[신간의 별자리x] 우리/미술, 그리고 ‘슬픔의 박물관’

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

BACKGROUND: The need for repeated treatment of restenosis of a treated vessel remains the main limitation of percutaneous coronary revascularization. Because sirolimus (rapamycin) inhibits the proliferation of lymphocytes and smooth-muscle cells, we compared a sirolimus-eluting stent with a standard uncoated stent in patients with angina pectoris. METHODS: We performed a randomized, double-blind trial to compare the two types of stents for revascularization of single, primary lesions in native coronary arteries. The trial included 238 patients at 19 medical centers. The primary end point was in-stent late luminal loss (the difference between the minimal luminal diameter immediately after the procedure and the diameter at six months). Secondary end points included the percentage of in-stent stenosis of the luminal diameter and the rate of restenosis (luminal narrowing of 50 percent or more). We also analyzed a composite clinical end point consisting of death, myocardial infarction, and percutaneous or surgical revascularization at 1, 6, and 12 months. RESULTS: At six months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01+/-0.33 mm) than in the standard-stent group (0.80+/-0.53 mm, P<0.001). None of the patients in the sirolimus-stent group, as compared with 26.6 percent of those in the standard-stent group, had restenosis of 50 percent or more of the luminal diameter (P<0.001). There were no episodes of stent thrombosis. During a follow-up period of up to one year, the overall rate of major cardiac events was 5.8 percent in the sirolimus-stent group and 28.8 percent in the standard-stent group (P<0.001). The difference was due entirely to a higher rate of revascularization of the target vessel in the standard-stent group. CONCLUSIONS: As compared with a standard coronary stent, a sirolimus-eluting stent shows considerable promise for the prevention of neointimal proliferation, restenosis, and associated clinical events.

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A Randomized Comparison of a Sirolimus-Eluting Stent with a Standard Stent for Coronary Revascularization

Alice K. Jacobs, MD, FACC, FAHA, Chair 

Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect 

Nancy Albert, PhD, CCNS, CCRN, FAHA

Mark A. Creager, MD, FACC, FAHA

Steven M. Ettinger, MD, FACC

Robert A. Guyton, MD, FACC

Jonathan L. Halperin, MD, FACC, FAHA

Judith S. Hochman, MD, FACC, FAHA

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions

http://www.columbiamedicine.org/education/r/Cardiology/ACS/Plavix/PCI-CURE.pdf

Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.

Objective: To seek an association between total arterial compliance (TAC) and the extent of ischaemia at stress echocardiography. Design: Cohort study. Setting: Regional cardiac centre. Methods: 255 consecutive patients (147 men; mean (SD) age 58 (8)) presenting for stress echocardiography for clinical indications were studied. Wall motion score index (WMSI) was calculated and ischaemia was defined by an inducible or worsening wall motion abnormality. Peak WMSI was used to reflect the extent of dysfunction (ischaemia or scar), and ΔWMSI was indicative of extent of ischaemia. TAC was assessed at rest by simultaneous radial applanation tonometry and pulsed wave Doppler in all patients. Results: Ischaemia was identified by stress echocardiography in 65 patients (25%). TAC was similar in the groups with negative and positive echocardiograms (1.08 (0.41) v 1.17 (0.51) ml/mm Hg, not significant). However, the extent of dysfunction was associated with TAC independently of age, blood pressure, risk factors, and use of a β blocker. Moreover, the extent of ischaemia was determined by TAC, risk factors, and use of a β blocker. Conclusion: While traditional cardiovascular risk factors are strong predictors of ischaemia on stress echocardiography, TAC is an independent predictor of the extent of ischaemia.

https://heart.bmj.com/content/heartjnl/92/1/40.full.pdf

Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography.

The quality of palpograms produced using multi-step averaging is superior compared to those created using a single-step approach. The length of the kernel used in both signal-processing strategies should be chosen carefully, since this will have a direct bearing on the quality of the elasticity images that are produced. Despite the apparent advantage gained when multi-step averaging is employed, this strain estimation approach has the distinct disadvantage of been computationally very demanding, therefore we recommend that in situations were real-time assessment of vessel elasticity is desired that palpograms should be created using the single step approach.

Advancing intravascular palpography towards clinical application

Although side looking intravascular ultrasound (SL-IVUS) imaging systems using single element piezoelectric transducers set the resolution standard in the assessment of the extent of coronary artery disease, improvements in transducer performance are needed to perform harmonic imaging and high resolution imaging of vulnerable plaque. With their small channel count, annular arrays exploiting the inherent broad bandwidth of CMUTs and electronic focusing capability of integrated electronics provide a path for desired SL-IVUS imaging catheters. In this paper, we first describe the design, low temperature fabrication of an 840 mum diameter, 8 element CMUT annular array. Testing of the individual elements in oil shows a uniform device behavior with 100% fractional bandwidth around 20 MHz without including the effects of attenuation and diffraction. We also present linear scan imaging results obtained on wire targets in oil, tissue and tissue mimicking phantoms using both unfocused and dynamically focused transducers. The results for axial and lateral resolution are in agreement predicted by the simulations and show the feasibility of this approach for high resolution SL-IVUS imaging.

2F-2 Annular CMUT Arrays for Side Looking Intravascular Ultrasound Imaging

http://lib.nsmu.ru/student/faculty/department/department_of_surgery/Handbook.pdf

Handbook of Complications during Percutaneous Cardiovascular Interventions

Introduction Quantitative angiographic assessment after balloon angioplasty is a poor predictor of immediate and long-term outcome. However, the measurement of blood flow velocity during angioplasty has been proved clinically useful.

Aims To analyse the value of the maximal stenotic flow velocity and the presence of stenotic flow velocity acceleration (aSV) for the long-term outcome after balloon angioplasty.

Methods and Results Patients undergoing single lesion angioplasty within the DEBATE trial were included. aSV was defined as acceleration in the stenotic coronary flow velocity >50% baseline velocity assessed at a reference site of the target vessel. After balloon angioplasty diameter stenosis, minimal lumen diameter (MLD) and coronary flow velocity reserve were similar between the aSV (n=54) and non-aSV group (n=125). At follow-up, the aSV group had a higher restenosis rate (52% vs 30%, P =0·006) The presence of aSV was the strongest independent predictor of restenosis (OR 3·08, 95% CI 1·35 to 7·05, P =0·008). The best predictive cut-off value of SV was 101cm.s−1 (sensitivity of 46%, specificity of 81%, positive predictive value of 85% and a negative predictive value of 58%).

Conclusion Following angioplasty, SV appears to be exquisitely sensitive to the changes experienced at the treated area without depending on the status of the microcirculation. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

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Stephane Carlier

Papers

Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography.

Advancing intravascular palpography towards clinical application

2F-2 Annular CMUT Arrays for Side Looking Intravascular Ultrasound Imaging

Handbook of Complications during Percutaneous Cardiovascular Interventions

Value of coronary stenotic flow velocity acceleration in prediction of angiographic restenosis following balloon angioplasty.