Clinical outcomes after heterogeneous overlap stenting with drug-eluting stents and bare-metal stents for de novo coronary artery narrowings.

When it is difficult to deliver multiple drug-eluting stents (DES) or when size constraints limit DES implantation, bare-metal stents (BMS) may be implanted contiguous to DES. However, the clinical outcomes after overlapping DES and BMS implantation are not known. From September 2004 to June 2006, 4,872 consecutive patients who underwent percutaneous coronary intervention consented to be enrolled in a prospective registry. Of these patients, 44 (0.9%) with de novo lesions were treated with DES and BMS overlap stenting. All patients were followed to 12 months for the assessment of clinical outcomes. The average implanted stent diameter was 2.68 +/- 0.30 mm for DES and 2.35 +/- 0.38 mm for BMS. Overlapping BMS were implanted distal to DES in all but 1 case. One patient (2.3%) experienced acute stent thrombosis and died 2 days after the procedure. No other patient died or had a myocardial infarction during 12 months. The target vessel revascularization rate at 12 months, however, was 31.8%, mainly driven by diffuse in-stent restenosis in the BMS segments. In conclusion, the incidence of DES and BMS overlap stenting is rare in daily practice, but this procedure is associated with a high rate of target vessel revascularization.

Comparación entre manguera difusora y tubería PVC para la aireación en la producción de Litopenaeus vannamei con biofloc a diferentes niveles de proteína / Comparison between diffuser hose and PVC pipe for aeration in production of Litopenaeus vannamei with biofloc at different protein levels / Comparação entre mangueira difusora e tubo de PVC para aeração na produção de Litopenaeus vannamei com bioflocos em diferentes níveis de proteína

Resumen Al implementar la tecnología biofloc, la aireación es uno de los problemas para obtener buenos resultados productivos, por tanto, el objetivo fue comparar la eficiencia de la tubería PVC y manguera difusora, como sistema de aireación en cultivos con biofloc y dos niveles de proteína. Se aplicó un diseño completamente al azar con arreglo factorial con cuatro tratamientos, tres réplicas cada uno, con los dos sistemas de aireación y dos niveles de proteína bruta (PB) en el alimento balanceado en producciones de camarón Litopenaeus vannamei, distribuidos de la siguiente manera: para el tratamiento uno (T1) se utilizó tubería PVC y 28% de PB; para T2, manguera difusora y 22% de PB; para T3, manguera difusora y 28% de PB; para T4, tubería PVC y 22% de PB, todos producidos con biofloc. Las variables peso, talla, alimentación y el factor tratamiento influencian significativamente en la concentración de oxígeno disuelto (OD, mg/l) en la tarde, T1 es el que mejor se comportó en la tarde y T3 en la mañana. El tratamiento con menor sedimentación a los 20 y 30 minutos en la prueba de cono Imhoff fue T4 y el de mayor sedimentación fue el T3. No hubo diferencia significativa en la supervivencia entre tratamientos, los niveles de proteína sí influencian en las concentraciones del OD. El uso de tubería PVC aporta en el incremento de peso y de la concentración de OD en relación al sistema de manguera difusora con el 22% y 28% de proteína bruta.

Abstract When implementing biofloc technology, aeration is one of the problems to obtain good productive results, therefore, the objective was to compare the efficiency of PVC pipe and diffuser hose, as an aeration system in crops with biofloc and two levels of protein. A completely randomized design with factorial arrangement was applied with four treatments with three replicates each, with the two aeration systems and with two levels of crude protein (CP) in the balanced feed in Litopenaeus vannamei shrimp productions, distributors of the following way, for treatment one (T1) PVC pipes and 28% PB were achieved; for T2, diffuser hose and 22% PB; for T3, diffuser hose and 28% PB; for T4, PVC pipe and 22% PB, produced with biofloc. The variables weight, height, feeding and the treatment factor significantly influence the concentration of dissolved oxygen (DO, mg/l) in the afternoon. T1 is the one that behaves best in the afternoon and T3 in the morning, the treatment with the lowest sedimentation at 20 and 30 minutes in the Imhoff cone test was T4 and the highest sedimentation was T3. There was no significant difference in survival between treatments, protein levels did influence OD concentrations. The use of PVC pipe provides an increase in weight and DO concentration in relation to the diffuser hose system with 22% and 28% crude protein.

Resumo Ao implementar a tecnologia de bioflocos, a aeração é um dos problemas para obter bons resultados produtivos, portanto, objetivou-se comparar a eficiência do tubo de PVC e da mangueira difusora, como sistema de aeração em lavouras com bioflocos e dois níveis de proteína. Foi aplicado um delineamento inteiramente casualizado com arranjo fatorial com quatro tratamentos com três repetições cada, com os dois sistemas de aeração e com dois níveis de proteína bruta (PB) na ração balanceada em produções de camarão Litopenaeus vannamei, distribuidores da seguinte forma, para tratamento com tubo de PVC (T1) e PB de 28%; para T2, mangueira difusora e PB 22%; para T3, mangueira difusora e PB 28%; para T4, tubo de PVC e PB 22%, produzido com biofloco. As variáveis peso, altura, alimentação e o fator de tratamento influenciam significativamente na concentração de oxigênio dissolvido (OD, mg/l) no período da tarde, T1 é o que apresenta melhor desempenho no período da tarde e T3 no período da manhã, tratamento com menor sedimentação aos 20 e 30 minutos no teste do cone de Imhoff foi T4 e a maior sedimentação foi T3. Não houve diferença significativa na sobrevivência entre os tratamentos, os níveis de proteína influenciaram as concentrações de DO. A utilização de tubo de PVC proporciona um aumento de peso e concentração de OD em relação ao sistema de mangueiras difusoras com 22% e 28% de proteína bruta.

Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents.

OBJECTIVES: This study sought to assess the impact of intravascular ultrasound (IVUS)-guided versus angiography-guided drug-eluting stent (DES) implantation. BACKGROUND: There are limited data on IVUS guidance in the DES era. Therefore, we investigated the impact of IVUS guidance on clinical outcomes in the MATRIX (Comprehensive Assessment of Sirolimus-Eluting Stents in Complex Lesions) registry. METHODS: The MATRIX registry prospectively enrolled consecutive, unselected patients treated with sirolimus-eluting stents (SES) (n = 1,504); 631 patients (42%) underwent IVUS-guided stenting, and 873 (58%) had only angiographic guidance. We assessed 30-day, 1-year, and 2-year rates of death/myocardial infarction (MI), major adverse cardiac events (cardiac death, MI, or target vessel revascularization), and definite/probable stent thrombosis in 548 propensity-score matched patient pairs. RESULTS: After matching, baseline and angiographic characteristics were similar in IVUS and no-IVUS groups. Patients in the IVUS group had significantly less death/MI at 30 days (1.5% vs. 4.6%, p < 0.01), 1 year (3.3% vs. 6.5%, p < 0.01), and 2 years (5.0% vs. 8.8%, p < 0.01). Patients in the IVUS group had significantly less major adverse cardiac events at 30 days (2.2% vs. 4.8%, p = 0.04) and numerically less major adverse cardiac events at 1 year (9.1% vs. 13.5%, p = 0.07) and 2 years (12.9% vs. 16.7%, p = 0.18). Rates of MI were significantly lower in the IVUS group at 30 days (1.5% vs. 4.0%, p < 0.01), 1 year (1.8% vs. 4.8%, p < 0.01), and 2 years (2.1% vs. 5.7%, p < 0.01). CONCLUSIONS: IVUS-guided stent implantation appears to be associated with a reduction in both early and long-term clinical events. Further investigation in randomized controlled trials is warranted.