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Sample records for high absolute coronary

  1. Absolute coronary risk analyser--a tool for managing coronary heart disease risk.

    PubMed

    Mitrabasu, P P B; Shahapurkar, J S; Sreekumar, T P; Vyawahare, M K; Sarma, C G S

    2003-06-01

    The aim of the present study was to develop a coronary risk analyser which can calculate authentically the absolute coronary risk of an individual for coronary risk management. After extensive literature survey was done to derive the most appropriate method to calculate the absolute coronary risk. Joint British recommendations derived from Framingham's heart study were adopted for its supreme sensitivity and specificity. A windows based software is developed using Visual basic programming language. The software is easily installable in any pentium PC with windows operating system and requires entry of a detailed medical profile of an individual for the calculation of absolute coronary risk. Coronary risk analyser developed by DEBEL effectively calculates the absolute coronary risk of an individual over 2, 5 or 10 years and stores the patient's data properly. The software is a tool to manage the coronary risk of a patient in the field of preventive cardiology.

  2. Cryogenic, Absolute, High Pressure Sensor

    NASA Technical Reports Server (NTRS)

    Chapman, John J. (Inventor); Shams. Qamar A. (Inventor); Powers, William T. (Inventor)

    2001-01-01

    A pressure sensor is provided for cryogenic, high pressure applications. A highly doped silicon piezoresistive pressure sensor is bonded to a silicon substrate in an absolute pressure sensing configuration. The absolute pressure sensor is bonded to an aluminum nitride substrate. Aluminum nitride has appropriate coefficient of thermal expansion for use with highly doped silicon at cryogenic temperatures. A group of sensors, either two sensors on two substrates or four sensors on a single substrate are packaged in a pressure vessel.

  3. Absolute eosinophils count and the extent of coronary artery disease: a single centre cohort study.

    PubMed

    Verdoia, Monica; Schaffer, Alon; Cassetti, Ettore; Di Giovine, Gabriella; Marino, Paolo; Suryapranata, Harry; De Luca, Giuseppe

    2015-05-01

    Leukocytes have been involved in the pathogenesis of atherosclerosis, and recent attention has been raised on eosinophils, that have been claimed for a wide number of cardiovascular pathologies, affecting endocardium, myocardium and vascular walls. However, few data have been reported so far on the relationship between absolute eosinophils count (AEC) and the prevalence and extent of coronary artery disease (CAD), that was the aim of present study. Consecutive patients undergoing non-urgent coronary angiography were included. Haematological parameters were measured at admission. Significant CAD was defined as at least 1 vessel stenosis >50 %, while severe CAD as left main and/or trivessel disease, as evaluated by Quantitative Coronary Angiography. Our population is represented by 3,742 patients, divided according to tertiles values of AEC (≤0.1; 0.1-0.2; >0.2 × 10(3)/µl). Higher eosinophils values were significantly associated to male gender, main established cardiovascular risk factors, previous percutaneous or surgical coronary revascularization, antihypertensive and antiplatelet therapy at admission but inversely with acute presentation. Higher AEC was directly related with platelets count (p < 0.001), haemoglobin levels (p = 0.02), white blood cells count (p = 0.02), higher serum creatinine (p < 0.001), triglycerides (p < 0.001) and glycosylated haemoglobin (p < 0.001), while inversely with HDL cholesterol (p < 0.001). AEC was associated with multivessel disease (p = 0.03), chronic occlusions (p = 0.01), in-stent restenosis (p = 0.002), while inversely with the presence of intracoronary thrombus (p < 0.001). A significant relationship was found between AEC and the prevalence of coronary artery disease (p = 0.049), but not for the extent of more severe LM/trivessel CAD (p = 0.31). At multivariate analysis no independent role of eosinophils was found for CAD (adjusted OR [95 % CI] = 1.02 [0.91-1.15], p = 0.70), or severe CAD (adjusted OR [95 % CI] = 0.99 [0

  4. Absolute Value Inequalities: High School Students' Solutions and Misconceptions

    ERIC Educational Resources Information Center

    Almog, Nava; Ilany, Bat-Sheva

    2012-01-01

    Inequalities are one of the foundational subjects in high school math curricula, but there is a lack of academic research into how students learn certain types of inequalities. This article fills part of the research gap by presenting the findings of a study that examined high school students' methods of approaching absolute value inequalities,…

  5. [Bilateral blood pressure measurement before and after coronary bypass surgery: an absolute necessity].

    PubMed

    Ernst, J M; van Bergen, P F; Schepens, M A; Brutel de la Rivière, A; Plokker, H W

    1999-09-11

    Anginous symptoms and a difference in blood pressure between the two arms prompted angiography in two patients, men aged 66 and 50 years. The examination revealed coronary sclerosis and a stenosis in the left subclavian artery. The symptoms disappeared after percutaneous dilatation of the subclavian artery, followed by a coronary bypass operation (CABG) using an internal thoracic artery (a branch of the subclavian artery). In two other patients, men aged 61 and 71 years, who had undergone an arterial CABG 12 years previously, anginous symptoms were the manifestation of a narrowed subclavian artery. The symptoms disappeared after balloon dilatation of the subclavian artery and revascularization of the anterior interventricular branch (left artery descendens) and embolization of the internal thoracic artery graft (internal mammarian artery graft), respectively. Stenosis or occlusion of the proximal subclavian artery may attenuate the blood flow in the ipsilateral A. thoracica interna graft. The diagnosis can simply be made by bilateral blood pressure measurement.

  6. Integration of Quantitative Positron Emission Tomography Absolute Myocardial Blood Flow Measurements in the Clinical Management of Coronary Artery Disease.

    PubMed

    Gewirtz, Henry; Dilsizian, Vasken

    2016-05-31

    In the >40 years since planar myocardial imaging with(43)K-potassium was introduced into clinical research and management of patients with coronary artery disease (CAD), diagnosis and treatment have undergone profound scientific and technological changes. One such innovation is the current state-of-the-art hardware and software for positron emission tomography myocardial perfusion imaging, which has advanced it from a strictly research-oriented modality to a clinically valuable tool. This review traces the evolving role of quantitative positron emission tomography measurements of myocardial blood flow in the evaluation and management of patients with CAD. It presents methodology, currently or soon to be available, that offers a paradigm shift in CAD management. Heretofore, radionuclide myocardial perfusion imaging has been primarily qualitative or at best semiquantitative in nature, assessing regional perfusion in relative terms. Thus, unlike so many facets of modern cardiovascular practice and CAD management, which depend, for example, on absolute values of key parameters such as arterial and left ventricular pressures, serum lipoprotein, and other biomarker levels, the absolute levels of rest and maximal myocardial blood flow have yet to be incorporated into routine clinical practice even in most positron emission tomography centers where the potential to do so exists. Accordingly, this review focuses on potential value added for improving clinical CAD practice by measuring the absolute level of rest and maximal myocardial blood flow. Physiological principles and imaging fundamentals necessary to understand how positron emission tomography makes robust, quantitative measurements of myocardial blood flow possible are highlighted. © 2016 American Heart Association, Inc.

  7. Absolute measurements of ultrasonic pressure by using high magnetic fields.

    PubMed

    Sharf, Y; Clement, G T; Hynynen, K

    1999-01-01

    A hydrophone is introduced that exploits the emf signal generated in a conductor when sonicated in the presence of a uniform static magnetic field. The method uses a small metal coil or metal membrane as a hydrophone receiver. Acoustic signals at 748 kHz are introduced in 1.5 T and 4.7 T fields and recorded both through direct electrical contact with the hydrophone and via RF pick-up coils, allowing wireless placement of the hydrophone. Linear response Is confirmed over four orders of magnitude in the pressure amplitude. Waveforms determined from the detected voltage are shown to be in excellent agreement with those obtained using a calibrated polyvinylidene difluoride film, and absolute values correlate within 20%. The methods are conceptually suitable for use in the presence of the high and uniform field of commercial MR scanners. The hydrophone may appear particularly useful as a quality assurance device in therapeutic and diagnostic acoustic techniques that use MRI.

  8. Relative deprivation between neighbouring wards is predictive of coronary heart disease mortality after adjustment for absolute deprivation of wards.

    PubMed

    Allender, Steven; Scarborough, Peter; Keegan, Thomas; Rayner, Mike

    2012-09-01

    The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk. Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards. Deprivation inequality within LAs was positively associated with CHD mortality rates per 100000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (p<0.001 for all models). Relative deprivation for wards was positively associated with CHD mortality rates per 100000 (eg, all men 1.4; 0.7 to 2.1) after adjustment for absolute deprivation (p<0.001 for all models). Subgroup analyses showed that relative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards. Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas, and poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.

  9. Measuring the absolute magnetic field using high-Tc SQUID

    NASA Astrophysics Data System (ADS)

    He, D. F.; Itozaki, H.

    2006-06-01

    SQUID normally can only measure the change of magnetic field instead of the absolute value of magnetic field. Using a compensation method, a mobile SQUID, which could keep locked when moving in the earth's magnetic field, was developed. Using the mobile SQUID, it was possible to measure the absolute magnetic field. The absolute value of magnetic field could be calculated from the change of the compensation output when changing the direction of the SQUID in a magnetic field. Using this method and the mobile SQUID, we successfully measured the earth's magnetic field in our laboratory.

  10. High speed image acquisition system of absolute encoder

    NASA Astrophysics Data System (ADS)

    Liao, Jianxiang; Chen, Xin; Chen, Xindu; Zhang, Fangjian; Wang, Han

    2017-01-01

    Absolute optical encoder as a product of optical, mechanical and electronic integration has been widely used in displacement measuring fields. However, how to improve the measurement velocity and reduce the manufacturing cost of absolute optical encoder is the key problem to be solved. To improve the measurement speed, a novel absolute optical encoder image acquisition system is proposed. The proposed acquisition system includes a linear CCD sensor is applied for capturing coding pattern images, an optical magnifying system is used for enlarging the grating stripes, an analog-digital conversion(ADC) module is used for processing the CCD analogy signal, a field programmable gate array(FPGA) device and other peripherals perform driving task. An absolute position measurement experiment was set up to verify and evaluate the proposed image acquisition system. The experimental result indicates that the proposed absolute optical encoder image acquisition system has the image acquisition speed of more than 9500fp/s with well reliability and lower manufacture cost.

  11. New Ultra-High Sensitivity, Absolute, Linear, and Rotary Encoders

    NASA Technical Reports Server (NTRS)

    Leviton, Douglas B.

    1998-01-01

    Several new types of absolute optical encoders of both rotary and linear function are discussed. The means for encoding are complete departures from conventional optical encoders and offer advantages of compact form, immunity to damage-induced dropouts of position information, and about an order of magnitude higher sensitivity over what is commercially available. Rotary versions have sensitivity from 0.02 arcseconds down to 0.003 arcsecond while linear models have sensitivity of 10 nm.

  12. Trends of relative and absolute socioeconomic equity in access to coronary revascularisations in 1995-2010 in Finland: a register study.

    PubMed

    Lumme, Sonja; Manderbacka, Kristiina; Keskimäki, Ilmo

    2017-02-20

    Resources for coronary revascularisations have increased substantially since the early 1990s in Finland. At the same time, ischaemic heart disease (IHD) mortality has decreased markedly. This study aims to examine how these changes have influenced trends in absolute and relative differences between socioeconomic groups in revascularisations and age group differences in them using IHD mortality as a proxy for need. Hospital Discharge Register data on revascularisations among Finns aged 45-84 in 1995-2010 were individually linked to population registers to obtain socio-demographic data. We measured absolute and relative income group differences in revascularisation and IHD mortality with slope index of inequality (SII) and concentration index (C), and relative equity taking need for care into account with horizontal inequity index (HII). The supply of procedures doubled during the years. Socioeconomic distribution of revascularisations was in absolute and relative terms equal in 1995 (Men: SII = -12, C = -0.00; Women, SII = -30, C = -0.03), but differences favouring low-income groups emerged by 2010 (M: SII = -340, C = -0.08; W: SII = -195, C = -0.14). IHD mortality decreased markedly, but absolute and relative differences favouring the better-off existed throughout study years. Absolute differences decreased somewhat (M: SII = -760 in 1995, SII = -681 in 2010; W: SII = -318 in 1995, SII = -211 in 2010), but relative differences increased significantly (M: C = -0.14 in 1995, C = -0.26 in 2010; W: C = -0.15 in 1995, C = -0.25 in 2010). HII was greater than zero in each year indicating inequity favouring the better-off. HII increased from 0.15 to 0.18 among men and from 0.10 to 0.12 among women. We found significant and increasing age group differences in HII. Despite large increase in supply of revascularisations and decrease in IHD mortality, there is still marked socioeconomic inequity in

  13. Exploring Coronary Circulatory Response to Stenosis and Its Association with Invasive Physiologic Indices Using Absolute Myocardial Blood Flow and Coronary Pressure.

    PubMed

    Lee, Joo Myung; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Tong, Yaliang; Kim, Chee Hae; Bang, Ji-In; Suh, Minseok; Paeng, Jin Chul; Cheon, Gi Jeong; Koo, Bon-Kwon

    2017-08-29

    Background -Although invasive physiologic assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiologic indices, according to different anatomical and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease. Methods -One hundred fifteen patients with left anterior descending artery stenosis who underwent both (13)N-ammonia positron emission tomography (PET) and invasive physiologic measurement were analyzed. Myocardial blood flow (MBF) measured using PET and invasively measured coronary pressures were used to calculate microvascular resistance (MVR) and stenosis resistance. Results -With progressive worsening of angiographic stenosis severity, both resting and hyperemic trans-stenotic pressure gradient and stenosis resistance increased (P<0.001 for all) and hyperemic MBF (P<0.001) and resting MVR (P=0.012) decreased. Resting MBF (P=0.383) and hyperemic MVR (P=0.431) were not changed and maintained stable. Both fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) decreased as angiographic stenosis severity, stenosis resistance, and trans-stenotic pressure gradient increased, and hyperemic MBF decreased (all P values<0.001). When the presence of myocardial ischemia was defined by both low hyperemic MBF and low coronary flow reserve (CFR), the diagnostic accuracy of FFR and iFR did not differ, regardless of cut-off values of hyperemic MBF and CFR. Conclusions -This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using (13)N-ammonium PET-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiologic indices have similar patterns of relationships to the different anatomic and hemodynamic lesion severity. Clinical Trial Registration -URL: https://clinicaltrials.gov Unique Identifier: NCT

  14. The Relationship of Epicardial Fat Volume to Coronary Plaque, Severe Coronary Stenosis, and High-Risk Coronary Plaque Features Assessed by Coronary CT Angiography

    PubMed Central

    Rajani, Ronak; Shmilovich, Haim; Nakazato, Ryo; Nakanishi, Rine; Otaki, Yuka; Cheng, Victor Y.; Hayes, Sean W.; Thomson, Louise E.J.; Friedman, John D.; Slomka, Piotr J.; Min, James K.; Berman, Daniel S.; Dey, Damini

    2013-01-01

    Background Associations of epicardial fat volume (EFV) measured on non-contrast cardiac computed tomography (NCT) include coronary plaque, myocardial ischemia and adverse cardiac events. Objectives This study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and to the presence of high-risk plaque features (HRPFs). Methods We retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day non-contrast cardiac computed tomography (NCT) and coronary CT angiography (CTA). EFV was measured on NCT using validated, semi-automated, software. The coronary arteries were evaluated for coronary plaque type [calcified (CP), non-calcified (NCP) or partially-calcified (MP)] and coronary stenosis severity ≥70% using coronary CTA. For patients with NCP and PCP, 2 high risk plaque features were evaluated: Low-attenuation plaque and positive remodeling. Results There were 402 patients with a median age of 66 years (range 23–92) of whom 226 (56%) were male. The EFV was larger in patients with CP (112 ± 55 cm3 vs. 89 ± 39 cm3), PCP (110 ± 57 cm3 vs. 98 ± 45 cm3) and NCP (115 ± 44 cm3 vs. EFV 100 ± 52 cm3. In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (OR 3.0, 95% CI 1.3–6.6, p=0.008), any high risk plaque features (OR 1.7, 95% CI 0.9–3.4, p=0.04) and low attention plaque (OR 2.4, 95% CI 1.1–5.1, p=0.02), but not of positive remodeling. Conclusions Epicardial fat volume is larger in patients with CP, PCP and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high risk plaque features and low attenuation plaque. PMID:23622507

  15. Persistent high fever and systemic inflammation induced by percutaneous coronary intervention-related periaortitis

    PubMed Central

    Kakino, Takamori; Nakayama, Tomohiro; Yamamoto, Hideo

    2009-01-01

    After coronary catheterization, fever sometimes occurs, usually transiently. We report a very rare case that suggests persistent high fever and systemic inflammation might be caused by periaortitis induced by coronary catheterization including percutaneous coronary intervention. PMID:20057898

  16. High resolution study of magnetic ordering at absolute zero.

    PubMed

    Lee, M; Husmann, A; Rosenbaum, T F; Aeppli, G

    2004-05-07

    High resolution pressure measurements in the zero-temperature limit provide a unique opportunity to study the behavior of strongly interacting, itinerant electrons with coupled spin and charge degrees of freedom. Approaching the precision that has become the hallmark of experiments on classical critical phenomena, we characterize the quantum critical behavior of the model, elemental antiferromagnet chromium, lightly doped with vanadium. We resolve the sharp doubling of the Hall coefficient at the quantum critical point and trace the dominating effects of quantum fluctuations up to surprisingly high temperatures.

  17. Absolute coronary blood flow measurement and microvascular resistance in ST-elevation myocardial infarction in the acute and subacute phase.

    PubMed

    Wijnbergen, Inge; van 't Veer, Marcel; Lammers, Jeroen; Ubachs, Joey; Pijls, Nico H J

    2016-03-01

    In a number of patients with acute myocardial infarction (AMI), myocardial hypoperfusion, known as the no-reflow phenomenon, persists after primary percutaneous intervention (PPCI). The aim of this study was to evaluate the feasibility and safety of a new quantitative method of measuring absolute blood flow and resistance within the perfusion bed of an infarct-related artery. Furthermore, we sought to study no-reflow by correlating these measurements to the index of microvascular resistance (IMR) and the area at risk (AR) as determined by cardiac magnetic resonance imaging (CMR). Measurements of absolute flow and myocardial resistance were performed in 20 patients with ST-segment elevation myocardial infarction (STEMI), first immediately following PPCI and then again after 3-5days. These measurements used the technique of thermodilution during a continuous infusion of saline. Flow was expressed in ml/min per gram of tissue within the area at risk. The average time needed for measurement of absolute flow, resistance and IMR was 20min, and all measurements could be performed without complication. A higher flow supplying the AR correlated with a lower IMR in the acute phase. Absolute flow increased from 3.14 to 3.68ml/min/g (p=0.25) and absolute resistance decreased from 1317 to 1099 dyne.sec.cm-5/g (p=0.40) between the first day and fifth day after STEMI. Measurement of absolute flow and microvascular resistance is safe and feasible in STEMI patients and may allow for a better understanding of microvascular (dys)function in the early phase of AMI. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. High quality absolute paleointensity data from Santa Fe, New Mexico

    NASA Astrophysics Data System (ADS)

    Jones, S. A.; Tauxe, L.; Blinman, E.; Genevey, A.

    2015-12-01

    Preliminary paleointensity experiments were conducted using the IZZI protocol on one hundred and fourteen specimens from fifty-seven baked pottery fragments collected from nine archaeological sites near Santa Fe, New Mexico. Twenty of these fragments passed our weakest selection criteria. Seven additional specimens were made from each passing fragment for further paleointensity experiments. The results of these second experiments indicate that the samples are mildly anisotropic, so anisotropy experiments were conducted to correct for this behavior. Experiments to determine the cooling rate correction will be completed to ensure the robustness of the dataset. Stylistic evidence, historical documentation, dendrochronology, and 14C analyses provide age constraints with up to decade resolution for the VADM results. The twenty pottery fragments analyzed span five distinct time periods between 1300 and 1900 AD. Our new results for each fragment differ slightly from those predicted by the cals3k.4b and arch3k models, suggesting the models require refinement. This is expected because there are few archaeomagnetic constraints on the models from this region. Future pottery fragments and burned adobe fragments from the New Mexico area will be analyzed for paleointensity and combined with our pottery fragment data set to create a high-resolution paleointensity curve for the recent archaeological time in the American Southwest.

  19. Red ginseng extract improves coronary flow reserve and increases absolute numbers of various circulating angiogenic cells in patients with first ST-segment elevation acute myocardial infarction.

    PubMed

    Ahn, Chul Min; Hong, Soon Jun; Choi, Seung Cheol; Park, Jae Hyung; Kim, Jae Sang; Lim, Do-Sun

    2011-02-01

    The effects of red ginseng extract on circulating angiogenic cell mobilization and improvement of microvascular integrity were evaluated in ST-elevation acute myocardial infarction (AMI) patients during 8-month follow-up. AMI patients (n = 50) were randomly assigned to the red ginseng group (3 g/day, n = 25) or the placebo group (n = 25) after coronary stenting. Coronary flow reserve (CFR) was measured at baseline and at 8 months with an intracoronary Doppler wire. Serial changes in the absolute numbers of circulating angiogenic cells such as CD34(+) , CXCR4(+) , CD117(+) , CD133(+) and C-met(+) were measured at baseline, 1 day, 5 days and at 8 months. CFR were similar between the two groups at baseline, and CFR was significantly higher in the red ginseng group than in the placebo group (2.80 ± 0.91 and 2.56 ± 0.77, p < 0.05, respectively) after 8 months of red ginseng administration. The absolute numbers of circulating CD34(+) , CXCR4(+) and CD117(+) cells were significantly higher in the red ginseng group at 1 and 5 days after stenting. Significant positive correlations were found between the numbers of circulating angiogenic cells at day 1 and the changes from baseline in CFR for CD34(+) , CXCR4(+) , CD117(+) and C-met(+) cells. Red ginseng extract increased CD34(+) , CXCR4(+) and CD117(+) circulating angiogenic cell mobilization and decreased inflammation in AMI patients, thereby improving CFR during the 8-month follow-up. Copyright © 2010 John Wiley & Sons, Ltd.

  20. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography.

    PubMed

    Naya, Masanao; Murthy, Venkatesh L; Taqueti, Viviany R; Foster, Courtney R; Klein, Josh; Garber, Mariya; Dorbala, Sharmila; Hainer, Jon; Blankstein, Ron; Resnic, Frederick; Di Carli, Marcelo F

    2014-02-01

    Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.

  1. Preserved Coronary Flow Reserve Effectively Excludes High-Risk Coronary Artery Disease on Angiography

    PubMed Central

    Naya, Masanao; Murthy, Venkatesh L.; Taqueti, Viviany R.; Foster, Courtney R.; Klein, Josh; Garber, Mariya; Dorbala, Sharmila; Hainer, Jon; Blankstein, Ron; Resnic, Frederick; Di Carli, Marcelo F.

    2014-01-01

    Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. Methods We studied 290 consecutive patients undergoing 82Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. Results Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). Conclusion A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular

  2. Absolute measurements of the high-frequency magnetic dynamics in high-{Tc} superconductors

    SciTech Connect

    Hayden, S.M.; Aeppli, G.; Dai, P.; Mook, H.A.; Perring, T.G.; Cheong, S.W.; Fisk, Z.; Dogan, F.; Mason, T.E.

    1997-08-07

    The authors review recent measurements of the high-frequency dynamic magnetic susceptibility in the high-T{sub c} superconducting systems La{sub 2{minus}x}Sr{sub x}CuO{sub 4} and YBa{sub 2}Cu{sub 3}O{sub 6+x}. Experiments were performed using the chopper spectrometers HET and MARI at the ISIS spallation source. The authors have placed their measurements on an absolute intensity scale, this allows systematic trends to be seen and comparisons with theory to be made. They find that the insulating S = 1/2 antiferromagnetic parent compounds show a dramatic renormalization in the spin wave intensity. The effect of doping on the response is to cause broadenings in wave vector and large redistributions of spectral weight in frequency.

  3. Dynamic frequency-domain interferometer for absolute distance measurements with high resolution.

    PubMed

    Weng, Jidong; Liu, Shenggang; Ma, Heli; Tao, Tianjiong; Wang, Xiang; Liu, Cangli; Tan, Hua

    2014-11-01

    A unique dynamic frequency-domain interferometer for absolute distance measurement has been developed recently. This paper presents the working principle of the new interferometric system, which uses a photonic crystal fiber to transmit the wide-spectrum light beams and a high-speed streak camera or frame camera to record the interference stripes. Preliminary measurements of harmonic vibrations of a speaker, driven by a radio, and the changes in the tip clearance of a rotating gear wheel show that this new type of interferometer has the ability to perform absolute distance measurements both with high time- and distance-resolution.

  4. Dynamic frequency-domain interferometer for absolute distance measurements with high resolution

    SciTech Connect

    Weng, Jidong; Liu, Shenggang; Ma, Heli; Tao, Tianjiong; Wang, Xiang; Liu, Cangli; Tan, Hua

    2014-11-15

    A unique dynamic frequency-domain interferometer for absolute distance measurement has been developed recently. This paper presents the working principle of the new interferometric system, which uses a photonic crystal fiber to transmit the wide-spectrum light beams and a high-speed streak camera or frame camera to record the interference stripes. Preliminary measurements of harmonic vibrations of a speaker, driven by a radio, and the changes in the tip clearance of a rotating gear wheel show that this new type of interferometer has the ability to perform absolute distance measurements both with high time- and distance-resolution.

  5. High-precision absolute distance and vibration measurement with frequency scanned interferometry

    SciTech Connect

    Yang, H.-J.; Deibel, Jason; Nyberg, Sven; Riles, Keith

    2005-07-01

    We report high-precision absolute distance and vibration measurements performed with frequency scanned interferometry using a pair of single-mode optical fibers. Absolute distance was determined by counting the interference fringes produced while scanning the laser frequency. A high-finesse Fabry-Perot interferometer was used to determine frequency changes during scanning. Two multiple-distance-measurement analysis techniques were developed to improve distance precision and to extract the amplitude and frequency of vibrations. Under laboratory conditions, measurement precision of {approx}50 nm was achieved for absolute distances ranging from 0.1 to 0.7 m by use of the first multiple-distance-measurement technique. The second analysis technique has the capability to measure vibration frequencies ranging from 0.1 to 100 Hz with an amplitude as small as a few nanometers without a priori knowledge.

  6. High-precision absolute distance and vibration measurement with frequency scanned interferometry.

    PubMed

    Yang, Hai-Jun; Deibel, Jason; Nyberg, Sven; Riles, Keith

    2005-07-01

    We report high-precision absolute distance and vibration measurements performed with frequency scanned interferometry using a pair of single-mode optical fibers. Absolute distance was determined by counting the interference fringes produced while scanning the laser frequency. A high-finesse Fabry-Perot interferometer was used to determine frequency changes during scanning. Two multiple-distance-measurement analysis techniques were developed to improve distance precision and to extract the amplitude and frequency of vibrations. Under laboratory conditions, measurement precision of approximately 50 nm was achieved for absolute distances ranging from 0.1 to 0.7 m by use of the first multiple-distance-measurement technique. The second analysis technique has the capability to measure vibration frequencies ranging from 0.1 to 100 Hz with an amplitude as small as a few nanometers without a priori knowledge.

  7. High Take Off Left Main and Abnormal Origin of Right Coronary Artery: A Case Report

    PubMed Central

    Salehi, Negar; Abdi, Seyfollah; Pouraliakba, Hamid Reza; Vakili-Zarch, Anoushiravan

    2013-01-01

    Coronary anomalies are rare congenital disorders with mostly benign course. We report a case of 54-year-old white male who was with stable angina scheduled for coronary angiography. Due to the difficulty of catheterization, patient underwent CT angiography and high take off left main and right coronary arteries were revealed. We conclude that anomalous coronary arteries are important and coronary interventions may be difficult in their presence.

  8. Detection of high risk coronary artery disease by thallium imaging.

    PubMed Central

    O'Hara, M J; Lahiri, A; Whittington, J R; Crawley, J C; Raftery, E B

    1985-01-01

    One hundred and three patients who underwent coronary arteriography were studied by thallium imaging and the results analysed by Bayesian principles to assess the usefulness of semiquantitative stress thallium imaging for predicting the presence or absence of multivessel coronary disease. Significant disease was found in 80 patients, of whom 77 had abnormal thallium scans (sensitivity 96%). Thallium images were normal in 15 of 23 patients with no significant disease (specificity 65%). Multiple thallium segmental defects were found to be 90% sensitive and 65% specific for multivessel coronary artery disease and were present in 80% of patients with left main stem disease and in 93% of patients with triple vessel disease. A single thallium defect or normal scan excluded multivessel, left main, and triple vessel disease with 81%, 94%, and 91% predictive accuracy respectively. By Bayesian analysis the predictive accuracy for excluding multivessel disease was greater than 90% in patients with a pretest probability of multivessel disease of less than or equal to 40%. Coronary arteriography to exclude multivessel disease is therefore unnecessary in a high proportion of patients with known or suspected coronary artery disease. PMID:4005084

  9. Misconceptions of High School Students Related to the Conceptions of Absolutism and Constitutionalism in History Courses

    ERIC Educational Resources Information Center

    Bal, Mehmet Suat

    2011-01-01

    The goal of this study is to analyze the 10th grade high school students' misconceptions related to the sense of ruling in the Ottoman State during the absolutist and constitutional periods and to investigate the causes of these misconceptions. The data were collected through eight open-ended questions related to the concepts of absolutism and…

  10. Misconceptions of High School Students Related to the Conceptions of Absolutism and Constitutionalism in History Courses

    ERIC Educational Resources Information Center

    Bal, Mehmet Suat

    2011-01-01

    The goal of this study is to analyze the 10th grade high school students' misconceptions related to the sense of ruling in the Ottoman State during the absolutist and constitutional periods and to investigate the causes of these misconceptions. The data were collected through eight open-ended questions related to the concepts of absolutism and…

  11. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease

    PubMed Central

    Nguyen, Patricia K; Meyer, Craig; Engvall, Jan; Yang, Phillip; McConnell, Michael V

    2008-01-01

    Background Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR) was used to investigate the vasodilatory response to nitroglycerine (NTG) of asymptomatic patients at high risk for CAD. Methods A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM), 5 with end stage renal disease (ESRD)] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre- and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA) was measured on pre- and post-NTG images and % coronary vasodilation was calculated. Results Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 ± 7.3% vs. 25.6 ± 7.1%, p = 0.002). This remained significant for ESRD patients alone (14.8 ± 7.7% vs. 25.6 ± 7.1%; p = 0.003) and for DM patients alone (19.8 ± 6.3% vs. 25.6 ± 7.1%; p = 0.049), with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 ± 7.7% vs. 19.8 ± 6.3%; p = 0.23). Conclusion Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance. PMID:18513419

  12. A highly accurate absolute gravimetric network for Albania, Kosovo and Montenegro

    NASA Astrophysics Data System (ADS)

    Ullrich, Christian; Ruess, Diethard; Butta, Hubert; Qirko, Kristaq; Pavicevic, Bozidar; Murat, Meha

    2016-04-01

    The objective of this project is to establish a basic gravity network in Albania, Kosovo and Montenegro to enable further investigations in geodetic and geophysical issues. Therefore the first time in history absolute gravity measurements were performed in these countries. The Norwegian mapping authority Kartverket is assisting the national mapping authorities in Kosovo (KCA) (Kosovo Cadastral Agency - Agjencia Kadastrale e Kosovës), Albania (ASIG) (Autoriteti Shtetëror i Informacionit Gjeohapësinor) and in Montenegro (REA) (Real Estate Administration of Montenegro - Uprava za nekretnine Crne Gore) in improving the geodetic frameworks. The gravity measurements are funded by Kartverket. The absolute gravimetric measurements were performed from BEV (Federal Office of Metrology and Surveying) with the absolute gravimeter FG5-242. As a national metrology institute (NMI) the Metrology Service of the BEV maintains the national standards for the realisation of the legal units of measurement and ensures their international equivalence and recognition. Laser and clock of the absolute gravimeter were calibrated before and after the measurements. The absolute gravimetric survey was carried out from September to October 2015. Finally all 8 scheduled stations were successfully measured: there are three stations located in Montenegro, two stations in Kosovo and three stations in Albania. The stations are distributed over the countries to establish a gravity network for each country. The vertical gradients were measured at all 8 stations with the relative gravimeter Scintrex CG5. The high class quality of some absolute gravity stations can be used for gravity monitoring activities in future. The measurement uncertainties of the absolute gravity measurements range around 2.5 micro Gal at all stations (1 microgal = 10-8 m/s2). In Montenegro the large gravity difference of 200 MilliGal between station Zabljak and Podgorica can be even used for calibration of relative gravimeters

  13. Easy Absolute Values? Absolutely

    ERIC Educational Resources Information Center

    Taylor, Sharon E.; Mittag, Kathleen Cage

    2015-01-01

    The authors teach a problem-solving course for preservice middle-grades education majors that includes concepts dealing with absolute-value computations, equations, and inequalities. Many of these students like mathematics and plan to teach it, so they are adept at symbolic manipulations. Getting them to think differently about a concept that they…

  14. Easy Absolute Values? Absolutely

    ERIC Educational Resources Information Center

    Taylor, Sharon E.; Mittag, Kathleen Cage

    2015-01-01

    The authors teach a problem-solving course for preservice middle-grades education majors that includes concepts dealing with absolute-value computations, equations, and inequalities. Many of these students like mathematics and plan to teach it, so they are adept at symbolic manipulations. Getting them to think differently about a concept that they…

  15. Particle visualization in high-power impulse magnetron sputtering. II. Absolute density dynamics

    SciTech Connect

    Britun, Nikolay Palmucci, Maria; Konstantinidis, Stephanos; Snyders, Rony

    2015-04-28

    Time-resolved characterization of an Ar-Ti high-power impulse magnetron sputtering discharge has been performed. The present, second, paper of the study is related to the discharge characterization in terms of the absolute density of species using resonant absorption spectroscopy. The results on the time-resolved density evolution of the neutral and singly-ionized Ti ground state atoms as well as the metastable Ti and Ar atoms during the discharge on- and off-time are presented. Among the others, the questions related to the inversion of population of the Ti energy sublevels, as well as to re-normalization of the two-dimensional density maps in terms of the absolute density of species, are stressed.

  16. Measuring Absolute RNA Copy Numbers at High Temporal Resolution Reveals Transcriptome Kinetics In Development

    PubMed Central

    Owens, Nick D. L.; Blitz, Ira L.; Lane, Maura A.; Patrushev, Ilya; Overton, John D.; Gilchrist, Michael J.; Cho, Ken W. Y.; Khokha, Mustafa K.

    2016-01-01

    Summary Transcript regulation is essential for cell function, and misregulation can lead to disease. Despite technologies to survey the transcriptome, we lack a comprehensive understanding of transcript kinetics, which limits quantitative biology. This is an acute challenge in embryonic development where rapid changes in gene expression dictate cell fate decisions. By ultra-high frequency sampling of Xenopus embryos and absolute normalization of sequence reads, we present smooth gene expression trajectories in absolute transcript numbers. During a developmental period approximating the first 8 weeks of human gestation, transcript kinetics vary by 8 orders of magnitude. Ordering genes by expression dynamics, we find temporal synexpression predicts common gene function. Remarkably, a single parameter, the characteristic timescale, can classify transcript kinetics globally and distinguish genes regulating development from those involved in cellular metabolism. Overall, our analysis provides unprecedented insight into the reorganization of maternal and embryonic transcripts and redefines our ability to perform quantitative biology. PMID:26774488

  17. High Accuracy, Absolute, Cryogenic Refractive Index Measurements of Infrared Lens Materials for JWST NIRCam using CHARMS

    NASA Technical Reports Server (NTRS)

    Leviton, Douglas; Frey, Bradley

    2005-01-01

    The current refractive optical design of the James Webb Space Telescope (JWST) Near Infrared Camera (NIRCam) uses three infrared materials in its lenses: LiF, BaF2, and ZnSe. In order to provide the instrument s optical designers with accurate, heretofore unavailable data for absolute refractive index based on actual cryogenic measurements, two prismatic samples of each material were measured using the cryogenic, high accuracy, refraction measuring system (CHARMS) at NASA GSFC, densely covering the temperature range from 15 to 320 K and wavelength range from 0.4 to 5.6 microns. Measurement methods are discussed and graphical and tabulated data for absolute refractive index, dispersion, and thermo-optic coefficient for these three materials are presented along with estimates of uncertainty. Coefficients for second order polynomial fits of measured index to temperature are provided for many wavelengths to allow accurate interpolation of index to other wavelengths and temperatures.

  18. Double domain wavelength multiplexed Fizeau interferometer with high resolution dynamic sensing and absolute length detection

    NASA Astrophysics Data System (ADS)

    Antonacci, Julián; Arenas, Gustavo F.; Duchowicz, Ricardo

    2017-04-01

    In this work, we present a simple photonic instrument that has the ability of measuring positions, distances and vibrations with very high resolution by means of two Fizeau interferometers (FI), both using the same optical fiber end as a probe tip itself. On the one hand we have a time domain FI powered with a 1310 nm laser and monitored by an InGaAs detector providing displacement information with resolution around a tenth of nm but regardless of the absolute position of object and of the displacement sense. On the other, a spectral domain FI version based on a super luminescent source (SLED) centred at 800 nm with bandwidth of nearly 40 nm is analysed in real time by means of a digital spectrometer. Each spectrum is acquired in a very small time interval and provides information of both length of the cavity as well as its correct sense of evolution. Resolution of this system is lower than its complementary temporal case, but distance and sense measurements are absolute and can be determined successfully by adequate processing of spectral signal.Both interferometers are optically coupled to a single fiber optic probe and are wavelength modulated.Therefore, combination of both sensors results in a new one which allows the correct knowledge of an object or surfaces under test, i.e. a high resolution of displacement data plus its absolute position and true sense of movement.

  19. High-accuracy absolute distance measurement with a mode-resolved optical frequency comb

    NASA Astrophysics Data System (ADS)

    Voigt, Dirk; van den Berg, Steven A.; Lešundák, Adam; van Eldik, Sjoerd; Bhattacharya, Nandini

    2016-04-01

    Optical interferometry enables highly accurate non-contact displacement measurement. The optical phase ambiguity needs to be resolved for absolute distance ranging. In controlled laboratory conditions and for short distances it is possible to track a non-interrupted displacement from a reference position to a remote target. With large distances covered in field applications this may not be feasible, e.g. in structure monitoring, large scale industrial manufacturing or aerospace navigation and attitude control. We use an optical frequency comb source to explore absolute distance measurement by means of a combined spectral and multi-wavelength homodyne interferometry. This relaxes the absolute distance ambiguity to a few tens of centimeters, covered by simpler electronic distance meters, while maintaining highly accurate optical phase measuring capability. A virtually imaged phased array spectrometer records a spatially dispersed interferogram in a single exposure and allows for resolving the modes of our near infrared comb source with 1 GHz mode separation. This enables measurements with direct traceability of the atomic clock referenced comb source. We observed agreement within 500 nm in comparison with a commercial displacement interferometer for target distances up to 50 m. Furthermore, we report on current work toward applicability in less controlled conditions. A filter cavity decimates the comb source to an increased mode separation larger than 20 GHz. A simple grating spectrometer then allows to record mode-resolved interferograms.

