Is production system a relevant attribute in consumers' food preferences? The case of Iberian dry-cured ham in Spain.

Spanish consumers have a strong preference for Iberian meat products, as they perceive them to be of extra sensorial and nutritional quality. The production of these meat products depends on multiple variables, such as genetics, livestock production systems and, above all, the feed provided. The aim of this paper is to study the preferences of Spanish consumers for the various types of Iberian dry-cured ham, analysing whether they are willing to pay the premium required by the highest-quality products. The methodological approach combined a sensory analysis and a choice-based conjoint experiment with obtained through tasting sessions in Extremadura (SW of Spain). Findings of the sensory test have shown that there are significant differences in odour, texture and taste, explained mainly by the type of feed pigs were fed. The main results of the choice experiment have also shown that the type of feed is the most preferred attribute by consumers, in line with the sensory analysis.

Role of carbonate burial in Blue Carbon budgets.

Calcium carbonates (CaCO3) often accumulate in mangrove and seagrass sediments. As CaCO3 production emits CO2, there is concern that this may partially offset the role of Blue Carbon ecosystems as CO2 sinks through the burial of organic carbon (Corg). A global collection of data on inorganic carbon burial rates (Cinorg, 12% of CaCO3 mass) revealed global rates of 0.8 TgCinorg yr-1 and 15-62 TgCinorg yr-1 in mangrove and seagrass ecosystems, respectively. In seagrass, CaCO3 burial may correspond to an offset of 30% of the net CO2 sequestration. However, a mass balance assessment highlights that the Cinorg burial is mainly supported by inputs from adjacent ecosystems rather than by local calcification, and that Blue Carbon ecosystems are sites of net CaCO3 dissolution. Hence, CaCO3 burial in Blue Carbon ecosystems contribute to seabed elevation and therefore buffers sea-level rise, without undermining their role as CO2 sinks.

The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial.

BACKGROUND: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. METHODS: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect. DISCUSSION: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018.

Determinants associated with chronic and incident depression in Mexican older adults. / Determinantes asociados a depresión crónica e incidente en adultos mayores mexicanos.

Objective: To describe the association among socio-demographic, environmental, psychosocial and health determinants in Mexican elders with chronic and incident depression from a 3-year follow-up study. Methods: Data from a cohort study of 1512 Mexicans, 65 and more years old was analyzed. We used a multinomial regression model in order to analyze the associations between determinants of interest with chronic and incident depression conditions, taking as reference a group without depression. In addition, the risk profiles were identified and stratified by sex; and finally, the determinant´s were estimated individually and combined. Results: 43.1% of the whole sample did not present depression during the follow-up, 41.9% had chronic depression and 15% incident depression. Chronic depression had more associations with determinants, than incident depression; the latter was associated with poverty and loneliness. The risk profiles for the three depression´s conditions stratified by sex, showed notorious differences. Conclusion: Chronic and incident depressions in the elderly are distinct phenomena, the evaluation of the determinant´s contribution to these entities, will allow to identify associated conditions to chronic and incident depression, and the sex differential effect, which will contribute to identify populations and risk factors, to implement objective interventions.

Prevalence and correlates of cervical HPV infection in a clinic-based sample of HIV-positive Hispanic women.

OBJECTIVES: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. METHODS: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. RESULTS: Mean age of participants was 40.3 years (± 10.3SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having ≥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02-4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93-6.62), active genital warts (aPOR = 3.45, 95% CI:1.60-7.42), and CD4 counts ≤ 200 (aPOR = 4.24, 95% CI: 1.67-10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. CONCLUSIONS: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population.

PrEFiNe Plan: Strategic plan for Fabry diseases in Nephrology. / Plan PrEFiNE: Plan estratégico para la enfermedad de Fabry en Nefrología.

