Evidence for Chiral Wobbler in Nuclei.

Three ΔI=1 bands with the πg_{9/2}⊗νg_{9/2} configuration have been identified in _{35}^{74}Br_{39}. Angular distribution, linear polarization, and lifetime measurements were performed to determine the multipolarity, type, mixing ratio, and absolute transition probability of the transitions. By comparing these experimental observations with the corresponding fingerprints and the quantum particle rotor model calculations, the second and third lowest bands are, respectively, suggested as the chiral partner and one-phonon wobbling excitation built on the yrast band. The evidence indicates the first chiral wobbler in nuclei.

Adolescents' exposure to and evaluation of food promotions on social media: a multi-method approach.

BACKGROUND: Traditional food marketing, mostly involving advertisement of nutrient poor and energy dense foods, has the effect of enhancing attitudes, preferences, and increasing intake of marketed foods in adolescents, with detrimental consequences for health. While the use of social media applications in adolescents has proliferated, little is known about the content of food promotions within these applications. The aim of this study was to investigate adolescents' exposure to and evaluation of social media food promotions (SMFPs). METHODS: Australian adolescents aged 13-16 years joined one-on-one Zoom meetings with the researcher on the device they normally used for social media. Participants shared their screen and visited up to three of their favourite social media platforms for 10 min each, during which the researcher pointed out examples of SMFPs to participants. Next, participants answered questions about their awareness and appreciation of SMFPs. Screenshots of SMFPs were de-identified and analysed. RESULTS: The study included 35 adolescents aged 14.4 (± 1.2) years (boys: n = 18; girls: n = 17). Instagram, Snapchat and YouTube were the most favoured social media platforms. During a total of 1000 min of viewing time, 1801 unbranded (n = 1221) and branded (n = 580) SMFPs were identified. Participants viewed a median rate (IQR) of 12.0 (6.3-20) SMFPs per 10 min, with a median rate of 6.0 (3-11) non-core SMFPs per 10 min. A majority of SMFPs (62%) were embedded into celebrity influencer or entertaining content (e.g., vlogs, cooking videos, streamed TV content). In total, 60% of the participants said they had sometimes, rarely or never noticed the SMFPs pointed out by the researcher themselves. Participants largely remembered non-core foods or brands (77%). Almost half (49%) of participants liked SMFPs, while only 6% disliked them. CONCLUSIONS: This study contributes to a relatively unexplored research area. The outcomes show adolescents' SMFP exposure mostly concerns unhealthy foods, shown in advertisements and other food-related posts, which are integrated into a wide variety of entertainment that is appreciated by adolescents. The results emphasise the need for more research on SMFPs, with particular focus on the impact on adolescent dietary behaviours, and clearer definitions and stricter regulations regarding adolescent-targeted social media food marketing.

A systematic review of recall errors associated with portion size estimation aids in children.

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

Evaluation of the effectiveness and usability of an educational portion size tool, ServARpreg, for pregnant women.

BACKGROUND: Elevated blood glucose levels in pregnancy increases the risk of adverse pregnancy outcomes. Modifying consumption of carbohydrate-rich foods is important for blood glucose regulation; however, the tools commonly used to assist in guiding portion control are impractical. The present study aimed to evaluate usability of ServARpreg, a mobile phone-based nutrition tool, and its effectiveness with respect to improving carbohydrate and standard serve size knowledge in pregnant women. METHODS: A baseline survey assessed knowledge of carbohydrates and standard serve sizes of pregnant women. A subset of women living in Newcastle were invited to use ServARpreg, containing pregnancy nutrition information and augmented reality guidance on portion control. A follow-up survey was sent to all women 4 weeks after baseline and women who received ServARpreg also received a process evaluation survey after 10 weeks. RESULTS: Responses were received from 186 pregnant women for the baseline survey, with 97 completing the follow-up (52.2%). Of the 56 women eligible to receive ServARpreg in the sub-study, 47 accepted (83.9%) and, of these, 40 completed the process evaluation survey (85.1%). At follow-up, there was a significant group × time interaction in favour of the ServARpreg group for carbohydrate quantification knowledge (F1,279  = 9.705, P = 0.002). Standard serve size knowledge did not change between groups. In the process evaluation survey, 80% strongly agreed/agreed that ServARpreg made them more aware of how much they ate and 72.5% found ServARpreg easy to use. CONCLUSIONS: ServARpreg has shown potential to educate pregnant women about carbohydrate quantification and increase portion size awareness. Further refinement of the tool and evaluation is needed to improve standard serve size knowledge.