  20. Teaching Absolute Value Meaningfully

    ERIC Educational Resources Information Center

    Wade, Angela

    2012-01-01

    What is the meaning of absolute value? And why do teachers teach students how to solve absolute value equations? Absolute value is a concept introduced in first-year algebra and then reinforced in later courses. Various authors have suggested instructional methods for teaching absolute value to high school students (Wei 2005; Stallings-Roberts…

  1. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography.

    PubMed

    Achenbach, Stephan; Goroll, Tobias; Seltmann, Martin; Pflederer, Tobias; Anders, Katharina; Ropers, Dieter; Daniel, Werner G; Uder, Michael; Lell, Michael; Marwan, Mohamed

    2011-04-01

    We sought to evaluate the diagnostic accuracy of a new prospectively electrocardiogram (ECG)-triggered high-pitch scan mode for coronary computed tomography angiography (CTA), which allows an effective dose of less than 1 mSv. Coronary CTA provides increasingly reliable image quality, but the associated radiation exposure can be high. Seventy-five patients with suspected coronary artery disease and in sinus rhythm were screened for participation. After exclusion of 25 patients for body weight >100 kg or failure to lower heart rate to ≤ 60 beats/min, 50 patients were studied by prospectively ECG-triggered high-pitch spiral computed tomography (CT). Coronary CTA was performed using a dual-source CT system with 2 × 128 × 0.6-mm collimation, 0.28-s rotation time, a pitch of 3.4, 100-kVp tube voltage, and current of 320 mA. Data acquisition was prospectively triggered at 60% of the R-R interval and completed within 1 cardiac cycle. Diagnostic accuracy for detection of coronary artery stenoses ≥ 50% diameter stenosis was determined by comparison to invasive coronary angiography. Per-patient diagnostic performance was the primary form of analysis. In all 50 patients (34 males, 59 ± 12 years of age), imaging was successful. For the detection of 16 patients with at least 1 coronary artery stenosis, CT demonstrated a sensitivity of 100% (95% confidence interval [CI]: 79% to 100%) and specificity of 82% (95% CI: 65% to 93%). The positive predictive value was 72% (95% CI: 49% to 89%) and the negative predictive value was 100% (95% CI: 87% to 100%). Sensitivity was 100% (95% CI: 88% to 100%) and specificity was 94% (95% CI: 89% to 97%) on a per-vessel basis. Per-segment sensitivity was 92% (95% CI: 80% to 97%), and specificity was 98% (95% CI: 96% to 98%). Mean dose-length product for coronary CTA was 54 ± 6 mGy · cm, the effective dose was 0.76 ± 0.08 mSv (0.64 to 0.95 mSv). In nonobese patients with a low and stable heart rate, prospectively ECG-triggered high

  2. Absolute Helmholtz free energy of highly anharmonic crystals: theory vs Monte Carlo.

    PubMed

    Yakub, Lydia; Yakub, Eugene

    2012-04-14

    We discuss the problem of the quantitative theoretical prediction of the absolute free energy for classical highly anharmonic solids. Helmholtz free energy of the Lennard-Jones (LJ) crystal is calculated accurately while accounting for both the anharmonicity of atomic vibrations and the pair and triple correlations in displacements of the atoms from their lattice sites. The comparison with most precise computer simulation data on sublimation and melting lines revealed that theoretical predictions are in excellent agreement with Monte Carlo simulation data in the whole range of temperatures and densities studied.

  3. The role of high cholesterol-high fructose diet on coronary arteriosclerosis.

    PubMed

    Swier, Vicki J; Tang, Lin; Radwan, Mohamed M; Hunter, William J; Agrawal, Devendra K

    2016-02-01

    The effect of fructose in conjunction with high cholesterol diet in the development of atherosclerotic lesions in coronary arteries is not well established. Microswine were fed high cholesterol (HC) or a high cholesterol-high fructose (HCHF) diet containing 18-20% calories from fructose. All swine had high levels of serum cholesterol and non-HDL, thickened intima and accumulation of collagen in the coronaries. Swine fed with HC diet had less stenosis in coronary arteries, lower serum levels of non-HDL, triglycerides, cholesterol, and blood glucose than HCHF group. Coronary lesions in the HC swine were not as progressed as in HCHF and showed low LDL-expressed lipid-laden foam cells. The M1/M2 macrophage phenotype in the HCHF swine differed with the progression of atherosclerosis, with higher density of M1-phenotype in HCHF swine. There was high expression of CCR7 (M1-phenotype) in more advanced lesions in the fibrous cap-like areas, whereas M2-macrophages were abundant in the foam-cell cores. These findings suggest that the addition of a fructose to high cholesterol diet accelerates atherosclerotic lesions in coronary arteries with an increase in M1-macrophages and the propensity to develop features of metabolic syndrome.

  4. High-resolution measurement of absolute {alpha}-decay widths in {sup 16}O

    SciTech Connect

    Wheldon, C.; Ashwood, N. I.; Barr, M.; Curtis, N.; Freer, M.; Kokalova, Tz.; Malcolm, J. D.; Spencer, S. J.; Ziman, V. A.; Faestermann, Th.; Kruecken, R.; Wirth, H.-F.; Hertenberger, R.; Lutter, R.; Bergmaier, A.

    2011-06-15

    By using a large-acceptance position-sensitive silicon detector array in coincidence with the high-resolution Munich Q3D spectrograph, unambiguous measurements have been made of the absolute {alpha}-particle decay widths from excited states in {sup 16}O* in the energy range 13.85 to 15.87 MeV. Carbon targets have been bombarded with 42-MeV {sup 6}Li beams to induce {sub 6}{sup 12}C({sub 3}{sup 6}Li, d){sub 8}{sup 16}O* reactions. The deuteron ejectiles were measured in the Q3D and the results gated by {sup 4}He+{sup 12}C breakup products detected in the silicon array, the efficiency of which was modeled using Monte Carlo simulations. By comparing total population and breakup-gated spectra, the following absolute {alpha}-decay widths have been measured with high resolution: {Gamma}{sub {alpha}}0/{Gamma}{sub tot} = 0.87{+-}0.11 (13.980 MeV), 1.04{+-}0.15 (14.302 MeV), 0.92{+-}0.10 (14.399 MeV), 0.59{+-}0.04 (14.815 MeV), 0.88{+-}0.18 (15.785 MeV), and {Gamma}{sub {alpha}}1/{Gamma}{sub tot}=1.14{+-}0.08 (14.660 MeV), 0.46{+-}0.06 (14.815 MeV).

  5. Normal incidence spectrophotometer using high density transmission grating technology and highly efficiency silicon photodiodes for absolute solar EUV irradiance measurements

    NASA Technical Reports Server (NTRS)

    Ogawa, H. S.; Mcmullin, D.; Judge, D. L.; Korde, R.

    1992-01-01

    New developments in transmission grating and photodiode technology now make it possible to realize spectrometers in the extreme ultraviolet (EUV) spectral region (wavelengths less than 1000 A) which are expected to be virtually constant in their diffraction and detector properties. Time dependent effects associated with reflection gratings are eliminated through the use of free standing transmission gratings. These gratings together with recently developed and highly stable EUV photodiodes have been utilized to construct a highly stable normal incidence spectrophotometer to monitor the variability and absolute intensity of the solar 304 A line. Owing to its low weight and compactness, such a spectrometer will be a valuable tool for providing absolute solar irradiance throughout the EUV. This novel instrument will also be useful for cross-calibrating other EUV flight instruments and will be flown on a series of Hitchhiker Shuttle Flights and on SOHO. A preliminary version of this instrument has been fabricated and characterized, and the results are described.

  6. High-precision laser-assisted absolute determination of x-ray diffraction angles.

    PubMed

    Kubicek, K; Braun, J; Bruhns, H; López-Urrutia, J R Crespo; Mokler, P H; Ullrich, J

    2012-01-01

    A novel technique for absolute wavelength determination in high-precision crystal x-ray spectroscopy recently introduced has been upgraded reaching unprecedented accuracies. The method combines visible laser beams with the Bond method, where Bragg angles (θ and -θ) are determined without any x-ray reference lines. Using flat crystals this technique makes absolute x-ray wavelength measurements feasible even at low x-ray fluxes. The upgraded spectrometer has been used in combination with first experiments on the 1s2p(1)P(1) → 1s(2)(1)S(0) w-line in He-like argon. By resolving a minute curvature of the x-ray lines the accuracy reaches there the best ever reported value of 1.5 ppm. The result is sensitive to predicted second-order QED contributions at the level of two-electron screening and two-photon radiative diagrams and will allow for the first time to benchmark predicted binding energies for He-like ions at this level of precision.

  7. High-precision laser-assisted absolute determination of x-ray diffraction angles

    SciTech Connect

    Kubicek, K.; Braun, J.; Bruhns, H.; Crespo Lopez-Urrutia, J. R.; Mokler, P. H.; Ullrich, J.

    2012-01-15

    A novel technique for absolute wavelength determination in high-precision crystal x-ray spectroscopy recently introduced has been upgraded reaching unprecedented accuracies. The method combines visible laser beams with the Bond method, where Bragg angles ({theta} and -{theta}) are determined without any x-ray reference lines. Using flat crystals this technique makes absolute x-ray wavelength measurements feasible even at low x-ray fluxes. The upgraded spectrometer has been used in combination with first experiments on the 1s2p {sup 1}P{sub 1}{yields} 1s{sup 2} {sup 1}S{sub 0} w-line in He-like argon. By resolving a minute curvature of the x-ray lines the accuracy reaches there the best ever reported value of 1.5 ppm. The result is sensitive to predicted second-order QED contributions at the level of two-electron screening and two-photon radiative diagrams and will allow for the first time to benchmark predicted binding energies for He-like ions at this level of precision.

  8. Measuring Absolute RNA Copy Numbers at High Temporal Resolution Reveals Transcriptome Kinetics in Development.

    PubMed

    Owens, Nick D L; Blitz, Ira L; Lane, Maura A; Patrushev, Ilya; Overton, John D; Gilchrist, Michael J; Cho, Ken W Y; Khokha, Mustafa K

    2016-01-26

    Transcript regulation is essential for cell function, and misregulation can lead to disease. Despite technologies to survey the transcriptome, we lack a comprehensive understanding of transcript kinetics, which limits quantitative biology. This is an acute challenge in embryonic development, where rapid changes in gene expression dictate cell fate decisions. By ultra-high-frequency sampling of Xenopus embryos and absolute normalization of sequence reads, we present smooth gene expression trajectories in absolute transcript numbers. During a developmental period approximating the first 8 weeks of human gestation, transcript kinetics vary by eight orders of magnitude. Ordering genes by expression dynamics, we find that "temporal synexpression" predicts common gene function. Remarkably, a single parameter, the characteristic timescale, can classify transcript kinetics globally and distinguish genes regulating development from those involved in cellular metabolism. Overall, our analysis provides unprecedented insight into the reorganization of maternal and embryonic transcripts and redefines our ability to perform quantitative biology. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  9. High coronary calcium score and post-procedural CK-MB are noninvasive predictors of coronary stent restenosis

    PubMed Central

    Lee, Jae-Beom; Choi, Yun-Seok; Chung, Woo-Baek; Kwon, Ami; Park, Chul-Soo; Lee, Man-Young

    2017-01-01

    Purpose High coronary calcium score (CCS) and post-procedural cardiac enzyme may be related with poor outcomes in patients with coronary stent implantation. Methods A total of 1,072 patients (63.2% male, mean age: 61.7±10.3 years) who underwent coronary multi-detect computed tomography at index procedure and follow-up coronary angiography (CAG) after drug-eluting stent (DES) were divided into two groups: those with and without target lesion revascularization (TLR; >50% reduction in luminal stent diameter or angina symptoms on follow-up CAG). The CCSs for predicting stent revascularization were elucidated. Results There were no significant differences between the two groups with regard to risk factors. The initial CCS was significantly higher in the TLR group (1,102.4±743.7 vs 345.8±51.05, P=0.04). After adjustment of significant factors for TLR, only CCS and post-procedural creatine kinase MB form (CK-MB) elevation were significant predictors of coronary artery TLR. Receiver operation curve revealed that >800 in CCS had 69% in sensitivity and 88% in specificity about predicting the TLR. Conclusion High CCS with post-procedural CK-MB might be the useful predictors for TLR after DES implantation. PMID:28255235

  10. ABSOLUTE MEASUREMENT OF THE POLARIZATION OF HIGH ENERGY PROTON BEAMS AT RHIC

    SciTech Connect

    MAKDISI,Y.; BRAVAR, A. BUNCE, G. GILL, R.; HUANG, H.; ET AL.

    2007-06-25

    The spin physics program at the Relativistic Heavy Ion Collider (RHIC) requires knowledge of the beam polarization to better than 5%. Such a goal is made the more difficult by the lack of knowledge of the analyzing power of high energy nuclear physics processes. To overcome this, a polarized hydrogen jet target was constructed and installed at one intersection region in RHIC where it intersects both beams and utilizes the precise knowledge of the jet atomic hydrogen beam polarization to measure the analyzing power in proton-proton elastic scattering in the Nuclear Coulomb Interference (CNI) region at the prescribed RHIC proton beam energy. The reverse reaction is used to assess the absolute beam polarization. Simultaneous measurements taken with fast high statistics polarimeters that measure the p-Carbon elastic scattering process also in the CNI region use the jet results to calibrate the latter.

  11. Miniature high-throughput chemosensing of yield, ee, and absolute configuration from crude reaction mixtures.

    PubMed

    Bentley, Keith W; Zhang, Peng; Wolf, Christian

    2016-02-01

    High-throughput experimentation (HTE) has emerged as a widely used technology that accelerates discovery and optimization processes with parallel small-scale reaction setups. A high-throughput screening (HTS) method capable of comprehensive analysis of crude asymmetric reaction mixtures (eliminating product derivatization or isolation) would provide transformative impact by matching the pace of HTE. We report how spontaneous in situ construction of stereodynamic metal probes from readily available, inexpensive starting materials can be applied to chiroptical chemosensing of the total amount, enantiomeric excess (ee), and absolute configuration of a wide variety of amines, diamines, amino alcohols, amino acids, carboxylic acids, α-hydroxy acids, and diols. This advance and HTS potential are highlighted with the analysis of 1 mg of crude reaction mixtures of a catalytic asymmetric reaction. This operationally simple assay uses a robust mix-and-measure protocol, is amenable to microscale platforms and automation, and provides critical time efficiency and sustainability advantages over traditional serial methods.

  12. Miniature high-throughput chemosensing of yield, ee, and absolute configuration from crude reaction mixtures

    PubMed Central

    Bentley, Keith W.; Zhang, Peng; Wolf, Christian

    2016-01-01

    High-throughput experimentation (HTE) has emerged as a widely used technology that accelerates discovery and optimization processes with parallel small-scale reaction setups. A high-throughput screening (HTS) method capable of comprehensive analysis of crude asymmetric reaction mixtures (eliminating product derivatization or isolation) would provide transformative impact by matching the pace of HTE. We report how spontaneous in situ construction of stereodynamic metal probes from readily available, inexpensive starting materials can be applied to chiroptical chemosensing of the total amount, enantiomeric excess (ee), and absolute configuration of a wide variety of amines, diamines, amino alcohols, amino acids, carboxylic acids, α-hydroxy acids, and diols. This advance and HTS potential are highlighted with the analysis of 1 mg of crude reaction mixtures of a catalytic asymmetric reaction. This operationally simple assay uses a robust mix-and-measure protocol, is amenable to microscale platforms and automation, and provides critical time efficiency and sustainability advantages over traditional serial methods. PMID:26933684

  13. Triglyceride, high density lipoprotein, and coronary heart disease.

    PubMed

    The National Institutes of Health Consensus Development Conference on Triglyceride, High Density Lipoprotein, and Coronary Heart Disease brought together experts in lipid metabolism, epidemiologists, and clinicians as well as other health care professionals and the public to address the following questions: (1) is the relationship of high triglyceride and/or low HDL cholesterol with coronary heart disease causal? (2) Will reduction of high triglyceride and/or elevation of HDL cholesterol help prevent coronary heart disease? (3) Under what circumstances should triglycerides and HDL cholesterol be measured? (4) Under what circumstances should active intervention to lower triglyceride and/or raise HDL cholesterol be considered in high risk individuals and the general population? (5) What can be accomplished by dietary, other hygienic, and drug treatments? (6) What are the significant questions for future research? Following two days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) existing data provide considerable support for a causal relationship between low HDL and CHD; however, with respect to TG data are mixed and the evidence on a causal relationship is incomplete; (2) initial TG and/or HDL levels modify benefit achieved by lowering low density lipoprotein cholesterol (LDL-C); however, evidence from clinical trials is insufficient to draw conclusions about specific benefits of TG and/or HDL altering therapy; (3) HDL-C measurement should be added to total cholesterol measurement when evaluating CHD risk in healthy individuals provided accuracy of measurement, appropriate counseling, and followup can be assured; (4) there is general agreement with the Adult Treatment Panel (ATP) guidelines that LDL-C is essential in cardiovascular risk assessment, as well as that persons with elevations of LDL-C greater than 150 mg

  14. Usage tests of oak moss absolutes containing high and low levels of atranol and chloroatranol.

    PubMed

    Mowitz, Martin; Svedman, Cecilia; Zimerson, Erik; Bruze, Magnus

    2014-07-01

    Atranol and chloroatranol are strong contact allergens in oak moss absolute, a lichen extract used in perfumery. Fifteen subjects with contact allergy to oak moss absolute underwent a repeated open application test (ROAT) using solutions of an untreated oak moss absolute (sample A) and an oak moss absolute with reduced content of atranol and chloroatranol (sample B). All subjects were in addition patch-tested with serial dilutions of samples A and B. Statistically significantly more subjects reacted to sample A than to sample B in the patch tests. No corresponding difference was observed in the ROAT, though there was a significant difference in the time required to elicit a positive reaction. Still, the ROAT indicates that the use of a cosmetic product containing oak moss absolute with reduced levels of atranol and chloroatranol is capable of eliciting an allergic reaction in previously sensitised individuals.

  15. Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

    PubMed

    Dedic, Admir; Ten Kate, Gert-Jan R; Roos, Cornelis J; Neefjes, Lisan A; de Graaf, Michiel A; Spronk, Angela; Delgado, Victoria; van Lennep, Jeanine E Roeters; Moelker, Adriaan; Ouhlous, Mohamed; Scholte, Arthur J H A; Boersma, Eric; Sijbrands, Eric J G; Nieman, Koen; Bax, Jeroen J; de Feijter, Pim J

    2016-03-01

    At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p <0.01). In conclusion, CCTA has incremental prognostic value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD.

  16. Relation between high density lipoprotein cholesterol and coronary artery disease in asymptomatic men

    SciTech Connect

    Uhl, G.S.; Troxler, R.G.; Hickman, J.R. Jr.; Clark, D.

    1981-11-01

    The well established inverse relation of high density lipoprotein cholesterol (HDL) and the risk of coronary artery disease was tested in a cross-sectional group of 572 asymptomatic aircrew members who were being screened for risk of coronary artery disease. A battery of tests was performed, including determinations of fasting serum cholesterol, HDL cholesterol and triglycerides and performance of a maximal symptom-limited exercise tolerance test. Of the 572 patients, 132 also had an abnormal S-T segment response to exercise testing or were otherwise believed to have an increased risk of organic heart disease and subsequently underwent coronary angiography. Significant coronary artery disease was found in 16 men and minimal or subcritical coronary disease in 14; coronary angiograms were normal in the remaining 102 men. The remaining 440 men, who were believed to have a 1 percent chance of having coronary artery disease by sequential testing of risk factors and treadmill testing, had a mean cholesterol level of 213 mg/100 ml, a mean HDL cholesterol of 51 mg/100 ml and a mean cholesterol/HDL ratio of 4.4. The mean values of cholesterol, HDL cholesterol and cholesterol/HDL cholesterol did not differ significantly in men with normal angiographic finding and those with subcritical coronary disease. However, 14 of 16 men with coronary artery disease had a cholesterol/HDL ratio of 6.0 or more whereas only 4 men with normal coronary arteries had a ratio of 6.0 or more. Of the classical coronary risk factors evaluated, the cholesterol/HDL ratio of 6.0 or more had the highest odds ratio (172:1). It appears that determination of HDL cholesterol level helps to identify asymptomatic persons with a greater risk of having coronary artery disease.

  17. Routine preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting.

    PubMed

    Vohra, Hunaid A; Briffa, Norman P

    2005-01-01

    The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.

  18. Absolute dose determination in high-energy electron beams: Comparison of IAEA dosimetry protocols

    PubMed Central

    Sathiyan, S.; Ravikumar, M.

    2008-01-01

    In this study, absorbed doses were measured and compared for high-energy electrons (6, 9, 12, 16, and 20 MeV) using International Atomic Energy Agency (IAEA), Technical Reports Series No. 277 (TRS), TRS 381, and TRS 398 dosimetry protocols. Absolute dose measurements were carried out using FC65-G Farmer chamber and Nordic Association of Clinical Physicists (NACP) parallel plate chamber with DOSE1 electrometer in WP1-D water phantom for reference field size of 15 × 15 cm2 at 100 cm source-to-surface distance. The results show that the difference between TRS 398 and TRS 381 was about 0.24% to 1.3% depending upon the energy, and the maximum difference between TRS 398 and TRS 277 was 1.5%. The use of cylindrical chamber in electron beam gives the maximum dose difference between the TRS 398 and TRS 277 in the order of 1.4% for energies above 10 MeV (R50 > 4 g/cm2). It was observed that the accuracy of dose estimation was better with the protocols based on the water calibration procedures, as no conversion quantities are involved for conversion of dose from air to water. The cross-calibration procedure of parallel plate chamber with high-energy electron beams is recommended as it avoids pwall correction factor entering into the determination of kQ,Qo. PMID:19893700

  19. The high-precision videometrics methods to determining absolute vertical benchmark

    NASA Astrophysics Data System (ADS)

    Liu, Jinbo; Zhu, Zhaokun

    2013-01-01

    The mobile measurement equipment plays an important role in engineering measurement tasks and its measuring device is fixed with the vehicle platform. Therefore, how to correct the measured error in time that caused by swayed platform is a basic problem. Videometrics has its inherent advantages in solving this problem. First of all, videometrics technology is non-contact measurement, which has no effect on the target's structural characteristics and motion characteristics. Secondly, videometrics technology has high precision especially for surface targets and linear targets in the field of view. Thirdly, videometrics technology has the advantages of automatic, real-time and dynamic. This paper is mainly for mobile theodolite.etc that works under the environment of absolute vertical benchmark and proposed two high-precision methods to determine vertical benchmark: Direct-Extracting, which is based on the intersection of plats under the help of two cameras; Benchmark-Transformation, which gets the vertical benchmark by reconstructing the level-plat. Two methods both have the precision of under 10 seconds by digital simulation and physical experiments. The methods proposed by this paper have significance both on the theory and application.

  20. Lower ratio of high-molecular-weight adiponectin level to total may be associated with coronary high-risk plaque.

    PubMed

    Moroi, Masao; Akter, Shamima; Nakazato, Ryo; Kunimasa, Taeko; Masai, Hirofumi; Furuhashi, Tatsuhiko; Fukuda, Hiroshi; Koda, Eiichi; Sugi, Kaoru; Jesmin, Subrina

    2013-03-06

    Although high-molecular-weight (HMW) adiponectin is believed to protect against atherosclerosis, the association between HMW adiponectin and the composition of coronary plaques is unknown. We evaluated whether the HMW to total adiponectin ratio was associated with the presence of coronary plaque and its composition using multi-slice computed tomography coronary angiography (MSCTCA). Serum total and HMW adiponectin levels were measured in 53 consecutive patients (age, 71) with >50% coronary artery stenosis detected by MSCTCA. A low-attenuation coronary plaque was defined as a plaque with a mean CT density <50 Hounsfield units. Multivariate logistic regression analyses were performed to evaluate the predictors of the presence of low-attenuation coronary plaques, which is thought to be high risk, on CT. Decreased serum levels of total as well as HMW adiponectin were significantly associated with the presence of at least one calcified or non-calcified coronary artery plaque (total adiponectin level: odds ratio 0.76, 95% CI 0.58-0.99, P = 0.048; HMW adiponectin level: odds ratio 0.65, 95% CI 0.42-0.99, P = 0.047). A low ratio of HMW to total adiponectin was significantly associated with the presence of low-attenuation coronary plaques (4.55, 1.94-21.90, P = 0.049). However, neither the total adiponectin nor the HMW adiponectin level was associated with the presence of low-attenuation coronary plaques. Lower total or HMW adiponectin levels are associated with the presence of calcified and non-calcified coronary plaques, whereas a lower ratio of HMW to total adiponectin associated with the presence of low-attenuation coronary plaques (thought to be high risk). Measurement of total and HMW adiponectin levels and the HMW to total adiponectin ratio may be useful for risk stratification of coronary artery plaques.

  1. The absolute radiometric calibration of the advanced very high resolution radiometer

    NASA Technical Reports Server (NTRS)

    Slater, P. N.; Teillet, P. M.; Ding, Y.

    1988-01-01

    The need for independent, redundant absolute radiometric calibration methods is discussed with reference to the Thematic Mapper. Uncertainty requirements for absolute calibration of between 0.5 and 4 percent are defined based on the accuracy of reflectance retrievals at an agricultural site. It is shown that even very approximate atmospheric corrections can reduce the error in reflectance retrieval to 0.02 over the reflectance range 0 to 0.4.

  2. An absolute dose determination of helical tomotherapy accelerator, TomoTherapy High-Art II.

    PubMed

    Bailat, Claude J; Buchillier, Thierry; Pachoud, Marc; Moeckli, Raphaël; Bochud, François O

    2009-09-01

    A helical tomotherapy accelerator presents a dosimetric challenge because, to this day, there is no internationally accepted protocol for the determination of the absolute dose. Because of this reality, we investigated the different alternatives for characterizing and measuring the absolute dose of such an accelerator. We tested several dosimetric techniques with various metrological traceabilities as well as using a number of phantoms in static and helical modes. Firstly, the relationship between the reading of ionization chambers and the absorbed dose is dependent on the beam quality value of the photon beam. For high energy photons, the beam quality is specified by the tissue phantom ratio (TPR20,10) and it is therefore necessary to know the TPR20,10 to calculate the dose delivered by a given accelerator. This parameter is obtained through the ratio of the absorbed dose at 20 and 10 cm depths in water and was measured in the particular conditions of the tomotherapy accelerator. Afterward, measurements were performed using the ionization chamber (model A1SL) delivered as a reference instrument by the vendor. This chamber is traceable in absorbed dose to water in a Co-60 beam to a water calorimeter of the American metrology institute (NIST). Similarly, in Switzerland, each radiotherapy department is directly traceable to the Swiss metrology institute (METAS) in absorbed dose to water based on a water calorimeter. For our research, this traceability was obtained by using an ionization chamber traceable to METAS (model NE 2611A), which is the secondary standard of our institute. Furthermore, in order to have another fully independent measurement method, we determined the dose using alanine dosimeters provided by and traceable to the British metrology institute (NPL); they are calibrated in absorbed dose to water using a graphite calorimeter. And finally, we wanted to take into account the type of chamber routinely used in clinical practice and therefore measured the

  3. An absolute dose determination of helical tomotherapy accelerator, TomoTherapy High-Art II

    SciTech Connect

    Bailat, Claude J.; Buchillier, Thierry; Pachoud, Marc; Moeckli, Raphaeel; Bochud, Francois O.

    2009-09-15

    Purpose: A helical tomotherapy accelerator presents a dosimetric challenge because, to this day, there is no internationally accepted protocol for the determination of the absolute dose. Because of this reality, we investigated the different alternatives for characterizing and measuring the absolute dose of such an accelerator. We tested several dosimetric techniques with various metrological traceabilities as well as using a number of phantoms in static and helical modes. Methods: Firstly, the relationship between the reading of ionization chambers and the absorbed dose is dependent on the beam quality value of the photon beam. For high energy photons, the beam quality is specified by the tissue phantom ratio (TPR{sub 20,10}) and it is therefore necessary to know the TPR{sub 20,10} to calculate the dose delivered by a given accelerator. This parameter is obtained through the ratio of the absorbed dose at 20 and 10 cm depths in water and was measured in the particular conditions of the tomotherapy accelerator. Afterward, measurements were performed using the ionization chamber (model A1SL) delivered as a reference instrument by the vendor. This chamber is traceable in absorbed dose to water in a Co-60 beam to a water calorimeter of the American metrology institute (NIST). Similarly, in Switzerland, each radiotherapy department is directly traceable to the Swiss metrology institute (METAS) in absorbed dose to water based on a water calorimeter. For our research, this traceability was obtained by using an ionization chamber traceable to METAS (model NE 2611A), which is the secondary standard of our institute. Furthermore, in order to have another fully independent measurement method, we determined the dose using alanine dosimeters provided by and traceable to the British metrology institute (NPL); they are calibrated in absorbed dose to water using a graphite calorimeter. And finally, we wanted to take into account the type of chamber routinely used in clinical

  4. The absolute radiometric calibration of the advanced very high resolution radiometer

    NASA Technical Reports Server (NTRS)

    Slater, P. N.; Teillet, P. M.; Ding, Y.

    1988-01-01

    An increasing number of remote sensing investigations require radiometrically calibrated imagery from NOAA Advanced Very High Resolution Radiation (AVHRR) sensors. Although a prelaunch calibration is done for these sensors, there is no capability for monitoring any changes in the in-flight absolute calibration for the visible and near infrared spectral channels. Hence, the possibility of using the reflectance-based method developed at White Sands for in-orbit calibration of LANDSAT Thematic Mapper (TM) and SPOT Haute Resolution Visible (HVR) data to calibrate the AVHRR sensor was investigated. Three diffrent approaches were considered: Method 1 - ground and atmospheric measurements and reference to another calibrated satellite sensor; Method 2 - ground and atmospheric measurements with no reference to another sensor; and Method 3 - no ground and atmospheric measurements but reference to another satellite sensor. The purpose is to describe an investigation on the use of Method 2 to calibrate NOAA-9 AVHRR channels 1 and 2 with the help of ground and atmospheric measurements at Rogers (dry) Lake, Edwards Air Force Base (EAFB) in the Mojave desert of California.

  5. Absolute Effective Area of the Chandra High-Resolution Mirror Assembly

    NASA Technical Reports Server (NTRS)

    Schwartz, D. A.; David, L. P.; Donnelly, R. H.; Edgar, R. J.; Gaetz, T. J.; Jerius, D.; Juda, M.; Kellogg, E. M.; McNamara, B. R.; Dewey, D.

    2000-01-01

    The Chandra X-ray Observatory was launched in July 1999, and is returning exquisite sub-arcsecond x-ray images of star groups, supernova remnants, galaxies, quasars, and clusters of galaxies. In addition to being the premier X-ray observatory in terms of angular and spectral resolution, Chandra is the best calibrated X-ray facility ever flown. We discuss here the calibration of the effective area of the High Resolution Mirror Assembly. Because we do not know the absolute X-ray flux density of any celestial source, this must be based primarily on ground measurements and on modeling. In particular, we must remove the calibrated modeled responses of the detectors and gratings to obtain the mirror area. For celestial sources which may be assumed to have smoothly varying spectra, such as the Crab Nebula, we may verify the continuity of the area calibration as a function of energy. This is of significance in energy regions such as the Ir M-edges, or near the critical grazing angle cutoff of the various mirror shells.

  6. Investigations of high-speed optical transmission systems employing Absolute Added Correlative Coding (AACC)

    NASA Astrophysics Data System (ADS)

    Dong-Nhat, Nguyen; Elsherif, Mohamed A.; Malekmohammadi, Amin

    2016-07-01

    A novel multilevel modulation format based on partial-response signaling called Absolute Added Correlative Coding (AACC) is proposed and numerically demonstrated for high-speed fiber-optic communication systems. A bit error rate (BER) estimation model for the proposed multilevel format has also been developed. The performance of AACC is examined and compared against other prevailing On-Off-Keying and multilevel modulation formats e.g. non-return-to-zero (NRZ), 50% return-to-zero (RZ), 67% carrier-suppressed return-to-zero (CS-RZ), duobinary and four-level pulse-amplitude modulation (4-PAM) in terms of receiver sensitivity, spectral efficiency and dispersion tolerance. Calculated receiver sensitivity at a BER of 10-9 and chromatic dispersion tolerance of the proposed system are ˜-28.3 dBm and ˜336 ps/nm, respectively. The performance of AACC is delineated to be improved by 7.8 dB in terms of receiver sensitivity compared to 4-PAM in back-to-back scenario. The comparison results also show a clear advantage of AACC in achieving longer fiber transmission distance due to the higher dispersion tolerance in optical access networks.

  7. Single stage substernal thyroidectomy and off-pump coronary artery bypass grafting: is it worth using cardiopulmonary bypass unless absolutely necessary?

    PubMed Central

    Cetin, Erdem; Ozyuksel, Arda; Dalbasi, Erkan

    2014-01-01

    It is a rare entity to observe the coexistence of thyroid gland pathologies and coronary artery disease, whose surgical treatment may be performed simultaneously. In this case, we present a case of a patient with substernal thyroidectomy concurrent with off-pump coronary artery bypass grafting. A 57-year-old female patient was admitted to the hospital with exertional dyspnoea, intermittent coughing and stable angina pectoris. The substernal goitre measuring 5×5×4 cm was accompanied by a 95% in-stent restenosis at the left anterior descending artery. Thyroidectomy and off-pump coronary artery bypass grafting procedures were performed simultaneously. The postoperative period was uneventful and the patient was discharged 5 days after the operation. This case indicates that off-pump revascularisation seems to be a better option in cases where surgical interventions for thyroid and coronary artery diseases are necessary instead of on-pump revascularisation where the adverse effects of the cardiopulmonary bypass are considered. PMID:24722708

  8. High-risk coronary angioplasty assisted by active hemoperfusion. A feasibility study.

    PubMed Central

    Angelini, P; Hernandez, C; Ferguson, J J; Leachman, R D; Garcia-Gregory, J A; Benrey, J; Schnee, M J; Fighali, S F; Krajcer, Z

    1996-01-01

    We assessed the effectiveness of distal hemoperfusion support during gradual, prolonged balloon inflation during percutaneous transluminal coronary angioplasty in high-risk patients. The patients were identified as having a poor left ventricular ejection fraction ( < 35%), > 50% of viable myocardium at risk percutaneous coronary balloon angioplasty, or both. A total of 64 procedures were performed in 61 patients. Angiographic success was achieved in 83 of 86 (96.5%) lesions treated with hemoperfusion support. Hospital complications included 1 patient who had a non-Q-wave infarction, 1 who had to undergo redo percutaneous coronary balloon angioplasty, and 5 who required coronary artery bypass operations. The hospital mortality was 7.8% (5 patients). This preliminary study indicates that hemoperfusion support can enable expeditious, simple, economical, and effective percutaneous transluminal coronary balloon angioplasty in a subset of labile patients in whom procedural failure frequently leads to sudden death. PMID:8680269

  9. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.

    PubMed

    Ferrari, Enrico; Stalder, Nicolas; von Segesser, Ludwig K

    2008-07-02

    Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%). All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One

  10. High susceptibility of atherosclerotic coronary arteries to the onset of vasospasm and angina pectoris-like symptoms due to coronary spasm in WHHLMI rabbits

    PubMed Central

    Koike, Tomonari; Tamura, Shiori; Yu, Ying; Kuniyoshi, Nobue; Shiomi, Masashi

    2016-01-01

    We examined the relationship between atherosclerosis and the provocation of coronary spasm as well as the influence of coronary spasm on the onset of acute ischemic myocardial disease. Coronary spasm was provoked in anesthetized normal Japanese white (JW) rabbits and myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits, an animal model for coronary atherosclerosis and myocardial infarction, by injecting ergonovine during the infusion of norepinephrine through a marginal ear vein. A decrease in contrast flow in the left circumflex artery was observed on coronary angiograms. Ischemic changes were observed on the electrocardiograms of 29% (2/7) of JW and 79% (27/34, P=0.007) of WHHLMI rabbits. The frequency of coronary spasm was significantly high in rabbits with severe coronary plaques showing diffuse lesions. Left ventricle motility in vasospasm-positive rabbits, which was evaluated with echocardiograms, was decreased by 29% following the ergonovine injection (P<0.001), and every serum ischemic marker markedly increased 4 h after the provocation of vasospasm. These results demonstrate that atherosclerotic coronary arteries are positively related to the provocation of vasospasm, and vasospasm in severe atherosclerotic coronary segments evokes angina pectoris-like findings and/or non-fatal myocardial infarction. WHHLMI rabbits may be a novel animal model for angina pectoris and acute ischemic heart disease. PMID:27301847

  11. Toward a self-consistent, high-resolution absolute plate motion model for the Pacific

    NASA Astrophysics Data System (ADS)

    Wessel, Paul; Harada, Yasushi; Kroenke, Loren W.

    2006-03-01

    The hot spot hypothesis postulates that linear volcanic trails form as lithospheric plates move relative to stationary or slowly moving plumes. Given geometry and ages from several trails, one can reconstruct absolute plate motions (APM) that provide valuable information about past and present tectonism, paleogeography, and volcanism. Most APM models have been designed by fitting small circles to coeval volcanic chain segments and determining stage rotation poles, opening angles, and time intervals. Unlike relative plate motion (RPM) models, such APM models suffer from oversimplicity, self-inconsistencies, inadequate fits to data, and lack of rigorous uncertainty estimates; in addition, they work only for fixed hot spots. Newer methods are now available that overcome many of these limitations. We present a technique that provides high-resolution APM models derived from stationary or moving hot spots (given prescribed paths). The simplest model assumes stationary hot spots, and an example of such a model is presented. Observations of geometry and chronology on the Pacific plate appear well explained by this type of model. Because it is a one-plate model, it does not discriminate between hot spot drift or true polar wander as explanations for inferred paleolatitudes from the Emperor chain. Whether there was significant relative motion within the hot spots under the Pacific plate during the last ˜70 m.y. is difficult to quantify, given the paucity and geological uncertainty of age determinations. Evidence in support of plume drift appears limited to the period before the 47 Ma Hawaii-Emperor Bend and, apart from the direct paleolatitude determinations, may have been somewhat exaggerated.