BACKGROUND: Renal failure is one of the main causes of death in patients with Fabry disease (FD). Due to the low prevalence of FD, delayed diagnosis and misdiagnosis, often the correct diagnosis is made when organ damage is already present. Early recognition of the disease would allow the prevention of severe complications and the premature death of patients with FD. OBJECTIVE: We present here the PrEFiNE project, which includes a wide spectrum of activities with the aim of improve knowledge and diagnosis of FD. The project is sponsored by Shire Iberia (http://shireiberica.com/) METHODS: From January 2016 to the end of 2017 several activities will be carried out, starting with a survey to evaluate current FD knowledge among nephrologists; in addition some studies to assess prevalence of this disease will be performed. One study will include patients receiving dialysis, another study will cover kidney transplant patients, and a pilot study in chronic kidney disease in stage 3-5 predialysis. Also planned is a pharmacoeconomic study to focus on burden of FD. At the same time medical education activities will be conducted both on line and on site. Plan for dissemination will include medical publications and diffusion to media. PrEFiNE Project will finish with the publication of a compilation book on FD in Nephrology including all planned activities and proposing recommendations based on results and detected unmet needs. PrEfiNE Plan will be coordinated by severa scientific committees, one at national level and 10 other regionals comittees, tha will be responsible to ensure the maximum scientific quality of proposed activities. An advisory board will supervise the project. DISCUSSION: PrEfiNE project will evaluate an action plan focused on improving FD knowledge to make necessary recommendations for an early recognition of the disease. In addition will generate a plan to improve previously undetected needs.

Interventional assessment of the lumbar disk: provocation lumbar diskography and functional anesthetic diskography.

The diagnosis of diskogenic low back pain (LBP) can be elusive. Physical examination of the lumbar disk is limited and imaging offers few objective clues. While invasive, lumbar diskography is a method available to examine or "provoke" the disk directly and determine if LBP is coming from a disk and which disk(s) is responsible for the pain. Once identified, features of the abnormal disk can be evaluated, including the disk's response to intradiskal local anesthetic and disk architecture as observed on diskography imaging and postdiskogram computed tomography. Response to anesthetic can be correlated with imaging features potentially impacting treatment but can also stand alone as an independent objective marker of diskogenic LBP. Here we review the indications for lumbar diskography and the basic lumbar diskogram procedure. We also review the alternative more advanced technique for studying the anesthetic and mechanical features of the disk, functional anesthetic diskography.

[Patients on peritoneal dialysis with type 2 diabetes present poorer progress than non-diabetics at the expense of their cardiovascular comorbidity]. / Los pacientes diabéticos tipo 2 presentan peor evolución que los no diabéticos en diálisis peritoneal a expensas de su comorbilidad cardiovascular.

AIM: To describe the characteristics, practice patterns, targets and outcome of the Type 2 diabetic patients (DM 2) in peritoneal dialysis (PD) and to compare them with non-diabetic ones. METHODS: Prospective cohort study of every incident PD patient in a regional public health care system (2003-2006). We prospectively collected baseline data, hospital admissions, peritonitis, transplants, CV events and deaths. Every six months PD prescription data and results on efficacy, anaemia, blood pressure (BP) were collected. RESULTS: DM 2 patients (n = 65) were older and presented a higher rate of previous CV events (60.9% vs. 17.7% p<0001) than non-DM patients (n = 376) and worse BP control at inclusion on PD. There were no differences in dialysis efficacy targets and anaemia management. HOSPITAL ADMISSIONS: DM 2 patients present higher hospitalisation rates 1.1 [0.9-1.4] than NoDM ones 0.6 [0.5-0.7] admissions per year at risk. Survival: DM 2 patients present lower PD-technique survival than No DM ones (870 vs. 1002 days Kaplan-Mayer estimation p = 0.009) and higher annual mortality rate (13.7 vs. 4.1%, p: 0.021) with a crude mortality hazard ratio (HR) of 2.5 [1.1-5.6] after correction by age. However, the best predictive model for mortality by Cox proportional hazards model includes age, existence of previous CV events and forced inclusion on PD and excludes DM 2. The association between DM 2 and CV events ruled out DM 2 from the multivariate risk model. CONCLUSION: Type 2 DM patients had a higher prevalence of previous CV events, and a worse global outcome. Previous CV events may explain part of this risk.

