Serial analysis of the malapposed and uncovered struts of the new generation of everolimus-eluting bioresorbable scaffold with optical coherence tomography

The aim of this study is to assess the serial changes in strut apposition and coverage of the bioresorbable vascular scaffolds (BVS) and to relate this with the presence of intraluminal masses at 6 months with optical coherence tomography (OCT).

Delayed coverage in malapposed and side-branch struts with respect to well-apposed struts in drug-eluting stents: in vivo assessment with optical coherence tomography

Background—Pathology studies on fatal cases of very late stent thrombosis have described incomplete neointimal coverage as common substrate, in some cases appearing at side-branch struts. Intravascular ultrasound studies have described the association between incomplete stent apposition (ISA) and stent thrombosis, but the mechanism explaining this association remains unclear. Whether the neointimal coverage of nonapposed side-branch and ISA struts is delayed with respect to well-apposed struts is unknown. Methods and Results—Optical coherence tomography studies from 178 stents implanted in 99 patients from 2 randomized trials were analyzed at 9 to 13 months of follow-up. The sample included 38 sirolimus-eluting, 33 biolimus-eluting, 57 everolimus-eluting, and 50 zotarolimus-eluting stents. Optical coherence tomography coverage of nonapposed side-branch and ISA struts was compared with well-apposed struts of the same stent by statistical pooled analysis with a random-effects model. A total of 34 120 struts were analyzed. The risk ratio of delayed coverage was 9.00 (95% confidence interval, 6.58 to 12.32) for nonapposed side-branch versus well-apposed struts, 9.10 (95% confidence interval, 7.34 to 11.28) for ISA versus well-apposed struts, and 1.73 (95% confidence interval, 1.34 to 2.23) for ISA versus nonapposed side-branch struts. Heterogeneity of the effect was observed in the comparison of ISA versus well-apposed struts (H=1.27; I2=38.40) but not in the other comparisons. Conclusions—Coverage of ISA and nonapposed side-branch struts is delayed with respect to well-apposed struts in drug-eluting stents, as assessed by optical coherence tomography.

Six-month clinical outcomes following implantation of the bioresorbable everolimus-eluting vascular scaffold in vessels smaller or larger than 2.5 mm

We investigated the 6-month clinical outcomes after implantation of second-generation 3.0-mm bioresorbable everolimus-eluting vascular scaffolds (BVS) in small coronary vessels (<2.5 mm).

Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial

Aims To compare the tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent (ZES) vs. a fluoropolymer-coated everolimus-eluting stent (EES) at 13 months, using optical coherence tomography (OCT) in an ‘all-comers' population of patients, in order to clarify the mechanism of eventual differences in the biocompatibility and thrombogenicity of the devices. Methods and results Patients randomized to angiographic follow-up in the RESOLUTE All Comers trial (NCT00617084) at pre-specified OCT sites underwent OCT follow-up at 13 months. Tissue coverage and apposition were assessed strut by strut, and the results in both treatment groups were compared using multilevel logistic or linear regression, as appropriate, with clustering at three different levels: patient, lesion, and stent. Fifty-eight patients (30 ZES and 28 EES), 72 lesions, 107 stents, and 23 197 struts were analysed. Eight hundred and eighty-seven and 654 uncovered struts (7.4 and 5.8%, P= 0.378), and 216 and 161 malapposed struts (1.8 and 1.4%, P= 0.569) were found in the ZES and EES groups, respectively. The mean thickness of coverage was 116 ± 99 µm in ZES and 142 ± 113 µm in EES (P= 0.466). No differences in per cent neointimal volume obstruction (12.5 ± 7.9 vs. 15.0 ± 10.7%) or other areas–volumetric parameters were found between ZES and EES, respectively. Conclusion No significant differences in tissue coverage, malapposition, or lumen/stent areas and volumes were detected by OCT between the hydrophilic polymer-coated ZES and the fluoropolymer-coated EES at 13-month follow-up.