  12. Assignment of absolute configurations of highly flexible linear diterpenes from the brown alga Bifurcaria bifurcata by VCD spectroscopy.

    PubMed

    Merten, Christian; Smyrniotopoulos, Vangelis; Tasdemir, Deniz

    2015-11-21

    Correct assignment of the stereogenic centers of highly flexible linear diterpenes (LDs) is challenging. Herein we report the first application of VCD spectroscopy for the absolute configuration determination of LDs of algal origin and provide experimental and computational procedures, such as a fragmentation approach, which will facilitate the use of VCD spectroscopy for configuration assignments of LDs.

  13. Diode-laser-based high-precision absolute distance interferometer of 20 m range.

    PubMed

    Pollinger, Florian; Meiners-Hagen, Karl; Wedde, Martin; Abou-Zeid, Ahmed

    2009-11-10

    We present a hybrid absolute distance measurement method that is based on a combination of frequency sweeping, variable synthetic, and two-wavelength, fixed synthetic wavelength interferometry. Both experiments were realized by two external cavity diode lasers. The measurement uncertainty was experimentally and theoretically demonstrated to be smaller than 12 microm at a measurement distance of 20 m.

  14. Ground-based lidar and microwave radiometry synergy for high vertical resolution absolute humidity profiling

    NASA Astrophysics Data System (ADS)

    Barrera-Verdejo, María; Crewell, Susanne; Löhnert, Ulrich; Orlandi, Emiliano; Di Girolamo, Paolo

    2016-08-01

    Continuous monitoring of atmospheric humidity profiles is important for many applications, e.g., assessment of atmospheric stability and cloud formation. Nowadays there are a wide variety of ground-based sensors for atmospheric humidity profiling. Unfortunately there is no single instrument able to provide a measurement with complete vertical coverage, high vertical and temporal resolution and good performance under all weather conditions, simultaneously. For example, Raman lidar (RL) measurements can provide water vapor with a high vertical resolution, albeit with limited vertical coverage, due to sunlight contamination and the presence of clouds. Microwave radiometers (MWRs) receive water vapor information throughout the troposphere, though their vertical resolution is poor. In this work, we present an MWR and RL system synergy, which aims to overcome the specific sensor limitations. The retrieval algorithm combining these two instruments is an optimal estimation method (OEM), which allows for an uncertainty analysis of the retrieved profiles. The OEM combines measurements and a priori information, taking the uncertainty of both into account. The measurement vector consists of a set of MWR brightness temperatures and RL water vapor profiles. The method is applied to a 2-month field campaign around Jülich (Germany), focusing on clear sky periods. Different experiments are performed to analyze the improvements achieved via the synergy compared to the individual retrievals. When applying the combined retrieval, on average the theoretically determined absolute humidity uncertainty is reduced above the last usable lidar range by a factor of ˜ 2 with respect to the case where only RL measurements are used. The analysis in terms of degrees of freedom per signal reveal that most information is gained above the usable lidar range, especially important during daytime when the lidar vertical coverage is limited. The retrieved profiles are further evaluated using

  15. Enantiomeric high-performance liquid chromatography resolution and absolute configuration of 6β-benzoyloxy-3α-tropanol.

    PubMed

    Muñoz, Marcelo A; González, Natalia; Joseph-Nathan, Pedro

    2016-07-01

    The absolute configuration of the naturally occurring isomers of 6β-benzoyloxy-3α-tropanol (1) has been established by the combined use of chiral high-performance liquid chromatography with electronic circular dichroism detection and optical rotation detection. For this purpose (±)-1, prepared in two steps from racemic 6-hydroxytropinone (4), was subjected to chiral high-performance liquid chromatography with electronic circular dichroism and optical rotation detection allowing the online measurement of both chiroptical properties for each enantiomer, which in turn were compared with the corresponding values obtained from density functional theory calculations. In an independent approach, preparative high-performance liquid chromatography separation using an automatic fraction collector, yielded an enantiopure sample of OR (+)-1 whose vibrational circular dichroism spectrum allowed its absolute configuration assignment when the bands in the 1100-950 cm(-1) region were compared with those of the enantiomers of esters derived from 3α,6β-tropanediol. In addition, an enantiomerically enriched sample of 4, instead of OR (±)-4, was used for the same transformation sequence, whose high-performance liquid chromatography follow-up allowed their spectroscopic correlation. All evidences lead to the OR (+)-(1S,3R,5S,6R) and OR (-)-(1R,3S,5R,6S) absolute configurations, from where it follows that samples of 1 isolated from Knightia strobilina and Erythroxylum zambesiacum have the OR (+)-(1S,3R,5S,6R) absolute configuration, while the sample obtained from E. rotundifolium has the OR (-)-(1R,3S,5R,6S) absolute configuration.

  16. SYNTAX Score in Patients with High Computed Tomography Coronary Calcium Score

    PubMed Central

    Hegde, Madhav; Rajendran, Ravindran

    2016-01-01

    Objectives: To study the conventional coronary angiogram ( CA) findings in patients with high coronary calcium on multidetector computed tomogram. Materials and Methods: Fifty patients with coronary calcium high enough in its extent and location to interfere with the interpretation of a contrast-filled coronary artery for a significant lesion were studied with conventional CA. Framingham risk score (FRS), computed tomography (CT) coronary calcium score (CCS), and SYNTAX score (SS) from the CA were calculated by separate investigators who were blinded to other scores. Effectively, 250 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery and posterior descending artery in each subject) with calcium scores were studied for lesions on CA. Results: Thirty-five subjects had high FRS, 10 had intermediate FRS, and 5 had low FRS. Eight subjects of 25 (32%) with CCS between 350 and 1000 had no significant coronary artery disease (CAD). Overall, the CCS and the SS had a strong agreement with each other (r = 0.68, P < 0.01) that persisted in those with very high scores >1000 (r = 0.55, P < 0.01, n = 30), but only a nonsignificant weak correlation with scores between 350 and 1000 (r = 0.1, P = 0.62, n = 20). Individual vessel calcium scores correlated strongly for the presence of any lesion (r = 0.52, P < 0.01) in the same artery but only weakly for a significant lesion (r = 0.29, P = 0.05). Conclusion: High CT CCS in this cohort of intermediate to high (Framingham score) risk patients correlated strongly with the subject's global burden of the CAD as derived by the SS, more so for subjects with very high scores. Similarly, CCS correlated strongly with the presence of any lesion but only weakly for a significant stenosis; also, about one-third of patients with CCS between 350 and 1000 may not have significant disease on conventional CA. PMID:28028450

  17. Optimal Design of the Absolute Positioning Sensor for a High-Speed Maglev Train and Research on Its Fault Diagnosis

    PubMed Central

    Zhang, Dapeng; Long, Zhiqiang; Xue, Song; Zhang, Junge

    2012-01-01

    This paper studies an absolute positioning sensor for a high-speed maglev train and its fault diagnosis method. The absolute positioning sensor is an important sensor for the high-speed maglev train to accomplish its synchronous traction. It is used to calibrate the error of the relative positioning sensor which is used to provide the magnetic phase signal. On the basis of the analysis for the principle of the absolute positioning sensor, the paper describes the design of the sending and receiving coils and realizes the hardware and the software for the sensor. In order to enhance the reliability of the sensor, a support vector machine is used to recognize the fault characters, and the signal flow method is used to locate the faulty parts. The diagnosis information not only can be sent to an upper center control computer to evaluate the reliability of the sensors, but also can realize on-line diagnosis for debugging and the quick detection when the maglev train is off-line. The absolute positioning sensor we study has been used in the actual project. PMID:23112619

  18. Optimal design of the absolute positioning sensor for a high-speed maglev train and research on its fault diagnosis.

    PubMed

    Zhang, Dapeng; Long, Zhiqiang; Xue, Song; Zhang, Junge

    2012-01-01

    This paper studies an absolute positioning sensor for a high-speed maglev train and its fault diagnosis method. The absolute positioning sensor is an important sensor for the high-speed maglev train to accomplish its synchronous traction. It is used to calibrate the error of the relative positioning sensor which is used to provide the magnetic phase signal. On the basis of the analysis for the principle of the absolute positioning sensor, the paper describes the design of the sending and receiving coils and realizes the hardware and the software for the sensor. In order to enhance the reliability of the sensor, a support vector machine is used to recognize the fault characters, and the signal flow method is used to locate the faulty parts. The diagnosis information not only can be sent to an upper center control computer to evaluate the reliability of the sensors, but also can realize on-line diagnosis for debugging and the quick detection when the maglev train is off-line. The absolute positioning sensor we study has been used in the actual project.

  19. High-speed coronary rotational angioplasty with the rotablator

    NASA Astrophysics Data System (ADS)

    Zacca, Nadim M.; Kleiman, Neal S.; Asimacopoulos, P. J.

    1992-08-01

    Percutaneous mechanical rotational ablation with the rotablator can be used effectively as a stand alone treatment for coronary arterial lesions, including those with angiographic morphology considered unfavorable for balloon angioplasty (eccentric, at bends, bifurcating, calcified, ulcerated, completely occluded_, as well as for balloon angioplasty procedure failures. The use of single rather than multiple burrs without balloon assistance, the use of fewer passes and of the nitroglycerine infusion through the rotablator catheter have considerably shortened the time necessary to complete a rotational atherectomy. Further, the apparently infrequent occurrence of post procedure abrupt closure makes this technique attractive in the clinical management of patients with complex coronary artery lesions.

  20. Coronary artery computed tomography as the first-choice imaging diagnostics in patients with high pre-test probability of coronary artery disease (CAT-CAD).

    PubMed

    Rudziński, Piotr N; Kruk, Mariusz; Demkow, Marcin; Dzielińska, Zofia; Pręgowski, Jerzy; Witkowski, Adam; Rużyłło, Witold; Kępka, Cezary

    2015-01-01

    The primary diagnostic examination performed in patients with a high pre-test probability of coronary artery disease (CAD) is invasive coronary angiography. Currently, approximately 50% of all invasive coronary angiographies do not end with percutaneous coronary intervention (PCI) because of the absence of significant coronary artery lesions. It is desirable to eliminate such situations. There is an alternative, non-invasive method useful for exclusion of significant CAD, which is coronary computed tomography angiography (CCTA). We hypothesize that use of CCTA as the first choice method in the diagnosis of patients with high pre-test probability of CAD may reduce the number of invasive coronary angiographies not followed by interventional treatment. Coronary computed tomography angiography also seems not to be connected with additional risks and costs of the diagnosis. Confirmation of these assumptions may impact cardiology guidelines. One hundred and twenty patients with indications for invasive coronary angiography determined by current ESC guidelines regarding stable CAD are randomized 1 : 1 to classic invasive coronary angiography group and the CCTA group. All patients included in the study are monitored for the occurrence of possible end points during the diagnostic and therapeutic cycle (from the first imaging examination to either complete revascularization or disqualification from the invasive treatment), or during the follow-up period. Based on the literature, it appears that the use of modern CT systems in patients with high pre-test probability of CAD, as well as appropriate clinical interpretation of the imaging study by invasive cardiologists, enables precise planning of invasive therapeutic procedures. Our randomized study will provide data to verify these assumptions.

  1. Absolute asymmetric synthesis of enantiopure organozinc reagents, followed by highly enantioselective chlorination.

    PubMed

    Olsson, Susanne; Lennartson, Anders; Håkansson, Mikael

    2013-09-09

    We report the absolute asymmetric synthesis (AAS) of indenylzinc reagents by using total spontaneous resolution followed by enantiospecific conversion into 1-chloroindene. The chiral complex [Zn(dcp)(ind)(tmeda)] (dcp = 2,6-dichlorophenoxy and tmeda = N,N,N',N'-tetramethylethylenediamine) (3) was prepared from the achiral starting materials indene, potassium, zinc chloride, TMEDA, and 2,6-dichlorophenol. The reagent resolved spontaneously on crystallization, and single crystals of 3 react with N-chlorosuccinimide in the presence of benzoquinone in 2-propanol to give 1-chloroindene in >98 % enantiomeric excess. It was found that (R)-3 gave (R)-1-chloroindene upon reaction, indicating an SE 2'-mechanism. Since bulk samples of 3 gave optically active product upon chlorination, total spontaneous resolution must have occurred. This demonstrates that enantiopure products can be obtained through the absolute asymmetric synthesis of organometallic reagents starting from achiral materials. The general absolute asymmetric synthesis (AAS) method offers easy access to both enantiomers and an almost limitless variation in the design of the product.

  2. High Platelet Reactivity in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Randomised Controlled Trial Comparing Prasugrel and Clopidogrel

    PubMed Central

    Geisler, Tobias; Booth, Jean; Tavlaki, Elli; Karathanos, Athanasios; Müller, Karin; Droppa, Michal; Gawaz, Meinrad; Yanez-Lopez, Monica; Davidson, Simon J.; Stables, Rod H.; Banya, Winston; Zaman, Azfar; Flather, Marcus; Dalby, Miles

    2015-01-01

    Background Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. Objectives To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome (ACS). Patients Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer, i.e. “poor responders” were randomised to prasugrel (60 mg loading and 10 mg maintenance dose) or clopidogrel (600 mg reloading and 150 mg maintenance dose). The primary outcome measure was proportion of patients with platelet reactivity <40 AUC 4 hours after loading with study medication, and also at one hour (secondary outcome). 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors. Results At 4 hours after study medication 100% of patients treated with prasugrel compared to 91% of those treated with clopidogrel had platelet reactivity <40 AUC (p = 0.49), while at 1 hour the proportions were 95% and 64% respectively (p = 0.02). Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 (p = 0.005) and 19 versus 34 (p = 0.01) respectively. Conclusions Routine platelet function testing identifies patients with high residual platelet reactivity (“poor responders”) on clopidogrel. A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity. Future trials need to identify if this translates into clinical benefit. Trial Registration ClinicalTrials.gov NCT01339026 PMID:26317618

  3. High correlation between absolute psychophysical threshold and the scotopic threshold response to the same stimulus.

    PubMed Central

    Graham, S. L.; Vaegan

    1991-01-01

    The scotopic threshold response (STR) is a negative potential to low intensity light recorded from the dark-adapted retina. It reflects inner retinal function. The STR is now recorded routinely as part of our electroretinography protocol. The projected absolute threshold calculated from the amplitude versus intensity function for the STR has been found to correlate well (r = 0.59) with the absolute subjective threshold to the same stimulus. The correlation holds for about 1.5 log units above normal. With further elevation the STR is usually abnormal or absent as b wave threshold is approached. The correlation would have been much greater were it not for this truncated range over which both are recordable. This report includes our findings in 127 patients and examines several disease groups. When the STR had a reduced and abnormal intensity series or was absent, the subjective threshold was elevated in almost all cases (92.2%). The converse relationship also held. When there was a discrepancy, recording problems were usually identified. Since the STR requires difficult, time consuming signal averaging for reliable recording, it may be adequate to record the subjective threshold alone to provide a relatively easily recordable indicator of inner retinal function. Additional STR recording will seldom be warranted. PMID:1954209

  4. Renal dysfunction and coronary disease: a high-risk combination.

    PubMed

    Schiele, Francois

    2009-01-01

    Chronic kidney dysfunction is recognized as a risk factor for atherosclerosis and complicates strategies and treatment. Therefore, it is important for cardiologists not only to detect and measure potential kidney dysfunction, but also to know the mechanisms by which the heart and kidney interact, and recognize that in cases of acute coronary syndrome, the presence of renal dysfunction increases the risk of death. The detection and classification of kidney dysfunction into 5 stages is based on the estimated glomerular filtration rate (GFR). The presence of hypertension, endothelial dysfunction, dyslipidemia, inflammation, activation of the renin-angiotensin system and specific calcifications are the main mechanisms by which renal dysfunction can induce or compound cardiovascular disease. The magnitude of renal dysfunction is related to the cardiovascular risk; a linear relation links the extent of GFR decrease and the risk of cardiovascular events. Renal dysfunction and acute coronary syndromes are a dangerous combination: more common comorbidities, more frequent contraindications for effective drugs and higher numbers of drug-related adverse events such as bleeding partially explain the higher mortality in patients with renal dysfunction. In addition, despite higher risk, patients with renal dysfunction often receive fewer guideline-recommended treatments even in the absence of contraindications. Renal dysfunction induces and promotes atherosclerosis by various pathophysiologic pathways and is associated with other cardiovascular risk factors and underuse of appropriate therapy. Therefore, the assessment of renal function is an important step in the risk evaluation of patients with coronary artery disease.

  5. Are high coronary risk patients missing out on lipid-lowering drugs in Australia?

    PubMed

    Simons, Leon A; Chung, Eric

    2014-08-18

    To examine whether high coronary risk patients in Australia, where use of lipid-lowering drugs (LLD) is very high by international standards, are receiving LLD. Assessment of Pharmaceutical Benefits Scheme pharmacy payment claim records between January 2006 and May 2013 for a 10% random sample of Australian concession card holders. Co-prescriptions were used as a surrogate for high coronary risk groups - coronary heart disease (CHD): antiplatelet drugs (not including solo aspirin) and anti-anginal drugs; diabetes: all standard drugs; hypertension: all standard drugs (not including solo diuretics). Proportions of patients in high-risk groups not receiving LLD (statins, fibrates or ezetimibe). The database yielded information on 276,212 patients defined as being at high coronary risk (mean age, 66.1 [SD, 14.8] years; 44% male). Of this group, 115,477 patients (42%) had not received any LLD during the study period. For patients in the risk group for CHD in combination with diabetes and hypertension, only 8% (1111/14,257) were not receiving LLD. Across all risk groups, the proportions not receiving LLD were generally highest in those aged ≥ 81 years and, to a lesser extent, < 41 years, and were lowest in those aged 51-70 years. A large proportion of concession card holders at high coronary risk, especially those in middle age with CHD and multiple risk factors, are being appropriately prescribed LLD in Australia.

  6. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography.

    PubMed

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-10-01

    To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min.

  7. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography

    PubMed Central

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-01-01

    Objective To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min. PMID:27928222

  8. Method and apparatus for ultra-high-sensitivity, incremental and absolute optical encoding

    NASA Technical Reports Server (NTRS)

    Leviton, Douglas B. (Inventor)

    1999-01-01

    An absolute optical linear or rotary encoder which encodes the motion of an object (3) with increased resolution and encoding range and decreased sensitivity to damage to the scale includes a scale (5), which moves with the object and is illuminated by a light source (11). The scale carries a pattern (9) which is imaged by a microscope optical system (13) on a CCD array (17) in a camera head (15). The pattern includes both fiducial markings (31) which are identical for each period of the pattern and code areas (33) which include binary codings of numbers identifying the individual periods of the pattern. The image of the pattern formed on the CCD array is analyzed by an image processor (23) to locate the fiducial marking, decode the information encoded in the code area, and thereby determine the position of the object.

  9. Absolute Zero

    NASA Astrophysics Data System (ADS)

    Donnelly, Russell J.; Sheibley, D.; Belloni, M.; Stamper-Kurn, D.; Vinen, W. F.

    2006-12-01

    Absolute Zero is a two hour PBS special attempting to bring to the general public some of the advances made in 400 years of thermodynamics. It is based on the book “Absolute Zero and the Conquest of Cold” by Tom Shachtman. Absolute Zero will call long-overdue attention to the remarkable strides that have been made in low-temperature physics, a field that has produced 27 Nobel Prizes. It will explore the ongoing interplay between science and technology through historical examples including refrigerators, ice machines, frozen foods, liquid oxygen and nitrogen as well as much colder fluids such as liquid hydrogen and liquid helium. A website has been established to promote the series: www.absolutezerocampaign.org. It contains information on the series, aimed primarily at students at the middle school level. There is a wealth of material here and we hope interested teachers will draw their student’s attention to this website and its substantial contents, which have been carefully vetted for accuracy.

  10. Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments.

    PubMed

    de Knegt, Martina C; Linde, Jesper J; Fuchs, Andreas; Nordestgaard, Børge G; Køber, Lars V; Hove, Jens D; Kofoed, Klaus F

    2016-10-01

    To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.

  11. Quantitative coronary plaque analysis predicts high-risk plaque morphology on coronary computed tomography angiography: results from the ROMICAT II trial.

    PubMed

    Liu, Ting; Maurovich-Horvat, Pál; Mayrhofer, Thomas; Puchner, Stefan B; Lu, Michael T; Ghemigian, Khristine; Kitslaar, Pieter H; Broersen, Alexander; Pursnani, Amit; Hoffmann, Udo; Ferencik, Maros

    2017-08-12

    Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm(3), 95% CI 1.04-1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10-1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08-2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.

  12. High-risk plaque in patients with near normal coronary angiograms.

    PubMed

    Turner, Michael C

    2016-11-01

    The increased use of cardiac computed tomography angiography in the emergency room to triage patients who present with chest pain syndrome has led to the identification of individuals with coronary plaques with high-risk characteristics in the absence of significant stenoses. Anecdotal observations have suggested that the presence of coronary high-risk plaque results in an increased risk of acute coronary syndrome over time. This case presentation represents an example of this subgroup of patients. Intuitively, it would seem that high-dose statin therapy would be the treatment of choice, with percutaneous intervention reserved for the development of flow-limiting lesions; however, a prospective trial to determine outcomes to our knowledge has not been performed.

  13. The absolute radiometric calibration of the advanced very high resolution radiometer

    NASA Technical Reports Server (NTRS)

    Slater, P. N.; Teillet, P. M.; Mao, Y.

    1987-01-01

    The early results of an absolute radiometric calibration of the NOAA-9 AVHRR sensor indicate significant degradations in the response of bands 1 and 2 compared to prelaunch values. The results are currently in the process of being verified and it may be that refinements of the methodology will be in order as additional data sets are analyzed. The LANDSAT TM calibration used in this approach is known to be very precise and the Herman radiative transfer code, supplemented by the 5-S code for gaseous transmission, is reliable as well. The extent to which other steps in the analysis procedure give rise to uncertainties in the results is currently under investigation. Particular attention is being given to the geometric matching of the AVHRR and TM imagery, as well as to the spectral redistribution procedure. By taking advantage of a reasonably precise calibration of TM imagery acquired on the same day as the AVHRR data at White Sands, a promising approach to the in-orbit calibration of AVHRR sensors is being developed. Current efforts involve primarily the examination of additional test cases and the investigation of possible simplifications in the procedure through judicious use of atmospheric models.

  14. Comparison of 3D free-breathing coronary MR angiography and 64-MDCT angiography for detection of coronary stenosis in patients with high calcium scores.

    PubMed

    Liu, Xin; Zhao, Xihai; Huang, Jie; Francois, Christopher J; Tuite, David; Bi, Xiaoming; Li, Debiao; Carr, James C

    2007-12-01

    The objective of our study was to compare the diagnostic performance of coronary MR angiography (MRA) and 64-MDCT angiography (MDCTA) for the detection of significant stenosis (> or = 50%) in patients with high calcium scores. Eighteen patients (12 men, six women; mean age, 56 y; age range, 38-77 y) who had at least one calcified plaque with a calcium score of > 100 underwent coronary MRA and conventional coronary angiography (CAG) within 2 weeks of MDCTA. Coronary MRA image quality of the calcified segments was assessed by two observers in consensus on a 4-point scale (1 = not visible, 2 = poor, 3 = good, 4 = excellent) using a 10-segment model from the modified American Heart Association classification. Three experienced radiologists, unaware of the results of conventional CAG, independently assessed for the presence of significant stenosis on MDCTA images and the corresponding MRA images. Receiver operating characteristic (ROC) curves were calculated for each reader using conventional CAG as the gold standard. Thirty-three calcified plaques with a calcium score of > 100 were detected on MDCTA in the 18 patients. The coronary segments with nodal calcification (n = 17) showed a higher mean image quality score than the segments with diffuse calcification (n = 16) (3.47 +/- 0.62 vs 2.94 +/- 0.77, respectively; p < 0.05). Of the 33 coronary segments with calcification, 12 significant stenoses were identified on conventional CAG. The sensitivity, specificity, and area under the ROC curve (AUC) for MRA and MDCTA, respectively, were as follows: reader 1, 75%, 81%, 0.82 versus 75%, 48%, 0.68; reader 2, 83%, 71%, 0.82 versus 67%, 52%, 0.63; and reader 3, 83%, 71%, 0.85 versus 83%, 43%, 0.65, respectively. The average AUC of MRA for the three readers was significantly higher than that of MDCTA (p = 0.030). Coronary MRA has higher image quality for coronary segments with nodal calcification than for coronary segments with diffuse calcification. Coronary MRA has better

  15. Comparison of 3D Free-Breathing Coronary MR Angiography and 64-MDCT Angiography for Detection of Coronary Stenosis in Patients with High Calcium Scores

    PubMed Central

    Liu, Xin; Zhao, Xihai; Huang, Jie; Francois, Christopher J.; Tuite, David; Bi, Xiaoming; Li, Debiao; Carr, James C.

    2014-01-01

    OBJECTIVE The objective of our study was to compare the diagnostic performance of coronary MR angiography (MRA) and 64-MDCT angiography (MDCTA) for the detection of significant stenosis (≥ 50%) in patients with high calcium scores. MATERIALS AND METHODS Eighteen patients (12 men, six women; mean age, 56 y; age range, 38–77 y) who had at least one calcified plaque with a calcium score of > 100 underwent coronary MRA and conventional coronary angiography (CAG) within 2 weeks of MDCTA. Coronary MRA image quality of the calcified segments was assessed by two observers in consensus on a 4-point scale (1 = not visible, 2 = poor, 3 = good, 4 = excellent) using a 10-segment model from the modified American Heart Association classification. Three experienced radiologists, unaware of the results of conventional CAG, independently assessed for the presence of significant stenosis on MDCTA images and the corresponding MRA images. Receiver operating characteristic (ROC) curves were calculated for each reader using conventional CAG as the gold standard. RESULTS Thirty-three calcified plaques with a calcium score of > 100 were detected on MDCTA in the 18 patients. The coronary segments with nodal calcification (n = 17) showed a higher mean image quality score than the segments with diffuse calcification (n = 16) (3.47 ± 0.62 vs 2.94 ± 0.77, respectively; p < 0.05). Of the 33 coronary segments with calcification, 12 significant stenoses were identified on conventional CAG. The sensitivity, specificity, and area under the ROC curve (AUC) for MRA and MDCTA, respectively, were as follows: reader 1, 75%, 81%, 0.82 versus 75%, 48%, 0.68; reader 2, 83%, 71%, 0.82 versus 67%, 52%, 0.63; and reader 3, 83%, 71%, 0.85 versus 83%, 43%, 0.65, respectively. The average AUC of MRA for the three readers was significantly higher than that of MDCTA (p = 0.030). CONCLUSION Coronary MRA has higher image quality for coronary segments with nodal calcification than for coronary segments with

  16. Effect of high-dose intravenous eletriptan on coronary artery diameter.

    PubMed

    Goldstein, J A; Massey, K D; Kirby, S; Gibson, M; Hettiarachchi, J; Rankin, A J; Jackson, N C

    2004-07-01

    The goal of this study was to evaluate the coronary vasoconstrictive effects of high doses of eletriptan compared with a standard dose of sumatriptan. Patients with no clinically significant coronary artery disease were randomized to receive high-dose intravenous eletriptan (n = 24) vs a standard dose of sumatriptan (n = 18; 6 mg subcutaneously) vs placebo (n = 18). Serial angiograms were obtained. The primary non-inferiority analysis found equivalence between the mean maximum change in left anterior descending coronary artery diameter for eletriptan, -22%[95% confidence interval (CI) -26, -19], and sumatriptan, -19% (95% CI -22, -16). The change due to placebo was -16% (95% CI -20, -12). No individual cases of clinically significant vasoconstriction were observed. The results confirm that eletriptan has a broad cardiovascular safety margin, with plasma concentrations comparable to three to five times the Cmax of an oral 80-mg dose associated with modest vasoconstriction equivalent to standard therapeutic doses of sumatriptan.

  17. Combining sub-Nyquist sampling and chirp decomposition for a high-precision and speed absolute distance measurement method.

    PubMed

    Liu, Guodong; Lu, Cheng; Liu, Bingguo; Chen, Fengdong; Gan, Yu

    2016-12-10

    A high-precision and speed absolute distance measurement based on swept-wavelength interferometry is reported. A powerful method combining sub-Nyquist sampling and chirp decomposition for dispersion mismatch compensation is proposed. A standard deviation of 0.72 μm is obtained for the measurement of a target located at 3.9 m, which is better than the traditional method. The measurement can be completed in 1.9 s when the frequency range is 4.26 THz, which is much better than chirp decomposition without sub-Nyquist sampling.

  18. Absolute Summ

    NASA Astrophysics Data System (ADS)

    Phillips, Alfred, Jr.

    Summ means the entirety of the multiverse. It seems clear, from the inflation theories of A. Guth and others, that the creation of many universes is plausible. We argue that Absolute cosmological ideas, not unlike those of I. Newton, may be consistent with dynamic multiverse creations. As suggested in W. Heisenberg's uncertainty principle, and with the Anthropic Principle defended by S. Hawking, et al., human consciousness, buttressed by findings of neuroscience, may have to be considered in our models. Predictability, as A. Einstein realized with Invariants and General Relativity, may be required for new ideas to be part of physics. We present here a two postulate model geared to an Absolute Summ. The seedbed of this work is part of Akhnaton's philosophy (see S. Freud, Moses and Monotheism). Most important, however, is that the structure of human consciousness, manifest in Kenya's Rift Valley 200,000 years ago as Homo sapiens, who were the culmination of the six million year co-creation process of Hominins and Nature in Africa, allows us to do the physics that we do. .

  19. Coronary blood flow during percutaneous hemopump in patients at high risk for angioplasty

    NASA Astrophysics Data System (ADS)

    Geschwind, Herbert J.; Dubois-Rande, Jean Luc; Dupouy, Patrick J.; Larrazet, Fabrice S.; Kvasnicka, Jan; El-Ghalid, Ahmed; Deleuze, Philippe; Loisance, Daniel

    1995-05-01

    Hemopump is a ventricular assist device which is aimed at improving the management of high- risk patients for PTCA. The aim of the study was to access coronary blood flow velocity during hemopump. The hemopump was inserted percutaneously into the femoral artery. Coronary blood flow was measured with a 12 MHz Doppler-tipped guidewire proximal and distal to the stenosis before, during and after PTCA. Coronary vascular reserve was assessed by intracoronary 12 mg bolus injection of Papaverine. Collateral flow was assessed during balloon occlusion by inverted velocity signals below baseline. Eight patients aged 59 +/- 11 yrs, with unstable angina, a last patent vessel and/or major left ventricular dysfunction (EF < 0.20) had hemopump during PTCA of stenosis (86 +/- 14%) of the LAD (n equals 4) or the LCX (n equals 4). Collateral flow was slightly increased (+25 +/- 18%) by the Hemopump. Hemopump did not strongly affect coronary flow velocity, did not significantly increase collateral flow and increased slightly coronary vascular reserve.

  20. Left main coronary disease: improved early outcomes after off-pump coronary artery bypass grafting in high-risk patients.

    PubMed

    Kiziltepe, Ugursay; Kurtoglu, Murat; Ozerdem, Gokhan; Sahinalp, Sahin; Temizturk, Zeki; Bozguney, Muhammed

    2013-01-01

    Left main coronary artery (LMCA) stenosis is a risk factor in coronary artery bypass grafting (CABG). Although improved outcomes of off-pump CABG have been well documented, LMCA stenosis is often perceived as a contraindicationfor off-pump CABG. In this study, we compared on-pump and off-pump techniques in high-risk patients with LMCA disease. Documentation of safety and feasibility of off-pump CABG in patients with LMCA disease. One hundred ninty nine patients with LMCA disease and a EuroScore ≥ 5 were operated upon between 2007 and 2010. One hundred patients (Group I) were operated upon using off-pump techniques, while 99 (Group II) were operated upon using conventional on-pump techniques. Perioperative variables and outcomes at first six months were compared. Despite higher mean age and EuroScore (70.9 ± 4.8 vs. 65.6 ± 7.9, p < 0.001, and 6.09 ± 0.8 vs. 5.31 ± 0.68,p < 0.001, respectively), and lower ejection fraction (41.4 ± 7.3 vs. 49.0 ± 6.2, p < 0.001), hospital mortality (1% vs. 6.1%,p = 0.065), postoperative inotropic support (9% vs. 48.4%, p < 0.001), blood loss (680.6 ± 265.0 vs. 847.2 ± 382, p < 0.001) and transfusions of blood (0.57 ± 0.79 U vs. 1.49 ± 0.82 U, p < 0.001), and hospital stay (6.57 ± 2.04 vs. 7.68 ± 3.44,p = 0.006) were lower in Group I. In both groups, mean number of distal anastomoses and completeness of revascularisation were similar. Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.

  1. Effectiveness of music interventions for women with high anxiety during coronary angiographic procedures: a randomized controlled.

    PubMed

    Nilsson, Ulrica

    2012-06-01

    The purpose was to investigate if women with high pre-procedural anxiety reported higher degree of relaxation and comfort if listening to music during coronary angiographic procedures. A prospective randomized controlled trial was used included 68 patients undergoing coronary angiography and/or PCI. The women were allocated to receive calming music and standard care or standard care only. Relaxation, environmental sound and discomfort associated with lying still were assessed. There was significantly more positive impression of the sound environment and less discomfort associated with lying still in women listening to music in comparison to women who received only standard care. No effect in relaxation was found.

  2. Absolute Photometry

    NASA Astrophysics Data System (ADS)

    Hartig, George

    1990-12-01

    The absolute sensitivity of the FOS will be determined in SV by observing 2 stars at 3 epochs, first in 3 apertures (1.0", 0.5", and 0.3" circular) and then in 1 aperture (1.0" circular). In cycle 1, one star, BD+28D4211 will be observed in the 1.0" aperture to establish the stability of the sensitivity and flat field characteristics and improve the accuracy obtained in SV. This star will also be observed through the paired apertures since these are not calibrated in SV. The stars will be observed in most detector/grating combinations. The data will be averaged to form the inverse sensitivity functions required by RSDP.

  3. High stability multiplexed fiber interferometer and its application on absolute displacement measurement and on-line surface metrology.

    PubMed

    Lin, Dejiao; Jiang, Xiangqian; Xie, Fang; Zhang, Wei; Zhang, Lin; Bennion, Ian

    2004-11-15

    We propose a self-reference multiplexed fiber interferometer (MFI) by using a tunable laser and fiber Bragg grating (FBG). The optical measurement system multiplexes two Michelson fiber interferometers with shared optical path in the main part of optical system. One fiber optic interferometer is used as a reference interferometer to monitor and control the high accuracy of the measurement system under environmental perturbations. The other is used as a measurement interferometer to obtain information from the target. An active phase tracking homodyne (APTH) technique is applied for signal processing to achieve high resolution. MFI can be utilized for high precision absolute displacement measurement with different combination of wavelengths from the tunable laser. By means of Wavelength-Division-Multiplexing (WDM) technique, MFI is also capable of realizing on-line surface measurement, in which traditional stylus scanning is replaced by spatial light-wave scanning so as to greatly improve the measurement speed and robustness.

  4. Relative atherogenicity and predictive value of non-high-density lipoprotein cholesterol for coronary heart disease

    USDA-ARS?s Scientific Manuscript database

    Although low-density lipoprotein cholesterol (LDL-C) is a well-established atherogenic factor for coronary heart disease, it does not completely represent the risk associated with atherogenic lipoproteins in the presence of high triglyceride (TG) levels. Constituent lipoproteins constituting non–hig...

  5. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial.

    PubMed

    Price, Matthew J; Berger, Peter B; Teirstein, Paul S; Tanguay, Jean-François; Angiolillo, Dominick J; Spriggs, Douglas; Puri, Sanjeev; Robbins, Mark; Garratt, Kirk N; Bertrand, Olivier F; Stillabower, Michael E; Stillablower, Michael E; Aragon, Joseph R; Kandzari, David E; Stinis, Curtiss T; Lee, Michael S; Manoukian, Steven V; Cannon, Christopher P; Schork, Nicholas J; Topol, Eric J

    2011-03-16

    High platelet reactivity while receiving clopidogrel has been linked to cardiovascular events after percutaneous coronary intervention (PCI), but a treatment strategy for this issue is not well defined. To evaluate the effect of high-dose compared with standard-dose clopidogrel in patients with high on-treatment platelet reactivity after PCI. Randomized, double-blind, active-control trial (Gauging Responsiveness with A VerifyNow assay-Impact on Thrombosis And Safety [GRAVITAS]) of 2214 patients with high on-treatment reactivity 12 to 24 hours after PCI with drug-eluting stents at 83 centers in North America between July 2008 and April 2010. High-dose clopidogrel (600-mg initial dose, 150 mg daily thereafter) or standard-dose clopidogrel (no additional loading dose, 75 mg daily) for 6 months. The primary end point was the 6-month incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis. The key safety end point was severe or moderate bleeding according to the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) definition. A key pharmacodynamic end point was the rate of persistently high on-treatment reactivity at 30 days. At 6 months, the primary end point had occurred in 25 of 1109 patients (2.3%) receiving high-dose clopidogrel compared with 25 of 1105 patients (2.3%) receiving standard-dose clopidogrel (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.58-1.76; P = .97). Severe or moderate bleeding was not increased with the high-dose regimen (15 [1.4%] vs 25 [2.3%], HR, 0.59; 95% CI, 0.31-1.11; P = .10). Compared with standard-dose clopidogrel, high-dose clopidogrel provided a 22% (95% CI, 18%-26%) absolute reduction in the rate of high on-treatment reactivity at 30 days (62%; 95% CI, 59%-65% vs 40%; 95% CI, 37%-43%; P < .001). Among patients with high on-treatment reactivity after PCI with drug-eluting stents, the use of high-dose clopidogrel compared with standard-dose clopidogrel

  6. Contrast media volume optimization in high-pitch dual-source CT coronary angiography: feasibility study.

    PubMed

    Yang, Wen Jie; Chen, Ke Min; Liu, Bo; Pang, Li Fang; Zhang, Huan; Pan, Zi Lai; Yan, Fu Hua

    2013-01-01

    To investigate the feasibility of contrast media (CM) volume reduction in dual-source coronary computed tomography angiography high-pitch mode without affecting coronary artery enhancement. Eighty patients were involved in a preliminary experiment with a default injection protocol (60 ml of CM). The age, BMI, test bolus (TB) enhancement peak and the CT values of coronary artery for each patient were recorded and the key factors for determining coronary artery enhancement were investigated. Based on the results of the preliminary experiment, 120 patients were involved in the main experiment with a new injection protocol. For each patient, the CT values and noise of left coronary sinus (LCS), and the distal segment of right coronary artery were measured. In the preliminary experiment, the peak enhancement of TB correlated most strongly with the HU values of coronary artery. Consequently, the new injection protocol was devised to catalog patients into four groups (30, 40, 50 and 60 ml) of CM based on their TB peak enhancement. In the main experiment, the 30 ml CM injection group whose peak attenuation of TB were the highest (30 vs. 40,50,60 ml: 323.0 ± 27.5 vs. 264.2 ± 11.9, 242.1 ± 8.8, 206.2 ± 18.2 HU, p < 0.05), obtained the highest attenuation of LCS (30 vs. 40,50,60 ml: 365.0 ± 41.2 vs. 341.8 ± 40.0, 326.9 ± 34.7, 312.5 ± 38.2 HU p < 0.05). Contrast optimization is feasible in high-pitch DSCT coronary angiography. Certain patients may receive 30 ml of CM without affecting vessel enhancement.