A government sponsored clinic for the evaluation and treatment of chronic hepatitis C in an underinsured population in Puerto Rico

BACKGROUND: Chronic hepatitis C (CHC) is a major health problem in Puerto Rico (PR). More than 50% of the population is insured by a government-sponsored managed care system that does not cover treatment for CHC. Lack of access to treatment will result in an increase in end-stage liver disease with its high socioeconomic impact in the future. In an attempt to identify strategies for the treatment of CHC in the publicly insured population, the PR Health Department and the University of Puerto Rico (UPR) Gastroenterology (GI) Division have developed a pilot clinic for the evaluation and treatment of CHC. METHODS: UPR and the PR Health Department negotiated a fee per patient to include all medical care and follow-up laboratories. Viral studies were covered by a grant to the Health Department. Medications were bought at a discount price by the government and dispensed at a government pharmacy. The Health Department allocated funds for 200 patients with government insurance. A dedicated clinic was established at the UPR, staffed by an internist under the supervision of the GI faculty. Patients with a positive HCVab were referred to this clinic. The public insurance covered the CBC, liver tests, metabolic panel, TSH, HBsAg, HIV, ultrasound and liver biopsy, which were required prior to evaluation for possible treatment. In the initial visit, patients underwent a medical evaluation, including assessment of suitability for therapy and counseling. Those deemed to be candidates who still needed a liver biopsy had it performed by the GI staff. Genotype and viral titers were ordered after the decision on treatment had been made. The clinic physician prescribed pegylated interferon and ribavirin, which were dispensed by the government pharmacy. Instruction on proper drug administration was given. Clinic visits were scheduled for 1, 3, 6 and 12 months but also allowed on demand. Laboratory tests were done at the clinic and reviewed by the physician expediently to monitor...

[Influence of energy expenditure on childhood obesity]. / Influencia del gasto energético en la obesidad infantil.

OBJECTIVES: To study differences in resting energy expenditure (REE) according to its determining factors (sex, weight, body fat mass, lean body mass) and in the oxidation of energy substrates in obese and non-obese children. PATIENTS AND METHODS: We studied 71 children (39 obese and 32 non-obese) aged from 4.1 to 13.6 years. The male/female ratio was 34/37. Energy expenditure (EE) was measured by using open circuit indirect calorimetry. The oxidation of energy substrates was calculated from oxygen consumption, carbon dioxide production, and urinary nitrogen excretion from urea. Body composition was determined by anthropometry. RESULTS: REE (kcal/day), adjusted for anthropometric parameters and body composition, was higher in boys than in girls. The absolute REE was significantly higher in obese than in non-obese children (1512.82 6 234.47 vs 1172.59 6 190.20) and was higher or the same when adjusted for its determinants. Compared with the non-obese group, the obese group presented a significantly higher percentage of fat oxidation (57.15 6 10.68 vs 51.08 6 13.61, p 5 0.04), a lower percentage of carbohydrate oxidation (30.10 6 9.85 vs 36.34 6 13.61, p 5 0.03) and a lower respiratory quotient (0.79 6 0.03 vs 0.82 6 0.04, p 5 0.02). No differences were found between male and female subjects in the percentages of carbohydrate, fat, and protein oxidation. CONCLUSIONS: We obtained the followings conclusions: a) When adjusted for anthropometric measurements and body composition, REE was significantly higher in boys than in girls; b) REE was higher in obese than in non-obese children, after adjustment for lean body mass; and c) Compared with the control group, obese children presented a higher percentage of fat oxidation, a lower percentage of carbohydrate oxidation, and a lower respiratory quotient.