Vascular tissue reaction to acute malapposition in human coronary arteries: sequential assessment with optical coherence tomography

The vascular tissue reaction to acute incomplete stent apposition (ISA) is not well known. The aim of this study was to characterize the vascular response to acute ISA in vivo and to look for predictors of incomplete healing.

Erhöhung der Achtsamkeit durch Taiji-Training - Ergebnisse aus einer randomisierten Warteliste-kontrollierten Studie mit gesunden Versuchspersonen

Hintergrund: Taiji ist eine meditative Bewegungsform mit Ursprung in den chinesischen Kampfkünsten. In mehreren Studien konnten positive Effekte von Taiji auf das psychische und körperliche Wohlbefinden nachgewiesen werden. Eine mögliche Wirkkomponente von Taiji könnte die Förderung von Achtsamkeit sein. Studienergebnisse, welche eine Verbesserung der Körperwahrnehmung durch Taiji nahe legen, stützen diese Annahme. Mit der vorliegenden Arbeit wurde untersucht, inwiefern sich Taiji auf die allgemeine Achtsamkeit im Sinne eines erweiterten multidimensionalen Konzeptes als auch auf den achtsamen Umgang mit sich selbst in belastenden Situationen auswirkt. Methoden: 70 gesunde Versuchspersonen wurden randomisiert einer Taiji-Interventionsgruppe oder zu einer Warteliste-Kontrollgruppe zugeteilt. Die Interventionsgruppe erhielt während drei Monaten zweimal wöchentlich je eine Stunde Taiji-Unterricht. Die allgemeine Achtsamkeit wurde mittels dem Freiburger Fragebogens zur Achtsamkeit (FFA-Kurzform), die Achtsamkeit in belastenden Situationen wurde über die Subskala „Achtsamkeit“ der Self-Compassion-Scale (SCS) vor Beginn und nach Beendigung der Intervention gemessen. Resultate: Die Interventionsgruppe (N=28) wies nach Kursende im Vergleich zur Kontrollgruppe (N=31) einen signifikanten Anstieg der Achtsam-keitswerte im FFA (F(1, 34.70) = 4.29, p = 0.043) und in der SCS-Subskala (F(1, 3.58) = 4.62, p = 0.036) auf. Schlussfolgerung: Die gegenwärtigen Studienergebnisse sprechen dafür, dass bei gesunden Personen Achtsamkeit im Allgemeinen als auch in schwierigen Lebenslagen durch das Üben von Taiji gefördert werden kann.

Flow experience during Taiji practice - an oberservational study in healthy subjects

Background: Taiji is a mind-body practice, characterised by gentle and mindful body movements originating from Chinese martial arts. Studies investigating the reasons why people engage into Taiji and maintain their practice routine have emphasised extrinsic motivational outcome related aspects. The relevance of intrinsic motivation (i.e. motivation that comes from inside an individual and is driven by an interest or enjoyment in the performed activity itself) has not yet been examined. The autotelic aspect of intrinsic motivation is an essential precondition for experiencing flow, a state where subjects fully immersed into the performance of an activity report to be highly concentrated, optimally challenged and in control of the action. The aim of our study was to assess to which degree flow was experienced in the course of a 3 month Taiji-beginners class and to examine the relationship between the degree of flow experience at the end of the course and the Taiji practice behaviour. Materials and Methods: 28 healthy subjects participated in a Taiji beginners course (2 x 1h per week for 3 months). Flow values were measured at week 1, 6 and 12 by using the Flow-Kurz-Skala (FKS) questionnaire. Data were analysed by using ANOVA with repeated measurements, students t-Tests for comparison with normative values, and pearson correlation coefficients were calculated. Results: In the course of the 12 weeks Taiji training, mean flow values increased continuously (F(1.34, 8.92) = 19.49; p < .001). The mean value for experienced flow during Taiji practice at week 12 (M = 5.54; SD = ±.77) was significantly above the norm value (t = 3.705; df = 27; p < .01). Since average course attendance rate was high (86.8 %), a ceiling effect is assumed, thus flow values did not correlate with course adherence (r = .236; p = .227). However, a significant correlation was found between flow values at week 12 and practice at home (r = .439; p < .05). Conclusion: Our findings emphasise the potential value of intrinsic motivational aspects inherent in Taiji practice for developing a regular practice routine. The impact of increased flow experience on health related outcome measures, and its relevance in clinical trials is subject of further research.