  7. Supramolecular spectrally encoded microgels with double strand probes for absolute and direct miRNA fluorescence detection at high sensitivity.

    PubMed

    Causa, Filippo; Aliberti, Anna; Cusano, Angela M; Battista, Edmondo; Netti, Paolo A

    2015-02-11

    We present novel microgels as a particle-based suspension array for direct and absolute microRNA (miRNA) detection. The microgels feature a flexible molecular architecture, antifouling properties, and enhanced sensitivity with a large dynamic range of detection. Specifically, they possess a core-shell molecular architecture with two different fluorescent dyes for multiplex spectral analyses and are endowed with a fluorescent probe for miRNA detection. Encoding and detection fluorescence signals are distinguishable by nonoverlapping emission spectra. Tunable fluorescence probe conjugation and emission confinement on single microgels allow for ultrasensitive miRNA detection. Indeed, the suspension array has high selectivity and sensitivity with absolute quantification, a detection limit of 10(-15) M, a dynamic range from 10(-9) to 10(-15) M, and higher accuracy than qRT-PCR. The antifouling properties of the microgels also permit the direct measurement of miRNAs in serum, without sample pretreatment or target amplification. A multiplexed assay has been tested for a set of miRNAs chosen as cancer biomarkers.

  8. Frovatriptan use in migraineurs with or at high risk of coronary artery disease.

    PubMed

    Elkind, Arthur H; Satin, Lawrence Z; Nila, Alice; Keywood, Charlotte

    2004-05-01

    To investigate the cardiovascular effects of frovatriptan 2.5 mg during a migraine attack in patients with, or at high risk of, coronary artery disease. Rare occurrences of myocardial ischemia and coronary and peripheral vasospasm associated with the use of sumatriptan have triggered concern over the vasoconstrictor properties of the triptan class of drugs. This randomized, double-blind, placebo-controlled, parallel-group study was conducted in 14 US private headache referral centers or clinics. Seventy-five patients, aged 18 years and older, with a history of migraine who were at high risk (Framingham score > or =14) of or who had previously documented coronary artery disease were evaluated. Incidence of clinically significant electrocardiogram changes was higher at all time points postdose with placebo than with frovatriptan, reaching statistical significance at 4 hours (40% versus 19%, P=.026). Similar proportions of patients had ischemia documented on Holter monitoring in the placebo (13%) and frovatriptan (11%) groups, and the incidence of arrhythmias was higher in the placebo group (11% versus 3%). There were no clinically significant changes in heart rate or blood pressure in either group. Adverse event profiles were similar for placebo and frovatriptan. In this exploratory study of migraineurs with, or at high risk of, coronary artery disease, frovatriptan 2.5 mg was well tolerated and not associated with an increase in cardiovascular monitoring abnormalities.

  9. Improved determination of seafloor absolute magnetization from uneven, near-seafloor magnetic measurements and high-resolution bathymetry

    NASA Astrophysics Data System (ADS)

    Szitkar, F.; Dyment, J.; Choi, Y.; Fouquet, Y.

    2012-12-01

    Vector magnetometers installed on deep-sea submersibles offer a unique opportunity to achieve high resolution magnetic investigations at the scale of hundred to thousand meters. Once corrected for the vehicle induced and remanent magnetization, the measurements mostly reflect variations of the topography and the submersible path - i.e. the distance between the sources and the observation points. The interesting parameter, however, is the seafloor magnetization that can be interpreted in terms of geological processes. Here we present methods to compute absolute magnetization of the seafloor by taking advantage of the uneven track of the submersible. In these methods, synthetic anomalies are computed for a unit magnetization assuming the geometry of the experiment, i.e. the source and the submersible path. The absolute magnetization is determined by a comparison between the observed anomalies and the synthetic ones along sliding windows. The coherency between the two signals gives an estimation of the quality of the determination, and the phase provides information on the magnetic polarity, and therefore the age of volcanic features. Such a method has been developed by Honsho et al. (JGR, 2009) using deep-sea submersible data only, i.e. magnetic anomaly, depth and altitude of the submersible. The synthetic anomalies are computed using 2D forward modeling, i.e. assuming the structures to be infinite in the direction perpendicular to the submersible path. The method has been applied with success to linear profiles crossing elongated structures such as mid-ocean ridges, but may fail for structures departing from the 2D assumption. The adaptation of improving multibeam systems to autonomous underwater vehicles (AUVs) has opened the way to the collection of very high resolution bathymetric data (around 2m between each measurement). This development has triggered a new strategy to explore the seafloor using manned submersibles: an AUV is operated during night time to

  10. Validation of high temporal resolution spiral phase velocity mapping of temporal patterns of left and right coronary artery blood flow against Doppler guidewire.

    PubMed

    Keegan, Jennifer; Raphael, Claire E; Parker, Kim; Simpson, Robin M; Strain, Stephen; de Silva, Ranil; Di Mario, Carlo; Collinson, Julian; Stables, Rod H; Wage, Ricardo; Drivas, Peter; Sugathapala, Malindie; Prasad, Sanjay K; Firmin, David N

    2015-10-02

    Temporal patterns of coronary blood flow velocity can provide important information on disease state and are currently assessed invasively using a Doppler guidewire. A non-invasive alternative would be beneficial as it would allow study of a wider patient population and serial scanning. A retrospectively-gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Velocity maps were acquired in 8 proximal right and 15 proximal left coronary arteries of 18 subjects who had previously had a Doppler guidewire study at the time of coronary angiography. Cardiovascular magnetic resonance (CMR) velocity-time curves were processed semi-automatically and compared with corresponding invasive Doppler data. When corrected for differences in heart rate between the two studies, CMR mean velocity through the cardiac cycle, peak systolic velocity (PSV) and peak diastolic velocity (PDV) were approximately 40 % of the peak Doppler values with a moderate - good linear relationship between the two techniques (R(2): 0.57, 0.64 and 0.79 respectively). CMR values of PDV/PSV showed a strong linear relationship with Doppler values with a slope close to unity (0.89 and 0.90 for right and left arteries respectively). In individual vessels, plots of CMR velocities at all cardiac phases against corresponding Doppler velocities showed a consistent linear relationship between the two with high R(2) values (mean +/-SD: 0.79 +/-.13). High temporal resolution breath-hold spiral phase velocity mapping underestimates absolute values of coronary flow velocity but allows accurate assessment of the temporal patterns of blood flow.

  11. Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses.

    PubMed

    Koplay, M; Erdogan, H; Avci, A; Sivri, M; Demir, K; Guler, I; Demir, L S; Paksoy, Y

    2016-04-01

    "Flash Spiral" imaging is a new prospective ECG-triggered spiral scan mode that uses a very high-pitch for coronary computed tomography angiography (CTA). This enables complete image acquisition within one cardiac cycle with a very low radiation exposure. The aim of this study was to investigate the diagnostic accuracy, image quality, and effective radiation dose of prospectively ECG-triggered high-pitch spiral method (Flash spiral mode) of coronary CTA using dual-source technology for the evaluation of coronary artery stenoses. The study included 186 consecutive patients (115men, 71women; mean age: 53.37 years) who underwent coronary CTA. Coronary CTA was performed with a 128×2-slice dual-source CT (Somatom Definition Flash, Siemens, Germany) using a prospectively ECG-triggered high-pitch spiral mode. Patients were divided into three groups according to heart rate (≤65bpm, 66-75bpm, ≥76bpm) and body mass index (BMI) (20-24kg/m(2), 25-29kg/m(2), 30-34kg/m(2)) values. The correlation between heart rates, image quality and BMI values are investigated. A four-point scale (1=excellent, 4=poor/non-diagnostic) was used to rank the comparative image quality. Effective radiation doses were calculated. Also the correlation between radiation dose, sex and BMI values were investigated. In addition, diagnostic accuracy of CTA for detection of significant (≥50%) coronary artery stenoses was compared with invasive coronary angiography findings of 612vessel segments in 38patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were calculated. A total of 2976coronary artery segments were present. Of all coronary artery segments, 2381 (80%) had an image quality score of 1, and 1.5% segments were rated as "poor/non-diagnostic". When the correlation between heart rate and image quality is investigated, there was a significant difference between ≤65bpm and ≥76bpm groups. However, there was no significant

  12. Coronary patients with high plasma omentin are at a higher cardiovascular risk.

    PubMed

    Saely, Christoph H; Leiherer, Andreas; Muendlein, Axel; Vonbank, Alexander; Rein, Philipp; Geiger, Kathrin; Malin, Cornelia; Drexel, Heinz

    2016-03-01

    The adipokine omentin, also known as intelectin, is a secretory protein, expressed in visceral adipose tissue and is highly abundant in plasma. It is involved in the development of chronic inflammatory diseases, but nothing is known about its impact on the cardiovascular event risk. Here, plasma omentin was measured in 295 patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD). Patients were separated according to the median plasma omentin concentrations into a high and low omentin group and cardiovascular events occurring during a period of 3.5 years have been recorded. We observed that patients within the high omentin group had significantly more cardiovascular events than patients in the low omentin group. This was true even if using different study endpoints. This article describes data related to a research article titled "High Plasma Omentin Predicts Cardiovascular Events Independently From the Presence and Extent of Angiographically Determined Atherosclerosis" (Saely et al., 2015) [1].

  13. A simple method for the absolute determination of uranium enrichment by high-resolution gamma spectrometry.

    PubMed

    Korob, R O; Blasiyh Nuño, G A

    2006-05-01

    A simple method for the determination of uranium enrichment using high-resolution gamma spectrometry is presented in this paper. The method relies solely on the gamma-ray emission probabilities of 235U and 234mPa, and an iterative procedure for the least squares fit of a polynomial to a set of experimentally determined data. To ensure the reliability of the 234mPa gamma-ray emission probabilities employed, a new determination of these probabilities was carried out using a combination of gamma spectrometry and Cerenkov counting of a purified 234Th solution. Using these new data, a maximum difference of approximately 5% has been found between the experimental and declared uranium enrichment in a set of solid and liquid samples containing uranium compounds.

  14. ABSOLUTE PROPERTIES OF THE HIGHLY ECCENTRIC, SOLAR-TYPE ECLIPSING BINARY HD 74057

    SciTech Connect

    Sowell, James R.; Henry, Gregory W.; Fekel, Francis C. E-mail: gregory.w.henry@gmail.com

    2012-01-15

    We have obtained Stroemgren b and y differential photometric observations of the solar-type eclipsing binary HD 74057 plus follow-up high-resolution, red wavelength spectroscopic observations. The system has an orbital period of 31.2198 days, a high eccentricity of 0.47, and is seen almost exactly edge on with an inclination of 89.{sup 0}8. The two main-sequence G0 stars are nearly identical in all physical characteristics. We used the Wilson-Devinney program to obtain a simultaneous solution of our photometric and spectroscopic observations. The resulting masses of the components are M{sub 1} = 1.138 {+-} 0.003 M{sub Sun} and M{sub 2} = 1.131 {+-} 0.003 M{sub Sun }, and the radii are R{sub 1} = 1.064 {+-} 0.002 R{sub Sun} and R{sub 2} = 1.049 {+-} 0.002 R{sub Sun }. The effective temperatures are 5900 K (fixed) and 5843 K, and the iron abundance, [Fe/H], is estimated to be +0.07. A comparison with evolutionary tracks suggests that the system may be even more metal rich. The components rotate with periods of 8.4 days, significantly faster than the predicted pseudosynchronous period of 12.7 days. We see evidence that one or both components have cool spots. Both stars are close to the zero-age main sequence and are about 1.0 Gyr old.

  15. Absolute neutrino mass scale

    NASA Astrophysics Data System (ADS)

    Capelli, Silvia; Di Bari, Pasquale

    2013-04-01

    Neutrino oscillation experiments firmly established non-vanishing neutrino masses, a result that can be regarded as a strong motivation to extend the Standard Model. In spite of being the lightest massive particles, neutrinos likely represent an important bridge to new physics at very high energies and offer new opportunities to address some of the current cosmological puzzles, such as the matter-antimatter asymmetry of the Universe and Dark Matter. In this context, the determination of the absolute neutrino mass scale is a key issue within modern High Energy Physics. The talks in this parallel session well describe the current exciting experimental activity aiming to determining the absolute neutrino mass scale and offer an overview of a few models beyond the Standard Model that have been proposed in order to explain the neutrino masses giving a prediction for the absolute neutrino mass scale and solving the cosmological puzzles.

  16. The comparison of high and standard definition computed tomography techniques regarding coronary artery imaging.

    PubMed

    Aykut, Aktas; Bumin, Degirmenci; Omer, Yilmaz; Mustafa, Kayan; Meltem, Cetin; Orhan, Celik; Nisa, Unlu; Hikmet, Orhan; Hakan, Demirtas; Mert, Koroglu

    2015-09-01

    The aim was to compare coronary high-definition CT (HDCT) with standard-definition CT (SDCT) angiography as to radiation dose, image quality and accuracy. 28 patients with history of coronary artery disease scanned by HDCT (Discovery CT750 HD) and SDCT (Somatom Definition AS). The scan modes were both axial prospective ECG-triggered. The vessel diameters and vessel attenuation values of totally 280 measurements from 140 coronary arteries were analyzed by two experienced radiologists. All data was analyzed by intraclass correlation test. Image quality graded by motion and stair step artifacts (grade 1, poor, to grade 4, excellent), accuracy of vessel inner and outer diameters were compared between the two CT units using the independent samples t-test and Mann-Whitney U test. The intraclass correlation coefficient (ICC) of measured vessel attenuation values in SDCT between the two radiologists was exceedingly good. The ICC was higher in HDCT. The radiation dose of HDCT was higher than that of SDCT. The mean tube current was 180 (mA) in HDCT and 147(mA) in SDCT with the same tube voltage (kVp). There was no significant difference between image quality. HDCT has a higher radiation dose but has much more atenuation and the spatial resolution which improve measurement accuracy for imaging coronary arteries.

  17. High density lipoprotein cholesterol in male relatives of patients with coronary heart disease.

    PubMed

    Micheli, H; Pometta, D; Jornot, C; Scherrer, J R

    1979-03-01

    To study factors that play a role in the familial occurrence of coronary heart disease, very low density lipoprotein (VLDL) triglycerides, low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol were measured after preparative ultracentrifugation in first degree male relatives of coronary patients and in control subjects. The HDL cholesterol concentration was significantly lower in relatives of 20--71 years old than in controls. No increase of serum and LDL cholesterol was found. A low level of HDL cholesterol was observed even in the younger relatives who are less likely to have cardiovascualr disease. In older relatives low HDL cholesterol was found in the presence or absence of clinical evidence of coronary artery disease. The HDL-cholesterol concentration was inversely related to the VLDL triglycerides both in relatives and controls, but the regression lines were different ((P less than 0.001) for the relative (y = --0.166x + 0.43) and for the controls (y = 0.191x + 0.49). A low HDL cholesterol level appears to be a marker of relatives of coronary patients.

  18. Severe multivessel coronary artery disease and high-sensitive troponin T

    PubMed Central

    Huziuk, Inga Magdalena

    2015-01-01

    Introduction A key problem in stable coronary artery disease (CAD) is non-invasive identification of patients with severe multivessel CAD. Determination of biomarkers that have pro-inflammatory properties (C-reactive protein – hsCRP) and indicate heart muscle ischemia (high-sensitive troponin T – hsTnT) can contribute to the improvement of stratification in this regard. The aim of the study The aim of the study was to identify factors associated with the presence of multivessel CAD in clinically stable men. Material and methods The study included 92 symptomatic men (mean age 64.05 ± 9.42 years) with preserved left ventricular function, scheduled for elective coronary angiography. Patients were divided and analyzed in two groups: with multivessel coronary artery disease (2-3-vessel disease, n = 46) vs. without multivessel coronary artery disease (n = 46). Results Patients with multivessel CAD had significantly higher levels of hsTnT (0.01 vs. 0.007, p = 0.0021) and fasting glucose (6.0 vs. 5.45, p = 0.0112). Based on the drawn ROC curves, the cut-off points were determined for hsTnT ≥ 0.0085 ng/ml and fasting plasma glucose ≥ 5.85 mmol/l. From multivariate analysis only hsTnT in concentration higher than the cut-off point enhanced the risk of multivessel CAD (OR 4.286, 95% CI: 1.79-10.263, p = 0.001). Conclusions In men with stable CAD, preserved systolic left ventricular function and non-high cardiovascular risk determined from the initial concentration of hsCRP, elevated level of hsTnT was independently associated with the risk of multivessel coronary artery disease. PMID:26336496

  19. High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis: insights from SATURN.

    PubMed

    Stegman, Brian; Puri, Rishi; Cho, Leslie; Shao, Mingyuan; Ballantyne, Christie M; Barter, Phillip J; Chapman, M John; Erbel, Raimund; Libby, Peter; Raichlen, Joel S; Uno, Kiyoko; Kataoka, Yu; Nissen, Steven E; Nicholls, Stephen J

    2014-11-01

    Although statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We tested the hypothesis that high-intensity statin therapy may promote coronary atheroma regression in patients with diabetes. The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes. At baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, P = 0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (-0.83 ± 0.13 vs. -1.15 ± 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (-0.31 ± 0.23 vs. -1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤70 mg/dL (-1.09 ± 0.16 vs. -1.24 ± 0.16%, P = 0.50). High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  20. Going High with Heart Disease: The Effect of High Altitude Exposure in Older Individuals and Patients with Coronary Artery Disease.

    PubMed

    Levine, Benjamin D

    2015-06-01

    Levine, Benjamin D. Going high with heart disease: The effect of high altitude exposure in older individuals and patients with coronary artery disease. High Alt Med Biol 16:89-96, 2015.--Ischemic heart disease is the largest cause of death in older men and women in the western world (Lozano et al., 2012 ; Roth et al., 2015). Atherosclerosis progresses with age, and thus age is the dominant risk factor for coronary heart disease in any algorithm used to assess risk for cardiovascular events. Subclinical atherosclerosis also increases with age, providing the substrate for precipitation of acute coronary syndromes. Thus the risk of high altitude exposure in older individuals is linked closely with both subclinical and manifest coronary heart disease (CHD). There are several considerations associated with taking patients with CHD to high altitude: a) The reduced oxygen availability may cause or exacerbate symptoms; b) The hypoxia and other associated environmental conditions (exercise, dehydration, change in diet, thermal stress, emotional stress from personal danger or conflict) may precipitate acute coronary events; c) If an event occurs and the patient is far from advanced medical care, then the outcome of an acute coronary event may be poor; and d) Sudden death may occur. Physicians caring for older patients who want to sojourn to high altitude should keep in mind the following four key points: 1). Altitude may exacerbate ischemic heart disease because of both reduced O2 delivery and paradoxical vasoconstriction; 2). Adverse events, including acute coronary syndromes and sudden cardiac death, are most common in older unfit men, within the first few days of altitude exposure; 3). Ensuring optimal fitness, allowing for sufficient acclimatization (at least 5 days), and optimizing medical therapy (especially statins and aspirin) are prudent recommendations that may reduce the risk of adverse events; 4). A graded exercise test at sea level is probably sufficient for

  1. Absolute intensity calibration of the Wendelstein 7-X high efficiency extreme ultraviolet overview spectrometer system

    NASA Astrophysics Data System (ADS)

    Greiche, Albert; Biel, Wolfgang; Marchuk, Oleksandr; Burhenn, Rainer

    2008-09-01

    The new high effiency extreme ultraviolet overview spectrometer (HEXOS) system for the stellarator Wendelstein 7-X is now mounted for testing and adjustment at the tokamak experiment for technology oriented research (TEXTOR). One part of the testing phase was the intensity calibration of the two double spectrometers which in total cover a spectral range from 2.5 to 160.0 nm with overlap. This work presents the current intensity calibration curves for HEXOS and describes the method of calibration. The calibration was implemented with calibrated lines of a hollow cathode light source and the branching ratio technique. The hollow cathode light source provides calibrated lines from 16 up to 147 nm. We could extend the calibrated region in the spectrometers down to 2.8 nm by using the branching line pairs emitted by an uncalibrated pinch extreme ultraviolet light source as well as emission lines from boron and carbon in TEXTOR plasmas. In total HEXOS is calibrated from 2.8 up to 147 nm, which covers most of the observable wavelength region. The approximate density of carbon in the range of the minor radius from 18 to 35 cm in a TEXTOR plasma determined by simulating calibrated vacuum ultraviolet emission lines with a transport code was 5.5×1017 m-3 which corresponds to a local carbon concentration of 2%.

  2. Massively parallel digital high resolution melt for rapid and absolutely quantitative sequence profiling

    NASA Astrophysics Data System (ADS)

    Velez, Daniel Ortiz; Mack, Hannah; Jupe, Julietta; Hawker, Sinead; Kulkarni, Ninad; Hedayatnia, Behnam; Zhang, Yang; Lawrence, Shelley; Fraley, Stephanie I.

    2017-02-01

    In clinical diagnostics and pathogen detection, profiling of complex samples for low-level genotypes represents a significant challenge. Advances in speed, sensitivity, and extent of multiplexing of molecular pathogen detection assays are needed to improve patient care. We report the development of an integrated platform enabling the identification of bacterial pathogen DNA sequences in complex samples in less than four hours. The system incorporates a microfluidic chip and instrumentation to accomplish universal PCR amplification, High Resolution Melting (HRM), and machine learning within 20,000 picoliter scale reactions, simultaneously. Clinically relevant concentrations of bacterial DNA molecules are separated by digitization across 20,000 reactions and amplified with universal primers targeting the bacterial 16S gene. Amplification is followed by HRM sequence fingerprinting in all reactions, simultaneously. The resulting bacteria-specific melt curves are identified by Support Vector Machine learning, and individual pathogen loads are quantified. The platform reduces reaction volumes by 99.995% and achieves a greater than 200-fold increase in dynamic range of detection compared to traditional PCR HRM approaches. Type I and II error rates are reduced by 99% and 100% respectively, compared to intercalating dye-based digital PCR (dPCR) methods. This technology could impact a number of quantitative profiling applications, especially infectious disease diagnostics.

  3. The orbital motion, absolute mass and high-altitude winds of exoplanet HD 209458b.

    PubMed

    Snellen, Ignas A G; de Kok, Remco J; de Mooij, Ernst J W; Albrecht, Simon

    2010-06-24

    For extrasolar planets discovered using the radial velocity method, the spectral characterization of the host star leads to a mass estimate of the star and subsequently of the orbiting planet. If the orbital velocity of the planet could be determined, the masses of both star and planet could be calculated using Newton's law of gravity, just as in the case of stellar double-line eclipsing binaries. Here we report high-dispersion ground-based spectroscopy of a transit of the extrasolar planet HD 209458b. We see a significant wavelength shift in absorption lines from carbon monoxide in the planet's atmosphere, which we conclude arises from a change in the radial component of the planet's orbital velocity. The masses of the star and planet are 1.00 +/- 0.22M(Sun) and 0.64 +/- 0.09M(Jup) respectively. A blueshift of the carbon monoxide signal of approximately 2 km s(-1) with respect to the systemic velocity of the host star suggests the presence of a strong wind flowing from the irradiated dayside to the non-irradiated nightside of the planet within the 0.01-0.1 mbar atmospheric pressure range probed by these observations. The strength of the carbon monoxide signal suggests a carbon monoxide mixing ratio of (1-3) x 10(-3) in this planet's upper atmosphere.

  4. Massively parallel digital high resolution melt for rapid and absolutely quantitative sequence profiling.

    PubMed

    Velez, Daniel Ortiz; Mack, Hannah; Jupe, Julietta; Hawker, Sinead; Kulkarni, Ninad; Hedayatnia, Behnam; Zhang, Yang; Lawrence, Shelley; Fraley, Stephanie I

    2017-02-08

    In clinical diagnostics and pathogen detection, profiling of complex samples for low-level genotypes represents a significant challenge. Advances in speed, sensitivity, and extent of multiplexing of molecular pathogen detection assays are needed to improve patient care. We report the development of an integrated platform enabling the identification of bacterial pathogen DNA sequences in complex samples in less than four hours. The system incorporates a microfluidic chip and instrumentation to accomplish universal PCR amplification, High Resolution Melting (HRM), and machine learning within 20,000 picoliter scale reactions, simultaneously. Clinically relevant concentrations of bacterial DNA molecules are separated by digitization across 20,000 reactions and amplified with universal primers targeting the bacterial 16S gene. Amplification is followed by HRM sequence fingerprinting in all reactions, simultaneously. The resulting bacteria-specific melt curves are identified by Support Vector Machine learning, and individual pathogen loads are quantified. The platform reduces reaction volumes by 99.995% and achieves a greater than 200-fold increase in dynamic range of detection compared to traditional PCR HRM approaches. Type I and II error rates are reduced by 99% and 100% respectively, compared to intercalating dye-based digital PCR (dPCR) methods. This technology could impact a number of quantitative profiling applications, especially infectious disease diagnostics.

  5. Massively parallel digital high resolution melt for rapid and absolutely quantitative sequence profiling

    PubMed Central

    Velez, Daniel Ortiz; Mack, Hannah; Jupe, Julietta; Hawker, Sinead; Kulkarni, Ninad; Hedayatnia, Behnam; Zhang, Yang; Lawrence, Shelley; Fraley, Stephanie I.

    2017-01-01

    In clinical diagnostics and pathogen detection, profiling of complex samples for low-level genotypes represents a significant challenge. Advances in speed, sensitivity, and extent of multiplexing of molecular pathogen detection assays are needed to improve patient care. We report the development of an integrated platform enabling the identification of bacterial pathogen DNA sequences in complex samples in less than four hours. The system incorporates a microfluidic chip and instrumentation to accomplish universal PCR amplification, High Resolution Melting (HRM), and machine learning within 20,000 picoliter scale reactions, simultaneously. Clinically relevant concentrations of bacterial DNA molecules are separated by digitization across 20,000 reactions and amplified with universal primers targeting the bacterial 16S gene. Amplification is followed by HRM sequence fingerprinting in all reactions, simultaneously. The resulting bacteria-specific melt curves are identified by Support Vector Machine learning, and individual pathogen loads are quantified. The platform reduces reaction volumes by 99.995% and achieves a greater than 200-fold increase in dynamic range of detection compared to traditional PCR HRM approaches. Type I and II error rates are reduced by 99% and 100% respectively, compared to intercalating dye-based digital PCR (dPCR) methods. This technology could impact a number of quantitative profiling applications, especially infectious disease diagnostics. PMID:28176860

  6. Off-pump coronary artery bypass grafting in high-risk patients: a review

    PubMed Central

    Chivasso, Pierpaolo; Fudulu, Daniel; Rapetto, Filippo; Sedmakov, Christo; Marsico, Roberto; Zakkar, Mustafa; Bryan, Alan J.; Angelini, Gianni D.

    2016-01-01

    The role of off-pump coronary artery bypass (OPCAB) grafting in high risk patients remains controversial. While there have been studies showing the potential benefits of it, there is still a lot to be learned from the application of this technique in this sub-group of patients. The results of the different trials and papers that we reviewed seem to indicate a benefit in the OPCAB group. Despite of the fact that trials were significantly different in methodology, especially when choosing the risk score stratification tool or the cut-off to define high risk the literature seems to suggest a benefit from the use of OPCAB surgery. Here, we present a review which focussed on early and late outcome in high risk patients undergoing on- and off-pump coronary revascularization. PMID:27942397

  7. The ASTEROID trial: coronary plaque regression with high-dose statin therapy.

    PubMed

    Chhatriwalla, Adnan K; Nicholls, Stephen J; Nissen, Steven E

    2006-11-01

    A Study To Evaluate the effect of Rosuvastatin On Intravascular ultrasound-Derived coronary atheroma burden (ASTEROID) investigated the impact of high-dose rosuvastatin therapy on the rate of atheroma progression in patients with coronary artery disease. Serial intravascular ultrasound (IVUS) was performed in 349 patients at baseline and following 24 months of therapy with rosuvastatin 40 mg/day. Rosuvastatin therapy lowered low-density lipoprotein cholesterol to 60.8 mg/dl and raised high-density lipoprotein cholesterol by 14.7%. This was associated with a significant reduction in all IVUS measures of atheroma burden. These results suggest that intensive modification of lipid levels with high-dose statin therapy can promote atheroma regression. Further studies will be required to determine whether this benefit is associated with a reduction in clinical events.

  8. High-resolution imaging spectrometer for recording absolutely calibrated far ultraviolet spectra from laser-produced plasmas

    SciTech Connect

    Brown, Charles M.; Seely, John F.; Feldman, Uri; Holland, Glenn E.; Weaver, James L.; Obenschain, Steven P.; Kjornrattanawanich, Benjawan; Fielding, Drew

    2008-10-15

    An imaging spectrometer was designed and fabricated for recording far ultraviolet spectra from laser-produced plasmas with wavelengths as short as 155 nm. The spectrometer implements a Cassegrain telescope and two gratings in a tandem Wadsworth optical configuration that provides diffraction limited resolution. Spectral images were recorded from plasmas produced by the irradiation of various target materials by intense KrF laser radiation with 248 nm wavelength. Two pairs of high-resolution gratings can be selected for the coverage of two wavebands, one grating pair with 1800 grooves/mm and covering approximately 155-175 nm and another grating pair with 1200 grooves/mm covering 230-260 nm. The latter waveband includes the 248 nm KrF laser wavelength, and the former waveband includes the wavelength of the two-plasmon decay instability at (2/3) the KrF laser wavelength (165 nm). The detection media consist of a complementary metal oxide semiconductor imager, photostimulable phosphor image plates, and a linear array of 1 mm{sup 2} square silicon photodiodes with 0.4 ns rise time. The telescope mirrors, spectrometer gratings, and 1 mm{sup 2} photodiode were calibrated using synchrotron radiation, and this enables the measurement of the absolute emission from the laser-produced plasmas with temporal, spatial, and spectral resolutions. The spectrometer is capable of measuring absolute spectral emissions at 165 nm wavelength as small as 5x10{sup -7} J/nm from a plasma source area of 0.37 mm{sup 2} and with 0.4 ns time resolution.

  9. Candidate genetic analysis of plasma high-density lipoprotein-cholesterol and severity of coronary atherosclerosis

    PubMed Central

    Chen, Suet Nee; Cilingiroglu, Mehmet; Todd, Josh; Lombardi, Raffaella; Willerson, James T; Gotto, Antonio M; Ballantyne, Christie M; Marian, AJ

    2009-01-01

    Background Plasma level of high-density lipoprotein-cholesterol (HDL-C), a heritable trait, is an important determinant of susceptibility to atherosclerosis. Non-synonymous and regulatory single nucleotide polymorphisms (SNPs) in genes implicated in HDL-C synthesis and metabolism are likely to influence plasma HDL-C, apolipoprotein A-I (apo A-I) levels and severity of coronary atherosclerosis. Methods We genotyped 784 unrelated Caucasian individuals from two sets of populations (Lipoprotein and Coronary Atherosclerosis Study- LCAS, N = 333 and TexGen, N = 451) for 94 SNPs in 42 candidate genes by 5' nuclease assays. We tested the distribution of the phenotypes by the Shapiro-Wilk normality test. We used Box-Cox regression to analyze associations of the non-normally distributed phenotypes (plasma HDL-C and apo A-I levels) with the genotypes. We included sex, age, body mass index (BMI), diabetes mellitus (DM), and cigarette smoking as covariates. We calculated the q values as indicators of the false positive discovery rate (FDR). Results Plasma HDL-C levels were associated with sex (higher in females), BMI (inversely), smoking (lower in smokers), DM (lower in those with DM) and SNPs in APOA5, APOC2, CETP, LPL and LIPC (each q ≤0.01). Likewise, plasma apo A-I levels, available in the LCAS subset, were associated with SNPs in CETP, APOA5, and APOC2 as well as with BMI, sex and age (all q values ≤0.03). The APOA5 variant S19W was also associated with minimal lumen diameter (MLD) of coronary atherosclerotic lesions, a quantitative index of severity of coronary atherosclerosis (q = 0.018); mean number of coronary artery occlusions (p = 0.034) at the baseline and progression of coronary atherosclerosis, as indicated by the loss of MLD. Conclusion Putatively functional variants of APOA2, APOA5, APOC2, CETP, LPL, LIPC and SOAT2 are independent genetic determinants of plasma HDL-C levels. The non-synonymous S19W SNP in APOA5 is also an independent determinant of plasma

  10. Prevalence by Computed Tomographic Angiography of Coronary Plaques in South Asian and White Patients With Type 2 Diabetes Mellitus at Low and High Risk Using Four Cardiovascular Risk Scores (UKPDS, FRS, ASCVD, and JBS3).

    PubMed

    Gobardhan, Sanjay N; Dimitriu-Leen, Aukelien C; van Rosendael, Alexander R; van Zwet, Erik W; Roos, Cornelis J; Oemrawsingh, Pranobe V; Kharagjitsingh, Aan V; Jukema, J Wouter; Delgado, Victoria; Schalij, Martin J; Bax, Jeroen J; Scholte, Arthur J H A

    2017-03-01

    The aim of this study was to explore the association between various cardiovascular (CV) risk scores and coronary atherosclerotic burden on coronary computed tomography angiography (CTA) in South Asians with type 2 diabetes mellitus and matched whites. Asymptomatic type 2 diabetic South Asians and whites were matched for age, gender, body mass index, hypertension, and hypercholesterolemia. Ten-year CV risk was estimated using different risk scores (United Kingdom Prospective Diabetes Study [UKPDS], Framingham Risk Score [FRS], AtheroSclerotic CardioVascular Disease [ASCVD], and Joint British Societies for the prevention of CVD [JBS3]) and categorized into low- and high-risk groups. The presence of coronary artery calcium (CAC) and obstructive coronary artery disease (CAD; ≥50% stenosis) was assessed using coronary CTA. Finally, the relation between coronary atherosclerosis on CTA and the low- and high-risk groups was compared. UKPDS, FRS, and ASCVD showed no differences in estimated CV risk between 159 South Asians and 159 matched whites. JBS3 showed a significant greater absolute CV risk in South Asians (18.4% vs 14.2%, p <0.01). Higher presence of CAC score >0 (69% vs 55%, p <0.05) and obstructive CAD (39% vs 27%, p <0.05) was observed in South Asians. South Asians categorized as high risk, using UKPDS, FRS, and ASCVD, showed more CAC and CAD compared than whites. JBS3 showed no differences. In conclusion, asymptomatic South Asians with type 2 diabetes mellitus more frequently showed CAC and obstructive CAD than matched whites in the population categorized as high-risk patients using UKPDS, FRS, and ASCVD as risk estimators. However, JBS3 seems to correlate best to CAC and CAD in both ethnicity groups compared with the other risk scores. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Operative mortality and stroke after on-pump vs off-pump surgery in high-risk patients: an analysis of 83,914 coronary bypass operations.

    PubMed

    Cavallaro, Paul; Itagaki, Shinobu; Seigerman, Matthew; Chikwe, Joanna

    2014-01-01

    The objective of this study was to compare the early outcomes of off-pump and on-pump surgeries in high-risk patient groups. The outcomes of 83,914 high-risk patients undergoing off-pump or on-pump isolated coronary bypass surgery identified from the Nationwide Inpatient Sample from 2005 to 2010 were compared using propensity analysis. Off-pump surgery was associated with a significant reduction in stroke rates compared with on-pump surgery in propensity-matched patients ≥ 80 years (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52-0.93, P = 0.02), those with peripheral vascular disease (OR 0.53, 95% CI 0.36-0.77, P = 0.001) and those with aortic atherosclerosis (OR 0.30, 95% CI 0.13-0.72, P = 0.007). In these high-risk subgroups, off-pump surgery was associated with an absolute risk reduction in stroke rates of 0.5, 0.5 and 1.2%, respectively: the minimum number needed to treat to prevent one stroke is 200 patients. There was no significant difference in in-hospital mortality or the incidence of postoperative renal failure or respiratory failure between off-pump and on-pump surgeries in these patient subgroups, or in patients with preoperative renal failure, or chronic obstructive airways disease. High-risk patients undergoing coronary artery bypass surgery gain a short-term benefit from off-pump approaches due to a small absolute reduction in the risk of postoperative stroke.

  12. Avoiding hemodynamic collapse during high-risk percutaneous coronary intervention: Advanced hemodynamics of impella support.

    PubMed

    Verma, Sanjay; Burkhoff, Daniel; O'Neill, William W

    2017-03-01

    The rate of performing primary percutaneous coronary intervention in patients with complex coronary artery disease is increasing. The use of percutaneous mechanical circulatory support devices provides critical periprocedural hemodynamic support. Mechanical support has increased the safety and efficacy of interventional procedures in this high-risk patient population. Predicting patient response to the selected intervention can be clinically challenging. Here we demonstrate a case where complete hemodynamic collapse during PCI was avoided by mechanical support provided by the Impella device. Further, we employ a comprehensive cardiovascular model to predict ventricular function and patient hemodynamics in response to the procedure. New computational tools may help interventionists visualize, understand, and predict the multifaceted hemodynamic aspects of these high risk procedures in individual patients. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  13. Relationship between coronary calcium score and high-risk plaque/significant stenosis

    PubMed Central

    Iwasaki, Kohichiro; Matsumoto, Takeshi

    2016-01-01

    AIM To investigate the relationship between coronary calcium score (CCS) and vulnerable plaque/significant stenosis using coronary computed tomographic angiography (CCTA). METHODS CCTA was performed in 651 patients and these patients were divided into the four groups (CCS 0, 1-100, 101-400 and > 400). We studied the incidence of high-risk plaque, including positive remodeling, low attenuation plaque, spotty calcification, and napkin-ring sign, and significant stenosis in each group. RESULTS High-risk plaque was found in 1.3%, 10.1%, 13.3% and 13.4% of patients with CCS 0, 1-100, 101-400 and > 400, respectively (P < 0.001). The difference was only significant for patients with zero CCS. The incidence of significant stenosis was 0.6%, 7.6%, 13.3% and 26.9% for each patient group, respectively (P < 0.001), which represented a significant stepwise increase as CCS increased. The combined incidence of high-risk plaque and significant stenosis was 1.9%, 17.7%, 26.9% and 40.3% in each patient group, respectively (P < 0.001), again representing a significant stepwise increase with CCS. The rate of major coronary event was 0%, 4.0%, 7.9% and 17.2% in each patient group, respectively (P < 0.001), another significant stepwise increase as CCS increased. CONCLUSION Stepwise increased risk of coronary events associated with increasing CCS is caused by increasing incidence of significant stenosis, while that of high-risk plaque remains the same. PMID:27621776

  14. Preliminary results of absolute and high-precision gravity measurements at the Nevada Test Site and vicinity, Nevada

    NASA Astrophysics Data System (ADS)

    Zumberge, M. A.; Harris, R. N.; Oliver, H. W.; Sasagawa, G. S.; Ponce, D. A.

