Comprehensive Overview of Retrograde-Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques.

Background: Advancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization.

Objectives: To detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios.

Methods: We describe the two main techniques, tip-in and rendezvous, and their derivatives such a facilitated tip-in, manual MC-tip modification, tip-in the balloon, tip-in the stent, deep dive rendezvous, catch-it and antegrade microcatheter probing.

Acellular Piscine Dermis for Pediatric Hand Burn Reconstruction.

Pediatric hand burns are difficult to treat, with thin tissue with critical structures close to the skin and the small scale of the anatomy of children's hands. Additionally, pediatric burns can be challenging due to the concern for donor-site morbidity and the paucity of donor sites when reconstructing these wounds. In this report, we discuss the successful application of a piscine-derived acellular dermal matrix in a 13-month-old child with deep partial thickness and full-thickness burns to the right upper extremity.

Ten tips and tricks for successful distal true lumen wiring from three-dimensional wiring experts.

Antegrade wiring is the dominant method used in chronic total occlusion percutaneous coronary intervention (CTO PCI). However, distal cap puncture for distal true lumen wiring remains a significant barrier toward success. Three-dimensional (3D) fluoroscopic wiring can improve the speed, safety, and success of distal cap wiring.

Extraplaque blood withdrawal stenting: A miraculous cure for subintimal hematoma.

We report the Extraplaque Blood Withdrawal stenting technique to treat chronic total occlusion percutaneous coronary intervention (CTO PCI)-induced extraplaque hematoma.

Dual-Lumen Catheter and Floating-Wire Technique to Access Protruding Aorto-Ostial Stent.

PCI in the setting of previous aorto-ostial stenting can be difficult, especially if there is excessive stent protrusion. Various techniques have been described, including double-wire technique, double-guide snare technique, side-strut sequential ballooning technique, and guide extension facilitated sidestrut stenting. These techniques can sometimes be complicated, and intervention through a side-strut may lead to excessive stent deformation or avulsion of the protruding segment.

Synergistic Coronary Artery Calcium Modification With Combined Atherectomy and Intravascular Lithotripsy.

Background: Severe coronary artery calcification (CAC) remains challenging during percutaneous coronary intervention (PCI) and often requires 1 or more advanced calcium modification tools.

Objectives: We describe the combination use of rotational (RA) or orbital atherectomy (OA), with intravascular lithotripsy (IVL), termed rotatripsy and orbital-tripsy, respectively, for modifying CAC prior to stent implantation during PCI.

Methods: We performed a retrospective analysis of patients treated with rotatripsy or orbital-tripsy at our center between July 2019 and March 2022.

A neural network solves, explains, and generates university math problems by program synthesis and few-shot learning at human level.

We demonstrate that a neural network pretrained on text and fine-tuned on code solves mathematics course problems, explains solutions, and generates questions at a human level. We automatically synthesize programs using few-shot learning and OpenAI's Codex transformer and execute them to solve course problems at 81% automatic accuracy. We curate a dataset of questions from Massachusetts Institute of Technology (MIT)'s largest mathematics courses (Single Variable and Multivariable Calculus, Differential Equations, Introduction to Probability and Statistics, Linear Algebra, and Mathematics for Computer Science) and Columbia University's Computational Linear Algebra.

View Composition Algebra for Ad Hoc Comparison.

Comparison is a core task in visual analysis. Although there are numerous guidelines to help users design effective visualizations to aid known comparison tasks, there are few techniques available when users want to make ad hoc comparisons between marks, trends, or charts during data exploration and visual analysis. For instance, to compare voting count maps from different years, two stock trends in a line chart, or a scatterplot of country GDPs with a textual summary of the average GDP.

DIEL: Interactive Visualization Beyond the Here and Now.

Interactive visualization design and research have primarily focused on local data and synchronous events. However, for more complex use cases-e.g.

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Pavement Burns in New Mexico: Our Experiences, Treatments, and Outcomes.

This study focused on patients treated at the University of New Mexico Burn Center who sustained burn injuries from contact with environmentally heated pavement. We report on our patient demographics and outcomes as well as describe our institutional staged surgical approach to treatment. We provide a comparison of our results with other case reports as well as other findings.

Impact of Cognitive Biases on Progressive Visualization.

Progressive visualization is fast becoming a technique in the visualization community to help users interact with large amounts of data. With progressive visualization, users can examine intermediate results of complex or long running computations, without waiting for the computation to complete. While this has shown to be beneficial to users, recent research has identified potential risks.

Temporary Use of Acellular Dermal Matrix in Upper Extremity Salvage.

Wound coverage of exposed vascular bypasses after acute limb revascularization may not be immediately possible, while delay may create a hostile environment for the bypass graft. The use of negative-pressure wound therapy may not be possible because of extrinsic compression. Temporary use of acellular dermal matrix can help salvage upper extremity.

Short term clinical outcomes and analysis of risk factors for pacemaker implantation: a single center experience of self-expandable TAVI valves.

Objectives: Transcatheter aortic valve implantation is a recognized treatment for patients with severe aortic stenosis at all risk groups. However, permanent pacemaker rates remain high for self expandable transcatheter valves and permanent pacemaker implantation has been associated with increased morbidity. In this analysis we aim to evaluate short term clinical outcomes post self expandable transcatheter aortic valve implantation and determine risk factors for permanent pacemaker implantation.

From reverse CART to antegrade wire access: a guide to externalisation, tip-in, rendezvous, and snaring from the APCTO club: Reverse CART to antegrade access.

We at the Asia Pacific Chronic Total Occlusion (APCTO) club, provide this review to address the gap between reverse controlled antegrade and retrograde subintimal tracking (CART) and antegrade wire access. We describe the usual method for wire externalisation. We then address how to deal with failure to wire the proximal part of the chronic total occlusion (CTO) vessel or the guiding catheter.

The importance of Ile716 toward the mutagenicity of 8-Oxo-2'-deoxyguanosine with Bacillus fragment DNA polymerase.

8-oxo-2'-deoxyguanosine (OdG) is a prominent DNA lesion that can direct the incorporation of dCTP or dATP during replication. As the latter reaction can lead to mutation, the ratio of dCTP/dATP incorporation can significantly affect the mutagenic potential of OdG. Previous work with the A-family polymerase BF and seven analogues of OdG identified a major groove amino acid, Ile716, which likely influences the dCTP/dATP incorporation ratio opposite OdG.

Retrograde Versus Antegrade Approach for Coronary Chronic Total Occlusion in an Algorithm-Driven Contemporary Asia-Pacific Multicentre Registry: Comparison of Outcomes.

Background: The use of a retrograde approach and algorithm-driven CTO (chronic total occlusion) percutaneous coronary intervention (PCI) has become widespread, and many registries have reported good results. This study established a new algorithm and applied it to current CTO practice and collected a CTO registry to document the results. It compared the outcomes of a retrograde versus antegrade approach in a contemporary multicentre CTO registry.