The international food unit: a new measurement aid that can improve portion size estimation.

BACKGROUND: Portion size education tools, aids and interventions can be effective in helping prevent weight gain. However consumers have difficulties in estimating food portion sizes and are confused by inconsistencies in measurement units and terminologies currently used. Visual cues are an important mediator of portion size estimation, but standardized measurement units are required. In the current study, we present a new food volume estimation tool and test the ability of young adults to accurately quantify food volumes. The International Food Unit™ (IFU™) is a 4x4x4 cm cube (64cm3), subdivided into eight 2 cm sub-cubes for estimating smaller food volumes. Compared with currently used measures such as cups and spoons, the IFU™ standardizes estimation of food volumes with metric measures. The IFU™ design is based on binary dimensional increments and the cubic shape facilitates portion size education and training, memory and recall, and computer processing which is binary in nature. METHODS: The performance of the IFU™ was tested in a randomized between-subject experiment (n = 128 adults, 66 men) that estimated volumes of 17 foods using four methods; the IFU™ cube, a deformable modelling clay cube, a household measuring cup or no aid (weight estimation). Estimation errors were compared between groups using Kruskall-Wallis tests and post-hoc comparisons. RESULTS: Estimation errors differed significantly between groups (H(3) = 28.48, p < .001). The volume estimations were most accurate in the group using the IFU™ cube (Mdn = 18.9%, IQR = 50.2) and least accurate using the measuring cup (Mdn = 87.7%, IQR = 56.1). The modelling clay cube led to a median error of 44.8% (IQR = 41.9). Compared with the measuring cup, the estimation errors using the IFU™ were significantly smaller for 12 food portions and similar for 5 food portions. Weight estimation was associated with a median error of 23.5% (IQR = 79.8). CONCLUSIONS: The IFU™ improves volume estimation accuracy compared to other methods. The cubic shape was perceived as favourable, with subdivision and multiplication facilitating volume estimation. Further studies should investigate whether the IFU™ can facilitate portion size training and whether portion size education using the IFU™ is effective and sustainable without the aid. A 3-dimensional IFU™ could serve as a reference object for estimating food volume.

Evidence for Octupole Correlations in Multiple Chiral Doublet Bands.

Two pairs of positive-and negative-parity doublet bands together with eight strong electric dipole transitions linking their yrast positive- and negative-parity bands have been identified in ^{78}Br. They are interpreted as multiple chiral doublet bands with octupole correlations, which is supported by the microscopic multidimensionally-constrained covariant density functional theory and triaxial particle rotor model calculations. This observation reports the first example of chiral geometry in octupole soft nuclei.

What is healthy food? Objective nutrient profile scores and subjective lay evaluations in comparison.

To date, it is unclear how consumers evaluate the healthiness of individual foods and meals and how consumers' perceptions are related to expert opinions. This knowledge is essential for efficient communication of nutrition information with the goal of promoting healthy eating. This study used the fake food buffet method to investigate health perceptions of selected meals and of 54 individual foods and beverages. Lay consumers' subjective healthiness evaluations of meals and foods were compared to objective nutrient profile scores, which were previously shown to correlate highly with expert opinions. The results show that nutrition profile scores and lay evaluations were highly correlated, which indicates that lay people used similar criteria as experts to evaluate the healthiness of foods. However, lay consumers tended to neglect the amount of saturated fat, protein and sodium for their judgments. Also, it was found that while lay consumers were quite able to evaluate single food products, they had difficulties in evaluating entire meals. Future interventions should focus particularly on educating the consumer about the negative effects of diets high in salt and saturated fat and they should improve the consumer's abilities to evaluate entire meals.

Intracisternal delivery of AAV9 results in oligodendrocyte and motor neuron transduction in the whole central nervous system of cats.