    Absolute gravity measurements were made at 4 sites in southern Nevada using the absolute gravity free-fall apparatus. Three of the sites are located on the Nevada Test Site at Mercury, Yucca Pass, and in northern Jackass Flats. The fourth site is at Kyle Canyon ranger station near Charleston Park where observed gravity is 216.19 mGal lower than at Mercury. Although there is an uncertainty of about 0.02 mGal in the absolute measured values, their gravity differences are considered accurate to about 0.03 mGal. Therefore, the absolute measurements should provide local control for the calibration of gravity meters between Mercury and Kyle Canyon ranger station to about 1 to 2 parts in 10,000. The average gravity differences between Mercury and Kyle Canyon obtained using LaCoste and Romberg gravity meters is 216.13 mGal, 0.06 mGal lower, or 3 parts in 10,000 lower than using the absolute gravity meter. Because of the discrepancy between the comparison of the absolute and relative gravity meters, more absolute and relative gravity control in southern Nevada, as well as the Mt. Hamilton area where the LaCoste and Romberg instruments were calibrated, is needed. Multiple gravity meter ties were also made between each of the four absolute stations to nearby base stations located on bedrock. These stations were established to help monitor possible real changes in gravity at the absolute sites that could result from seasonal variations in the depth to the water table.

  15. Oxidized LDL and Fructosamine Associated with Severity of Coronary Artery Atherosclerosis in Insulin Resistant Pigs Fed a High Fat/High NaCl Diet

    PubMed Central

    Nichols, Timothy C.; Merricks, Elizabeth P.; Bellinger, Dwight A.; Raymer, Robin A.; Yu, Jing; Lam, Diana; Koch, Gary G.; Busby, Walker H.; Clemmons, David R.

    2015-01-01

    Background Insulin-resistant subjects develop more severe and diffuse coronary artery atherosclerosis than insulin-sensitive controls but the mechanisms that mediate this atherosclerosis phenotype are unknown. Research Objective To determine the metabolic parameters that associate with the severity of coronary atherosclerosis in insulin resistant pigs fed a high fat/high NaCl diet. Key Methods The primary endpoint was severity of coronary atherosclerosis in adult pigs (Sus scrofa, n = 37) fed a high fat diet that also contained high NaCl (56% above recommended levels) for 1 year. Principal Findings Twenty pigs developed severe and diffuse distal coronary artery atherosclerosis (i.e., severe = intimal area as a percent medial area > 200% in at least 2 coronary artery cross sections and diffuse distal = intimal area as a percent medial area ≥ 150% over 3 sections separated by 2 cm in the distal half of the coronary artery). The other 17 pigs had substantially less coronary artery atherosclerosis. All 37 pigs had blood pressure in a range that would be considered hypertensive in humans and developed elevations in total and LDL and HDL cholesterol, weight gain, increased backfat, and increased insulin resistance (Bergman Si) without overt diabetes. Insulin resistance was not associated with atherosclerosis severity. Five additional pigs fed regular pig chow also developed increased insulin resistance but essentially no change in the other variables and little to no detectible coronary atherosclerosis. Most importantly, the 20 high fat/high NaCl diet -fed pigs with severe and diffuse distal coronary artery atherosclerosis had substantially greater increases (p< 0.05) in oxidized LDL (oxLDL) and fructosamine consistent with increased protein glycation. Conclusion In pigs fed a high fat/high NaCl diet, glycated proteins are induced in the absence of overt diabetes and this degree of increase is associated with the development of severe and diffuse distal coronary artery

  16. Oxidized LDL and Fructosamine Associated with Severity of Coronary Artery Atherosclerosis in Insulin Resistant Pigs Fed a High Fat/High NaCl Diet.

    PubMed

    Nichols, Timothy C; Merricks, Elizabeth P; Bellinger, Dwight A; Raymer, Robin A; Yu, Jing; Lam, Diana; Koch, Gary G; Busby, Walker H; Clemmons, David R

    2015-01-01

    Insulin-resistant subjects develop more severe and diffuse coronary artery atherosclerosis than insulin-sensitive controls but the mechanisms that mediate this atherosclerosis phenotype are unknown. To determine the metabolic parameters that associate with the severity of coronary atherosclerosis in insulin resistant pigs fed a high fat/high NaCl diet. The primary endpoint was severity of coronary atherosclerosis in adult pigs (Sus scrofa, n = 37) fed a high fat diet that also contained high NaCl (56% above recommended levels) for 1 year. Twenty pigs developed severe and diffuse distal coronary artery atherosclerosis (i.e., severe = intimal area as a percent medial area > 200% in at least 2 coronary artery cross sections and diffuse distal = intimal area as a percent medial area ≥ 150% over 3 sections separated by 2 cm in the distal half of the coronary artery). The other 17 pigs had substantially less coronary artery atherosclerosis. All 37 pigs had blood pressure in a range that would be considered hypertensive in humans and developed elevations in total and LDL and HDL cholesterol, weight gain, increased backfat, and increased insulin resistance (Bergman Si) without overt diabetes. Insulin resistance was not associated with atherosclerosis severity. Five additional pigs fed regular pig chow also developed increased insulin resistance but essentially no change in the other variables and little to no detectible coronary atherosclerosis. Most importantly, the 20 high fat/high NaCl diet-fed pigs with severe and diffuse distal coronary artery atherosclerosis had substantially greater increases (p< 0.05) in oxidized LDL (oxLDL) and fructosamine consistent with increased protein glycation. In pigs fed a high fat/high NaCl diet, glycated proteins are induced in the absence of overt diabetes and this degree of increase is associated with the development of severe and diffuse distal coronary artery atherosclerosis.

  17. [Coronary stents. From a simple idea to a medical high-tech device].

    PubMed

    Wieneke, Heinrich; Böse, Dirk; Haude, Michael; Eggebrecht, Holger; Konorza, Thomas; Naber, Christoph; Erbel, Raimund

    2005-08-15

    Coronary stents were introduced in clinical cardiology in the middle of the 1980s, as balloon angioplasty was associated with a high incidence of acute vessel closure and restenosis. However, primarily designed to counteract elastic recoil after angioplasty, initial results were complicated by acute and subacute stent thrombosis. With the introduction of drugs effectively inhibiting platelet aggregation like ticlopidine and clopidogrel, stent could exhibit its superiority in comparison to angioplasty. Although the incidence of restenosis could be decreased significantly by coronary stents, restenosis remained a major drawback of this interventional technique. Several modifications of stent design and stent material had been tested, but without a real breakthrough. The introduction of active stent coating with anti-inflammatory and antiproliferative drugs marks a milestone in the development of this technology. With this approach the restenosis problem could be, even though not solved, but essentially mitigated. Current developments address bioabsorbable materials to make stents compatible with new upcoming noninvasive imaging techniques. Introduced 20 years ago as a simple wire mesh, modified by new designs and materials, and coated by highly effective drugs, coronary stents have advanced to medical high-tech devices in interventional cardiology.

  18. High-density lipoprotein particles, coronary heart disease, and niacin

    USDA-ARS?s Scientific Manuscript database

    In clinical trials, the use of statins in patients with high risk for cardiovascular disease (CVD) has resulted in a 25% to 40% decrease in major clinical events. However, despite a marked reduction (up to 60%) in LDL-C, approximately 50% (or more) of patients continue to have CVD events. This high ...

  19. High frequency rotational ablation: an alternative in treating coronary artery stenoses and occlusions.

    PubMed Central

    Dietz, U; Erbel, R; Rupprecht, H J; Weidmann, S; Meyer, J

    1993-01-01

    OBJECTIVE--To prove the safety and effectiveness of high frequency rotational ablation of coronary artery stenoses and occlusion in humans. SUBJECTS--106 patients with symptoms (91 men, 15 women) who had 67 significant stenoses, mainly types B and C, and 46-chronic occlusions. MAIN OUTCOME MEASURES--Mean change in diameter stenosis after rotational angioplasty alone and in combination with percutaneous transluminal coronary angioplasty immediately after treatment and 24 hours and six months later; restenosis rates at six months; complication of treatment. RESULTS--Rotational ablation could not be used in five stenoses and 16 chronic occlusions because of inability to reach or cross the lesion with the Rotablator guide wire. In four cases rotational ablation failed. Initial angiographic and clinical success by rotational ablation was achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic occlusions (39%). Additional balloon angioplasty was performed in 45 patients, increasing the success rates to 79% and 54%, respectively. In the 62 stenoses treated by rotational ablation the angiographic diameter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotablator treatment alone and from 75% (11%) to 33% (17%) with additional balloon angioplasty. In the 30 chronic occlusions treated by rotational ablation the angiographic diameter stenoses were reduced to 38% (18%). At six months angiographic restenosis was evident in nine of the 25 (36%) stenoses treated with rotational ablation alone, in seven of the 22 (32%) stenoses treated with rotational and balloon angioplasty, and in 14 of the 24 (58%) chronic occlusions. There were no procedural deaths and two patients (2%) underwent emergency coronary artery bypass grafting. Although no transmural infarction occurred, there were five (6%) non-Q wave infarctions (two embolic side branch occlusions, two subacute occlusions, and one acute occlusion). Clinically insignificant slight increases in creatine kinase

  20. Measurement of Absolute Excitation Cross Sections in Highly-Charged Ions Using Electron Energy Loss and Merged Beams

    NASA Technical Reports Server (NTRS)

    Chutjian, A.; Smith, Steven J.; Lozano, J.

    2002-01-01

    There is increasing emphasis during this decade on understanding energy balance and phenomena observed in high electron temperature plasmas. The UV spectral return from FUSE, the X-ray spectral return from the HETG on Chandra and the LETGS 011 XMM-Newton are just beginning. Line emissions are almost entirely from highly-charged ions (HCIs) of C, N, 0, Ne, Mg, S, Si, Ca, and Fe. The Constellation-X mission will provide X-ray spectroscopy up to photon energies of 0.12 nm (10 keV) where primary line emitters will be HCIs. A variety of atomic parameters are required to model the stellar and solar plasma. These include cross sections for excitation, ionization, charge-exchange, X-ray emission, direct and indirect recombination, lifetimes and branching ratios, and dependences on l, m mixing by external E and B fields. In almost all cases the atomic quantities are calculated, and few comparisons to experiment have been carried out. Collision strengths and Einstein A-values are required to convert the observed spectral intensities to electron temperatures and densities in the stellar plasma. The JPL electron energy-loss and merged beam approach has been used to measure absolute collision strengths in a number of ions, with critical comparison made to the best available theories.

  1. Coronary CT angiography in patients with high calcium score: evaluation of plaque characteristics and diagnostic accuracy.

    PubMed

    Park, Mi Jung; Jung, Jung Im; Choi, Yun-Seok; Ann, Soe Hee; Youn, Ho-Joong; Jeon, Gyeong Nyeo; Choi, Ho Cheol

    2011-12-01

    Our aim was to evaluate the plaque characteristics of coronary arteries related to significant stenosis with coronary CT angiography (CCTA) and to discuss the diagnostic accuracy of CCTA in patients with high calcium scores. After institutional review board approval, 110 patients (63 men; mean age: 67.1 ± 7.9 years) with Agatston scores >400 were retrospectively reviewed. Patients underwent Agatston calcium scoring and 64-slice CCTA, in addition to invasive coronary angiography (CAG). The composition (calcified, mixed, and non-calcified) and configuration (concentric, eccentric) of coronary artery plaques were analyzed on a per-segment basis by CCTA. We analyzed the differences in plaque composition and configuration between significant (≥ 50%) and non-significant (<50%) stenosis. Additionally, the diagnostic accuracy of stenosis according to plaque composition was evaluated by CCTA, using CAG as a reference method. Significant differences in plaque composition and configurations were observed between the two groups. In cases of significant stenosis, the proportions of concentric, mixed, and non-calcified plaques were significantly higher than those of eccentric and calcified plaques (P < 0.001). The sensitivity and positive predictive value of mixed (97.4, 87.6%) and non-calcified plaques (97.8, 95.7%) were significantly higher than those of calcified plaques (87.6, 67.2%). Although CCTA has limited value due to low diagnostic accuracy of calcified plaques, knowledge about the high frequencies of mixed and non-calcified plaques in significant stenosis help to make an accurate assessment of CAD with CCTA in patients with high calcium scores.

  2. Effect of High-Calcium Diet on Coronary Artery Disease in Ossabaw Miniature Swine With Metabolic Syndrome.

    PubMed

    Phillips-Eakley, Alyssa K; McKenney-Drake, Mikaela L; Bahls, Martin; Newcomer, Sean C; Radcliffe, John S; Wastney, Meryl E; Van Alstine, William G; Jackson, George; Alloosh, Mouhamad; Martin, Berdine R; Sturek, Michael; Weaver, Connie M

    2015-08-13

    Calcium is a shortfall essential nutrient that has been a mainstay of osteoporosis management. Recent and limited findings have prompted concern about the contribution of calcium supplementation to cardiovascular risk. A proposed mechanism is through the acceleration of coronary artery calcification. Determining causality between calcium intake and coronary artery calcification has been hindered by a lack of sensitive methodology to monitor early vascular calcium accumulation. The primary study aim was to assess the impact of high calcium intake on coronary artery calcification using innovative calcium tracer kinetic modeling in Ossabaw swine with diet-induced metabolic syndrome. Secondary end points (in vitro wire myography, histopathology, intravascular ultrasound) assessed coronary disease. Pigs (n=24; aged ≈15 months) were fed an atherogenic diet with adequate calcium (0.33% by weight) or high calcium (1.90% from calcium carbonate or dairy) for 6 months. Following 5 months of feeding, all pigs were dosed intravenously with (41)Ca, a rare isotope that can be measured in serum and tissues at a sensitivity of 10(-18) mol/L by accelerator mass spectrometry. Kinetic modeling evaluated early coronary artery calcification using (41)Ca values measured in serial blood samples (collected over 27 days) and coronary artery samples obtained at sacrifice. Serum disappearance of (41)Ca and total coronary artery (41)Ca accumulation did not differ among groups. Secondary end points demonstrated no treatment differences in coronary artery disease or function. There was no detectable effect of high calcium diets (from dairy or calcium carbonate) on coronary artery calcium deposition in metabolic syndrome swine. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  3. Effect of High-Calcium Diet on Coronary Artery Disease in Ossabaw Miniature Swine With Metabolic Syndrome

    PubMed Central

    Phillips-Eakley, Alyssa K; McKenney-Drake, Mikaela L; Bahls, Martin; Newcomer, Sean C; Radcliffe, John S; Wastney, Meryl E; Van Alstine, William G; Jackson, George; Alloosh, Mouhamad; Martin, Berdine R; Sturek, Michael; Weaver, Connie M

    2015-01-01

    Background Calcium is a shortfall essential nutrient that has been a mainstay of osteoporosis management. Recent and limited findings have prompted concern about the contribution of calcium supplementation to cardiovascular risk. A proposed mechanism is through the acceleration of coronary artery calcification. Determining causality between calcium intake and coronary artery calcification has been hindered by a lack of sensitive methodology to monitor early vascular calcium accumulation. The primary study aim was to assess the impact of high calcium intake on coronary artery calcification using innovative calcium tracer kinetic modeling in Ossabaw swine with diet-induced metabolic syndrome. Secondary end points (in vitro wire myography, histopathology, intravascular ultrasound) assessed coronary disease. Methods and Results Pigs (n =24; aged ≈15 months) were fed an atherogenic diet with adequate calcium (0.33% by weight) or high calcium (1.90% from calcium carbonate or dairy) for 6 months. Following 5 months of feeding, all pigs were dosed intravenously with 41Ca, a rare isotope that can be measured in serum and tissues at a sensitivity of 10−18 mol/L by accelerator mass spectrometry. Kinetic modeling evaluated early coronary artery calcification using 41Ca values measured in serial blood samples (collected over 27 days) and coronary artery samples obtained at sacrifice. Serum disappearance of 41Ca and total coronary artery 41Ca accumulation did not differ among groups. Secondary end points demonstrated no treatment differences in coronary artery disease or function. Conclusion There was no detectable effect of high calcium diets (from dairy or calcium carbonate) on coronary artery calcium deposition in metabolic syndrome swine. PMID:26272654

  4. Association of Serum Pentraxin-3 and High-Sensitivity C-Reactive Protein with the Extent of Coronary Stenosis in Patients Undergoing Coronary Angiography

    PubMed Central

    Vuković-Dejanović, Vesna; Bogavac-Stanojević, Nataša; Spasić, Slavica; Spasojević-Kalimanovska, Vesna; Kalimanovska-Oštrić, Dimitra; Topalović, Mirko; Jelić-Ivanović, Zorana

    2015-01-01

    Summary Background We compared factors of inflammation – high sensitivity C-reactive protein (hsCRP) and pentraxin-3 (PTX3), and we explored their relationship with coronary artery disease (CAD). Also, we tested the usefulness of hsCRP and PTX3 in the risk assessment of coronary stenosis development and the diagnostic ability of these biomarkers to detect disease severity. Methods The study group consisted of 93 CAD patients undergoing coronary angiography. Patients were divided into CAD(0), representing subclinical stenosis, and CAD (1–3), representing significant stenosis in one, two or three vessels. Results We determined the concentration of lipid status parameters, hsCRP and PTX3. We found significantly lower PTX3 and hsCRP concentrations in CAD(0) than in CAD(1–3) group. Concentration of PTX3 showed an increasing trend with the increasing number of vessels affected. The area under ROC curve (AUC) for the combinations of hsCRP and PTX3 with lipid parameters had useful accuracy for detecting CAD(1–3) patients (AUC=0.770, p<0.001). Conclusion PTX3 is a promising independent diagnostic marker for identifying patients with CAD, and a useful indicator of disease progression. In all the analyses PTX3 showed better performance than hsCRP. A combination of PTX3, hsCRP with the lipid status parameters provides risk stratification of the development of coronary stenosis and better classification than their individual application. PMID:28356853

  5. High-Caloric Expenditure Exercise: A New Approach to Cardiac Rehabilitation for Overweight Coronary Patients Ades: High-Caloric Exercise Overweight Coronary Patients

    PubMed Central

    Ades, Philip A; Savage, Patrick D; Toth, Michael J; Harvey-Berino, Jean; Schneider, David J; Bunn, Janice Y; Audelin, Marie C; Ludlow, Maryann

    2009-01-01

    Background Over 80% of patients entering cardiac rehabilitation (CR) are overweight and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change. Methods and Results We performed a randomized-controlled clinical trial to evaluate the effect of high-caloric expenditure exercise (3000-3500 kcal/week exercise-related energy expenditure) compared with standard CR exercise (7-800 kcal/week) on weight loss and risk factors in 74 overweight patients with coronary heart disease (CHD). Both groups were counseled for weight loss and taking evidence-based preventive medications. High-caloric exercise resulted in double the weight loss (8.2±4 vs 3.7±5 kg, P<0.001) and fat mass loss (5.9±4 vs 2.8±3 kg, P< 0.001) and a greater waist reduction (-7±5 vs. -5±5 cm, P=0.02) than standard CR exercise at 5-months. High-caloric exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the Cholesterol/HDL-Cholesterol ratio and components of the metabolic syndrome more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased HDL-Cholesterol and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1 and the Cholesterol/HDL-Cholesterol ratio (each P<0.05). Significant weight loss was maintained at 1-year. Conclusions High-caloric exercise promotes greater weight loss and more favorable cardio-metabolic risk profiles than standard CR for overweight coronary patients. PMID:19433757

  6. Is high high-density lipoprotein cholesterol beneficial for premature coronary heart disease? A meta-analysis.

    PubMed

    Shahid, Murtuza; Sun, Run L; Liu, Yu; Bao, Jin L; Huang, Can X; Liao, Yu; Zhou, Shu X; Wang, Jing F; Zhang, Yu L

    2016-05-01

    To clarify the association between premature coronary heart disease of patients ≤55 years and high-density lipoprotein cholesterol (HDL-C) plasma levels. Searches were performed between 2002 and 2013 using PubMed, Web of Science, Science Direct, and Google Scholar. The original articles selected published premature coronary heart disease diagnosed by World Health Organization criteria or via angiograph both in males and females ≤55 years and with plasma HDL-C levels in both the case and control groups. The 'related articles' function and manual searches of the related references was used to broaden the search. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of papers. Standard mean difference with 95% confidence interval was used as a measure of the association between HDL and premature coronary heart disease, after pooling data across trials in a random effect model. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. The influences of publication year, sample size and district were assessed by meta-regression. STATA (version 11.0) was used to conduct all statistical analyses. Only 13 case-control studies met the criteria, which included 1775 patients and 1989 controls. The Newcastle-Ottawa Quality Assessment Scale score was about 5-7. A strong association was identified between HDL-C and premature coronary heart disease. The premature coronary heart disease patients had lower levels of HDL-C compared with the controls: standard mean difference = -0.48, 95% confidence interval = -0.71 to -0.26, p < 0.001, pheterogeneity < 0.001. By meta-regression and subgroup analysis, we found publication year might be the source of heterogeneity, but not the main reason for heterogeneity. After removing the heterogeneity of outlier studies, the significant association between low HDL-C levels and premature coronary heart disease was still retained. Low plasma

  7. Coronary collaterals.

    PubMed

    Gorlin, R

    1976-01-01

    Coronary collaterals are probably enlargements of pre-existing channels which respond to local vasodilators and which function whenever pressure differences exist across them. Thus, in human coronary atherosclerosis collaterals are only seen when there is a severe intervening arterial obstruction (in excess of 75%). Coronary collaterals follow epicardial and intramycardial pathways, and the intermediary connections may be at vessels of highly varying caliber. The flow potential of most collateral pathways in man is possibly adequate for segmental myocardial function at lower than normal demands but clearly is inadequate for most, if not all, stressful interventions. In the last analysis, coronary collaterals in man are more an indication of severe regional ischemia (present or potential) than a sign of biological "compensation'' for a perfusion deficit.

  8. Two-modality laser diode interferometer for high-accuracy measurement of long-range absolute distance

    NASA Astrophysics Data System (ADS)

    Wang, Bofan; Li, Zhongliang; Wang, Xiangzhao; Bu, Peng

    2010-08-01

    This paper presents a two-modality laser diode (LD) interferometer which combine as two-wavelength sinusoidal phase modulating (SPM) interferometer with a wavelength scanning interferometer (WSI) for measurement of distance over long range with high accuracy. Moreover, the intensity modulation due to power changes of LD is suppressed by appropriately choosing the modulation amplitude of injection current (IC) of LD. Triangle wave is used to modulate the IC of one LD with that of the other LD being constant at first. Thus the interferometer works as a wavelength scanning interferometer. An initial estimate of the distance can be obtained from the phase change of the interference signal. Then sinusoidal wave is used for modulating IC of both LDs to realize a two-wavelength SPM interferometer. However, the modulation of the IC of two LDs results in not only the wavelength modulation but also the intensity modulation. This intensity modulation will cause a measured phase error. To eliminate this error, SPM depths are appropriately chosen, therefore the distance to be measured can be accurately obtained with synthetic-wavelength algorithm. Experimental results indicate that an absolute distance measurement accuracy of 1μm can be achieved over the range of 40mm to 100mm.

  9. Measurement of Absolute Excitation Cross Sections in Highly-Charged Ions Using Electron Energy Loss and Merged Beams

    NASA Astrophysics Data System (ADS)

    Chutjian, A.; Smith, Steven J.; Lozano, J. A.

    2002-11-01

    There is increasing emphasis within this decade on understanding energy balance and new phenomena observed in high electron temperature plasmas. The UV spectral return from FUSE, and the X-ray spectral return from the HETG on Chandra and the LETGS on XMM-Newton are just beginning. The line emissions are almost entirely from highly-charged ions (HCIs) of C, N, O, Ne, Mg, S, Si, Ca, and Fe. In addition, the Constellation-X mission, currently in the planning stages, will provide high-throughput X-ray spectroscopy up to photon energies of 0.12 nm (10 keV), where the primary line emitters will again be the HCIs. This array of space instruments is providing an overwhelming return of HCI spectral data from a variety of astrophysical objects. Collision strengths and Einstein A-values are required to convert the observed spectral intensities to electron temperatures and densities in the stellar plasma [1]. The JPL electron energy-loss and merged-beams approach [2] has been used to measure absolute collision strengths in a number of ions, with critical comparisons to the best available theories. Experimental methods will be reviewed, and results presented on experimental comparisons to R-Matrix and Breit-Pauli theoretical results in C3+[3], O2+[4], O5+[5], S2+[6], and Fe9+ [7]. Work is planned for comparisons in Mgq+, and higher charge states Fe(10-15)+. J. Lozano thanks the National Research Council for a fellowship though the NASA- NRC program. This work was carried out at the Jet Propulsion Laboratory, California Institute of Technology, and was supported under contract with the National Aeronautics and Space Administration.

  10. Modeled PFOA exposure and coronary artery disease, hypertension, and high cholesterol in community and worker cohorts.

    PubMed

    Winquist, Andrea; Steenland, Kyle

    2014-12-01

    Several previous studies, mostly cross-sectional, have found associations between perfluorooctanoic acid (PFOA) and high cholesterol levels, but studies of hypertension and heart disease have had inconsistent findings. In this study we examined the association between modeled PFOA exposure and incident hypertension, hypercholesterolemia, and coronary artery disease among workers at a Mid-Ohio Valley chemical plant that used PFOA, and residents of the surrounding community. Community- and worker-cohort participants completed surveys during 2008-2011 covering demographics, health-related behaviors, and medical history. Cox proportional hazard models, stratified by birth year, modeled the hazard of each outcome (starting at 20 years of age) as a function of retrospective serum PFOA concentration estimates (generated through fate, transport and exposure modeling), controlling for sex, race, education, smoking, alcohol use, body mass index, and diabetes. Among 32,254 participants (28,541 community; 3,713 worker), 12,325 reported hypertension with medication, 9,909 reported hypercholesterolemia with medication, and 3,147 reported coronary artery disease (2,550 validated). Hypercholesterolemia incidence increased with increasing cumulative PFOA exposure (sum of yearly serum concentration estimates), most notably among males 40-60 years of age. Compared with the lowest exposure quintile (< 142 ng/mL-years), hazard ratios for subsequent quintiles (ng/mL-years: 142 to < 234; 234 to < 630; 630 to < 3,579; ≥ 3,579) were 1.24, 1.17, 1.19, and 1.19 overall and 1.38, 1.32, 1.31, and 1.44 among men 40-60 years of age. There was no apparent association between PFOA exposure and hypertension or coronary artery disease incidence. Higher PFOA exposure was associated with incident hypercholesterolemia with medication, but not with hypertension or coronary artery disease.

  11. Absolute dose measurements by means of a small cylindrical ionization chamber for very high dose per pulse high energy electron beams

    SciTech Connect

    Karaj, E.; Righi, S.; Di Martino, F.

    2007-03-15

    Very high dose per pulse (3-13 cGy/pulse) high energy electron beams are currently produced by special linear accelerators (linac) dedicated to Intra Operative Radiation Therapy (IORT). The electron beams produced by such linacs are collimated by special Perspex applicators of various size and cylindrically shaped. The biggest problems from the dosimetric point of view are caused by the high dose-per-pulse values and the use of inclined applicators. In this work measurements of absolute dose for the inclined applicators were done by using a small cylindrical ionization chamber, type CC01 (Wellhofer), a parallel plane ionization chamber type Markus (PTW 23343) and radiochromic films type EBT. We show a method which allows calculating the quality correction factors for CC01 chamber with an uncertainty of 1% and the absolute dose value for the inclined applicators using CC01 with an uncertainty of 3.1% for electron beams of energy of 6 and 7 MeV produced by the linac dedicated to IORT Novac7.

  12. Coronary high-intensity plaque on T1-weighted magnetic resonance imaging and its association with myocardial injury after percutaneous coronary intervention.

    PubMed

    Hoshi, Tomoya; Sato, Akira; Akiyama, Daiki; Hiraya, Daigo; Sakai, Shunsuke; Shindo, Masashi; Mori, Kensaku; Minami, Manabu; Aonuma, Kazutaka

    2015-08-01

    Non-contrast T1-weighted imaging (T1WI) has emerged as a novel non-invasive imaging for vulnerable coronary plaque showing a high-intensity plaque (HIP). However, the association between HIP and percutaneous coronary intervention (PCI) has not been evaluated. We investigated the association between the presence of HIP and the incidence of myocardial injury after PCI. A total of 77 patients with stable angina were imaged with non-contrast T1WI by using a 1.5 T magnetic resonance system (HIP and non-HIP group, N = 31 and 46 patients, respectively). We defined HIP as a coronary plaque to myocardium signal intensity ratio (PMR) of ≥1.4. High-sensitive cardiac troponin-T (hs-cTnT) was measured at baseline and 24 h after PCI. Percutaneous coronary intervention-related myocardial injury (PMI) was defined as an elevation of hs-cTnT >5× 99th percentile upper reference limit. High-intensity plaque was associated with the characteristics of ultrasound attenuation and positive remodelling on intravascular ultrasound. Although baseline hs-cTnT was similar between the groups, increase in hs-cTnT was significantly greater in the HIP vs. non-HIP group (0.065 [0.023-0.304] vs. 0.017 [0.005-0.026], P < 0.001). Percutaneous coronary intervention-related myocardial injury occurred more frequently in the HIP than non-HIP group (58.1 vs. 10.9%, P < 0.001), and the cut-off value of PMR found to be 1.44 for predicting PMI (sensitivity 78.3% and specificity 81.5%). In multivariate analysis, a PMR of ≥1.4 was a significant predictor of PMI (odds ratio 5.63, 95% confidence interval 1.28-24.7, P = 0.022). High-intensity plaque on non-contrast T1WI was characterized as vulnerable coronary plaque on IVUS and was associated with higher incidence of PMI. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  13. The role of volume-load in strength and absolute endurance adaptations in adolescent's performing high- or low-load resistance training.

    PubMed

    Steele, James; Fisher, James P; Assunção, Ari R; Bottaro, Martim; Gentil, Paulo

    2017-02-01

    This study compared high- (HL) and low-load (LL) resistance training (RT) on strength, absolute endurance, volume-load, and their relationships in untrained adolescents. Thirty-three untrained adolescents of both sexes (males, n = 17; females, n = 16; 14 ± 1 years) were randomly assigned into either (i) HL (n = 17): performing 3 sets of 4-6 repetitions to momentary concentric failure; or (ii) LL (n = 16): performing 2 sets of 12-15 repetitions to momentary concentric failure. RT was performed for 2×/week for 9 weeks. Change in maximum strength (1 repetition maximum) and absolute muscular endurance for barbell bench press was assessed. Weekly volume-load was calculated as sets (n) × repetitions (n) × load (kg). Ninety-five percent confidence intervals (CIs) revealed that both groups significantly increased in strength and absolute endurance with large effect sizes (d = 1.51-1.66). There were no between-group differences for change in strength or absolute endurance. Ninety-five percent CIs revealed that both groups significantly increased in weekly volume-load with large effect sizes (HL = 1.66, LL = 1.02). There were no between-group differences for change in volume-load though average weekly volume-load was significantly greater for LL (p < 0.001). Significant Pearson's correlations were found for the HL group between average weekly volume-load and both strength (r = 0.650, p = 0.005) and absolute endurance (r = 0.552, p = 0.022) increases. Strength and absolute endurance increases do not differ between HL and LL conditions in adolescents when performed to momentary concentric failure. Under HL conditions greater weekly volume-load is associated with greater strength and absolute endurance increases.

  14. Absolute Dating of Strath Terraces along the Western High Plains Reveals Complicated History of Occupation and Incision

    NASA Astrophysics Data System (ADS)

    Foster, M. A.; Anderson, R. S.; Gray, H. J.; Mahan, S.

    2015-12-01

    Gravel-capped strath terraces are preserved along the western High Plains, adjacent to the Colorado Front Range. Terrace elevations appear to connect across the landscape, representing previous levels of the Denver Basin during fluvial exhumation. In this tectonically quiescent region, climatically-driven fluctuations in sediment supply are often interpreted to drive terrace occupation and basin exhumation. We dated a series of strath terraces near Boulder, CO using 10Be/26Al cosmogenic radionuclides (CRNs) and optically stimulated luminescence. Results reveal: (1) a long history of fluvial occupation (0.5-1.0 Myr duration), with recent (<120 ka) fluvial abandonment of the highest surface; (2) a brief occupation of a narrow spillway, abandoned at 97.0 ± 4.2 ka, preserved because the stream was subsequently pirated; and (3) a long period of fluvial occupation of a lower terrace, recorded by the deposition of distinct gravel packages at 50-75 ka and 40.5 ± 5.0 ka. In conjunction with absolute dating on nearby terraces, our study indicates the system is more complex than originally thought. Ages are not consistent among terraces of similar elevations deposited by different stream systems. The link between terrace age and climate is not straightforward, as terraces can be occupied through several glacial-interglacial cycles. When a surface is abandoned, incision to the next level appears to occur quite rapidly through the soft Cretaceous shales. Long-term incision rates may be derived from elevations and ages of high preserved surfaces, but such incision rates reflect long periods of no vertical erosion punctuated with short periods of rapid incision. Such interpretations would not be possible without paired CRNs or combination with other geochronologic techniques. This study therefore represents a cautionary tale for the interpretation of tectonic or climatic processes and process rates from single-method dating of fluvial terraces.

  15. High-Efficiency SPECT MPI: Comparison of Automated Quantification, Visual Interpretation, and Coronary Angiography

    PubMed Central

    Duvall, W. Lane; Slomka, Piotr J.; Gerlach, Jim R.; Sweeny, Joseph M.; Baber, Usman; Croft, Lori B.; Guma, Krista A.; George, Titus; Henzlova, Milena J.

    2013-01-01

    Background Recently introduced high-efficiency (HE) SPECT cameras with solid-state CZT detectors have been shown to decrease imaging time and reduce radiation exposure to patients. An automated, computer derived quantification of HE MPI has been shown to correlate well with coronary angiography on one HE SPECT camera system (D-SPECT), but has not been compared to visual interpretation on any of the HE SPECT platforms. Methods Patients undergoing a clinically indicated Tc-99m sestamibi HE SPECT (GE Discovery 530c with supine and prone imaging) study over a one year period followed by a coronary angiogram within 2 months were included. Only patients with a history of CABG surgery were excluded. Both MPI studies and coronary angiograms were reinterpreted by blinded readers. One hundred and twenty two very low (risk of CAD < 5%) or low (risk of CAD < 10%) likelihood subjects with normal myocardial perfusion were used to create normal reference limits. Computer derived quantification of the total perfusion deficit (TPD) at stress and rest was obtained with QPS software. The visual and automated MPI quantification were compared to coronary angiography (≥ 70% luminal stenosis) by receiver operating curve (ROC) analysis. Results Of the 3,111 patients who underwent HE SPECT over a one year period, 160 patients qualified for the correlation study (66% male, 52% with a history of CAD). The ROC area under the curve (AUC) was similar for both the automated and visual interpretations using both supine only and combined supine and prone images (0.69-0.74). Using thresholds determined from sensitivity and specificity curves, the automated reads showed higher specificity (59-67% versus 27-60%) and lower sensitivity (71-72% versus 79-93%) than the visual reads. By including prone images sensitivity decreased slightly but specificity increased for both. By excluding patients with known CAD and cardiomyopathies, AUC and specificity increased for both techniques (0.72-0.82). The use

  16. Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease.

    PubMed

    Nagahara, Yasuomi; Motoyama, Sadako; Sarai, Masayoshi; Ito, Hajime; Kawai, Hideki; Takakuwa, Yoko; Miyagi, Meiko; Shibata, Daisuke; Takahashi, Hiroshi; Naruse, Hiroyuki; Ishii, Junichi; Ozaki, Yukio

    2016-07-01

    Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0% male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. HRP was observed in 37 (19%) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p=0.046), number of vessel disease (OR 1.87; p=0.031), and EPA/AA ratio (OR 0.65; p=0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p=0.0049) and IDI (0.054, p=0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14% vs. 3%, Logrank p=0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p=0.047). Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA

  17. A high-resolution, absolute-dated deglacial speleothem record of Indian Ocean climate from Socotra Island, Yemen

    NASA Astrophysics Data System (ADS)

    Shakun, Jeremy D.; Burns, Stephen J.; Fleitmann, Dominik; Kramers, Jan; Matter, Albert; Al-Subary, Abdulkarim

    2007-07-01

    Stalagmite M1-5 from Socotra Island, Yemen in the northwest Indian Ocean provides a robust, high-resolution paleoclimate record from ˜ 27.4-11.1 ka based on 717 stable isotope and 28 230Th measurements. Variations in M1-5 oxygen isotope ratios ( δ18O) are interpreted to be primarily driven by an amount effect related to changes in the mean position and/or intensity of convection of the intertropical convergence zone, the island's only source of precipitation. The M1-5 δ18O time series is strongly correlated to the Greenland ice cores, similar to an older Socotra speleothem deposited from 53-40 ka [S.J. Burns, D. Fleitmann, A. Matter, J. Kramers, A. Al-Subbary, Indian Ocean climate and an absolute chronology over Dansgaard/Oeschger events 9 to 13, Science 301 (2003) 1365-1367], indicating that a North Atlantic-Indian Ocean cold-dry/warm-wet teleconnection persisted through the end of the last glacial period. Peak aridification occurred at ˜ 23 ka and a gradual increase in moisture thereafter was interrupted by an abrupt drying event at ˜ 16.4 ka, perhaps related to Heinrich event 1. Indian Ocean rainfall increased dramatically during the Bølling period and then decreased continuously and gradually through the Allerød and Younger Dryas. The Holocene began abruptly with increased precipitation at 11.4 ka and was followed by a major but short-lived drying during the Preboreal Oscillation at ˜ 11.2 ka. M1-5 is highly correlated to the Dongge Cave record from 15.5-11 ka, suggesting much of the Indian Ocean monsoon region responded similarly to the major climate changes of the last deglaciation. The transitions into the Younger Dryas and to a lesser extent the Bølling are remarkably gradual in M1-5, as they are in all other Asian speleothem records, occurring over several centuries. These gradual transitions are in striking contrast to high-resolution records from around the North Atlantic basin where the transitions are extremely abrupt and generally occur in

  18. Coronary Arteries

    MedlinePlus

    ... and animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  19. Development of highly efficient proton recoil counter telescope for absolute measurement of neutron fluences in quasi-monoenergetic neutron calibration fields of high energy

    NASA Astrophysics Data System (ADS)

    Shikaze, Yoshiaki; Tanimura, Yoshihiko; Saegusa, Jun; Tsutsumi, Masahiro

    2010-04-01

    Precise calibration of monitors and dosimeters for use with high energy neutrons necessitates reliable and accurate neutron fluences being evaluated with use of a reference point. A highly efficient Proton Recoil counter Telescope (PRT) to make absolute measurements with use of a reference point was developed to evaluate neutron fluences in quasi-monoenergetic neutron fields. The relatively large design of the PRT componentry and relatively thick, approximately 2 mm, polyethylene converter contributed to high detection efficiency at the reference point over a large irradiation area at a long distance from the target. The polyethylene converter thickness was adjusted to maintain the same carbon density per unit area as the graphite converter for easy background subtraction. The high detection efficiency and thickness adjustment resulted in efficient absolute measurements being made of the neutron fluences of sufficient statistical precision over a short period of time. The neutron detection efficiencies of the PRT were evaluated using MCNPX code at 2.61×10-6, 2.16×10-6 and 1.14×10-6 for the respective neutron peak energies of 45, 60 and 75 MeV. The neutron fluences were determined to have been evaluated at an uncertainty of within 6.5% using analysis of measured data and the detection efficiencies. The PRT was also designed so as to be capable of simultaneously obtaining TOF data. The TOF data also increased the reliability of neutron fluence measurements and provided useful information for use in interpreting the source of proton events.