Similarities and differences between physician and non-physician acupuncturists in using diagnostic methods - an explorative study

Purpose: Acupuncture is one of the complementary medicine therapies with the greatest demand in Switzerland and many other countries in the West and in Asia. Over the past decades, the pool of scientific literature in acupuncture has markedly increased. The diagnostic methods upon which acupuncture treatment is based, have only been addressed sporadically in scientific journals. The goal of this study is to assess the use of different diagnostic methods in the acupuncture practices and to investigate similarities and differences in using these diagnostic methods between physician and non-physician acupuncturists. Methods: 44 physician acupuncturists with certificates of competence in acupuncture – traditional chinese medicine (TCM) from ASA (Assoziation Schweizer Ärztegesellschaften für Akupunktur und Chinesische Medizin: the Association of Swiss Medical Societies for Acupuncture and Chinese Medicine) and 33 non-physician acupuncturists listed in the EMR (Erfahrungsmedizinisches Register: a national register, which assigns a quality label for CAM therapists in complementary and alternative medicine) in the cantons Basel-Stadt and Basel-Land were asked to fill out a questionnaire on diagnostic methods. The responder rate was 46.8% (69.7% non-physician acupuncturists and 29, 5% physician acupuncturists). Results: The results show that both physician and non-physician acupuncturists take patients’ medical history (94%), use pulse diagnosis (89%), tongue diagnosis (83%) and palpation of body and ear acupuncture points (81%) as diagnostic methods to guide their acupuncture treatments. Between the two groups, there were significant differences in the diagnostic tools being used. Physician acupuncturists do examine their patients significantly more often with western medical methods (p<.05) than this is the case for nonphysician acupuncturists. Non-physician acupuncturists use pulse diagnosis more often than physicians (p<.05). A highly significant difference was observed in the length of time spent with collecting patients’ medical history, where nonphysician acupuncturists clearly spent more time (p<.001). Conclusion: Depending on the educational background of the acupuncturist, different diagnostic methods are used for making the diagnosis. Especially the more time consuming methods like a comprehensive anamnesis and pulse diagnosis are more frequently employed by non-physician practitioners. Further studies will clarify if these results are valid for Switzerland in general, and to what extent the differing use of diagnostic methods has an impact on the diagnosis itself and on the resulting treatment methods, as well as on the treatment success and the patients’ satisfaction.

Taiji practice attenuates psychobiological stress reactivity - A randomized controlled trial in healthy subjects

Background: Stress reducing effects of Taiji, a mindful and gentle form of body movement, have been reported in previous studies, but standardized and controlled experimental studies are scarce. The present study investigates the effect of regular Taiji practice on psychobiological stress response in healthy men and women. Methods: 70 participants were randomly assigned to either Taiji classes or a waiting list. After 3 months, 26 (8 men, 18 women) persons in the Taiji group and 23 (9 men, 14 women) in the waiting control group underwent a standardized psychosocial stress test combining public speaking and mental arithmetic in front of an audience. Salivary cortisol and α-amylase, heart rate, and psychological responses to psychosocial stress were compared between the study groups. (ClinicalTrials.gov number, NCT01122706.) Results: Stress induced characteristic changes in all psychological and physiological measures. Compared to controls, Taiji participants exhibited a significantly lower stress reactivity of cortisol (p = .028) and heart rate (p = .028), as well as lower α-amylase levels (p = .049). They reported a lower increase in perceived stressfulness (p = .006) and maintained a higher level of calmness (p = .019) in response to psychosocial stress. Conclusion: Our results consistently suggest that practicing Taiji attenuates psychobiological stress reactivity in healthy subjects. This may underline the role of Taiji as a useful mind–body practice for stress prevention.