Systemic and intracerebrospinal fluid delivery of adeno-associated virus serotype 9 (AAV9) has been shown to achieve widespread gene delivery to the central nervous system (CNS). However, after systemic injection, the neurotropism of the vector has been reported to vary according to age at injection, with greater neuronal transduction in newborns and preferential glial cell tropism in adults. This difference has not yet been reported after cerebrospinal fluid (CSF) delivery. The present study analyzed both neuronal and glial cell transduction in the CNS of cats according to age of AAV9 CSF injection. In both newborns and young cats, administration of AAV9-GFP in the cisterna magna resulted in high levels of motor neurons (MNs) transduction from the cervical (84±5%) to the lumbar (99±1%) spinal cord, demonstrating that the remarkable tropism of AAV9 for MNs is not affected by age at CSF delivery. Surprisingly, numerous oligodendrocytes were also transduced in the brain and in the spinal cord white matter of young cats, but not of neonates, indicating that (i) age of CSF delivery influences the tropism of AAV9 for glial cells and (ii) AAV9 intracisternal delivery could be relevant for both the treatment of MN and demyelinating disorders.

The influence of plate size on meal composition. Literature review and experiment.

Environmental factors, such as the size of containers, can influence our energy intake. Even though different sized food containers are often recommended to control portion sizes, the evidence to support this is contradictory. In the present study, we conducted a literature review and a controlled laboratory experiment to investigate whether plate size influences the composition of a meal and the total meal energy. The results of the review suggest that distraction factors, the type of container, the food-serving mode (self-service or being served) and the type of food offered all influenced the results observed in the various published studies. For the experiment in this study, eighty-three participants were individually invited to serve themselves a lunch from a buffet containing 55 replica food items. Either a standard size plate (27 cm) or a large plate (32 cm) was provided to the participants. The results of the experiment suggest that the plate size had no significant effect on the total energy of the meal (F(1,81) =0.782, P> .05). However, participants using a large plate served themselves significantly more vegetables (F(1,81) =4.786, P< .05), particularly vegetables generally eaten as side dishes (F(1,81) =6.804, P< .05). Therefore, reducing the plate size does not seem to be an appropriate intervention to reduce the total energy intake in order to promote weight loss. Rather, using a large plate might be a simple and inexpensive strategy to increase vegetable consumption.

Fruit for dessert. How people compose healthier meals.

The present study assessed whether factual nutritional information on portion sizes helps consumers to select healthier meals. 124 people were invited to serve themselves lunch from a 'fake food buffet' containing 55 replica food items. Participants in the control group were instructed to serve themselves a meal, as they would normally eat from the given selections (control). Participants in the second condition were asked to select a healthy, balanced meal (instruction). People in the third group were also instructed to select a healthy meal, but in addition, they received nutrition information (instruction+information). The results suggest that participants in the instruction and instruction+information condition chose fewer sweets and desserts (F((2,121))=6.91, P<.05) but more fruits (F((2,121))=5.16, P<.05). This led to overall healthier meals than in the control group. All other food categories, including vegetables, were not altered. No difference was found between the two experimental groups. The results indicate that factual nutrition information does not help consumers compose healthier meals.

The fake food buffet - a new method in nutrition behaviour research.

Experimental research in behavioural nutrition is often limited by practical applicability. In the present study, we assess the reproducibility and validity of a new experimental method using food replicas. A total of fifty-seven people were invited on two separate occasions with an interval of 2 weeks to serve themselves a meal from a fake food buffet (FFB) containing replica carrots, beans, pasta and chicken. The external validity of the FFB was assessed in a second study by comparing meals served from replica foods (beans, pasta, chicken) with meals served from a corresponding real food buffet (RFB). For the second study, forty-eight participants were invited on two separate occasions; first to serve themselves a meal from the FFB or an RFB and 2 weeks later from the other buffet. The amounts of food items served and (theoretical) energy content were compared. Correlation coefficients between the amounts of fake foods served were 0·77 (95 % CI 0·68, 0·86) for chicken, 0·79 (95 % CI 0·68, 0·87) for carrots, 0·81 (95 % CI 0·69, 0·89) for beans and 0·89 (95 % CI 0·82, 0·93) for pasta. For the FFB meal and the RFB meal, the correlations ranged between 0·76 (95 % CI 0·73, 0·91) for chicken and 0·87 (95 % CI 0·77, 0·92) for beans. The theoretical energy of the fake meal was 132 kJ (32 kcal) lower compared to the energy of the real meal. Results suggest that the FFB can be a valuable tool for the experimental assessment of relative effects of environmental influences on portion sizes and food choice under well-controlled conditions.

