Assessment of Post-Dilatation Strategies for Optimal Stent Expansion in Calcified Coronary Lesions: Ex Vivo Analysis With Optical Coherence Tomography.

INTRODUCTION: Interventional cardiologists make adjustments in the presence of coronary calcifications known to limit stent expansion, but proper balloon sizing, plaque-modification approaches, and high-pressure regimens are not well established. Intravascular optical coherence tomography (IVOCT) provides high-resolution images of coronary tissues, including detailed imaging of calcifications, and accurate measurements of stent deployment, providing a means for detailed study of stent deployment. OBJECTIVE: Evaluate stent expansion in an ex vivo model of calcified coronary arteries as a function of balloon size and high-pressure, post-dilatation strategies. METHODS: We conducted experiments on cadaver hearts with calcified coronary lesions. We assessed stent expansion as a function of size and pressure of non-compliant (NC) balloons (i.e., nominal, 0.5, 1.0, and 1.5 mm balloons at 10, 20 and 30 atm). IVOCT images were acquired pre-stent, post-stent, and at all post-dilatations. Stent expansion was calculated using minimum expansion index (MEI). RESULTS: We analyzed 134 IVOCT pullbacks from ten ex-vivo experiments. The mean distal and proximal reference lumen diameters were 2.2 ± 0.5 mm and 2.5 ± 0.7 mm, respectively, 80% of times using a 3.0 mm diameter stent. Overall, based on stent sizing, a good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at 20 atm, and expansion > 100% was reached using the 1:1 NC balloon at 30 atm. In the subgroup analysis, comparing low-calcified and high-calcified lesions, good expansion (MEI ≥ 80%) was reached using the 1:1 NC balloon at nominal pressure (10 atm) versus using 1:1 NC balloon at 30 atm, respectively. Significant vessel rupture was identified in all the vessels mainly upon post-dilatation with larger balloons, and 60% of the experiments (6 vessels, 3 in each calcium subgroup) presented rupture with the +1.0 mm NC balloon at 20 atm. CONCLUSION: When treating calcified lesions, good stent expansion was reached using smaller balloons at higher pressures without coronary injuries, whereas bigger balloons yielded unpredictable expansion even at lower pressures and demonstrated potential harmful damages to the vessels. As these findings could help physicians with appropriate planning of stent post-dilatation for calcified lesions, it will be important to clinically evaluate the recommended protocol.

Repetitive ultrasonographic assessment of adrenal size and shape changes: a clue for an asymptomatic sex hormone-secreting adenoma.

Diagnosis of an adrenal tumor without typical clinical signs related to hyperadrenocorticism and elevated alkaline phosphatase is challenging. This report describes a sex hormone-secreting adrenal tumor in a 10-year-old castrated male Shih Tzu evaluated through repetitive ultrasonographic examination. An adrenocorticotropic hormone stimulation test revealed elevated concentrations of androstenedione and 17-hydroxyprogesterone but a normal cortisol concentration. A mass was surgically excised and adenoma was diagnosed histopathologically. In the present case, adrenal tumor was strongly suspected based on a gradual increase in adrenal size and a change from peanut shape to an irregular mass on repetitive ultrasonography. Repetitive ultrasonographic examination of the adrenal gland is recommended when an abnormal ultrasonographic appearance of adrenal gland is identified, even in an asymptomatic dog.

Simulating greenhouse gas budgets of four California cropping systems under conventional and alternative management.

Despite the importance of agriculture in California's Central Valley, the potential of alternative management practices to reduce soil greenhouse gas (GHG) emissions has been poorly studied in California. This study aims at (1) calibrating and validating DAYCENT, an ecosystem model, for conventional and alternative cropping systems in California's Central Valley, (2) estimating CO2, N2O, and CH4 soil fluxes from these systems, and (3) quantifying the uncertainty around model predictions induced by variability in the input data. The alternative practices considered were cover cropping, organic practices, and conservation tillage. These practices were compared with conventional agricultural management. The crops considered were beans, corn, cotton, safflower, sunflower, tomato, and wheat. Four field sites, for which at least five years of measured data were available, were used to calibrate and validate the DAYCENT model. The model was able to predict 86-94% of the measured variation in crop yields and 69-87% of the measured variation in soil organic carbon (SOC) contents. A Monte Carlo analysis showed that the predicted variability of SOC contents, crop yields, and N2O fluxes was generally smaller than the measured variability of these parameters, in particular for N2O fluxes. Conservation tillage had the smallest potential to reduce GHG emissions among the alternative practices evaluated, with a significant reduction of the net soil GHG fluxes in two of the three sites of 336 +/- 47 and 550 +/- 123 kg CO2-eq x ha(-1) x yr(-1) (mean +/- SE). Cover cropping had a larger potential, with net soil GHG flux reductions of 752 +/- 10, 1072 +/- 272, and 2201 +/- 82 kg CO2-eq x ha(-1) x yr(-1). Organic practices had the greatest potential for soil GHG flux reduction, with 4577 +/- 272 kg CO2-eq x ha(-1) x yr(-1). Annual differences in weather or management conditions contributed more to the variance in annual GHG emissions than soil variability did. We concluded that the DAYCENT model was successful at predicting GHG emissions of different alternative management systems in California, but that a sound error analysis must accompany the predictions to understand the risks and potentials of GHG mitigation through adoption of alternative practices.