[Geriatric drug therapy guide: evaluation of the effect on prescription at old people's homes in Gipuzkoa]. / Guía farmacoterapéutica geriátrica: evaluación del impacto en la prescripción de las residencias de personas mayores de Gipuzkoa.

OBJECTIVE: To analyse the impact of the composition, publication and dissemination of the Geriatric Drug-therapy Guide of Gipuzkoa (GDGG) and monitoring of adherence to it, as an intervention in the community to improve medical prescription in old people s homes (OPH) in Gipuzkoa. DESIGN: Descriptive evaluation <> the intervention. SAMPLE: billed prescriptions for pharmaceutical products (PP) from Osakidetza in 1996 (pre-intervention) and 1997-1999 (post-intervention). SOURCE: the prescription data base of the Basque Government. SETTING: 35 OPH in Gipuzkoa (2963 residents). MEASUREMENTS AND RESULTS: Indicators: Adherence percentage=(No. units prescribed of PP with selected active principles)x100/total No. PP prescribed); Mean price per unit (MPU)=(total RSP of units/total No. PP units). Overall adherence rose from 44% in 1996 to 62% in 1999; the groups accounting for 84% of prescription and the sub-groups accounting for 65% of prescription went up in these years from 43% to 64% and from 50% to 67%, respectively. A deceleration of the increase in MPU in OPH was detected, when compared with the figure for primary care. CONCLUSIONS: Overall adherence to the GDGG is high, with an upwards tendency that lasts about three years after the initial intervention. Similarly, the evolution of the MPU for the PP prescribed in OPH is better than the primary care average, with a steady deceleration in the indirect indicator analysed. The community intervention undertaken is an effective tool for improving medical prescription in the old people s homes examined.

Preparing a business justification for going electronic.

Exponential advances in the technology sector and computer industry have benefited the science and practice of radiology. Modalities such as digital radiography, computed radiography, computed tomography, magnetic resonance imaging, ultrasound, digital angiography, and gamma cameras are all capable of producing DICOM compliant images. Text can likewise be acquired using voice recognition technology (VRT) and efficiently rendered into a digital format. All of these digital data sets can subsequently be transferred over a network between machines for display and further manipulation on workstations. Large capacity archiving units are required to store these voluminous data sets. The enterprise components of radiology departments and imaging centers--radiology information systems (RIS) and picture archiving and communications systems (PACS)--have thus undergone a transition from hardcopy to softcopy. When preparing to make transition to a digital environment, the first step is introspective. A detailed SWOT (strengths, weaknesses, opportunities and threats) analysis, with a focus on the status of "electronic preparedness," ensues. The next step in the strategic planning process is to formulate responses to the following questions: Will this technology acquisition provide sufficient value to my organization to justify the expense? Is there a true need for the new technology? What issues or problems does this technology address? What customer needs will this technology satisfy today and tomorrow? How will the organization's shareholders benefit from this technology? The answers to these questions and the questions that they in turn generate will stimulate the strategic planning process to define demands, investigate technology and investment options, identify resources and set goals. The mission of your radiology center will determine what you will demand from the electronic environment. All radiology practices must address the demand of clinical service. Additional demands based on your mission may include education and research. The investigation of options is probably the most time consuming portion of the analysis. It is in this stage where the system architecture is drafted. Important contributions must be solicited from your information technology division, radiologists and other physicians, hospital administration and any other service where the use of imaging technology information is required and beneficial. Vendors and consultants can be extremely valuable in generating workflow diagrams, which include imaging acquisition components and imaging display components. A request for proposal (RFP) may facilitate this step. A detailed inventory of imaging equipment, imaging equipment locations and use, imaging equipment DICOM compatibility, imaging equipment upgrade requirements, reading locations and user locations must be obtained and confirmed. It is a good idea to take a careful inventory of your resources during the process of investigating system architecture and financial options. An often-ignored issue is the human resource allocation that is required to implement, maintain and upgrade the system. These costs must be estimated and included in the financial analysis. Further, to predict the finances of your operation in the future, a solid understanding of your center's historical financial data is required. This will enable you to make legitimate and reasonable financial calculations using incremental volumes. The radiology center must formulate and articulate discrete clinical and business goals for the transition to a digital environment that are consistent with the institutional or enterprise mission. Once goals are set, it is possible to generate a strategic plan. It is necessary to establish individual accountability for all aspects of the planning and implementation process. A realistic timetable should be implemented. Keep in mind that this is a dynamic process; technology is rapidly changing, as are clinical service demands and regulatory initiatives. It is therefore prudent to monitor the process, make appropriate revisions when necessary and address contingencies as they arise.

Optimization of the technique to isolate fetal hepatocytes, and assessment of their functionality by transplantation.

In contrast to adult hepatocytes, fetal hepatocytes (FH) are thought to be highly proliferative less immunogenic and more resistant to both cryopreservation and ischemic injury. In the present study, we describe the method for isolation of FH and the relationship between the transplantability of FH into the spleen of analbuminemic rats and expression of albumin mRNA. Rat FH were obtained using the nonperfusion collagenase/DNase digestion method. Nagase analbuminemic rats (NAR), a strain which bears a mutation that determines the impossibility of the normal splicing of the albumin mRNA were used as recipients. The transplanted FH immediately migrated to the liver via portal vein, and anchored there. To assess the functional state of the transplanted cells, one month after transplantation, the expression of the albumin gene was studied in the liver of the recipients.

CAFASP2: the second critical assessment of fully automated structure prediction methods.

The results of the second Critical Assessment of Fully Automated Structure Prediction (CAFASP2) are presented. The goals of CAFASP are to (i) assess the performance of fully automatic web servers for structure prediction, by using the same blind prediction targets as those used at CASP4, (ii) inform the community of users about the capabilities of the servers, (iii) allow human groups participating in CASP to use and analyze the results of the servers while preparing their nonautomated predictions for CASP, and (iv) compare the performance of the automated servers to that of the human-expert groups of CASP. More than 30 servers from around the world participated in CAFASP2, covering all categories of structure prediction. The category with the largest participation was fold recognition, where 24 CAFASP servers filed predictions along with 103 other CASP human groups. The CAFASP evaluation indicated that it is difficult to establish an exact ranking of the servers because the number of prediction targets was relatively small and the differences among many servers were also small. However, roughly a group of five "best" fold recognition servers could be identified. The CASP evaluation identified the same group of top servers albeit with a slightly different relative order. Both evaluations ranked a semiautomated method named CAFASP-CONSENSUS, that filed predictions using the CAFASP results of the servers, above any of the individual servers. Although the predictions of the CAFASP servers were available to human CASP predictors before the CASP submission deadline, the CASP assessment identified only 11 human groups that performed better than the best server. Furthermore, about one fourth of the top 30 performing groups corresponded to automated servers. At least half of the top 11 groups corresponded to human groups that also had a server in CAFASP or to human groups that used the CAFASP results to prepare their predictions. In particular, the CAFASP-CONSENSUS group was ranked 7. This shows that the automated predictions of the servers can be very helpful to human predictors. We conclude that as servers continue to improve, they will become increasingly important in any prediction process, especially when dealing with genome-scale prediction tasks. We expect that in the near future, the performance difference between humans and machines will continue to narrow and that fully automated structure prediction will become an effective companion and complement to experimental structural genomics.

Dynamic modeling of outpatient systems to balance provider resources and patient access.

Improving patients' access to appointments remains a major goal for most managed care organizations and group practices. A number of factors affect the length of time a patient must wait to see a physician or other provider. This article describes those factors and how dynamic modeling can assist decision makers in determining the appropriate number of providers or changes in practice or operations needed to meet given access targets.

Derivation of protein-specific pair potentials based on weak sequence fragment similarity.

