Data from the ILUMIEN II trial found that guidance from optimal coherence tomography (OCT) was associated with comparable stent expansion as guidance from intravascular ultrasound (IVUS) in patients undergoing percutaneous coronary intervention (PCI). Coronary stents must be optimally deployed with full lesion coverage and complete stent expansion to optimize outcomes. Less than full expansion can result in stent thrombosis or restenosis. Previous studies have found that the strongest predictor of stent thrombosis and restenosis is the minimum stent area (MSA) achieved after PCI.
Advanced imaging techniques, such as IVUS and OCT, help cardiologists to measure, place, and expand the stent with optimal precision. By achieving greater stent luminal dimensions, IVUS-guidance has been associated with improved event-free survival compared to angiographic guidance alone. Compared to IVUS, OCT has superior resolution but does not penetrate as deeply into the arterial wall. Consequently it has limitations in assessing the true diameter of the native artery. It is unknown whether stent expansion, a surrogate of clinical outcomes, is as great with OCTguidance as with IVUS-guidance.
ILUMIEN II was a prospectively planned, retrospective comparison of OCT-guidance in ILUMIEN I and IVUS-guidance in ADAPT-DES. The overall study population initially included a total of 940 patients (one lesion randomly chosen per patient; 354 from ILUMIEN I and 586 from ADAPTDES). Aft er 1:1 propensity matching, 286 patients/lesions from each group were analyzed (n=572).Both the OCT and IVUS analyses were performed by the CRF Clinical Trials Center.
The primary endpoint was post-PCI stent expansion (%) defined as the minimum stent area (MSA) divided by the mean reference lumen area as assessed by OCT in ILUMIEN I and by IVUS in ADAPT-DES. The secondary endpoints were the following IVUS and OCT core lab measures:
Mean stent expansion (defined as stent volume/stent length divided by the mean reference lumen area);
Prevalence of major edge dissection (≥3 mm in length); Prevalence of major stent malapposition (malapposition distance/luminal diameter ≥20%). The secondary endpoint using angiographic core lab measures (independent of technique) was post-PCI mean lumen diameter (MLD), percent diameter stenosis, and acute gain.
The post-PCI stent expansion was 72.8% [63.3, 81.3] in the OCT-guided group compared to 70.6% [62.3, 78.8] in the IVUSguided group (p=0.29). Similar rates of major stent edge dissection (2.4% vs. 1.0%, p=0.29) and major stent malapposition (1.4% vs. 0.7%, p=0.69) occurred in both groups.

Spinal manipulation involves applying force to move joints as a way of treating pain. A new study shows that the technique works for some patients with low-back pain but not for others.

Depending on whom you ask or what scientific paper you read last, spinal manipulation is either a mercifully quick, effective treatment for low-back pain or a complete waste of time.

Researchers at the University of Alberta have found that spinal manipulation

ESC Guidelines published on infective endocarditis boost the role of imaging in diagnosis of this deadly disease.

Scientists have developed a technique that could lead to therapies for pain relief in people with intractable pain, potentially including cancer-related pain.

A team of scientists at Kyoto University’s Institute for Integrated Cell-Material Sciences (iCeMS) has developed a novel technique using tiny gold rods to target pain receptors.

Gold nanorods are tiny rods that are 1-100 nanometers wide and long. In comparison, a human hair is 100,000 nanometers wide. The team coated gold nanorods with a special type of protein that transports fat within the body known as a lipoprotein. This allowed the nanorods to bind efficiently to nerve cell membranes bearing a pain receptor called TRPV1 (transient receptor potential vanilloid type 1). Near-infrared light was then applied to the nanorod-coated pain receptors. The nanorods heated up, activating the pain receptors to allow an influx of calcium ions through the membrane. Prolonged activation of TRPV1 is known to subsequently lead to their desensitization, bringing pain relief. Importantly, heating the gold nanorods enabled safe activation of the TRPV1 pain receptors alone, without affecting the membrane in which they lie.

Previous studies had shown that magnetic nanoparticles (tiny particles in the nano-range made out of magnetic materials) are also able to activate TRPV1 receptors by applying a magnetic field. The target cells in this method, however, require genetic modification for it to work. Using lipoprotein-coated gold nanorods does not require genetic modification of the target cells. Also, the nanorods were found to have at least 1,000 times greater efficiency than magnetic nanoparticles in heat generation and in activating TRPV1 receptors.

‘The gold nanorods can be retained in the body for a prolonged period,’ says Tatsuya Murakami, the principal investigator of this study. ‘Local injection of our gold nanorods might enable repetitive and on-demand treatment for people experiencing intractable pain because prior genetic engineering of the target cells is unnecessary.’ Kyoto University iCeMS

A recent study found that cervical cancer patients without enlarged lymph nodes could benefit from SPECT-MRI imaging of their sentinel lymph nodes (SLNs) to assess whether metastases are present.

Cervical cancer is the fourth most common cancer in women worldwide, with more than 500,000 new cases globally each year. According to a 2014 University of Maryland study, cervical cancer affects 18.6 women per 100,000 in the United States. Early diagnosis is critical. Although surgical removal and examination of the sentinel lymph nodes remains the most accurate way to determine whether the cancer has spread to the lymph nodes, SPECT-MRI imaging may reduce false negative MRI findings in early-stage patients and potentially save some from invasive diagnostic procedures.

Researchers at the University Medical Center Utrecht, Netherlands, used Tc-99m-nanocolloid SPECT-MRI fusion for the assessment of SLNs (for size and absence of sharp demarcation) in patients with early-stage cervical cancer.

 Jacob P. Hoogendam, MD, the corresponding author of the study, notes,