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Background The successful recanalization rate of chronic total occlusion (CTO) lesions without retrograde collaterals available is always low. Intravascular ultrasound (IVUS) may be useful to guide the subintimal guidewire to re-enter the true lumen. We evaluated the clinical feasibility and efficacy of the IVUS-guided wiring re-entry technique for these complex CTO lesions. Methods Twenty consecutive patients (19 male, mean age: 65.3 ± 12.8 years) with both failed antegrade and retrograde approaches were enrolled. The IVUS catheter was introduced into the subintimal space to identify the entry point into the subintimal space, and guide another stiff wire to re-enter the true lumen with the adjacent side-branch or first wire as markers, or using IVUS-guided parallel wire technique. Results The entry point into the subintimal space was identified by IVUS in all cases, and the IVUS-guided wiring re-entry technique succeeded in 17 cases (85%). No procedure-related complication was noted except one case of delayed cardiac tamponade due to the wire perforation. During the mean follow-up period of 1.9 ± 1.3 years, there was no adverse cardiac event, except one patient died of the complication of cardiac transplantation. Conclusion The IVUS-guided wiringre-entry technique might be feasible and safe for the recanalization of complex CTO lesions.

Impaired bioavailability of endothelium-derived nitric oxide (NO) and endothelial dysfunction may play a pivotal role in the pathogenesis of in-stent restenosis (ISR) after coronary stenting. We aimed to investigate the relation between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and the ISR lesions tissue characteristics assessed by optical coherence tomography (OCT).Forty-five patients with symptomatic ISR lesions (17 bare metal stents, 28 drug-eluting stents, medium implantation duration: 58.0 months) were evaluated by OCT for in-stent tissue characteristics and calcification. We defined neoatherosclerosis as the presence of lipid or calcified neointima in ISR lesions, and 12 (26.7%), 33 (73.3%) ISR lesions were classified as with homogenous neointima and neoatherosclerosis respectively. The patients with neoatherosclerosis have significantly higher plasma ADMA levels compared to those of patients with homogenous neointima (1.12 ± 0.21 μmol/l versus 0.83 ± 0.08 μmol/l, p 0.001). Furthermore, the plasma ADMA level of ISR lesions with intra-stent calcification (n = 24, 53.3%) was also significantly higher than those of ISR lesions without (n = 21, 46.7%; p 0.001). There was a highly significant association between plasma ADMA level and intra-stent relative calcium index (mean calcium arc × calcium length)/(360 × analyzed length) (p 0.001, r = 0.702). In multivariate analyses adjusted for age, sex, diabetes, eGFR, plasma ADMA level remained the only significant predictor for the presence of neoatherosclerosis (p = 0.008) and intra-stent calcification (p 0.001). In contrast, plasma ADMA level correlated with intra-stent relative lipid core index (mean lipid core arc × lipid core length)/(360 × analyzed length) only in subgroup without intra-stent calcification (p = 0.004, r = 0.596, multivariate-adjusted p = 0.022).Increased plasma ADMA levels were associated with the development of in-stent neoatherosclerosis and calcification.

In the digital information networking age, because of circulation and convergence of the information, the cost for enterprises to find trading partners to do business is getting lower and lower. By the emergence of e-Marketplace, it gathers a great number of buyers and sellers. It can promote business transactions and break the barriers, such as country and time, among trading partners. The enterprise may increase business revenue on the e-Marketplace. But only via integrating the e-Marketplace operation processes and corporation’s internal processes, it can fulfill the requests and provide services on e-Marketplace as rapidly as possible. In this research we follow the Electronic Business XML (ebXML) specification that is planned by The United Nations Center for Trade Facilitation and Electronic Business (UN/CEFACT) and The Organization for the Advancement of Structured Information Standards (OASIS). The vision of ebXML is to create a single global electronic marketplace where enterprises of any size and in any geographical location can meet and conduct business with each other through the exchange of XML based messages. We build an ebXML compatible collaboration module to deal with Business-to-Business integration issues. Via this module we can run business-to-business processes integration smoothly and reduce the integration cost with using ebXML specification.

Taiwan is the only country requiring public firms to disclose the degree of leverage (DOL). Mandatory disclosure of DOL could help amateur investors to get a clear picture of a firm's financial position. This paper tests the relationship between the DOL and the operating risk of companies in Taiwan. The consistency quality of DOL disclosed in financial reports is also examined. DOLs transformed by Model 1 (regulated by the Securities and Futures Commission, Taiwan) and Model 2 (Mandelker and Rhee, 1984) have a more significant relationship with risk. This finding is an important contribution of this paper. We also find that DOL information presented in financial statements is not consistent by time-series comparisons. This paper concludes that the degree of operating leverage presented in financial statements from Taiwanese public companies might lack reliability and relevance.