  20. On Arrival High Blood Glucose Level is Associated With Detrimental and Fatal Hospitalization Outcomes for Acute Coronary Syndrome

    PubMed Central

    Hartopo, Anggoro B.; Setianto, Budi Y.; Gharini, Putrika P.R.; Dinarti, Lucia K.

    2011-01-01

    Background High blood glucose level is frequently encountered in acute coronary syndrome. We investigated the effects of high blood glucose measured on arrival on hospitalization adverse events in acute coronary syndrome. Our study patients were Javanese in ethnicity, which constitute half of population in Indonesia. We hypothesized that elevated blood glucose has detrimental effects on hospitalization for acute coronary syndrome. Methods We designed an observasional cohort study and recruited 148 consecutive patients with acute coronary syndrome. Venous blood was collected on hospital arrival. High blood glucose level was determined as plasma glucose > 140 mg/dL. Adverse hospitalization events were recorded, i.e. mortality, acute heart failure, cardiogenic shock and heart rhythm disorders. Echocardiography examination was performed to determine left ventricular function. Results The prevalence of on arrival high blood glucose among Javanese patients with acute coronary syndrome was considerably high (36%). On arrival high blood glucose was associated with acute heart failure (P < 0.001) and shock cardiogenic (P = 0.02). Heart rhythm disorders were higher in high blood glucose patients (P = 0.004). Left ventricular dysfunction was more prevalent in high blood glucose patients (P = 0.001) and ejection fraction was lower (P = 0.001). On arrival high blood glucose was independently associated with hospitalization adverse events (adjusted odds ratio = 2.3, 95% confidence interval: 1.1-4.9, P = 0.03) and hospital mortality (adjusted odds ratio = 6.9, 95% confidence interval: 1.2-38.6, P = 0.03). Conclusions Our study suggests that on arrival high blood glucose among Javanese patients with acute coronary syndrome is considerably high and is associated with detrimental and fatal hospitalization outcomes.

  1. Two- and three-dimensional quantitative image analysis of coronary arteries from high-resolution histological sections

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Robb, Richard A.

    2000-05-01

    The study of coronary arteries has evolved from examining gross anatomy and morphology to scrutinizing micro-anatomy and cellular composition. Technological advances such as high-powered digital microscopes and high precision cutting devices have allowed clinicians to examine coronary artery morphology and pathology at micron resolution. Our work explores the composition of normal coronary arteries in order to provide the foundation for further study of remodeled tissue. The first of two coronary arteries was sliced into 442 sections with 4 micron inter-slice spacing. Each slice was stained for elastin and collagen. The second coronary artery was sectioned into 283 slices, also with 4 micron resolution. These slices were stained for cellular nuclei and smooth muscle. High sectioned into 283 slices, also with 4 micron resolution. These slices were stained for cellular nuclei and smooth muscle. High resolution light microscopy was used to image the sections. The data was analyzed for collagen/elastin content and nuclei density, respectively. Processing of this type of data is challenging in the areas of segmentation, visualization and quantification. Segmentation was confounded by variation in image quality as well as complexity of the coronary tissue. These problems were overcome by the development of 'smart' thresholding algorithms for segmentation. In addition, morphology and image statistics were used to further refine the result of the segmentation. Specificity/sensitivity analysis suggests that automatic segmentation can be very effective. 3D visualization of coronary arteries is challenging due to multiple tissue layers. Method such as summed voxel projection and maximum intensity projection appear to be effective. Shading methods also provide adequate visualization, however it is important to incorporate combined 2D and 3D displays. Surface rendering techniques are useful tools for visualizing parametric data. Quantification in 3D is simple in practice but

  2. High-Resolution Variable-Density 3D Cones Coronary MRA

    PubMed Central

    Addy, Nii Okai; Ingle, R. Reeve; Wu, Holden H.; Hu, Bob S.; Nishimura, Dwight G.

    2015-01-01

    Purpose To improve the spatial/temporal resolution of whole-heart coronary MR angiography (CMRA) by developing a variable-density (VD) 3D cones acquisition suitable for image reconstruction with parallel imaging and compressed sensing techniques. Methods A VD 3D cones trajectory design incorporates both radial and spiral trajectory undersampling techniques to achieve higher resolution. This design is used to generate a VD cones trajectory with 0.8 mm/66 ms isotropic spatial/temporal resolution, using a similar number of readouts as our previous fully sampled cones trajectory (1.2 mm/100 ms). Scans of volunteers and patients are performed to evaluate the performance of the VD trajectory, using non-Cartesian L1-ESPIRiT for high-resolution image reconstruction. Results With gridding reconstruction, the high-resolution scans experience an expected drop in signal-to-noise and contrast-to-noise ratios, but with L1-ESPIRiT, the apparent noise is substantially reduced. Compared to 1.2 mm images, in each volunteer, the L1-ESPIRiT 0.8 mm images exhibit higher vessel sharpness values in the right and left anterior descending arteries. Conclusion CMRA with isotropic sub-millimeter spatial resolution and high temporal resolution can be performed with VD 3D cones to improve the depiction of coronary arteries. PMID:26172829

  3. A kinetic-based sigmoidal model for the polymerase chain reaction and its application to high-capacity absolute quantitative real-time PCR

    PubMed Central

    Rutledge, Robert G; Stewart, Don

    2008-01-01

    Background Based upon defining a common reference point, current real-time quantitative PCR technologies compare relative differences in amplification profile position. As such, absolute quantification requires construction of target-specific standard curves that are highly resource intensive and prone to introducing quantitative errors. Sigmoidal modeling using nonlinear regression has previously demonstrated that absolute quantification can be accomplished without standard curves; however, quantitative errors caused by distortions within the plateau phase have impeded effective implementation of this alternative approach. Results Recognition that amplification rate is linearly correlated to amplicon quantity led to the derivation of two sigmoid functions that allow target quantification via linear regression analysis. In addition to circumventing quantitative errors produced by plateau distortions, this approach allows the amplification efficiency within individual amplification reactions to be determined. Absolute quantification is accomplished by first converting individual fluorescence readings into target quantity expressed in fluorescence units, followed by conversion into the number of target molecules via optical calibration. Founded upon expressing reaction fluorescence in relation to amplicon DNA mass, a seminal element of this study was to implement optical calibration using lambda gDNA as a universal quantitative standard. Not only does this eliminate the need to prepare target-specific quantitative standards, it relegates establishment of quantitative scale to a single, highly defined entity. The quantitative competency of this approach was assessed by exploiting "limiting dilution assay" for absolute quantification, which provided an independent gold standard from which to verify quantitative accuracy. This yielded substantive corroborating evidence that absolute accuracies of ± 25% can be routinely achieved. Comparison with the LinReg and Miner

  4. A kinetic-based sigmoidal model for the polymerase chain reaction and its application to high-capacity absolute quantitative real-time PCR.

    PubMed

    Rutledge, Robert G; Stewart, Don

    2008-05-08

    Based upon defining a common reference point, current real-time quantitative PCR technologies compare relative differences in amplification profile position. As such, absolute quantification requires construction of target-specific standard curves that are highly resource intensive and prone to introducing quantitative errors. Sigmoidal modeling using nonlinear regression has previously demonstrated that absolute quantification can be accomplished without standard curves; however, quantitative errors caused by distortions within the plateau phase have impeded effective implementation of this alternative approach. Recognition that amplification rate is linearly correlated to amplicon quantity led to the derivation of two sigmoid functions that allow target quantification via linear regression analysis. In addition to circumventing quantitative errors produced by plateau distortions, this approach allows the amplification efficiency within individual amplification reactions to be determined. Absolute quantification is accomplished by first converting individual fluorescence readings into target quantity expressed in fluorescence units, followed by conversion into the number of target molecules via optical calibration. Founded upon expressing reaction fluorescence in relation to amplicon DNA mass, a seminal element of this study was to implement optical calibration using lambda gDNA as a universal quantitative standard. Not only does this eliminate the need to prepare target-specific quantitative standards, it relegates establishment of quantitative scale to a single, highly defined entity. The quantitative competency of this approach was assessed by exploiting "limiting dilution assay" for absolute quantification, which provided an independent gold standard from which to verify quantitative accuracy. This yielded substantive corroborating evidence that absolute accuracies of +/- 25% can be routinely achieved. Comparison with the LinReg and Miner automated qPCR data

  5. High-accuracy interferometer with a prism pair for measurement of the absolute refractive index of glass

    SciTech Connect

    Hori, Yasuaki; Hirai, Akiko; Minoshima, Kaoru; Matsumoto, Hirokazu

    2009-04-10

    We propose a variable-path interferometric technique for the measurement of the absolute refractive index of optical glasses. We use two interferometers to decide the ratio between changes in the optical path in a prism-shaped sample glass and in air resulting from displacement of the sample. The method allows precise measurements to be made without prior knowledge of the properties of the sample. The combined standard uncertainty of the proposed method is 1.6x10{sup -6}.

  6. Early impairment of coronary microvascular perfusion capacity in rats on a high fat diet.

    PubMed

    van Haare, Judith; Kooi, M Eline; Vink, Hans; Post, Mark J; van Teeffelen, Jurgen W G E; Slenter, Jos; Munts, Chantal; Cobelens, Hanneke; Strijkers, Gustav J; Koehn, Dennis; van Bilsen, Marc

    2015-11-17

    It remains to be established if, and to what extent, the coronary microcirculation becomes compromised during the development of obesity and insulin resistance. Recent studies suggest that changes in endothelial glycocalyx properties contribute to microvascular dysfunction under (pre-)diabetic conditions. Accordingly, early effects of diet-induced obesity on myocardial perfusion and function were studied in rats under baseline and hyperaemic conditions. Rats were fed a high fat diet (HFD) for 6 weeks and myocardial microvascular perfusion was determined using first-pass perfusion MRI before and after adenosine infusion. The effect of HFD on microcirculatory properties was also assessed by sidestream darkfield (SDF) imaging of the gastrocnemius muscle. HFD-fed rats developed central obesity and insulin sensitivity was reduced as evidenced by the marked reduction in insulin-induced phosphorylation of Akt in both cardiac and gastrocnemius muscle. Early diet-induced obesity did not lead to hypertension or cardiac hypertrophic remodeling. In chow-fed, control rats a robust increase in cardiac microvascular perfusion was observed upon adenosine infusion (+40%; p < 0.05). In contrast, the adenosine response was abrogated in rats on a HFD (+8%; N.S.). HFD neither resulted in rarefaction or loss of glycocalyx integrity in skeletal muscle, nor reduced staining intensity of the glycocalyx of cardiac capillaries. Alterations in coronary microcirculatory function as assessed by first-pass perfusion MRI represent one of the earliest obesity-related cardiac adaptations that can be assessed non-invasively. In this early stage of insulin resistance, disturbances in glycocalyx barrier properties appeared not to contribute to the observed changes in coronary microvascular function.

  7. High incidence of inaccurate stent placement in the treatment of coronary aorto-ostial disease.

    PubMed

    Dishmon, Dwight A; Elhaddi, Adam; Packard, Kevin; Gupta, Vishal; Fischell, Tim A

    2011-08-01

    The purpose of this study was to evaluate the incidence of inaccurate stent positioning in the treatment of coronary aorto-ostial lesions. The percutaneous treatment of aorto-ostial disease is challenging, with a paucity of data describing the incidence of stent mispositioning. We retrospectively reviewed the accuracy of stent positioning in 100 consecutive coronary aorto-ostial lesions. Using careful angiographic review, each stent placement was classified as "missed" (> 1 mm distal or proximal to the angiographically determined ostium) or "accurately" positioned. The true ostium was missed during stent placement in 54% of cases. In 52% of the misses, the stent was placed too proximally. This proximal miss was associated with an inability to coaxially re-engage the treated vessel in 93% of the cases. The stent was placed too distally in 48% of missed cases, resulting in a placement of one or more additional overlapping stents in 38% of those cases. Clinical follow-up (mean, 24.5 ± 12.9 months) was obtained in 98% of cases. Angiographic follow-up prompted by recurrent chest pain or ischemia was performed in 45/100 cases. There was a three-fold increase in restenosis and target lesion revascularization (TLR) among the cohort of patients with stent misplacement (26% and 23%, respectively) compared to those with accurate stent placement (9% and 6%, respectively; p = 0.02 for both restenosis and TLR). Angiographically-guided stenting for coronary aorto-ostial disease leads to a high incidence of proximal and distal stent misplacement. Stent mispositioning is associated with significantly higher restenosis and clinically driven TLR compared to patients with accurate stent placement.

  8. A clinical model to identify patients with high-risk coronary artery disease.

    PubMed

    Yang, Yelin; Chen, Li; Yam, Yeung; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S; Budoff, Matthew J; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Cheng, Victor Y; Chinnaiyan, Kavitha; Cury, Ricardo; Delago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jörg; Karlsberg, Ronald P; Kaufmann, Philipp A; Kim, Yong-Jin; Leipsic, Jonathon; LaBounty, Troy; Lin, Fay; Maffei, Erica; Raff, Gilbert L; Shaw, Leslee J; Villines, Todd C; Min, James K; Chow, Benjamin J W

    2015-04-01

    This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify those patients with and without high-risk coronary anatomy. Retrospective analysis of a prospectively collected multinational coronary computed tomographic angiography (CTA) cohort was conducted. High-risk anatomy was defined as left main diameter stenosis ≥50%, 3-vessel disease with diameter stenosis ≥70%, or 2-vessel disease involving the proximal left anterior descending artery. Using a cohort of 27,125, patients with a history of CAD, cardiac transplantation, and congenital heart disease were excluded. The model was derived from 24,251 consecutive patients in the derivation cohort and an additional 7,333 nonoverlapping patients in the validation cohort. The risk score consisted of 9 variables: age, sex, diabetes, hypertension, current smoking, hyperlipidemia, family history of CAD, history of peripheral vascular disease, and chest pain symptoms. Patients were divided into 3 risk categories: low (≤7 points), intermediate (8 to 17 points) and high (≥18 points). The model was statistically robust with area under the curve of 0.76 (95% confidence interval [CI]: 0.75 to 0.78) in the derivation cohort and 0.71 (95% CI: 0.69 to 0.74) in the validation cohort. Patients who scored ≤7 points had a low negative likelihood ratio (<0.1), whereas patients who scored ≥18 points had a high specificity of 99.3% and a positive likelihood ratio (8.48). In the validation group, the prevalence of high-risk CAD was 1% in patients with ≤7 points and 16.7% in those with ≥18 points. We propose a scoring system, based on clinical variables, that can be used to identify patients at high and low pre-test probability of having high-risk CAD. Identification of these populations may detect those who may benefit

  9. The Joint Council on Thoracic Surgery Education coronary artery assessment tool has high interrater reliability.

    PubMed

    Lee, Richard; Enter, Daniel; Lou, Xiaoying; Feins, Richard H; Hicks, George L; Gasparri, Mario; Takayama, Hiroo; Young, J Nilas; Calhoon, John H; Crawford, Fred A; Mokadam, Nahush A; Fann, James I

    2013-06-01

    Barriers to incorporation of simulation in cardiothoracic surgery training include lack of standardized, validated objective assessment tools. Our aim was to measure interrater reliability and internal consistency reliability of a coronary anastomosis assessment tool created by the Joint Council on Thoracic Surgery Education. Ten attending surgeons from different cardiothoracic residency programs evaluated nine video recordings of 5 individuals (1 medical student, 1 resident, 1 fellow, 2 attendings) performing coronary anastomoses on two simulation models, including synthetic graft task station (low fidelity) and porcine explant (high fidelity), as well as in the operative setting. All raters, blinded to operator identity, scored 13 assessment items on a 1 to 5 (low to high) scale. Each performance also received an overall pass/fail determination. Interrater reliability and internal consistency were assessed as intraclass correlation coefficients and Cronbach's α, respectively. Both interrater reliability and internal consistency were high for all three models (intraclass correlation coefficients = 0.98, 0.99, and 0.94, and Cronbach's α = 0.99, 0.98, and 0.97 for low fidelity, high fidelity, and operative setting, respectively). Interrater reliability for overall pass/fail determination using κ were 0.54, 0.86, 0.15 for low fidelity, high fidelity, and operative setting, respectively. Even without instruction on the assessment tool, experienced surgeons achieved high interrater reliability. Future resident training and evaluation may benefit from utilization of this tool for formative feedback in the simulated and operative environments. However, summative assessment in the operative setting will require further standardization and anchoring. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis

    PubMed Central

    Blomquist, Gustav; Monier-Faugere, Marie-Claude; Cantor, Thomas L.; Davenport, Daniel L.

    2015-01-01

    Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD–associated CAC prevalence and progression. PMID:25838468

  11. High-density lipoprotein and coronary risk factors in normal men.

    PubMed

    Williams, P; Robinson, D; Bailey, A

    1979-01-01

    Serum high-density-lipoprotein cholesterol (H.D.L.) was measured in 2568 men attending a screening centre and registered with a medical practitioner in Great Britain. Serum-total-cholesterol (T.C.), serum-triglyceride, serum-glucose, systolic and diastolic blood-pressures, electrocardiogram, chest X-ray, height, weight, cigarette and alcohol history, and a brief assessment of physical activity were also recorded. H.D.L. was inversely related to cigarette-smoking, relative weight, and serum-triglyceride level, and directly related to physical activity, total-cholesterol level, and alcohol consumption. The ratio of H.D.L. to T.C. (H.D.L./T.C.) showed similar significant relationships to the above variables (except that the ratio was negatively correlated with T.C.). In addition the ratio was inversely related to age. These relationships were independent of the other measured variables. Both the H.D.L. and H.D.L./T.C. were inversely related to coronary risk rating. It is suggested that, despite methodological problems, H.D.L. is a useful biochemical measurement to add to a coronary risk profile.

  12. Meaning of low-density lipoprotein-apheresis for hypercholesterolemic patients at high risk for recurrence of coronary heart disease.

    PubMed

    Koga, Nobuhiko

    2002-10-01

    The goal of cholesterol-lowering therapy in hypercholesterolemic patients at high risk for recurrence of coronary heart disease (CHD) is the prevention of acute coronary syndrome by stabilization of coronary atheromatous plaque. We often encounter patients in whom it is difficult to maintain the serum cholesterol level at a desirable level with dietary therapy and drug treatment, despite the development and use of statins. For secondary prevention in patients who are at high risk for the recurrence of CHD and whose cholesterol level cannot be controlled by drugs alone, low-density lipoprotein (LDL)-apheresis therapy, which involves removal of LDL through extracorporeal circulation, is now available. Many reports concerning improvement of vascular endothelial function, improvement of myocardial ischemia, regression of coronary atherosclerotic lesions, stabilization of coronary plaque, and reduction in the incidence of cardiac events as a result of LDL-apheresis treatment have been published in various countries. We believe that LDL-apheresis should be performed on hypercholesterolemic patients with existing CHD for whom diet and maximum cholesterol-lowering drug therapies have been ineffective or not tolerated and whose LDL cholesterol level is 160 mg/dL or higher.

  13. Optimizing radiation dose by using advanced modelled iterative reconstruction in high-pitch coronary CT angiography.

    PubMed

    Gordic, Sonja; Desbiolles, Lotus; Sedlmair, Martin; Manka, Robert; Plass, André; Schmidt, Bernhard; Husarik, Daniela B; Maisano, Francesco; Wildermuth, Simon; Alkadhi, Hatem; Leschka, Sebastian

    2016-02-01

    To evaluate the potential of advanced modeled iterative reconstruction (ADMIRE) for optimizing radiation dose of high-pitch coronary CT angiography (CCTA). High-pitch 192-slice dual-source CCTA was performed in 25 patients (group 1) according to standard settings (ref. 100 kVp, ref. 270 mAs/rot). Images were reconstructed with filtered back projection (FBP) and ADMIRE (strength levels 1-5). In another 25 patients (group 2), high-pitch CCTA protocol parameters were adapted according to results from group 1 (ref. 160 mAs/rot), and images were reconstructed with ADMIRE level 4. In ten patients of group 1, vessel sharpness using full width at half maximum (FWHM) analysis was determined. Image quality was assessed by two independent, blinded readers. Interobserver agreements for attenuation and noise were excellent (r = 0.88/0.85, p < 0.01). In group 1, ADMIRE level 4 images were most often selected (84%, 21/25) as preferred data set; at this level noise reduction was 40% compared to FBP. Vessel borders showed increasing sharpness (FWHM) at increasing ADMIRE levels (p < 0.05). Image quality in group 2 was similar to that of group 1 at ADMIRE levels 2-3. Radiation dose in group 2 (0.3 ± 0.1 mSv) was significantly lower than in group 1 (0.5 ± 0.3 mSv; p < 0.05). In a selected population, ADMIRE can be used for optimizing high-pitch CCTA to an effective dose of 0.3 mSv. • Advanced modeled IR (ADMIRE) reduces image noise up to 50% as compared to FBP. • Coronary artery vessel borders show an increasing sharpness at higher ADMIRE levels. • High-pitch CCTA with ADMIRE is possible at a radiation dose of 0.3 mSv.

  14. Optimizing the imaging protocol for ex vivo coronary artery wall using high-resolution MRI: an experimental study on porcine and human.

    PubMed

    Yang, Jiong; Li, Tao; Cui, Xiaoming; Zhou, Weihua; Li, Xin; Zhang, Xinwu

    2013-01-01

    To optimize the MR imaging protocol for coronary arterial wall depiction in vitro and characterize the coronary atherosclerotic plaques. MRI examination was prospectively performed in ten porcine hearts in order to optimize the MR imaging protocol. Various surface coils were used for coronary arterial wall imaging with the same parameters. Then, the image parameters were further optimized for high-resolution coronary wall imaging. The signal-noise ratio (SNR) and contrast-noise ratio (CNR) of images were measured. Finally, 8 human cadaver hearts with coronary atherosclerotic plaques were prospectively performed with MRI examination using optimized protocol in order to characterize the coronary atherosclerotic plaques. The SNR and CNR of MR image with temporomandibular coil were the highest of various surface coils. High-resolution and high SNR and CNR for ex vivo coronary artery wall depiction can be achieved using temporomandibular coil with 512 × 512 in matrix. Compared with histopathology, the sensitivity and specificity of MRI for identifying advanced plaques were: type IV-V (lipid, necrosis, fibrosis), 94% and 95%; type VI (hemorrhage), 100% and 98%; type VII (calcification), 91% and 100%; and type VIII (fibrosis without lipid core), 100% and 98%, respectively. Temporomandibular coil appears to be dramatically superior to eight-channel head coil and knee coil for ex vivo coronary artery wall imaging, providing higher spatial resolution and improved the SNR. Ex vivo high-resolution MRI has capability to distinguish human coronary atherosclerotic plaque compositions and accurately classify advanced plaques.

  15. Dual-source computed tomographic coronary angiography: image quality and stenosis diagnosis in patients with high heart rates.

    PubMed

    Zheng, Minwen; Li, Jiayi; Xu, Jian; Chen, Kang; Zhao, Hongliang; Huan, Yi

    2009-01-01

    We sought to evaluate prospectively the effects of heart rate and heart-rate variability on dual-source computed tomographic coronary image quality in patients whose heart rates were high, and to determine retrospectively the accuracy of dual-source computed tomographic diagnosis of coronary artery stenosis in the same patients.We compared image quality and diagnostic accuracy in 40 patients whose heart rates exceeded 70 beats/min with the same data in 40 patients whose heart rates were 70 beats/min or slower. In both groups, we analyzed 1,133 coronary arterial segments. Five hundred forty-five segments (97.7%) in low-heart-rate patients and 539 segments (93.7%) in high-heart-rate patients were of diagnostic image quality. We considered P < 0.05 to be statistically significant. No statistically significant differences between the groups were found in diagnostic-image quality scores of total segments or of any coronary artery, nor were any significant differences found between the groups in the accurate diagnosis of angiographically significant stenosis.Calcification was the chief factor that affected diagnostic accuracy. In high-heart-rate patients, heart-rate variability was significantly related to the diagnostic image quality of all segments (P = 0.001) and of the left circumflex coronary artery (P = 0.016). Heart-rate variability of more than 5 beats/min most strongly contributed to an inability to evaluate segments in both groups. When heart rates rose, the optimal reconstruction window shifted from diastole to systole.The image quality of dual-source computed tomographic coronary angiography at high heart rates enables sufficient diagnosis of stenosis, although variability of heart rates significantly deteriorates image quality.

  16. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.

    PubMed

    Lerman, Joseph B; Joshi, Aditya A; Chaturvedi, Abhishek; Aberra, Tsion M; Dey, Amit K; Rodante, Justin A; Salahuddin, Taufiq; Chung, Jonathan H; Rana, Anshuma; Teague, Heather L; Wu, Jashin J; Playford, Martin P; Lockshin, Benjamin A; Chen, Marcus Y; Sandfort, Veit; Bluemke, David A; Mehta, Nehal N

    2017-07-18

    Psoriasis, a chronic inflammatory disease associated with an accelerated risk of myocardial infarction, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease burden composed of noncalcified plaques with high-risk features. However, inadequate efforts have been made to directly measure coronary artery disease in this vulnerable population. As such, we sought to compare total coronary plaque burden and noncalcified coronary plaque burden (NCB) and high-risk plaque (HRP) prevalence between patients with psoriasis (n=105), patients with hyperlipidemia eligible for statin therapy under National Cholesterol Education Program-Adult Treatment Panel III guidelines (n=100) who were ≈10 years older, and healthy volunteers without psoriasis (n=25). Patients underwent coronary computed-tomography angiography for total coronary plaque burden and NCB quantification and HRP identification, defined as low attenuation (<30 hounsfield units), positive remodeling (>1.10), and spotty calcification. A consecutive sample of the first 50 patients with psoriasis was scanned again 1 year after therapy. Despite being younger and at lower traditional risk than patients with hyperlipidemia, patients with psoriasis had increased NCB (mean±SD: 1.18±0.33 versus 1.11±0.32, P=0.02) and similar HRP prevalence (P=0.58). Furthermore, compared to healthy volunteers, patients with psoriasis had increased total coronary plaque burden (1.22±0.31 versus 1.04±0.22, P=0.001), NCB (1.18±0.33 versus 1.03±0.21, P=0.004), and HRP prevalence beyond traditional risk (odds ratio, 6.0; 95% confidence interval, 1.1-31.7; P=0.03). Last, among patients with psoriasis followed for 1 year, improvement in psoriasis severity was associated with improvement in total coronary plaque burden (β=0.45, 0.23-0.67; P<0.001) and NCB (β=0.53, 0

  17. High-dose insulin therapy attenuates systemic inflammatory response in coronary artery bypass grafting patients.

    PubMed

    Albacker, Turki; Carvalho, George; Schricker, Thomas; Lachapelle, Kevin

    2008-07-01

    Cardiac surgery with cardiopulmonary bypass (CPB) induces an acute phase reaction that is implicated in the pathogenesis of several postoperative complications. Studies have shown that proinflammatory cytokines are increased by acute hyperglycemia. Recent evidence suggests that insulin has antiinflammatory properties. Therefore, we hypothesized that high-dose insulin therapy would attenuate the systemic inflammatory response to cardiopulmonary bypass and surgery in coronary artery bypass patients while maintaining normoglycemia. A total of 52 patients who presented for elective coronary artery bypass were randomized to receive intraoperative intravenous insulin infusion, titrated to maintain blood glucose concentrations less than 180 mg/dL (group I, n = 25), or receive intraoperative fixed high dose of intravenous insulin infusion (5 mU/kg/min) with dextrose 20% infused separately to maintain a blood glucose level between 70 and 110 mg/dL (group II, n = 27). Blood samples were collected at different time points to determine tumor necrosis factor alpha (TNFalpha), interleukin 6 and 8 (IL6 and IL8), and complement factor 3 and 4 (C3 and C4). Patients in both groups had similar preoperative characteristics. Patients in the high-dose insulin group had higher blood insulin concentrations and tighter blood glucose control. There were lower levels of IL6 (150 pg/dL vs 245 pg/dL, p = 0.03), IL-8 (49 pg/dL vs 74 pg/dL, p = 0.05), and TNFalpha (2.2 pg/dL vs 3.0 pg/dL, p = 0.04) in group II in the early postoperative period. High-dose insulin therapy blunts the early postoperative surge in inflammatory response to CPB as reflected by decreased levels of IL6, IL8, and TNFalpha.

  18. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging.

    PubMed

    Nakanishi, Rine; Gransar, Heidi; Slomka, Piotr; Arsanjani, Reza; Shalev, Aryeh; Otaki, Yuka; Friedman, John D; Hayes, Sean W; Thomson, Louise E B; Fish, Mathews; Germano, Guido; Abidov, Aiden; Shaw, Leslee; Rozanski, Alan; Berman, Daniel S

    2016-06-01

    While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.

  19. Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score

    PubMed Central

    Namazi, Mohammad Hasan; Saadat, Habibollah; Safi, Morteza; Vakili, Hossein; Alipourparsa, Saeed; Bozorgmanesh, Mohammadreza

    2014-01-01

    Background and Objectives The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. Subjects and Methods We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52). Results The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng · dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92). Conclusion We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng · dL-1 was highly specific for diagnosing complex coronary artery stenosis. PMID:25089133

  20. Diet and the role of lipoproteins, lipases, and thyroid hormones in coronary lesion growth

    NASA Technical Reports Server (NTRS)

    Barth, Jacques D.; Jansen, Hans; Reiber, Johan H. C.; Birkenhager, Jan C.; Kromhout, Daan

    1987-01-01

    The relationships between the coronary lesion growth and the blood contents of lipoprotein fractions, thyroic hormones, and the lipoprotein lipase activity were investigated in male patients with severe coronary atherosclerosis, who participated in a lipid-lowering dietary intervention program. A quantitative computer-assisted image-processing technique was used to assess the severity of coronary obstructions at the beginning of the program and at its termination two years later. Based on absolute coronary scores, patients were divided into a no-lesion growth group (14 patients) and a progression group (21 paients). At the end of the trial, the very-low-density lipoprotein cholesterol and triglycerides were found to be significantly higher, while the high-density lipoprotein cholesterol and hepatic lipase (HL) were lower in the progression group. Multivariate regression analysis showed HL to be the most important determinant of changes in coronary atherosclerotic lesions.

  1. Diet and the role of lipoproteins, lipases, and thyroid hormones in coronary lesion growth

    NASA Technical Reports Server (NTRS)

    Barth, Jacques D.; Jansen, Hans; Reiber, Johan H. C.; Birkenhager, Jan C.; Kromhout, Daan

    1987-01-01

    The relationships between the coronary lesion growth and the blood contents of lipoprotein fractions, thyroic hormones, and the lipoprotein lipase activity were investigated in male patients with severe coronary atherosclerosis, who participated in a lipid-lowering dietary intervention program. A quantitative computer-assisted image-processing technique was used to assess the severity of coronary obstructions at the beginning of the program and at its termination two years later. Based on absolute coronary scores, patients were divided into a no-lesion growth group (14 patients) and a progression group (21 paients). At the end of the trial, the very-low-density lipoprotein cholesterol and triglycerides were found to be significantly higher, while the high-density lipoprotein cholesterol and hepatic lipase (HL) were lower in the progression group. Multivariate regression analysis showed HL to be the most important determinant of changes in coronary atherosclerotic lesions.

  2. Analysis of the correlation between non-high density lipoprotein cholesterol and coronary heart disease in elderly Chinese.

    PubMed

    Ke, Dazhi; Chen, Qingwei; Wu, Qing; Li, Xingsheng; Wu, Zhiqin; Li, Guiqiong; Deng, Wei; Mo, Xiangang

    2011-01-01

    In the aged population, serum cholesterol is directly correlated with coronary heart disease (CHD) risk. We aimed to investigate the correlation between non-high density lipoprotein cholesterol (non-HDL-C) level and CHD and coronary lesions in an aged population. 1,272 cases of old patients who were more than 65 years old and accepted for coronary angiography were analyzed retrospectively. Based on the result of coronary angiography, the patients were divided into control group and CHD group. Further, 767 CHD patients were divided into subgroups according to the number of branches with pathological changes and Gensini score. Serum TC, HDL-C, LDL-C and TG were assayed to measure the level of non-HDL-C. The differences in non-HDL-C among groups were compared, and the correlation between non-HDL-C and coronary artery disease degree was also analyzed. The non-HDL-C level in the CHD group was significantly higher than that in the control group (p < 0.01). Further, the serum non-HDL-C showed an increasing tendency accompanied by the increase in branches with lesions. Compared with patients with single or double coronary artery branches lesions, the non-HDL-C in those with multiple lesions in branches was significantly increased (p < 0.01, p < 0.05). With the aggravation of coronary artery stenosis, the serum non-HDL-C level was gradually increased. The most significant increase was observed in the group with Gensini score of more than 40. There was a significant difference between Gensini score > 40 group and Gensini score of 20-40 group and Gensini score < 20 group, respectively (p < 0.05, p < 0.01). Meanwhile, there were significant positive correlations between the serum non-HDL-C level and coronary lesions area and severity (r = 0.147, p < 0.01; r = 0.152, p < 0.01). In conclusion, serum non-HDL-C was closely associated with development of CHD and coronary artery lesions severity.

  3. Quantitative Upright–Supine High-Speed SPECT Myocardial Perfusion Imaging for Detection of Coronary Artery Disease: Correlation with Invasive Coronary Angiography

    PubMed Central

    Nakazato, Ryo; Tamarappoo, Balaji K.; Kang, Xingping; Wolak, Arik; Kite, Faith; Hayes, Sean W.; Thomson, Louise E.J.; Friedman, John D.; Berman, Daniel S.; Slomka, Piotr J.

    2011-01-01

    A recently developed camera system for high-speed SPECT (HS-SPECT) myocardial perfusion imaging shows excellent correlation with conventional SPECT. Our goal was to test the diagnostic accuracy of an automated quantification of combined upright and supine myocardial SPECT for detection of coronary artery disease (CAD) (≥70% luminal diameter stenosis or, in left main coronary artery, ≥50% luminal diameter stenosis) in comparison to invasive coronary angiography (ICA). Methods We studied 142 patients undergoing upright and supine HS-SPECT, including 56 consecutive patients (63% men; mean age 6 ± SD, 64 ± 13 y; 45% exercise stress) without known CAD who underwent diagnostic ICA within 6 mo of HS-SPECT and 86 consecutive patients with a low likelihood of CAD. Reference limits for upright and supine HS-SPECT were created from studies of patients with a low likelihood of CAD. Automated software adopted from supine–prone analysis was used to quantify the severity and extent of perfusion abnormality and was expressed as total perfusion deficit (TPD). TPD was obtained for upright (U-TPD), supine (S-TPD), and combined upright–supine acquisitions (C-TPD). Stress U-TPD ≥ 5%, S-TPD ≥ 5%, and C-TPD ≥ 3% myocardium were considered abnormal for per-patient analysis, and U-TPD, S-TPD, and C-TPD ≥ 2% in each coronary artery territory were considered abnormal for per-vessel analysis. Results On a per-patient basis, the sensitivity was 91%, 88%, and 94% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 59%, 73%, and 86% for U-TPD, S-TPD, and C-TPD, respectively. C-TPD had a larger area under the receiver-operating-characteristic curve than U-TPD or S-TPD for identification of stenosis ≥ 70% (0.94 vs. 0.88 and 0.89, P < 0.05 and not significant, respectively). On a per-vessel basis, the sensitivity was 67%, 66%, and 69% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 91%, 94%, and 97% for U-TPD, S-TPD, and C-TPD, respectively (P = 0

  4. High-Definition Computed Tomography for Coronary Artery Stent Imaging: a Phantom Study

    PubMed Central

    Yang, Wen Jie; Pang, Li Fang; Guo, Ying; Li, Jian Ying; Zhang, Huang; Pan, Zi Lai

    2012-01-01

    Objective To assess the performance of a high-definition CT (HDCT) for imaging small caliber coronary stents (≤ 3 mm) by comparing different scan modes of a conventional 64-row standard-definition CT (SDCT). Materials and Methods A cardiac phantom with twelve stents (2.5 mm and 3.0 mm in diameter) was scanned by HDCT and SDCT. The scan modes were retrospective electrocardiography (ECG)-gated helical and prospective ECG-triggered axial with tube voltages of 120 kVp and 100 kVp, respectively. The inner stent diameters (ISD) and the in-stent attenuation value (AVin-stent) and the in-vessel extra-stent attenuation value (AVin-vessel) were measured by two observers. The artificial lumen narrowing (ALN = [ISD - ISDmeasured]/ISD) and artificial attenuation increase between in-stent and in-vessel (AAI = AVin-stent - AVin-vessel) were calculated. All data was analyzed by intraclass correlation and ANOVA-test. Results The correlation coefficient of ISD, AVin-vessel and AVin-stent between the two observers was good. The ALNs of HDCT were statistically lower than that of SDCT (30 ± 5.7% versus 35 ± 5.4%, p < 0.05). HDCT had statistically lower AAI values than SDCT (15.7 ± 81.4 HU versus 71.4 ± 90.5 HU, p < 0.05). The prospective axial dataset demonstrated smaller ALN than the retrospective helical dataset on both HDCT and SDCT (p < 0.05). Additionally, there were no differences in ALN between the 120 kVp and 100 kVp tube voltages on HDCT (p = 0.05). Conclusion High-definition CT helps improve measurement accuracy for imaging coronary stents compared to SDCT. HDCT with 100 kVp and the prospective ECG-triggered axial technique, with a lower radiation dose than 120 kVp application, may be advantageous in evaluating coronary stents with smaller calibers (≤ 3 mm). PMID:22247632

  5. Absolutely classical spin states

    NASA Astrophysics Data System (ADS)

    Bohnet-Waldraff, F.; Giraud, O.; Braun, D.

