[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.

/pdf/a-randomized-comparison-of-a-sirolimus-eluting-stent-with-a-3h78nze073.pdf

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.

A 61-year-old man presented with unstable angina (Braunwald class 2B). Coronary angiography revealed a mild lesion on the very proximal segment of the left anterior descending coronary artery (LAD) and a significant stenosis (80%) in the mid-segment. Intracoronary ultrasound was used to further evaluate proximal coronary artery stenosis. It was found to be a soft plaque without significant luminal stenosis but without clear definition of the luminal-intimal boundary.\n\nIntravenous injection of gas-filled microbubble ultrasound contrast agents have been used for endocardial border detection, especially when they are sonicated by acoustic power and …

Images in cardiovascular medicine. Detection of luminal-intimal border and coronary wall enhancement in intravascular ultrasound imaging after injection of microbubbles ans simultaneous sonication with transthoracic echocardiography

Evaluation of acute percutaneous coronary intervention (PCI) results and long-term follow-up remains challenging with ongoing stent designs. Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion, improving overall PCI results and reducing adverse cardiac events. Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results. Digital stent enhancement methods have been well validated and improved stent strut visualization. Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure. With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results. We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.

Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency.

Development and performance of a new unsupervised classifier for IVUS-based tissue characterization

Intracoronary investigations using Doppler-tipped guidewires are now performed routinely to assess the severity of stenosis. Maximal peak velocity and average peak velocity computed on-line are used to this end, but when the quality of the Doppler signal is poor, the contour recognition fails to follow maximal velocity. We describe a system allowing the acquisition of intracoronary raw Doppler signals (I and Q components) with pressures, ECG and other signals for recording and postprocessing. The technique of multiple beats averaging allowed improvement of signal to noise ratio to be obtained. In-vitro experiments on steady and pulsatile flows in small tubes were performed. Influencing factors such as depth of measurements, rotations, and quality of the signal have been investigated. Our system may help collect high quality Doppler signals along with pressures which is useful for coronary blood flow assessment.

Acquisition of raw intracoronary Doppler signal for better characterization of flows

Intravascular ultrasound (IVUS) is a real-time cross-sectional imaging modality deployed in interventional cardiology for assessment of the extent of atherosclerosis. Visual reading of IVUS pull-backs is subject to inter- and intra-observer variability in reporting of vulnerable plaques causing myocardial infraction. In vivo IVUS tissue characterization (TC) aims at augmenting information about the constituent tissues beyond features visible in the log-compressed B-Mode scan by effectively leveraging characteristic ultrasonic backscattered signals acquired during live intervention. The co-located heterogeneity of biological tissues constituting the plaque, the presence of flowing blood and vessel dynamics openly challenge in vivo TC. As a solution, we introduce a framework that first uses a decision forest based classifier that learns to perform TC using tissue specific ultrasonic statistical physics and signal confidence features, from labeled data acquired under controlled in vitro conditions. Next, we adapt this in vitro trained classifier to work under in vivo settings through a novel error-correcting hierarchical transfer relaxation scheme for domain adaptation with few labeled samples. This effectively compensates for the shift in statistical features between in vitro and in vivo settings owed to the presence of flowing blood and vessel dynamic movements. Experiments reveal the ability of the framework to estimate constituents of the plaque reliably under both in vitro and in vivo settings. This framework can be leveraged for promising clinically applications requiring TC and to perform domain adaptation in the presence of few labeled samples.

Stephane Carlier

Papers

Images in cardiovascular medicine. Detection of luminal-intimal border and coronary wall enhancement in intravascular ultrasound imaging after injection of microbubbles ans simultaneous sonication with transthoracic echocardiography

Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency.

Development and performance of a new unsupervised classifier for IVUS-based tissue characterization

Acquisition of raw intracoronary Doppler signal for better characterization of flows

Domain Adapted Model for In Vivo Intravascular Ultrasound Tissue Characterization