.