A method is presented for the derivation of knowledge-based pair potentials that corrects for the various compositions of different proteins. The resulting statistical pair potential is more specific than that derived from previous approaches as assessed by gapless threading results. Additionally, a methodology is presented that interpolates between statistical potentials when no homologous examples to the protein of interest are in the structural database used to derive the potential, to a Go-like potential (in which native interactions are favorable and all nonnative interactions are not) when homologous proteins are present. For cases in which no protein exceeds 30% sequence identity, pairs of weakly homologous interacting fragments are employed to enhance the specificity of the potential. In gapless threading, the mean z score increases from -10.4 for the best statistical pair potential to -12.8 when the local sequence similarity, fragment-based pair potentials are used. Examination of the ab initio structure prediction of four representative globular proteins consistently reveals a qualitative improvement in the yield of structures in the 4 to 6 A rmsd from native range when the fragment-based pair potential is used relative to that when the quasichemical pair potential is employed. This suggests that such protein-specific potentials provide a significant advantage relative to generic quasichemical potentials.

Ab initio folding of proteins using restraints derived from evolutionary information.

We present our predictions in the ab initio structure prediction category of CASP3. Eleven targets were folded, using a method based on a Monte Carlo search driven by secondary and tertiary restraints derived from multiple sequence alignments. Our results can be qualitatively summarized as follows: The global fold can be considered "correct" for targets 65 and 74, "almost correct" for targets 64, 75, and 77, "half-correct" for target 79, and "wrong" for targets 52, 56, 59, and 63. Target 72 has not yet been solved experimentally. On average, for small helical and alpha/beta proteins (on the order of 110 residues or smaller), the method predicted low resolution structures with a reasonably good prediction of the global topology. Most encouraging is that in some situations, such as with target 75 and, particularly, target 77, the method can predict a substantial portion of a rare or even a novel fold. However, the current method still fails on some beta proteins, proteins over the 110-residue threshold, and sequences in which only a poor multiple sequence alignment can be built. On the other hand, for small proteins, the method gives results of quality at least similar to that of threading, with the advantage of not being restricted to known folds in the protein database. Overall, these results indicate that some progress has been made on the ab initio protein folding problem. Detailed information about our results can be obtained by connecting to http:/(/)www.bioinformatics.danforthcenter.org/+ ++CASP3.

Value of intravascular ultrasound in the assessment of coronary pseudostenosis during coronary interventions.

Coronary pseudostenosis (PS) are increasingly visualized during coronary interventions. In many patients PS are readily recognized by a characteristic angiographic pattern, but in other cases the diagnosis remains difficult. The value of intravascular ultrasound (IVUS) in the study of PS remains unknown. In this study, IVUS was used to assess the morphologic appearance of the vessel wall in 10 consecutive patients showing images of PS during coronary interventions. Mean age of the group was 60+/-12 years and two patients were female. IVUS was performed with a motorized pullback system to assess lumen, plaque, and total vessel cross-sectional areas. Measurements were performed both at the site of PS and at the distal reference segment. PS were always located on angled coronary segments. In one patient no lumen narrowing was detected with IVUS at the site of PS. In the remaining nine patients, however, a very localized elliptic-shaped lumen narrowing was demonstrated. As compared with the distal reference segment, coronary lumen (6.3+/-2.2 vs. 12.7+/-4.8 mm2, P < 0.001) and total vessel area (11.9+/-3.3 vs. 16.1+/-6.1 mm2, P < 0.05) were smaller at the site of PS. Severe lumen asymmetry was also documented at this site. In addition, a characteristic image of a flattened, three-layered wall, overlying a hypoechogenic space, was visualized in five patients. This unique pattern was considered the correlate of a partial coronary intussusception. PS induced some resistance to the advancement of catheters in two patients and temporary flow impairment in two additional patients. However, in every case, the image of PS disappeared once the guidewire was removed. Thus, at sites with PS, IVUS allows ruling out severe atherosclerosis and coronary dissections. In addition, IVUS also provides important diagnostic clues, including the image of intussusception, for making the correct diagnosis of this benign entity.