    2017-01-01

    We introduce the concept of "absolutely classical" spin states, in analogy to absolutely separable states of bipartite quantum systems. Absolutely classical states are states that remain classical (i.e., a convex sum of projectors on coherent states of a spin j ) under any unitary transformation applied to them. We investigate the maximal size of the ball of absolutely classical states centered on the maximally mixed state and derive a lower bound for its radius as a function of the total spin quantum number. We also obtain a numerical estimate of this maximal radius and compare it to the case of absolutely separable states.

  6. Low paraoxonase 1 arylesterase activity and high von Willebrand factor levels are associated with severe coronary atherosclerosis in patients with non-diabetic stable coronary artery disease.

    PubMed

    Ding, Jieying; Chen, Qizhi; Zhuang, Xing; Feng, Zhilei; Xu, Lili; Chen, Fuxiang

    2014-11-25

    Paraoxonase 1 (PON1) activity and von Willebrand factor (VWF) release are associated with lesion initiation in atherosclerosis. Diabetes can complicate coronary artery disease (CAD) due to the production of advanced glycation end products. This study evaluated PON1 activity and VWF levels in non-post-acute coronary syndrome, stable CAD (SCAD) patients without diabetes. Non-diabetic SCAD patients and patients experiencing acute stress periods were selected (n=130). Forty-seven cases with normal coronary angiography and 50 healthy individuals served as controls. The non-diabetic SCAD group was then stratified into single-vessel lesions, multiple-vessel lesions, and mild or severe luminal stenosis according to the number and the degree of luminal stenoses. Serum PON1 paraoxonase and arylesterase activities, and plasma VWF levels were measured, as well as serum total cholesterol, total triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein A1. PON1 arylesterase activity was detected with an ordinary chemistry system using a novel phenylacetate derivative. Both PON1 paraoxonase and arylesterase were lower in the non-diabetic SCAD group, but VWF levels were higher (versus controls, all P<0.001). PON1 paraoxonase activity (OR=0.991), PON1 arylesterase activity (OR=0.981), and VWF (OR 2.854) influenced SCAD in multiple logistic regression. Decreased PON1 arylesterase activity and increased VWF levels were associated with severe atherosclerosis in non-diabetic SCAD patients. We also observed a slight negative correlation between VWF and PON1 paraoxonase/arylesterase. PON1 and VWF are detectable markers that may predict the severity of stenoses, ideally facilitating a non-diabetic SCAD diagnosis before the sudden onset of life-threatening symptoms.

  7. Local motion-compensated method for high-quality 3D coronary artery reconstruction.

    PubMed

    Liu, Bo; Bai, Xiangzhi; Zhou, Fugen

    2016-12-01

    The 3D reconstruction of coronary artery from X-ray angiograms rotationally acquired on C-arm has great clinical value. While cardiac-gated reconstruction has shown promising results, it suffers from the problem of residual motion. This work proposed a new local motion-compensated reconstruction method to handle this issue. An initial image was firstly reconstructed using a regularized iterative reconstruction method. Then a 3D/2D registration method was proposed to estimate the residual vessel motion. Finally, the residual motion was compensated in the final reconstruction using the extended iterative reconstruction method. Through quantitative evaluation, it was found that high-quality 3D reconstruction could be obtained and the result was comparable to state-of-the-art method.

  8. Local motion-compensated method for high-quality 3D coronary artery reconstruction

    PubMed Central

    Liu, Bo; Bai, Xiangzhi; Zhou, Fugen

    2016-01-01

    The 3D reconstruction of coronary artery from X-ray angiograms rotationally acquired on C-arm has great clinical value. While cardiac-gated reconstruction has shown promising results, it suffers from the problem of residual motion. This work proposed a new local motion-compensated reconstruction method to handle this issue. An initial image was firstly reconstructed using a regularized iterative reconstruction method. Then a 3D/2D registration method was proposed to estimate the residual vessel motion. Finally, the residual motion was compensated in the final reconstruction using the extended iterative reconstruction method. Through quantitative evaluation, it was found that high-quality 3D reconstruction could be obtained and the result was comparable to state-of-the-art method. PMID:28018741

  9. Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial†

    PubMed Central

    Tardif, Jean-Claude; Ballantyne, Christie M.; Barter, Philip; Dasseux, Jean-Louis; Fayad, Zahi A.; Guertin, Marie-Claude; Kastelein, John J. P.; Keyserling, Constance; Klepp, Heather; Koenig, Wolfgang; L'Allier, Philippe L.; Lespérance, Jacques; Lüscher, Thomas F.; Paolini, John F.; Tawakol, Ahmed; Waters, David D.; Pfeffer, M.; Brown, V.; Rouleau, J.; Watkins, P.; Wei, L.J.; Gosselin, G.; Chayer, C.; Lanthier, S.; Pelletier, G.B.; Racine, N.; Agarwal, H.; Brilakis, E.; Cannon, L.; Carrié, D.; Corbelli, J.; Coste, P.; de Winter, R.; Diaz, A.; Eisenberg, S.; Ennis, B.; Fajadet, J.; Fam, N.; Fortuin, D.; Gessler, C.; Grines, C.; Guerra, D.; Gum, H.; Haldis, T.; Heestermans, T.; Herrman, J.P.; Huynh, T.; Kedhi, E.; Koren, M.; Kouz, S.; Krolick, M.; Kumkumian, G.; Lavi, S.; Li, R.J.; Masud, ARZ; McAlhany, C.; McGrew, F.A.; O'Shaughnessy, C.; Oude Ophuis, A.J.M.; Parr, K.; Penny, W.; Pesant, Y.; Post, H.; Robinson, S.; Rodes-Cabau, J.; Roy, A.; Schulman, S.; Spence, F.; Stouffer, G.; Stys, T.; Sussex, B.; Tahirkheli, N.; Tardif, J-C.; Grégoire, J.; ten Berg, J.; van Boven, A.J.; von Birgelen, C.; Weinstein, D.

    2014-01-01

    Aim High-density lipoproteins (HDLs) have several potentially protective vascular effects. Most clinical studies of therapies targeting HDL have failed to show benefits vs. placebo. Objective To investigate the effects of an HDL-mimetic agent on atherosclerosis by intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA). Design and setting A prospective, double-blinded, randomized trial was conducted at 51 centres in the USA, the Netherlands, Canada, and France. Intravascular ultrasonography and QCA were performed to assess coronary atherosclerosis at baseline and 3 (2–5) weeks after the last study infusion. Patients Five hundred and seven patients were randomized; 417 and 461 had paired IVUS and QCA measurements, respectively. Intervention Patients were randomized to receive 6 weekly infusions of placebo, 3 mg/kg, 6 mg/kg, or 12 mg/kg CER-001. Main outcome measures The primary efficacy parameter was the nominal change in the total atheroma volume. Nominal changes in per cent atheroma volume on IVUS and coronary scores on QCA were also pre-specified endpoints. Results The nominal change in the total atheroma volume (adjusted means) was −2.71, −3.13, −1.50, and −3.05 mm3 with placebo, CER-001 3 mg/kg, 6 mg/kg, and 12 mg/kg, respectively (primary analysis of 12 mg/kg vs. placebo: P = 0.81). There was also no difference among groups for the nominal change in per cent atheroma volume (0.02, −0.02, 0.01, and 0.19%; nominal P = 0.53 for 12 mg/kg vs. placebo). Change in the coronary artery score was −0.022, −0.036, −0.022, and −0.015 mm (nominal P = 0.25, 0.99, 0.55), and change in the cumulative coronary stenosis score was −0.51, 2.65, 0.71, and −0.77% (compared with placebo, nominal P = 0.85 for 12 mg/kg and nominal P = 0.01 for 3 mg/kg). The number of patients with major cardiovascular events was 10 (8.3%), 16 (13.3%), 17 (13.7%), and 12 (9.8%) in the four groups. Conclusion CER-001 infusions did not reduce coronary

  10. Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome?

    PubMed Central

    Lee, Bong-Ki; Nam, Chang-Wook; Doh, Joon-Hyung; Chung, Woo-Young; Cho, Byung-Ryul; Fearon, William F.

    2016-01-01

    Background and Objectives There is controversy surrounding whether or not high dose statin administration before percutaneous coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing PCI. Subjects and Methods Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration 12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinase-myocardial band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI. Results The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40 ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to 0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001). Conclusion Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an immediate anti-inflammatory effect in patients with NSTE-ACS. PMID:27482255

  11. The role of absolute phase of few-cycle laser field in the generation and measurement of attosecond high-order harmonic pulses

    NASA Astrophysics Data System (ADS)

    Zeng, Zhinan; Li, Ruxin; Xu, Zhizhan

    2002-11-01

    The effect of the absolute phase of the few-cycle driving laser pulse on the generation and measurement of high-order harmonic attosecond pulses is investigated theoretically. We find that the position of the generated attosecond soft-x-ray pulse in cutoff region is locked to the oscillations of the driving laser field, but not to the envelope of the laser pulse. This property ensures the success [M. Hentschel et al. Nature vol. 414, 509 (2001)] of the width measurement of attosecond soft-x-ray pulse based on the cross-correlation between the attosecond pulse and its driving laser pulse. However, there is a timing jitter of the order of tens of attoseconds between the attosecond pulse and the driving laser field. This sets a limit for the measurement with the shorter attosecond pulses if we cannot control the absolute phase of the few-cycle laser field. Also, we propose a novel method to detect the absolute phase of the driving laser field by measuring the spatial distribution of the photoelectrons induced by the attosecond soft-x-ray pulse and its driving laser pulse.

  12. High-precision GAFCHROMIC EBT film-based absolute clinical dosimetry using a standard flatbed scanner without the use of a scanner non-uniformity correction.

    PubMed

    Chung, Heeteak; Lynch, Bart; Samant, Sanjiv

    2010-04-17

    To report a study of the use of GAFCHROMIC EBT radiochromic film (RCF) digitized with a commercially available flatbed document scanner for accurate and reliable all-purpose two-dimensional (2D) absolute dosimetry within a clinical environment. We used a simplified methodology that yields high-precision dosimetry measurements without significant postirradiation correction. The Epson Expression 1680 Professional scanner and the Epson Expression 10000XL scanner were used to digitize the films. Both scanners were retrofitted with light-diffusing glass to minimize the effects of Newton rings. Known doses were delivered to calibration films. Flat and wedge fields were irradiated with variable depth of solid water and 5 cm back scatter solid water. No particular scanner nonuniformity effect corrections or significant post-scan image processing were carried out. The profiles were compared with CC04 ionization chamber profiles. The depth dose distribution was measured at a source-to-surface distance (SSD) of 100 cm with a field size of 10 x 10 cm2. Additionally, 22 IMRT fields were measured and evaluated using gamma index analysis. The overall accuracy of RCF with respect to CC04 was found to be 2%-4%. The overall accuracy of RCF was determined using the absolute mean of difference for all flat and wedge field profiles. For clinical IMRT fields, both scanners showed an overall gamma index passing rate greater than 90%. This work demonstrated that EBT films, in conjunction with a commercially available flatbed scanner, can be used as an accurate and precise absolute dosimeter. Both scanners showed that no significant scanner nonuniformity correction is necessary for accurate absolute dosimetry using the EBT films for field sizes smaller than or equal to 15 x 15 cm2.

  13. High platelet reactivity after P2Y12-inhibition in patients with atrial fibrillation and coronary stenting.

    PubMed

    Rilinger, Jonathan; Meyer, Melanie; Schnabel, Katharina; Weik, Patrick; Charlet, Anne; Esser, Jennifer S; Zhou, Qian; Bode, Christoph; Moser, Martin; Diehl, Philipp; Olivier, Christoph B

    2016-11-01

    High platelet reactivity (HPR) after P2Y12-inhibition in patients undergoing coronary stenting is associated with an increased risk for thromboembolic events and coronary death. So far it is not known how HPR affects the clinical outcome of different treatment strategies in patients with atrial fibrillation (AF) undergoing coronary stenting. In this single centre, observational study the antiplatelet effect of P2Y12-inhibitors in AF patients undergoing coronary stenting was investigated using impedance aggregometry. Patients received either dual antiplatelet therapy (DAPT) or triple therapy (TT). HPR was defined as the ratio of ADP-to TRAP-induced aggregation (r-ADP-agg) ≥50 %. Thromboembolic and bleeding events were assessed within the first 30 days after stenting. Out of 910 screened patients 167 patients were available for the present analysis. HPR was found in 5 of 43 (12 %) patients treated with DAPT and in 18 of 124 (15 %) patients treated with TT. In patients receiving TT, HPR was not a risk factor for thromboembolic events compared to patients with adequate response to P2Y12-inhibitors (6 vs. 8 %, p = 0.712). There was a trend for less bleeding events in patients with HPR compared to r-ADP-agg <50 % in the TT group (0 vs. 16 %, p = 0.077). Our data suggest that HPR after P2Y12-antagonism in patients receiving TT due to AF and coronary stenting might protect from bleeding without increasing thromboembolic risk. Future studies will need to investigate if patients with AF receiving coronary stenting benefit from a reduction of antithrombotic therapy.

  14. High-quality 3-D coronary artery imaging on an interventional C-arm x-ray system

    SciTech Connect

    Hansis, Eberhard; Carroll, John D.; Schaefer, Dirk; Doessel, Olaf; Grass, Michael

    2010-04-15

    Purpose: Three-dimensional (3-D) reconstruction of the coronary arteries during a cardiac catheter-based intervention can be performed from a C-arm based rotational x-ray angiography sequence. It can support the diagnosis of coronary artery disease, treatment planning, and intervention guidance. 3-D reconstruction also enables quantitative vessel analysis, including vessel dynamics from a time-series of reconstructions. Methods: The strong angular undersampling and motion effects present in gated cardiac reconstruction necessitate the development of special reconstruction methods. This contribution presents a fully automatic method for creating high-quality coronary artery reconstructions. It employs a sparseness-prior based iterative reconstruction technique in combination with projection-based motion compensation. Results: The method is tested on a dynamic software phantom, assessing reconstruction accuracy with respect to vessel radii and attenuation coefficients. Reconstructions from clinical cases are presented, displaying high contrast, sharpness, and level of detail. Conclusions: The presented method enables high-quality 3-D coronary artery imaging on an interventional C-arm system.

  15. Racial differences in admissions to high-quality hospitals for coronary heart disease.

    PubMed

    Popescu, Ioana; Nallamothu, Brahmajee K; Vaughan-Sarrazin, Mary S; Cram, Peter

    2010-07-26

    Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals. We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America's Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals. In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]). Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.

  16. Dysfunctional high-density lipoproteins have distinct composition, diminished anti-inflammatory potential and discriminate acute coronary syndrome from stable coronary artery disease patients.

    PubMed

    Carnuta, Mihaela G; Stancu, Camelia S; Toma, Laura; Sanda, Gabriela M; Niculescu, Loredan S; Deleanu, Mariana; Popescu, Andreea C; Popescu, Mihaela R; Vlad, Adelina; Dimulescu, Doina R; Simionescu, Maya; Sima, Anca V

    2017-08-04

    There is a stringent need to find means for risk stratification of coronary artery diseases (CAD) patients. We aimed at identifying alterations of plasma high-density lipoproteins (HDL) components and their validation as dysfunctional HDL that could discriminate between acute coronary syndrome (ACS) and stable angina (SA) patients. HDL2 and HDL3 were isolated from CAD patients' plasma and healthy subjects. ApolipoproteinAI (apoAI), apoAII, apoCIII, malondialdehyde (MDA), myeloperoxidase (MPO), ceruloplasmin and paraoxonase1 (PON1) were assessed. The anti-inflammatory potential of HDL subfractions was tested by evaluating the secreted inflammatory molecules of tumor necrosis factor α-activated endothelial cells (EC) upon co-incubation with HDL2 or HDL3. We found in ACS versus SA patients: 40% increased MPO, MDA, apoCIII in HDL2 and HDL3, 35% augmented apoAII in HDL2, and in HDL3 increased ceruloplasmin, decreased apoAII (40%) and PON1 protein and activity (15% and 25%). Co-incubation of activated EC with HDL2 or HDL3 from CAD patients induced significantly increased levels of secreted inflammatory molecules, 15-20% more for ACS versus SA. In conclusion, the assessed panel of markers correlates with the reduced anti-inflammatory potential of HDL subfractions isolated from ACS and SA patients (mostly for HDL3 from ACS) and can discriminate between these two groups of CAD patients.

  17. Photon-Counting CT: High-Resolution Imaging of Coronary Stents.

    PubMed

    Mannil, Manoj; Hickethier, Tilman; von Spiczak, Jochen; Baer, Matthias; Henning, André; Hertel, Madeleine; Schmidt, Bernhard; Flohr, Thomas; Maintz, David; Alkadhi, Hatem

    2017-09-23

    The aim of this study was to investigate computed tomography (CT) imaging characteristics of coronary stents using a novel photon-counting detector (PCD) in comparison with a conventional energy-integrating detector (EID). In this in vitro study, 18 different coronary stents were expanded in plastic tubes of 3 mm diameter, were filled with contrast agent (diluted to an attenuation of 250 Hounsfield units [HU] at 120 kVp), and were sealed. Stents were placed in an oil-filled custom phantom calibrated to an attenuation of -100 HU at 120 kVp for resembling pericardial fat. The phantom was positioned in the gantry at 2 different angles at 0 degree and 90 degrees relative to the z axis, and was imaged in a research dual-source PCD-CT scanner. Detector subsystem "A" used a standard 64-row EID, while detector subsystem "B" used a PCD, allowing high-resolution scanning (detector pixel-size 0.250 × 0.250 mm in the isocenter). Images were obtained from both detector systems at identical tube voltage (100 kVp) and tube current-time product (100 mA), and were both reconstructed using a typical convolution kernel for stent imaging (B46f) and using the same reconstruction parameters. Two independent, blinded readers evaluated in-stent visibility and measured noise, intraluminal stent diameter, and in-stent attenuation for each detector subsystem. Differences in noise, intraluminal stent diameter, and in-stent attenuation where tested using a paired t test; differences in subjective in-stent visibility were evaluated using a Wilcoxon signed-rank test. Best results for in-stent visibility, noise, intraluminal stent diameter, and in-stent attenuation in EID and PCD were observed at 0-degree phantom position along the z axis, suggesting higher in-plane compared with through-plane resolution. Subjective in-stent visibility was superior in coronary stent images obtained from PCD compared with EID (P < 0.001). Mean in-stent diameter was 28.8% and 8.4% greater in PCD (0.85 ± 0.24 mm

  18. High-accuracy absolute rotation rate measurements with a large ring laser gyro: establishing the scale factor.

    PubMed

    Hurst, Robert B; Mayerbacher, Marinus; Gebauer, Andre; Schreiber, K Ulrich; Wells, Jon-Paul R

    2017-02-01

    Large ring lasers have exceeded the performance of navigational gyroscopes by several orders of magnitude and have become useful tools for geodesy. In order to apply them to tests in fundamental physics, remaining systematic errors have to be significantly reduced. We derive a modified expression for the Sagnac frequency of a square ring laser gyro under Earth rotation. The modifications include corrections for dispersion (of both the gain medium and the mirrors), for the Goos-Hänchen effect in the mirrors, and for refractive index of the gas filling the cavity. The corrections were measured and calculated for the 16  m2 Grossring laser located at the Geodetic Observatory Wettzell. The optical frequency and the free spectral range of this laser were measured, allowing unique determination of the longitudinal mode number, and measurement of the dispersion. Ultimately we find that the absolute scale factor of the gyroscope can be estimated to an accuracy of approximately 1 part in 108.

  19. [Metal-tag labeling coupled with high performance liquid chromatography-selected ion monitoring mass spectrometry for absolute quantitation of proteins].

    PubMed

    Li, Jiabin; Zhou, Lianqi; Yan, Hui; Li, Nannan; Hao, Feiran; Tian, Fang; Zhang, Yangjun

    2014-04-01

    A novel method has been established based on metal element chelated tags coupled with high performance liquid chromatography-selected ion monitoring mass spectrometry (HPLC-SIM/MS). The labeling efficiency and stability of metal element chelated tags, the chromatographic retention behavior and MS behavior of the labeled peptides, the linear range and accuracy of this method were examined. The results showed that the metal element chelated tag method has high labeling efficiency and high labeling stability, and the labeled peptides with different kinds of metal tags have consistent chromatographic retention behavior. The method of metal tags coupled with HPLC-SIM/MS has high sensitivity with the limit of quantification (LOQ) up to 1 fmol. The linear range for the method was between 1 fmol to 500 fmol with R2 > 0.99, which means the method has a good linearity. Moreover, this method had an average recovery of 117.01%. The method was used in the absolute quantitation of a protein enolase in Thermoanaerobacter tengcongensis (TTE) with a relative standard deviation of 5.74%, which means high precision. All the results showed that this method is accurate and reliable for the absolute quantitation of proteins. This gives us an alternative for the quantitative determination of proteins in relatively simple biological samples.

  20. Absolute nuclear material assay

    DOEpatents

    Prasad, Manoj K [Pleasanton, CA; Snyderman, Neal J [Berkeley, CA; Rowland, Mark S [Alamo, CA

    2012-05-15

    A method of absolute nuclear material assay of an unknown source comprising counting neutrons from the unknown source and providing an absolute nuclear material assay utilizing a model to optimally compare to the measured count distributions. In one embodiment, the step of providing an absolute nuclear material assay comprises utilizing a random sampling of analytically computed fission chain distributions to generate a continuous time-evolving sequence of event-counts by spreading the fission chain distribution in time.

  1. Absolute nuclear material assay

    DOEpatents

    Prasad, Manoj K.; Snyderman, Neal J.; Rowland, Mark S.

    2010-07-13

    A method of absolute nuclear material assay of an unknown source comprising counting neutrons from the unknown source and providing an absolute nuclear material assay utilizing a model to optimally compare to the measured count distributions. In one embodiment, the step of providing an absolute nuclear material assay comprises utilizing a random sampling of analytically computed fission chain distributions to generate a continuous time-evolving sequence of event-counts by spreading the fission chain distribution in time.

  2. Urbanized South Asians' susceptibility to coronary heart disease: The high-heat food preparation hypothesis.

    PubMed

    Kakde, Smitha; Bhopal, Raj S; Bhardwaj, Swati; Misra, Anoop

    2017-01-01

    Known risk factors do not fully explain the comparatively high susceptibility to coronary heart disease (CHD) in South Asians (Indian, Pakistani, Bangladeshi, and Sri Lankan populations in South Asia and overseas). The search for explanatory hypotheses and cofactors that raise susceptibility of South Asians to CHD continues. The aim of this study was to propose "the high-heat food preparation hypothesis," where neo-formed contaminants (NFCs) such as trans-fatty acids (TFAs) and advanced glycation end-products (AGEs) are the cofactors. We reviewed the actions of AGEs and TFAs, the burden of these products in tissues and blood in South Asians, the relationship between these products and CHD, the effects of preparing food and reheating oils at high temperatures on NFCs, and the foods and mode of preparation in South Asian and Chinese cuisines. Animal and human studies show NFCs increase the risk for CHD. Evidence on the consumption and body burden of these products across ethnic groups is not available, and comparable data on the NFC content of the cuisine of South Asians and potential comparison populations (e.g., the Chinese with lower CHD rates) are limited. South Asians' cuisine is dominated by frying and roasting techniques that use high temperatures. South Asian foods have high TFA content primarily through the use of partially hydrogenated fats, reheated oils, and high-heat cooking. Reheating oils greatly increases the TFA content. In comparison, Chinese cuisine involves mostly braising, steaming, and boiling rather than frying. We hypothesize that South Asians' susceptibility to CHD is partly attributable to high-heat treated foods producing high NFCs. Research to accrue direct evidence is proposed. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. High-density lipoprotein cholesterol associated with change in coronary plaque lipid burden assessed by near infrared spectroscopy.

    PubMed

    Honda, Satoshi; Sidharta, Samuel L; Shishikura, Daisuke; Takata, Kohei; Di Giovanni, Giuseppe A; Nguyen, Tracy; Janssan, Alex; Kim, Susan W; Andrews, Jordan; Psaltis, Peter J; Worthley, Matthew I; Nicholls, Stephen J

    2017-10-01

    Little is known about the relation between serum lipid parameters and serial change in plaque composition using in vivo coronary imaging. The aim of this study was to examine the association between serum lipids and change in coronary plaque lipid burden assessed by near-infrared spectroscopy (NIRS). We performed serial NIRS-intravascular ultrasound studies in 49 patients who underwent coronary angiography for an acute coronary syndrome (ACS) or stable ischemic symptoms. Univariable and multivariable linear regression analyses were applied to evaluate the relationship between serum lipid parameters and change in lipid core burden index at the 4-mm maximal segment (max LCBI4mm). Mean patient age was 61 ± 9 y, 29% were women, 35% had an ACS clinical presentation, 78% received statin therapy at baseline, and median low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol and triglyceride levels were 101, 43, 174 and 133 mg/dL, respectively. During a median follow-up period of 13 months, max LCBI4mm significantly decreased from 277 to 194 (p = 0.001). On univariable analysis, the percent change in HDL-C negatively associated with the change in max LCBI4mm (β = -3.19, p = 0.004). There were no significant associations between the other lipid parameters and change in max LCBI4mm. On multivariable analysis, percent change in HDL-C remained significantly associated with the change in max LCBI4mm (p = 0.002). Change in HDL-C, but not other lipids parameters, associated with changes in coronary plaque lipid burden assessed by NIRS. These findings highlight the potential therapeutic importance of high-density lipoprotein on serial change in plaque composition. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. [Coronary surgery without extracorporeal circulation: the short-term results in high-risk patients].

    PubMed

    Pompilio, G; Antona, C; Cannata, A; Lotto, A; Alamanni, F; Gelpi, G; Tartara, P; Biglioli, P

    1999-03-01

    This study was conducted to assess the impact of coronary bypass surgery (CABG) without cardiopulmonary bypass (CPB) on high-risk patients. From February 1997 to July 1998, 71 patients considered at high-risk underwent a CABG off-pump. Using the "Higgins score", eleven preoperative risk factors were identified and stratified in this group of patients. Among 1271 patients who underwent CABG with CPB in the same period, using a computer-based matched comparison, a second identical group of patients was selected according to the 11 risk variables and the number with coronary disease, so that complete preoperative matching included the year of operation, score index and coronary target. Moreover, among seven other preoperative variables that were not included in the matching comparison, the two groups differed only in mean age (64 +/- 10.9 vs 61.6 +/- 7.3 in groups off and on-pump, respectively, p < 0.05). Postoperative outcome and complications and blood requirement were compared. Myocardial cell injury and left ventricular performance were also assessed in the two groups. The global incidence of neurologic complications in the off-pump group was significantly lower (9.8 vs 0%, in on and off-pump groups, respectively; p = 0.02). Patients undergoing CABG off-pump required blood far less often (% of transfused patients: 26.7% for the patients with CPB and 11.2% for the patients without CPB; p = 0.032). Three patients from the on-pump group (4.2%) had a perioperative myocardial infarction (AMI), versus 0% of the off-pump cases (p = ns). Postoperative atrial fibrillation accounted for 14.1% in off-pump patients and 30.9% in on-pump patients (p = 0.027). One patient in both groups (1.4%) suffered from postoperative heart failure. Mean ventilation time and ICU stay did not differ significantly between the two groups. However, hospital discharge occurred earlier in the off-pump group (9.3 +/- 3 vs 12.6 +/- 8, p = 0.007). In-hospital death occurred in one case from the on

  5. Exposure to loud noise, bilateral high-frequency hearing loss and coronary heart disease.

    PubMed

    Gan, Wen Qi; Moline, Jacqueline; Kim, Hyun; Mannino, David M

    2016-01-01

    Bilateral high-frequency hearing loss is an indicator for chronic exposure to loud noise. This study aimed to examine the association between bilateral high-frequency hearing loss and the presence of coronary heart disease (CHD). This study included 5223 participants aged 20-69 years who participated in the audiometry examination of the National Health and Nutrition Examination Survey 1999-2004. Bilateral high-frequency hearing loss was defined as the average high-frequency (3, 4 and 6 kHz) hearing threshold ≥25 dB in both ears. CHD was defined as self-reported diagnoses by doctors or other health professionals. Compared with those with normal high-frequency hearing, participants with bilateral high-frequency hearing loss were more likely to have CHD (OR 1.91; 95% CI 1.28 to 2.85) after adjustment for various covariates. This association was particularly strong for currently employed workers who were exposed to loud occupational noise (OR 4.23; 95% CI 1.32 to 13.55). For this subgroup, there was no significant association of CHD with unilateral high-frequency hearing loss, and unilateral or bilateral low-frequency hearing loss. Furthermore, there was no significant association of CHD with any types of hearing loss for participants who were not exposed to loud noise. Stratified analyses for participants exposed to loud noise showed that the observed association was particularly strong for those who were less than 50 years of age, less educated and current smokers. On the basis of an objective indicator for personal chronic exposure to loud noise, this study confirmed that exposure to loud occupational noise is associated with the presence of CHD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Absolute and relative dose measurements with Gafchromic trade mark sign EBT film for high energy electron beams with different doses per pulse

    SciTech Connect

    Fiandra, Christian; Ragona, Riccardo; Ricardi, Umberto; Anglesio, Silvia; Giglioli, Francesca Romana

    2008-12-15

    The authors have evaluated the accuracy, in absolute and relative dose measurements, of the Gafchromic trade mark sign EBT film in pulsed high-energy electron beams. Typically, the electron beams used in radiotherapy have a dose-per-pulse value of less than 0.1 mGy/pulse. However, very high dose-per-pulse electron beams are employed in certain linear accelerators dedicated to intraoperatory radiation therapy (IORT). In this study, the absorbed dose measurements with Gafchromic trade mark sign EBT in both low (less than 0.3 mGy per pulse) and high (30 and 70 mGy per pulse) dose-per-pulse electron beams were compared with ferrous sulfate chemical Fricke dosimetry (operated by the Italian Primary Standard Dosimetry Laboratory), a method independent of the dose per pulse. A summary of Gafchromic trade mark sign EBT in relative and absolute beam output determination is reported. This study demonstrates the independence of Gafchromic trade mark sign EBT absorption as a function of dose per pulse at different dose levels. A good agreement (within 3%) was found with Fricke dosimeters for plane-base IORT applicators. Comparison with a diode detector is presented for relative dose measurements, showing acceptable agreement both in the steep dose falloff zone and in the homogeneous dose region. This work also provides experimental values for recombination correction factor (K{sub sat}) of a Roos (plane parallel) ionization chamber calculated on the basis of theoretical models for charge recombination.

  7. Coronary artery imaging in children.

    PubMed

    Goo, Hyun Woo

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy.

  8. Coronary Artery Imaging in Children

    PubMed Central

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  9. Absolute multilateration between spheres

    NASA Astrophysics Data System (ADS)

    Muelaner, Jody; Wadsworth, William; Azini, Maria; Mullineux, Glen; Hughes, Ben; Reichold, Armin

    2017-04-01

    Environmental effects typically limit the accuracy of large scale coordinate measurements in applications such as aircraft production and particle accelerator alignment. This paper presents an initial design for a novel measurement technique with analysis and simulation showing that that it could overcome the environmental limitations to provide a step change in large scale coordinate measurement accuracy. Referred to as absolute multilateration between spheres (AMS), it involves using absolute distance interferometry to directly measure the distances between pairs of plain steel spheres. A large portion of each sphere remains accessible as a reference datum, while the laser path can be shielded from environmental disturbances. As a single scale bar this can provide accurate scale information to be used for instrument verification or network measurement scaling. Since spheres can be simultaneously measured from multiple directions, it also allows highly accurate multilateration-based coordinate measurements to act as a large scale datum structure for localized measurements, or to be integrated within assembly tooling, coordinate measurement machines or robotic machinery. Analysis and simulation show that AMS can be self-aligned to achieve a theoretical combined standard uncertainty for the independent uncertainties of an individual 1 m scale bar of approximately 0.49 µm. It is also shown that combined with a 1 µm m-1 standard uncertainty in the central reference system this could result in coordinate standard uncertainty magnitudes of 42 µm over a slender 1 m by 20 m network. This would be a sufficient step change in accuracy to enable next generation aerospace structures with natural laminar flow and part-to-part interchangeability.

  10. Safety of anacetrapib in patients with or at high risk for coronary heart disease.

    PubMed

    Cannon, Christopher P; Shah, Sukrut; Dansky, Hayes M; Davidson, Michael; Brinton, Eliot A; Gotto, Antonio M; Stepanavage, Michael; Liu, Sherry Xueyu; Gibbons, Patrice; Ashraf, Tanya B; Zafarino, Jennifer; Mitchel, Yale; Barter, Philip

    2010-12-16

    Anacetrapib is a cholesteryl ester transfer protein inhibitor that raises high-density lipoprotein (HDL) cholesterol and reduces low-density lipoprotein (LDL) cholesterol. We conducted a randomized, double-blind, placebo-controlled trial to assess the efficacy and safety profile of anacetrapib in patients with coronary heart disease or at high risk for coronary heart disease. Eligible patients who were taking a statin and who had an LDL cholesterol level that was consistent with that recommended in guidelines were assigned to receive 100 mg of anacetrapib or placebo daily for 18 months. The primary end points were the percent change from baseline in LDL cholesterol at 24 weeks (HDL cholesterol level was a secondary end point) and the safety and side-effect profile of anacetrapib through 76 weeks. Cardiovascular events and deaths were prospectively adjudicated. A total of 1623 patients underwent randomization. By 24 weeks, the LDL cholesterol level had been reduced from 81 mg per deciliter (2.1 mmol per liter) to 45 mg per deciliter (1.2 mmol per liter) in the anacetrapib group, as compared with a reduction from 82 mg per deciliter (2.1 mmol per liter) to 77 mg per deciliter (2.0 mmol per liter) in the placebo group (P<0.001)--a 39.8% reduction with anacetrapib beyond that seen with placebo. In addition, the HDL cholesterol level increased from 41 mg per deciliter (1.0 mmol per liter) to 101 mg per deciliter (2.6 mmol per liter) in the anacetrapib group, as compared with an increase from 40 mg per deciliter (1.0 mmol per liter) to 46 mg per deciliter (1.2 mmol per liter) in the placebo group (P<0.001)--a 138.1% increase with anacetrapib beyond that seen with placebo. Through 76 weeks, no changes were noted in blood pressure or electrolyte or aldosterone levels with anacetrapib as compared with placebo. Prespecified adjudicated cardiovascular events occurred in 16 patients treated with anacetrapib (2.0%) and 21 patients receiving placebo (2.6%) (P = 0.40). The

  11. High-intensity interval training in patients with coronary heart disease: Prescription models and perspectives.

    PubMed

    Ribeiro, Paula A B; Boidin, Maxime; Juneau, Martin; Nigam, Anil; Gayda, Mathieu

    2017-01-01

    Recently, high-intensity interval training (HIIT) has emerged as an alternative and/or complementary exercise modality to continuous aerobic exercise training (CAET) in CHD patients. However, the literature contains descriptions of many HIIT protocols with different stage durations, nature of recovery and intensities. In this review, we discuss the most recent forms of validated HIIT protocols in patients with coronary heart disease (CHD) and how to prescribe and use them during short- and long-term (phase II and III) cardiac rehabilitation programs. We also compare the superior and/or equivalent short- and long-term effects of HIIT versus CAET on aerobic fitness, cardiovascular function, and quality of life; their efficiency, safety, and tolerance; and exercise adherence. Short interval HIIT was found beneficial for CHD patients with lower aerobic fitness and would ideally be used in initiation and improvement stages. Medium and/or long interval HIIT protocols may be beneficial for CHD patients with higher aerobic fitness, and would be ideally used in the improvement and maintenance stages because of their high physiological stimulus. Finally, we propose progressive individualized models of HIIT programs (phase II to III) for patients with CHD and how to ideally use them according to the clinical status of patients and phase of the cardiac rehabilitation program.

  12. [High-sensitivity troponin in patients with stable coronary artery disease].

    PubMed

    van 't Hof, Arnoud W J

    2015-01-01

    With the introduction of more sensitive markers of myocardial necrosis, it was shown that the diagnosis of (acute) myocardial infarction could be improved. However, many patients without myocardial infarction have elevated troponin levels (low sensitivity), resulting in additional diagnostic testing and longer admission times to find the cause of the troponin rise. Elevated troponin levels in these patients were found to have limited diagnostic but strong prognostic value. This led to studies assessing the value of high-sensitivity troponin in patients with stable disease, e.g. coronary artery disease, or even in patients without apparent (clinical) disease. These studies consistently showed a strong association with long-term (cardiac) mortality. What is the value for the general physician in daily practice? Although troponin levels may help in finding (healthy?) patients at higher risk, it remains unclear whether interventions (medication, lifestyle) are more (cost-)effective in this high-risk subgroup. The role of troponin levels as a prognostic marker in stable patients therefore remains to be determined.

  13. Drugs targeting high-density lipoprotein cholesterol for coronary artery disease management.

    PubMed

    Katz, Pamela M; Leiter, Lawrence A

    2012-01-01

    Many patients remain at high risk for future cardiovascular events despite levels of low-density lipoprotein cholesterol (LDL-C) at, or below, target while taking statin therapy. Much effort is therefore being focused on strategies to reduce this residual risk. High-density lipoprotein cholesterol (HDL-C) is a strong, independent, inverse predictor of coronary heart disease risk and is therefore an attractive therapeutic target. Currently available agents that raise HDL-C have only modest effects and there is limited evidence of additional cardiovascular risk reduction on top of background statin therapy associated with their use. It was hoped that the use of cholesteryl ester transfer protein (CETP) inhibitors would provide additional benefit, but the results of clinical outcome studies to date have been disappointing. The results of ongoing trials with other CETP inhibitors that raise HDL-C to a greater degree and also lower LDL-C, as well as with other emerging therapies are awaited. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Virtual coaching for the high-intensity training of a powerlifter following coronary artery bypass grafting

    PubMed Central

    Adams, Richard; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M.

