Orbital atherectomy safety and efficacy: A comparative analysis of ostial versus non-ostial calcified coronary lesions.

BACKGROUND: The safety and efficacy of coronary orbital atherectomy (OA) for treatment of ostial lesions are not yet fully established. We sought to evaluate (OA) treatment of severely calcified ostial and non-ostial lesions. METHODS: A retrospective analysis of subjects treated with OA for severely calcified ostial and non-ostial lesions, at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) from January 2014 to September 2020, was completed. Study baseline characteristics, lesion and vessel characteristics, procedural outcomes, and in-hospital major adverse cardiovascular events (MACE) were analyzed and compared. RESULTS: A total of 609 patients that underwent PCI with OA were identified. The majority of patients (81.9 %) had non-ostial lesions, while 16.6 % had ostial lesions (of which 2.8 % classified as aorto-ostial) and 1.5 % had unknown lesion anatomy. The mean age of the overall cohort was 74.0 ± 9.3 years, and 63.5 % were male. All patients received drug-eluting stent (DES) placement, and the overall freedom from MACE was 98.5 %, with no significant difference observed between the ostial and non-ostial groups. The freedom from cardiac death and MI was also similar between the two groups. There were low rates of bleeding complications and severe angiographic complications, and no persistent slow flow/no reflow was reported. CONCLUSIONS: This study demonstrated no significant differences in in-hospital MACE outcomes between patients with ostial versus non-ostial lesions, indicating that OA is a safe and effective treatment option for both lesion types, including those classified as aorto-ostial.

Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016-2019 National Inpatient Sample.

BACKGROUND: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. METHODS: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. RESULTS: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. CONCLUSIONS: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.

Research on bilingualism as discovery science.

An important aim of research on bilingualism is to understand how the brain adapts to the demands of using more than one language.In this paper, we argue that pursuing such an aim entails valuing our research as a discovery process that acts on variety.Prescriptions about sample size and methodology, rightly aimed at establishing a sound basis for generalization, should be understood as being in the service of science as a discovery process. We propose and illustrate by drawing from previous and contemporary examples within brain and cognitive sciences, that this necessitates exploring the neural bases of bilingual phenotypes:the adaptive variety induced through the interplay of biology and culture. We identify the conceptual and methodological prerequisites for such exploration and briefly allude to the publication practices that afford it as a community practice and to the risk of allowing methodological prescriptions, rather than discovery, to dominate the research endeavor.

Do Cross-Language Script Differences Enable Bilinguals to Function Selectively When Speaking in One Language Alone?

The present study examined the role of script in bilingual speech planning by comparing the performance of same and different-script bilinguals. Spanish-English bilinguals (Experiment 1) and Japanese-English bilinguals (Experiment 2) performed a picture-word interference task in which they were asked to name a picture of an object in English, their second language, while ignoring a visual distractor word in Spanish or Japanese, their first language. Results replicated the general pattern seen in previous bilingual picture-word interference studies for the same-script, Spanish-English bilinguals but not for the different-script, Japanese-English bilinguals. Both groups showed translation facilitation, whereas only Spanish-English bilinguals demonstrated semantic interference, phonological facilitation, and phono-translation facilitation. These results suggest that when the script of the language not in use is present in the task, bilinguals appear to exploit the perceptual difference as a language cue to direct lexical access to the intended language earlier in the process of speech planning.

Codeswitching: A Bilingual Toolkit for Opportunistic Speech Planning.

The ability to engage in fluent codeswitching is a hallmark of the flexibility and creativity of bilingual language use. Recent discoveries have changed the way we think about codeswitching and its implications for language processing and language control. One is that codeswitching is not haphazard, but subject to unique linguistic and cognitive constraints. Another is that not all bilinguals codeswitch, but those who do, exhibit usage patterns conforming to community-based norms. However, less is known about the cognitive processes that regulate and promote the likelihood of codeswitched speech. We review recent empirical studies and provide corpus evidence that highlight how codeswitching serves as an opportunistic strategy for optimizing performance in cooperative communication. From this perspective, codeswitching is part and parcel of a toolkit available to bilingual codeswitching speakers to assist in language production by allowing both languages to remain active and accessible, and therefore providing an alternative means to convey meaning, with implications for bilingual speech planning and language control more generally.

Interactional context mediates the consequences of bilingualism for language and cognition.

Proficient bilinguals use two languages actively, but the contexts in which they do so may differ dramatically. The present study asked what consequences the contexts of language use hold for the way in which cognitive resources modulate language abilities. Three groups of speakers were compared, all of whom were highly proficient Spanish-English bilinguals who differed with respect to the contexts in which they used the two languages in their everyday lives. They performed two lexical production tasks and the "AX" variant of the Continuous Performance Task (AX-CPT), a nonlinguistic measure of cognitive control. Results showed that lexical access in each language, and how it related to cognitive control ability, depended on whether bilinguals used their languages separately or interchangeably or whether they were immersed in their second language. These findings suggest that even highly proficient bilinguals who speak the same languages are not necessarily alike in the way in which they engage cognitive resources. Findings support recent proposals that being bilingual does not, in itself, identify a unique pattern of cognitive control. An important implication is that much of the controversy that currently surrounds the consequences of bilingualism may be understood, in part, as a failure to characterize the complexity associated with the context of language use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cognitive Control Facilitates Attentional Disengagement during Second Language Comprehension.

Bilinguals learn to resolve conflict between their two languages and that skill has been hypothesized to create long-term adaptive changes in cognitive functioning. Yet, little is known about how bilinguals recruit cognitive control to enable efficient use of one of their languages, especially in the less skilled and more effortful second language (L2). Here we examined how real-time cognitive control engagement influences L2 sentence comprehension (i.e., conflict adaptation). We tested a group of English monolinguals and a group of L2 English speakers using a recently-developed cross-task adaptation paradigm. Stroop sequences were pseudo-randomly interleaved with a visual-world paradigm in which participants were asked to carry out spoken instructions that were either syntactically ambiguous or unambiguous. Consistent with previous research, eye-movement results showed that Stroop-related conflict improved the ability to engage correct-goal interpretations, and disengage incorrect-goal interpretations, during ambiguous instructions. Such cognitive-to-language modulations were similar in both groups, but only in the engagement piece. In the disengagement portion, the modulation emerged earlier in bilinguals than in monolinguals, suggesting group differences in attentional disengagement following cognitive control recruitment. Additionally, incorrect-goal eye-movements were modulated by individual differences in working memory, although differently for each group, suggesting an involvement of both language-specific and domain-general resources.