Kinefold web server for RNA/DNA folding path and structure prediction including pseudoknots and knots.

The Kinefold web server provides a web interface for stochastic folding simulations of nucleic acids on second to minute molecular time scales. Renaturation or co-transcriptional folding paths are simulated at the level of helix formation and dissociation in agreement with the seminal experimental results. Pseudoknots and topologically 'entangled' helices (i.e. knots) are efficiently predicted taking into account simple geometrical and topological constraints. To encourage interactivity, simulations launched as immediate jobs are automatically stopped after a few seconds and return adapted recommendations. Users can then choose to continue incomplete simulations using the batch queuing system or go back and modify suggested options in their initial query. Detailed output provide (i) a series of low free energy structures, (ii) an online animated folding path and (iii) a programmable trajectory plot focusing on a few helices of interest to each user. The service can be accessed at http://kinefold.curie.fr/.

Fracture of the stem of the femoral component after resurfacing arthroplasty of the hip.

Resurfacing arthroplasties of the hip are being undertaken with increasing frequency and the complications associated with this procedure are well documented. We have encountered a further problem with a fracture of the centralising peg of the femoral component in a prosthesis which had been in situ for three years.

Measuring practical knowledge about balanced meals: development and validation of the brief PKB-7 scale.

BACKGROUND/OBJECTIVES: As a high-quality diet is associated with a lower risk for several diseases and all-cause mortality, current nutrition education tools provide people with information regarding how to build a healthy and a balanced meal. To assess this basic nutrition knowledge, the research aim was to develop and validate a brief scale to measure the Practical Knowledge about Balanced meals (PKB-7). SUBJECTS/METHODS: A pool of 25 items was pretested with experts and laypeople before being tested on a random sample in Switzerland (n=517). For item selection, a Rasch model analysis was applied. The validity and reliability of the new scale were assessed by three additional studies including laypeople (n=597; n=145) and nutrition experts (n=59). RESULTS: The final scale consists of seven multiple-choice items, which met the assumptions of the Rasch model. The validity of the new scale was shown by several aspects: the Rasch model was replicated in a second study, and nutrition experts achieved significantly higher scores than laypeople (t(148)=20.27, P<0.001, d=1.78). In addition, the PKB-7 scale was correlated with other nutrition-related constructs and associated with reported vegetable consumption. Test-retest reliability (r=0.68, P<0.001) was acceptable. CONCLUSIONS: The PKB-7 scale is a reliable and a valid Rasch-based instrument in Swiss citizens aged between 18 and 80 years for measuring the practical knowledge about balanced meals based on current dietary guidelines. This brief and easy-to-use scale is intended for application in both research and practice.

Mechanisms and immediate and long-term results of adjunct directional coronary atherectomy after rotational atherectomy.

OBJECTIVES: The purpose of this study was to confirm the mechanisms and the immediate and long-term results of rotational atherectomy and adjunct directional coronary atherectomy. BACKGROUND: Rotational atherectomy is best suited for treating calcific stenoses, but the ability of rotational atherectomy alone to optimize lumen dimensions in large vessels is limited; this is only partly improved by adjunct balloon angioplasty. METHODS: We treated 165 lesions in 163 patients by use of rotational atherectomy and adjunct directional coronary atherectomy. Quantitative angiography and intravascular ultrasound were used for lesion analysis. A matched comparison with 208 lesions treated with rotational atherectomy and adjunct coronary angioplasty was performed. Patients were then followed up for at least 9 months, and target-lesion revascularization was assessed. RESULTS: In the 61 lesions imaged sequentially, lumen area increased from 1.7 +/- 0.8 (mean +/- 1 SD) to 3.9 +/- 1.1 mm(2) after rotational atherectomy, owing to a decrease in plaque plus media area from 16.8 +/- 5.0 to 15.2 +/- 5.2 mm(2) (both p < 0.0001). After adjunct directional coronary atherectomy, lumen area increased even more to 6.7 +/- 2.0 mm(2) (vs. 5.1 +/- 1.4 mm(2) after adjunct coronary angioplasty, p < 0.0001) as a result of both vessel expansion (18.8 +/ 5.3 to 20.8 +/- 5.7 mm(2)) and additional plaque removal (to 14.1 +/- 5.0 mm(2), all p < 0.0001). The total arcs of calcium decreased from 207 +/- 107 degrees to 166 +/- 93 degrees after rotational atherectomy and to 145 +/- 87 degrees after directional coronary atherectomy. Overall, procedural success was 96%, and final diameter stenosis was 15 +/- 17%. Target-lesion revascularization was 23%. The only independent predictor of target-lesion revascularization was a larger overall atherectomy index (84% vs. 59%, p = 0.048). CONCLUSIONS: There is a synergistic relationship between rotational atherectomy and directional coronary atherectomy in the treatment of calcific lesions. The immediate results show a high procedural success--lumen dimensions were larger and late target-lesion revascularization was lower in lesions treated with rotational atherectomy and directional coronary atherectomy than in those treated with rotational atherectomy and adjunct balloon angioplasty.

Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study.

OBJECTIVES: This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses. BACKGROUND: Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro. METHODS: Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel lesions in 1,442 patients. Target lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value +/- SD. RESULTS: Overall, 1,043 lesions contained target lesion calcium (72%); the arc of target lesion calcium was 110 +/- 109 degrees. Lesions with an ultrasound plaque burden > 0.75 or an angiographic diameter stenosis > 0.25 had a prevalence of calcium of at least 65%, with a mean arc > 100 degrees. Intermediate lesions had as much target lesion calcium as did angiographically severe lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of target lesion calcium (all p < 0.0001). CONCLUSIONS: Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable lesion subsets.

Atherosclerosis in angiographically "normal" coronary artery reference segments: an intravascular ultrasound study with clinical correlations.

OBJECTIVES: This study evaluated the magnitude, patterns and clinical correlates of atherosclerosis in angiographically "normal" reference segments in patients undergoing transcatheter therapy for symptomatic coronary artery disease. BACKGROUND: Pathologic studies indicate that the extent of coronary atherosclerosis is underestimated by visual analysis of angiographically normal coronary artery segments. Intravascular ultrasound allows detailed, high quality cross-sectional imaging of the coronary arteries in vivo. METHODS: Intravascular ultrasound was used to study angiographically normal coronary artery reference segments in 884 patients evaluated for transcatheter therapy for symptomatic native coronary artery disease. The reference segment was the most visually normal intravascular ultrasound cross section within 10 mm proximal to the target lesion but distal to any major side branch. Results are presented as mean value +/- 1 SD. RESULTS: Only 60 (6.8%) of 884 angiographically normal reference segments were normal by intravascular ultrasound. Reference segment percent cross-sectional narrowing measured 51 +/- 13% and correlated poorly with the target lesion percent cross-sectional narrowing (r = 0.166, p < 0.0001). Reference segments contained less calcific and dense fibrotic plaque and proportionately more soft plaque elements. Independent predictors of reference segment percent cross-sectional narrowing were male gender, patient age, diabetes mellitus, hypercholesterolemia and presence of multivessel disease. Independent predictors of reference segment calcification were patient age and serum creatinine levels. Reference segment percent cross-sectional narrowing in 723 patients undergoing transcatheter therapy was similar to that in patients studied for diagnostic purposes; however, reference segment arc of calcium was greater in treated patients (43 +/- 81 vs. 25 +/- 57, p = 0.015). Reference segment disease was not an independent predictor of subsequent angiographic restenosis or clinical events within 12 months of follow-up. CONCLUSIONS: Atherosclerosis is ubiquitous in angiographically normal coronary artery reference segments. Reference segment disease parallels the severity of target lesion disease and is associated with many of the conventional risk factors for coronary artery disease. Because of its sensitivity in detecting atherosclerosis in angiographically normal reference segments, intravascular ultrasound should enhance the study of risk factors for atherosclerosis and the results of therapies to control disease progression.

[Erectile dysfunction in men in their second half of life]. / Erektile Dysfunktion bei Männern in der zweiten Lebenshälfte.