    2015-01-01

    A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services. PMID:25552808

  15. Virtual coaching for the high-intensity training of a powerlifter following coronary artery bypass grafting.

    PubMed

    Adams, Richard; Adams, Jenny; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M

    2015-01-01

    A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services.

  16. [Identification of subjects at high risk of coronary disease in a working population using a prediction model].

    PubMed

    Laurier, D; Chau, N P

    1995-11-01

    Identification of subjects at high risk of coronary morbidity is of major interest in the prevention of cardiovascular disease. This report describes the use of a multifactorial prediction model for the identification of high risk subjects in a French male population. The PCV-METRA study (Prévention Cardiovasculaire en Médecine du Travail) monitors risk factors of cardiovascular morbidity in a population of men and women employed in big companies in the Paris region. A model adapted from a prediction model conceived by K.M. Anderson et al. in the Framingham study was used. The modified model enables an estimation of individual coronary risk based on 7 factors: age, total cholesterol, HDL-cholesterol, systolic blood pressure, smoking, diabetes and presence of left ventricular hypertrophy, taking into account the relatively low prevalence of coronary heart disease in France. The population comprised 4,131 active men aged 30 to 65 years. The average risk at 5 years was estimated to be 1.6%. Subjects at high risk (over the 80th percentile of the risk distribution curve) usually had high blood pressures and cholesterol levels. However, nearly 30% of these subjects were neither hypertensive nor hypercholesteraemic. It is important to note that 3/4 of these smoked. Moreover, they also had low HDL-cholesterol levels. A risk table, derived from the Framingham model, is presented. This table allows estimation of individual risk at 5 years in men aged 30 to 65 years. In each age group, the comparison of individual risk with the percentiles of risk distribution in the PCV-METRA population allows identification of high-risk subjects. This study proposes a tool for identifying subjects at high risk of coronary morbidity in a French male population. This multifactorial model is particularly useful for detecting subjects with several borderline factors none of which overstep the usually accepted limits.

  17. Intravascular near-infrared fluorescence molecular imaging of atherosclerosis: toward coronary arterial visualization of biologically high-risk plaques

    NASA Astrophysics Data System (ADS)

    Calfon, Marcella A.; Vinegoni, Claudio; Ntziachristos, Vasilis; Jaffer, Farouc A.

    2010-01-01

    New imaging methods are urgently needed to identify high-risk atherosclerotic lesions prior to the onset of myocardial infarction, stroke, and ischemic limbs. Molecular imaging offers a new approach to visualize key biological features that characterize high-risk plaques associated with cardiovascular events. While substantial progress has been realized in clinical molecular imaging of plaques in larger arterial vessels (carotid, aorta, iliac), there remains a compelling, unmet need to develop molecular imaging strategies targeted to high-risk plaques in human coronary arteries. We present recent developments in intravascular near-IR fluorescence catheter-based strategies for in vivo detection of plaque inflammation in coronary-sized arteries. In particular, the biological, light transmission, imaging agent, and engineering principles that underlie a new intravascular near-IR fluorescence sensing method are discussed. Intravascular near-IR fluorescence catheters appear highly translatable to the cardiac catheterization laboratory, and thus may offer a new in vivo method to detect high-risk coronary plaques and to assess novel atherosclerosis biologics.

  18. Site-specific characterization and absolute quantification of pegfilgrastim oxidation by top-down high-performance liquid chromatography-mass spectrometry.

    PubMed

    Forstenlehner, Ines C; Holzmann, Johann; Toll, Hansjörg; Huber, Christian G

    2015-09-15

    The characterization and absolute quantification of protein biopharmaceuticals and their product-related impurities, e.g., oxidation variants, is essential due to their potential impact on biological activity and immunogenicity. Here, we present site assignment and absolute quantification of oxidation variants of pegfilgrastim, a poly(ethylene glycol) modified recombinant human granulocyte-colony stimulating factor. Pegfilgrastim stressed with 1.0% hydrogen peroxide served as a model protein for developing a top-down high-performance liquid chromatography-mass spectrometry (HPLC-MS) platform that allowed direct site assignment of Met122, Met127, and Met138 oxidation within a total analysis time of 30 min. Three different absolute quantification methods, namely, UV absorption spectroscopy, full-scan MS, and all-ion fragmentation (AIF) MS were compared. Additionally, the monitoring of all generated fragment ions or selected sets of fragment ions were evaluated for the AIF method. Linearity of calibration curves from 5.0 to 25 ng μL(-1), 25 to 250 ng μL(-1), and 100 to 1000 ng μL(-1) was confirmed. The AIF method achieved a lower limit of detection of 0.85 ng μL(-1) and a lower limit of quantification of 2.54 ng μL(-1). On the basis of the comparison of relative standard deviations of interday measurements, AIF was concluded to be the method of choice for concentrations up to 50 ng μL(-1), and UV measurements should be carried out above this concentration. Finally, an expired pegfilgrastim batch was analyzed as a a real biopharmaceutical sample to confirm the feasibility of our approach for monitoring low levels of oxidation variants.

  19. Comparison of high energy gamma rays from absolute value of b greater than 30 deg with the galactic neutral hydrogen distribution

    NASA Technical Reports Server (NTRS)

    Ozel, M. E.; Ogelman, H.; Tumer, T.; Fichtel, C. E.; Hartman, R. C.; Kniffen, D. A.; Thompson, F. J.

    1978-01-01

    High-energy gamma-ray (energy above 35 MeV) data from the SAS 2 satellite have been used to compare the intensity distribution of gamma rays with that of neutral hydrogen (H I) density along the line of sight, at high galactic latitudes (absolute values greater than 30 deg). A model has been constructed for the case where the observed gamma-ray intensity has been assumed to be the sum of a galactic component proportional to the H I distribution plus an isotropic extragalactic emission. A chi-squared test of the model parameters indicates that about 30% of the total high-latitude emission may originate within the Galaxy.

  20. Hyaluronan based heparin free coated open and closed extracorporeal circuits for high risk coronary revascularization.

    PubMed

    Gunaydin, Serdar; Ucar, Halil Ibrahim; Serter, Tanzer; McCusker, Kevin; Ozcelik, Gokhan; Salman, Nevriye; Yorgancioglu, Ali Cem

    2010-12-01

    This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n = 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n = 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n = 12); and Group 4: Control-open, uncoated ECC (n = 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p < .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p < .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed + coated group at T4 (p < .05). Postoperative hemorrhage (mL) was 510 +/- 40 in closed + coated and 536 +/- 40 in open + coated groups (control: 784 +/- 48, p < .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 +/- .01 in closed+coated, 2.01 +/- .01 in open+coated, and 3.3 +/- .015 in control groups (p < or = .05). Use of a closed

  1. Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease.

    PubMed

    Zhang, J W; Liu, W W; McCaffrey, Timothy A; He, X Q; Liang, W Y; Chen, X H; Feng, X R; Fu, Sidney W; Liu, M L

    2017-01-01

    Previous studies have illustrated the link between high on-aspirin platelet reactivity (HAPR) with increasing thrombotic risks. The aim of our study was to investigate relative risk factors of HAPR in elderly patients with coronary artery disease. Elderly, hospitalized coronary artery disease patients on regular aspirin treatment were enrolled from January 2014 to September 2016. Medical records of each patient were collected, including demographic information, cardiovascular risk factors, concomitant drugs and routine biological parameters. Arachidonic acid (AA, 0.5 mg/mL) and adenosine diphosphate (ADP, 5 µmol/L) induced platelet aggregation were measured via light transmission assay (LTA) to evaluate antiplatelet responses, referred as LTA-AA and LTA-ADP. A total of 275 elderly patients were included, with mean age of 77.2±8.1 years, and males accounted for 81.8%. HAPR was defined as LTA-AA in the upper quartile of the enrolled population. HAPR patients tended to have lower renal function (P=0.052). Higher serum uric acid (SUA) level, as well as lower platelet count, hemoglobin and hematocrit were observed in HAPR patients, with a higher proportion of diuretics use (P<0.05). Multivariate analysis revealed that SUA (OR: 1.004, 95% CI: 1.000-1.007, P=0.048), platelet count (OR: 0.994, 95% CI: 0.989-1.000, P=0.045), hematocrit (OR: 0.921, 95% CI: 0.864-0.981, P=0.011) and concomitant P2Y12 receptor inhibitors use (OR: 1.965, 95% CI: 1.075-3.592, P=0.028) were correlated with HAPR. Spearman's correlation analysis demonstrated an inverse association of LTA-AA with hematocrit (r=-0.234, P<0.001), hemoglobin (r=-0.209, P<0.001) and estimated glomerular filtration rate (r=-0.132, P=0.031). SUA, platelet count, hematocrit and P2Y12 receptor inhibitors use were independently correlated with HAPR. These parameters might provide novel therapeutic targets for optimizing antiplatelet therapy.

  2. Hyaluronan Based Heparin Free Coated Open and Closed Extracorporeal Circuits for High Risk Coronary Revascularization

    PubMed Central

    Gunaydin, Serdar; Ucar, Halil Ibrahim; Serter, Tanzer; McCusker, Kevin; Ozcelik, Gokhan; Salman, Nevriye; Yorgancioglu, Ali Cem

    2010-01-01

    Abstract: This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were pro spectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF™, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC™, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n = 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n = 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n = 12); and Group 4: Control-open, uncoated ECC (n = 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p < .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p < .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed+coated group at T4 (p < .05). Postoperative hemorrhage (mL) was 510 ± 40 in closed+coated and 536 ± 40 in open+coated groups (control: 784 ± 48, p ≤ .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 ± .01 in closed+coated, 2.01 ± .01 in open+coated, and 3.3 ± .015 in control groups (p ≤ .05). Use of a

  3. Dysfunctional high-density lipoproteins in coronary heart disease: implications for diagnostics and therapy.

    PubMed

    Annema, Wijtske; von Eckardstein, Arnold

    2016-07-01

    Low plasma levels of high-density lipoprotein (HDL) cholesterol are associated with increased risks of coronary heart disease. HDL mediates cholesterol efflux from macrophages for reverse transport to the liver and elicits many anti-inflammatory and anti-oxidative activities which are potentially anti-atherogenic. Nevertheless, HDL has not been successfully targeted by drugs for prevention or treatment of cardiovascular diseases. One potential reason is the targeting of HDL cholesterol which does not capture the structural and functional complexity of HDL particles. Hundreds of lipid species and dozens of proteins as well as several microRNAs have been identified in HDL. This physiological heterogeneity is further increased in pathologic conditions due to additional quantitative and qualitative molecular changes of HDL components which have been associated with both loss of physiological function and gain of pathologic dysfunction. This structural and functional complexity of HDL has prevented clear assignments of molecules to the functions of normal HDL and dysfunctions of pathologic HDL. Systematic analyses of structure-function relationships of HDL-associated molecules and their modifications are needed to test the different components and functions of HDL for their relative contribution in the pathogenesis of atherosclerosis. The derived biomarkers and targets may eventually help to exploit HDL for treatment and diagnostics of cardiovascular diseases.

  4. Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome.

    PubMed

    Cohn, Tony; Prud'homme, Denis; Streiner, David; Kameh, Homa; Remington, Gary

    2004-11-01

    To determine the prevalence and characteristics of coronary heart disease (CHD) risk factors in patients with chronic schizophrenia or schizoaffective disorder. We compared individual CHD risk factors and Framingham risk predictions in a group of 240 patients with a large national sample (Canadian Heart Health Survey) matched for age and sex. In addition, we compared rates of the metabolic syndrome (syndrome X) with recently published rates in the US adult population. Compared with the reference population, Framingham 10-year risk of myocardial infarction was greater in the male patients (t3091 = 4.35, P < 0.001) but not in the female patients. Prevalence rates of the metabolic syndrome in the patients (42.6% of men and 48.5% of women) were approximately 2 times published rates in the US adult population. Further, the syndrome appears to occur at a younger age than in the general population. These long-term patients have increased CHD risks best captured by the metabolic syndrome conceptualization coupled with a high rate of cigarette smoking. This characterization is consistent with increased cardiovascular morbidity and decreased life expectancy in both men and women. We underscore the importance of both screening for and treating potentially reversible CHD risk factors in schizophrenia patients.

  5. Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries.

    PubMed

    Sun, Kai; Li, Kuncheng; Han, Ruijuan; Li, Wenhuan; Chen, Nan; Yang, Qi; Du, Xiangying; Wang, Chen; Liu, Guorong; Li, Yuechun; Zhou, Maorong; Li, Ligang; Heidrun, Endt

    2015-03-01

    To explore the feasibility and diagnostic accuracy of a combined one-step high-pitch dual-source computed tomography angiography (CTA) technique for evaluation of coronary and carotid-cerebrovascular arteries. 85 symptomatic patients suspected of coronary artery and cerebrovascular disease referred for simultaneous coronary and carotid-cerebrovascular CTA were included. Additional invasive angiography of the coronary and cerebral arteries was performed within 30 days in 23 and 13 patients, respectively. The objective parameters of image quality, the mean CT attenuations, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. The subjective image quality of vessels was also assessed by 2 independent radiologists blinded to the patients' medical history and scan protocols. The diagnostic performance of CTA including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection or exclusion of significant artery stenosis was calculated using the chi-squared test of contingency and correlated with the results of invasive angiography representing the standard of reference. Image quality was rated excellent (score 1) in 95.3% (1074/1127), good (score 2) in 3.3% (37/1127), adequate (score 3) in 1.0% (11/1127), and non-diagnostic (score 4) in 0.4% (5/1127) of coronary segments. Image quality of carotid and cerebral vessels was rated mostly excellent (score 1, 95.12% [78/82]; score 2, 3.66% [3/82]; score 3, 1.22% [1/82]). The sensitivity, specificity, PPV and NPV for the detection of coronary stenosis were 92.2% (81.1-97.7%), 95.2% (91.7-97.5%), 79.6% (67.1-89.1%) and 98.3% (95.8-99.5%), respectively. For the detection of carotid and cerebral artery stenosis, CTA demonstrated a sensitivity of 92.8% (80.5-98.4%), a specificity of 93.5% (88.3-96.8%), a PPV of 79.6% (65.6-89.7%) and a NPV of 97.9% (94.1-99.5%). The effective radiation dose was 1.42±0.44mSv (range, 0.88-3.35mSv). Dual

  6. Echocardiographic Evaluation of Coronary Abnormalities and Cardiac Function in a Murine Model of Kawasaki Disease Using High-frequency Ultrasound.

    PubMed

    Zhang, Xin-Xin; Du, Zhong-Dong; Wen, Shang-Guan; Sun, Xiu-Ping

    2017-06-20

    Murine model of coronary arterial inflammation has been widely accepted as an animal model of and used in Kawasaki disease (KD). This study sought to evaluate the developmental changes of coronary arteries and cardiac function in a murine model of KD with a high-frequency ultrasound system and to provide evidence for the preparation of the model of KD. Lactobacillus casei cell wall extract was prepared and injected into C57BL/6 mice intraperitoneally (i.p.) to induce KD. A total of 120 mice were grouped into three groups. The intravenous immunoglobulin (IVIG) treatment group was i.p. injected with IVIG (2 g/kg), while the KD model and normal control groups were i.p. injected with 0.5 ml of phosphate buffered solution on day 5. All high-resolution echocardiography detection of mouse heart was performed by the same senior technician. Animal echocardiography was performed by measuring the coronary artery dimensions and cardiac function on days 0, 7, 14, 28, and 56 (high-resolution small animal ultrasound [Vevo770 pattern; VisualSonic, Canada] with broadband probe [RMVTM707B; frequency, 30 mHz; depth of focus, 1.2 cm]) which were measured and analyzed with Vevo770 software. Pathological studies revealed focal inflammatory infiltrate asymmetrically distributed around the coronary artery trunk in the KD model group. Echocardiographic study including coronary dimension and cardiac function measurements was successfully performed in all subjects. The KD model and IVIG treatment groups showed left coronary artery dilation on days 7, 14, 28, and 56. The diameter of left coronary artery in the KD model group (0.53 ± 0.09 mm; 0.36 ± 0.07 mm; 0.34 ± 0.05 mm; 0.34 ± 0.04 mm) was significantly larger than those of IVIG treatment group (0.22 ± 0.02 mm; 0.28 ± 0.03 mm; 0.26 ± 0.03 mm; 0.27 ± 0.05 mm; 0.26 ± 0.03 mm; all P < 0.01) and the normal control group (0.21 ± 0.02 mm; 0.22 ± 0.03 mm; 0.22 ± 0.02 mm; 0.23 ± 0.02 mm; 0.27 ± 0.04 mm; all P< 0.01) on days 7, 14, 28

  7. The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era

    PubMed Central

    Wan, You-Dong; Sun, Tong-Wen; Kan, Quan-Cheng; Guan, Fang-Xia; Liu, Zi-Qi; Zhang, Shu-Guang

    2016-01-01

    Background Intra-aortic balloon pumps (IABP) have generally been used for patients undergoing high-risk mechanical coronary revascularization. However, there is still insufficient evidence to determine whether they can improve outcomes in reperfusion therapy patients, mainly by percutaneous coronary intervention (PCI) with stenting or coronary artery bypass graft (CABG). This study was designed to determine the difference between high-risk mechanical coronary revascularization with and without IABPs on mortality, by performing a meta-analysis on randomized controlled trials of the current era. Methods Pubmed and Embase databases were searched from inception to May 2015. Unpublished data were obtained from the investigators. Randomized clinical trials of IABP and non-IABP in high-risk coronary revascularization procedures (PCI or CABG) were included. In the case of PCI procedures, stents should be used in more than 80% of patients. Numbers of events at the short-term and long-term follow-up were extracted. Results A total of 12 randomized trials enrolling 2155 patients were included. IABPs did not significantly decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42–1.01), or long-term mortality (RR 0.79; 95% CI, 0.47–1.35), with low heterogeneity across the studies. The findings remained stable in patients with acute myocardial infarction with or without cardiogenic shock. But in high-risk CABG patients, IABP was associated with reduced mortality (71 events in 846 patients; RR 0.40; 95%CI 0.25–0.67). Conclusion In patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs. PMID:26784578

  8. Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis: comparison with patients with multiple- and single-vessel coronary artery disease

    SciTech Connect

    Nygaard, T.W.; Gibson, R.S.; Ryan, J.M.; Gascho, J.A.; Watson, D.D.; Beller, G.A.

    1984-02-01

    To determine the prevalence of high-risk thallium-201 (Tl-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise Tl-201 scintigrams were analyzed in 295 consecutive patients with angiographic (greater than or equal to 50% stenosis) CAD, of which 43 (14%) had greater than or equal to 50% LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (greater than or equal to 25% homogeneous decrease in Tl-201 activity in the middle and upper septal and posterolateral walls on the 45 degree left anterior oblique projection); (2) abnormal Tl-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung Tl-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95%) had an abnormal scintigram. Thirty-three (77%) had 1 or more high-risk scintigraphic findings, including 29 (67%) with a multivessel CAD scan pattern, of which 6 (14%) demonstrated a typical LMCAD pattern; and 18 (42%) with abnormal lung Tl-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58%) (p . 0.05), 99 patients with 2-vessel disease (60%) (p . 0.04) and 100 patients with 1-vessel disease (41%) (p less than 0.0001).

  9. Long-term outcomes of high-risk elderly male patients with multivessel coronary disease: optimal medical therapy versus revascularization.

    PubMed

    Tao, Tao; Wang, Hao; Wang, Shu-Xia; Guo, Yu-Tao; Zhu, Ping; Wang, Yu-Tang

    2016-02-01

    Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy (OMT) and revascularization-plus-OMT in elderly patients with high-risk angina. In this prospective non-randomized study, 241 consecutive high-risk elderly male patients (65-92 years of age) with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who underwent OMT than in those who underwent revascularization (6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04). However, the overall risks of major adverse cardiac cerebrovascular events (MACCE) were similar among all patients (6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67). OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.

  10. Long-term outcomes of high-risk elderly male patients with multivessel coronary disease: optimal medical therapy versus revascularization

    PubMed Central

    Tao, Tao; Wang, Hao; Wang, Shu-Xia; Guo, Yu-Tao; Zhu, Ping; Wang, Yu-Tang

    2016-01-01

    Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy (OMT) and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients (65–92 years of age) with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who underwent OMT than in those who underwent revascularization (6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04). However, the overall risks of major adverse cardiac cerebrovascular events (MACCE) were similar among all patients (6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67). Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease. PMID:27168741

  11. Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

    PubMed Central

    Cardoso, Rhanderson; Alfonso, Carlos E.; Coffey, James O.

    2016-01-01

    Complete atrioventricular (AV) block is known to be reversible in some cases of acute inferior wall myocardial infarction (MI). The reversibility of high-grade AV block in non-MI coronary artery disease (CAD), however, is rarely described in the literature. Herein we perform a literature review to assess what is known about the reversibility of high-grade AV block after right coronary artery revascularization in CAD patients who present without an acute MI. To illustrate this phenomenon we describe a case of 2 : 1 AV block associated with unstable angina, in which revascularization resulted in immediate and durable restoration of 1 : 1 AV conduction, thereby obviating the need for permanent pacemaker implantation. The literature review suggests two possible explanations: a vagally mediated response or a mechanism dependent on conduction system ischemia. Due to the limited understanding of AV block reversibility following revascularization in non-acute MI presentations, it remains difficult to reliably predict which patients presenting with high-grade AV block in the absence of MI may have the potential to avoid permanent pacemaker implantation via coronary revascularization. We thus offer this review as a potential starting point for the approach to such patients. PMID:26925272

  12. The prognostic value of high sensitivity troponin T 7 weeks after an acute coronary syndrome

    PubMed Central

    Kao, Michelle P C; Dow, Ellie; Lang, Chim; Struthers, Allan

    2012-01-01

    Objective The role of high sensitivity troponin T (hs-TnT) in the convalescence phase after an acute coronary syndrome (ACS) is unknown. The authors aim to assess the prognostic utility of a single hs-TnT level at 7-week post-ACS. Second, the authors evaluated whether any serial changes in hs-TnT between the index admission and 7 weeks post-ACS had any link with the prognosis. Third, the authors assessed whether the prognostic utility of hs-TnT is independent of various echocardiographic abnormalities. Methods The authors measured hs-TnT levels in 326 consecutive patients at 7 weeks after an ACS event. The composite end point of death from any cause or acute myocardial infarction was evaluated over a median duration of 30 months. Results A high 7-week hs-TnT (>14 ng/l) predicted adverse clinical outcomes independent of conventional risk factors, left ventricular dysfunction and left ventricular hypertrophy on echocardiography (adjusted RR: 2.69 (95% CI 1.45 to 5.00)). Patients with persistent hs-TnT elevation at 7 weeks were also at an increased risk of cardiovascular events compared with those with an initial high hs-TnT which then normalised (unadjusted RR 3.39 (95% CI 2.02 to 5.68)). Conclusion The authors have demonstrated the prognostic utility of a single 7-week hs-TnT measurement in routine ACS patients and that it could be used to assist medium term risk stratification in this patient cohort. In addition, the authors also showed that hs-TnT predicted long-term adverse prognosis independent of various echo parameters. Future studies should evaluate whether tailoring specific treatment interventions to higher risk individuals as identified by an elevated hs-TnT during the convalescence phase of ACS would improve clinical outcomes. PMID:22689713

  13. [Community nursing intervention in population with high-risk coronary heart disease in Hengyang].

    PubMed

    Huang, Yanjin; Chen, Jia; Zeng, Ying; Liu, Dan; He, Guoping

    2014-10-01

    To explore the effect of community nursing intervention on awareness regarding primary prevention knowledge, self-management, and risk factors for coronary heart disease (CHD) in Hengyang City, Hunan Province. A total of 120 individuals at high risk of CHD were recruited and divided into a control group and an intervention group. The intervention group was given the health knowledge lecture and individual community nursing intervention. The control group was given the routine management. Before and after the intervention, all of the recruiters were evaluated by the awareness on primary prevention knowledge, self-management and risk factors for CHD. Before the intervention, there was no significant difference in the demographic data, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups (P>0.05). After the intervention, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups changed. In the intervention group, the cognitive level was significantly increased (P<0.05); the self management score was improved; the systolic blood pressure, BMI, and the levels of fasting glucose, TC and low density lipoprotein-cholesterol were significantly decreased and the level of high density lipoprotein-cholesterol was significantly increased (P<0.05). There was no significant difference in the above-mentioned parameters between before and after intervention in the control group (P>0.05). The cognitive levels regarding primary prevention knowledge and self-management for CHD can be improved effectively by community nursing intervention in high-risk population of CHD, and the risk factors for CHD can also be reduced.

  14. Coronary microembolization.

    PubMed

    Skyschally, Andreas; Leineweber, Kkirsten; Gres, Petra; Haude, Michael; Erbel, Raimund; Heusch, Gerd

    2006-09-01

    Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the present experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and highlights the main consequences of coronary microembolization--reduced coronary reserve, microinfarction, inflammation and oxidative modification of contractile proteins, contractile dysfunction and perfusion-contraction mismatch.Furthermore, the review presents the available clinical evidence for coronary microembolization in patients and compares the clinical observations with observations in the experimental model.

  15. Noninvasive Diagnosis of Coronary Artery Disease Using 12-Lead High-Frequency Electrocardiograms

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Arenare, Brian

    2006-01-01

    A noninvasive, sensitive method of diagnosing certain pathological conditions of the human heart involves computational processing of digitized electrocardiographic (ECG) signals acquired from a patient at all 12 conventional ECG electrode positions. In the processing, attention is focused on low-amplitude, high-frequency components of those portions of the ECG signals known in the art as QRS complexes. The unique contribution of this method lies in the utilization of signal features and combinations of signal features from various combinations of electrode positions, not reported previously, that have been found to be helpful in diagnosing coronary artery disease and such related pathological conditions as myocardial ischemia, myocardial infarction, and congestive heart failure. The electronic hardware and software used to acquire the QRS complexes and perform some preliminary analyses of their high-frequency components were summarized in Real-Time, High-Frequency QRS Electrocardiograph (MSC- 23154), NASA Tech Briefs, Vol. 27, No. 7 (July 2003), pp. 26-28. To recapitulate, signals from standard electrocardiograph electrodes are preamplified, then digitized at a sampling rate of 1,000 Hz, then analyzed by the software that detects R waves and QRS complexes and analyzes them from several perspectives. The software includes provisions for averaging signals over multiple beats and for special-purpose nonrecursive digital filters with specific low- and high-frequency cutoffs. These filters, applied to the averaged signal, effect a band-pass operation in the frequency range from 150 to 250 Hz. The output of the bandpass filter is the desired high-frequency QRS signal. Further processing is then performed in real time to obtain the beat-to-beat root mean square (RMS) voltage amplitude of the filtered signal, certain variations of the RMS voltage, and such standard measures as the heart rate and R-R interval at any given time. A key signal feature analyzed in the present

  16. Risk factors for coronary artery disease in patients with elevated high-density lipoprotein cholesterol.

    PubMed

    DeFaria Yeh, Doreen; Freeman, Mason W; Meigs, James B; Grant, Richard W

    2007-01-01

    High high-density lipoprotein (HDL) levels protect against coronary artery disease (CAD) development. We hypothesized that patients with CAD and high HDL levels would have higher prevalence of other CAD risk factors compared with patients with CAD and normal HDL. We identified 41,982 patients from a single center with normal levels (40 to 60 mg/dl in men, 50 to 70 mg/dl in women) or high HDL levels (> or =70 mg/dl in men, > or =80 mg/dl in women) when last measured between January 2000 and April 2004. From this overall population, we characterized a cohort of 1,610 patients with CAD, including 98 patients with high HDL levels. We measured prevalence of traditional CAD risk factors by comparing these 98 patients with patients with CAD and normal HDL levels (n = 1,512). We performed manual chart review in patients (n = 196) matched 1:1 by age, gender, and HDL level to obtain further detail with regard to differences in family history and lifestyle factors. In patients with CAD, those with high HDL levels (98 of 1,610, 6.1%) were of similar age (71.1 vs 69.6 years, p = 0.23), had similar prevalence of hypertension (78.6% vs 88.7%, p = 0.30), lower levels of low-density lipoprotein (85.3 vs 90.9 mg/dl, p = 0.04) and triglycerides (87.1 vs 141.2 mg/dl, p <0.01), and a lower prevalence of diabetes (28.6% vs 38.4%, p = 0.05) compared with patients with normal HDL levels. In logistic regression models, patients with high HDL levels and CAD were less likely to have diabetes (adjusted odds ratio 0.60, 95% confidence interval 0.38 to 0.95, p = 0.03) or obesity (adjusted odds ratio 0.50, 95% confidence interval 0.25 to 0.99, p = 0.046) than patients with normal HDL levels and CAD. In conclusion, patients with high HDL and CAD had a similar or lower prevalence of traditional CAD risk factors compared with patients with normal HDL levels and CAD.

  17. Absolutely separating quantum maps and channels

    NASA Astrophysics Data System (ADS)

    Filippov, S. N.; Magadov, K. Yu; Jivulescu, M. A.

    2017-08-01

    Absolutely separable states ϱ remain separable under arbitrary unitary transformations U\\varrho {U}\\dagger . By example of a three qubit system we show that in a multipartite scenario neither full separability implies bipartite absolute separability nor the reverse statement holds. The main goal of the paper is to analyze quantum maps resulting in absolutely separable output states. Such absolutely separating maps affect the states in a way, when no Hamiltonian dynamics can make them entangled afterwards. We study the general properties of absolutely separating maps and channels with respect to bipartitions and multipartitions and show that absolutely separating maps are not necessarily entanglement breaking. We examine the stability of absolutely separating maps under a tensor product and show that {{{Φ }}}\\otimes N is absolutely separating for any N if and only if Φ is the tracing map. Particular results are obtained for families of local unital multiqubit channels, global generalized Pauli channels, and combination of identity, transposition, and tracing maps acting on states of arbitrary dimension. We also study the interplay between local and global noise components in absolutely separating bipartite depolarizing maps and discuss the input states with high resistance to absolute separability.

  18. Plasma total and high molecular weight adiponectin levels and risk of coronary heart disease in women

    PubMed Central

    Pischon, Tobias; Hu, Frank B.; Girman, Cynthia J.; Rifai, Nader; Manson, JoAnn E.; Rexrode, Kathryn M.; Rimm, Eric B.

    2011-01-01

    Objective To examine prospectively the association of total and high molecular weight (HMW) adiponectin, and HMW/total adiponectin ratio with risk of incident coronary heart disease (CHD) in women, and to examine to what extent adjustment for potentially intermediary variables would explain this association. Methods and Results Among 30,111 women from the Nurses’ Health Study, 468 women developed non-fatal myocardial infarction or fatal CHD during 14 years of follow-up. Using risk set sampling, controls were selected 2:1 matched on age, smoking, and date of blood draw. Adjusted for matching factors, parental history of myocardial infarction, hormone replacement therapy, alcohol consumption, physical activity, body mass index, hypertension, and low-density lipoprotein cholesterol levels, the relative risk in the highest versus lowest quintile was 0.50 (95%-CI 0.33-0.75; p trend=0.001) for total adiponectin, 0.53 (95%-CI 0.35-0.80; p trend=0.004) for HMW adiponectin, and 0.63 (95%-CI 0.43-0.93; p trend=0.03) for HMW/total adiponectin ratio. After adjustment for diabetes, HDL-cholesterol, HbA1c, and CRP these associations were attenuated and no longer significant (RRs, 0.84; 95%-CI 0.53-1.33; p trend=0.62; 0.95; 95%-CI 0.60-1.52; p trend=0.98; 0.97; 95%-CI 0.64-1.47; p trend=0.80). Conclusions High levels of total and HMW adiponectin, and HMW/total adiponectin ratio are associated with a lower risk of CHD among women. HMW adiponectin and HMW/total adiponectin ratio are not more closely related to risk than total adiponectin. These associations are largely mediated by parameters related to glucose and lipid metabolism and inflammation, especially HDL-cholesterol levels. PMID:21813129

  19. Plasma total and high molecular weight adiponectin levels and risk of coronary heart disease in women.

    PubMed

    Pischon, Tobias; Hu, Frank B; Girman, Cynthia J; Rifai, Nader; Manson, JoAnn E; Rexrode, Kathryn M; Rimm, Eric B

    2011-11-01

    To examine prospectively the association of total and high molecular weight (HMW) adiponectin, and HMW/total adiponectin ratio with risk of incident coronary heart disease (CHD) in women, and to examine to what extent adjustment for potentially intermediary variables would explain this association. Among 30,111 women from the Nurses' Health Study, 468 women developed non-fatal myocardial infarction or fatal CHD during 14 years of follow-up. Using risk set sampling, controls were selected 2:1 matched on age, smoking, and date of blood draw. Adjusted for matching factors, parental history of myocardial infarction, hormone replacement therapy, alcohol consumption, physical activity, body mass index, hypertension, and low-density lipoprotein cholesterol levels, the relative risk in the highest versus lowest quintile was 0.50 (95%-CI 0.33-0.75; p trend=0.001) for total adiponectin, 0.53 (95%-CI 0.35-0.80; p trend=0.004) for HMW adiponectin, and 0.63 (95%-CI 0.43-0.93; p trend=0.03) for HMW/total adiponectin ratio. After adjustment for diabetes, HDL-cholesterol, HbA1c, and CRP these associations were attenuated and no longer significant (RRs, 0.84; 95%-CI 0.53-1.33; p trend=0.62; 0.95; 95%-CI 0.60-1.52; p trend=0.98; 0.97; 95%-CI 0.64-1.47; p trend=0.80). High levels of total and HMW adiponectin, and HMW/total adiponectin ratio are associated with a lower risk of CHD among women. HMW adiponectin and HMW/total adiponectin ratio are not more closely related to risk than total adiponectin. These associations are largely mediated by parameters related to glucose and lipid metabolism and inflammation, especially HDL-cholesterol levels. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. A heart-coronary arteries structure of carbon nanofibers/graphene/silicon composite anode for high performance lithium ion batteries.

    PubMed

    Ma, Xiaoxin; Hou, Guangmei; Ai, Qing; Zhang, Lin; Si, Pengchao; Feng, Jinkui; Ci, Lijie

    2017-08-29

    In an animal body, coronary arteries cover around the whole heart and supply the necessary oxygen and nutrition so that the heart muscle can survive as well as can pump blood in and out very efficiently. Inspired by this, we have designed a novel heart-coronary arteries structured electrode by electrospinning carbon nanofibers to cover active anode graphene/silicon particles. Electrospun high conductive nanofibers serve as veins and arteries to enhance the electron transportation and improve the electrochemical properties of the active "heart" particles. This flexible binder free carbon nanofibers/graphene/silicon electrode consists of millions of heart-coronary arteries cells. Besides, in the graphene/silicon "hearts", graphene network improves the electrical conductivity of silicon nanopaticles, buffers the volume change of silicon, and prevents them from directly contacting with electrolyte. As expected, this novel composite electrode demonstrates excellent lithium storage performance with a 86.5% capacity retention after 200 cycles, along with a high rate performance with a 543 mAh g(-1) capacity at the rate of 1000 mA g(-1).

  1. Integrative physiology of coronary microcirculation.

    PubMed

    Kajiya, F; Goto, M

    1999-06-01

    Coronary microvessels play a crucial role for mechanoenergetic interaction between blood flow and myocardial function, which is not uniform transmurally. Thus, highly organized vascular regulations are required for matching local blood flow with myocardial energy requirement. Recently, new technologies to investigate in vivo coronary microcirculation with new knowledge of the signaling molecules for vascular regulation have revolutionized our abilities to understand the integrative regulation of coronary microcirculation. In this review, the mechanical aspects of the interaction between coronary blood flow and myocardium, coronary arte-rial tree and its roles in myocardial blood flow regulation, hierarchical and dynamic control of coronary flow, capillary network and function, function of venous drainage system, and molecular and cellular aspects of integrative coronary blood flow regulation are discussed, focusing on their integrational roles in maintaining coronary microvascular function and cell signaling.

  2. Absolute rate of the reaction of atomic hydrogen with ethylene from 198 to 320 K at high pressure

    NASA Technical Reports Server (NTRS)

    Lee, J. H.; Michael, J. V.; Payne, W. A.; Stief, L. J.

    1978-01-01

    The rate constant for the H+C2H4 reaction has been measured as a function of temperature. Experiments were performed with high pressures of Ar heat bath gas at seven temperatures from 198 to 320 K with the flash photolysis-resonance fluorescence (FP-RF) technique. Pressures were chosen so as to isolate the addition rate constant k1. The results are well represented by an Arrhenius expression. The results are compared with other studies and are theoretically discussed.

  3. Highly Luminescent Phase-Stable CsPbI3 Perovskite Quantum Dots Achieving Near 100% Absolute Photoluminescence Quantum Yield.

    PubMed

    Liu, Feng; Zhang, Yaohong; Ding, Chao; Kobayashi, Syuusuke; Izuishi, Takuya; Nakazawa, Naoki; Toyoda, Taro; Ohta, Tsuyoshi; Hayase, Shuzi; Minemoto, Takashi; Yoshino, Kenji; Dai, Songyuan; Shen, Qing

    2017-09-19

    Perovskite quantum dots (QDs) as a new type of colloidal nanocrystals have gained significant attention for both fundamental research and commercial applications owing to their appealing optoelectronic properties and excellent chemical processability. For their wide range of potential applications, synthesizing colloidal QDs with high crystal quality is of crucial importance. However, like most common QD systems such as CdSe and PbS, those reported perovskite QDs still suffer from a certain density of trapping defects, giving rise to detrimental nonradiative recombination centers and thus quenching luminescence. In this paper, we show that a high room-temperature photoluminescence quantum yield of up to 100% can be obtained in CsPbI3 perovskite QDs, signifying the achievement of almost complete elimination of the trapping defects. This is realized with our improved synthetic protocol that involves introducing organolead compound trioctylphosphine-PbI2 (TOP-PbI2) as the reactive precursor, which also leads to a significantly improved stability for the resulting CsPbI3 QD solutions. Ultrafast kinetic analysis with time-resolved transient absorption spectroscopy evidence the negligible electron or hole-trapping pathways in our QDs, which explains such a high quantum efficiency. We expect the successful synthesis of the "ideal" perovskite QDs will exert profound influence on their applications to both QD-based light-harvesting and -emitting devices.

  4. