4755 Ogletown Stanton Rd Department Of Radiology
Newark DE 19718
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License #: C1-0004350
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Endovascular Management of Acute Pulmonary Embolism Using the Ultrasound-Enhanced EkoSonic System. - Seminars in interventional radiology
Acute, symptomatic pulmonary embolism (PE) in the massive and submassive categories continues to be a healthcare concern with significant risk for increased morbidity and mortality. Despite increased awareness and venous thromboembolism prophylaxis, endovascular treatment is still an important option for many of these patients. There are a variety of techniques and devices used for treating PE, but none have been evaluated as extensively as the EkoSonic endovascular system that is also currently the only FDA-approved device for the treatment of pulmonary embolism. This article describes the use of the EkoSonic device for this patient population.
A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. - JACC. Cardiovascular interventions
This study conducted a prospective, single-arm, multicenter trial to evaluate the safety and efficacy of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis, using the EkoSonic Endovascular System (EKOS, Bothell, Washington).Systemic fibrinolysis for acute pulmonary embolism (PE) reduces cardiovascular collapse but causes hemorrhagic stroke at a rate exceeding 2%.Eligible patients had a proximal PE and a right ventricular (RV)-to-left ventricular (LV) diameter ratio â‰¥0.9 on chest computed tomography (CT). We included 150 patients with acute massive (n = 31) or submassive (n = 119) PE. We used 24 mg of tissue-plasminogen activator (t-PA) administered either as 1 mg/h for 24 h with a unilateral catheter or 1 mg/h/catheter for 12 h with bilateral catheters. The primary safety outcome was major bleeding within 72 h of procedure initiation. The primary efficacy outcome was the change in the chest CT-measured RV/LV diameter ratio within 48 h of procedure initiation.Mean RV/LV diameter ratio decreased from baseline to 48 h post-procedure (1.55 vs. 1.13; mean difference, -0.42; p < 0.0001). Mean pulmonary artery systolic pressure (51.4 mm Hg vs. 36.9 mm Hg; p < 0.0001) and modified Miller Index score (22.5 vs. 15.8; p < 0.0001) also decreased post-procedure. One GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries)-defined severe bleed (groin hematoma with transient hypotension) and 16 GUSTO-defined moderate bleeding events occurred in 15 patients (10%). No patient experienced intracranial hemorrhage.Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis decreased RV dilation, reduced pulmonary hypertension, decreased anatomic thrombus burden, and minimized intracranial hemorrhage in patients with acute massive and submassive PE. (A Prospective, Single-arm, Multi-center Trial of EkoSonicÂ® Endovascular System and Activase for Treatment of Acute Pulmonary Embolism (PE) [SEATTLE II]; NCT01513759).Copyright Â© 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry. - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
To present the results of rheolytic pharmacomechanical thrombectomy (PMT) for the management of acute limb ischemia (ALI) as reported in the PEARL Registry (PEripheral Use of AngioJet Rheolytic Thrombectomy with a variety of catheter Lengths).A total of 283 patients (mean age 65Â±13 years; 170 men) presenting with ALI undergoing treatment with the AngioJet System at participating institutions were enrolled in the registry. Rutherford ALI categories included 26% with viable limbs, 38% with marginally threatened limbs, 35% with immediately threatened limbs, and <1% with irreversible damage. Procedure and follow-up data were collected for the calculation of outcomes. To control for patient selection bias, propensity score matching was used to compare outcomes for patients undergoing PMT with or without catheter-directed thrombolysis (CDT).Procedure success was achieved in 235 (83%) of 283 patients. Half of the procedures (147, 52%) were completed without the need for adjunctive CDT. At 12-month follow-up, amputation-free survival and freedom from mortality were 81% and 91%, respectively; 12-month freedom from bleeding requiring transfusion was 91%, and freedom from renal failure was 95%. Subgroup analysis revealed significantly better outcomes in patients without infrapopliteal involvement and those who underwent PMT without CDT. In the matched cohorts, higher rates of procedure success, 12-month amputation-free survival, and 12-month freedom from amputation were observed in the PMT without CDT group (88% vs 74%, p=0.021; 87% vs 72%, p=0.028; 96% vs 81%, p=0.01, respectively).The results support the use of PMT as a first-line treatment for ALI, providing a rapid reperfusion to the extremity, reduced procedure time, and an acceptable risk profile without compromising limb salvage.Â© The Author(s) 2015.
Ready for a fight? The physiological effects of detecting an opponent's pheromone cues prior to a contest. - Physiology & behavior
Reception of pheromone cues can elicit significant physiological (e.g. steroid hormone levels) changes in the recipient. These pheromone-induced physiological changes have been well documented for male-female interactions, but scarcely in same-sex interactions (male-male and female-female). We sought to address this dearth in the current literature and examine whether mangrove rivulus fish (Kryptolebias marmoratus) could detect and, ultimately, mount a physiological response to the pheromone signature of a potential, same-sex competitor. We examined steroid hormone levels in mangrove rivulus exposed to one of three treatments: 1) isolation, 2) exposure to pheromones of a size-matched partner, and 3) pheromone exposure to a size-matched opponent followed by a physical encounter with the opponent. We found that exposure to a competitor's pheromone cues elicited a significant increase in testosterone levels. Increases in testosterone were similar across genetically distinct lineages derived from geographically distinct populations. Further, testosterone levels were similar between individuals only exposed to pheromone cues and individuals exposed to both pheromone cues and a subsequent physical encounter. Our findings led us to generate a number of testable predictions regarding how mangrove rivulus utilize pheromone signals in social interactions, the molecular mechanisms linking social stimuli and hormonal responses, and the possible adaptive benefits of hormonal responsiveness to receiving a potential competitor's pheromone cues.Copyright Â© 2015 Elsevier Inc. All rights reserved.
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4755 Ogletown Stanton Rd Department Of Radiology
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