BACKGROUND: Studies to date on the prevalence of erectile dysfunction (ED) report varying results. The present study investigates the frequency and degree of ED, its determining factors as well as the help-seeking behavior of the patients. PATIENTS AND METHODS: A random sample of 628 Swiss men (mean age: 61.5 years) were examined by questionnaire regarding their sexual functioning, comorbidity, and help-seeking behavior. RESULTS: Of the respondents, 9.6% reported complete, 18.0% moderate, and 41.4% minimal ED. All grades of the disorder increased with age and correlated with somatic and psychiatric comorbidity as well as with drug intake. Only 3.2% reported having used drugs for improvement of erectile functioning. CONCLUSION: Only a small number of men suffering from ED seek the help of a doctor. Considering the efficacy of PDE5 inhibitors, objective information and competent medical counseling of ED patients are indicated.

Comparison of men versus women in cross-sectional area luminal narrowing, quantity of plaque, presence of calcium in plaque, and lumen location in coronary arteries by intravascular ultrasound in patients with stable angina pectoris.

Women have an increased mortality after coronary interventions compared with men, which may be partly explained by differences in comorbid clinical conditions. However, whether women also have quantitative differences in coronary atherosclerosis is not known. Preinterventional intravascular ultrasound (IVUS) was used to study de novo, nonostial native coronary lesions in 169 women and 549 men with chronic angina. The external elastic membrane (EEM), lumen, and plaque + media (P + M) areas, plaque burden, plaque eccentricity, and calcium were measured at the target lesion and at a proximal reference site. All cross-sectional IVUS measures were also corrected for body surface area. Results are reported as mean +/- 1 SD. Women had significantly smaller reference site EEM (16.5 +/- 5.3 vs 19.4 +/- 6.3 mm2, p <0.0001), lumen (8.7 +/- 3.0 vs 9.9 +/- 4.0 mm2, p = 0.0020), and P + M areas (7.8 +/- 3.7 vs 9.5 +/- 4.2 mm2, p = 0.0001). Women also had significantly smaller lesion site EEM (16.2 +/- 5.9 vs 18.3 +/- 6.7 mm2, p = 0.0028), lumen (2.4 +/- 1.7 vs 2.9 +/- 2.6 mm2, p = 0.0273), and P + M areas (13.6 +/- 5.7 vs 15.3 +/- 6.4 mm2, p = 0.0112). However, when corrected for BSA, these differences were no longer significant. Women and men also had similar reference and lesion plaque burden, eccentricity, and calcium. Preinterventional IVUS analysis failed to detect any quantitative or qualitative differences in coronary atherosclerosis in men compared with women.

Clinical and angiographic outcome after directional coronary atherectomy. A qualitative and quantitative analysis using coronary arteriography and intravascular ultrasound.

To assess clinical and angiographic outcome after directional coronary atherectomy, the clinical course of 306 patients undergoing this procedure was reviewed. Directional atherectomy was successful in 290 (94.8%) procedures; complications developed in 8 (2.6%) patients. After atherectomy, percent diameter stenosis was reduced from 71 +/- 14 to 14 +/- 14% (p < 0.001) and minimal lumen diameter was increased from 0.87 +/- 0.42 to 2.55 +/- 0.57 mm (p < 0.001). In 128 (42%) patients, adjunct balloon angioplasty was performed to treat either complications or a residual stenosis > 30%. Intravascular ultrasound was also performed in 57 patients after directional atherectomy and demonstrated that a significant amount of residual plaque mass remained in lesions with a calcium arc > or = 90 degrees (17 +/- 5 mm2 vs 12 +/- 5 mm2 in lesions without calcium; p = 0.007). During the 11 +/- 6 month follow-up period, 69 (28.3%) patients developed recurrent clinical events (death, 5; Q wave myocardial infarction, 8; coronary bypass surgery, 31; coronary angioplasty, 36). Using a proportional hazards model, independent predictors of late clinical events included diabetes mellitus (relative risk [RR] = 1.95; p < 0.05), unstable angina (RR = 2.78; p < 0.005) and a prior history of restenosis (RR = 2.21; p < 0.01). We conclude that directional atherectomy is associated with high procedural success rates and infrequent complications in selected lesions subsets, although the degree of plaque resection may be limited if extensive calcium is present. Late clinical events develop in some (28%) patients after directional atherectomy, related to certain preprocedural clinical risk factors.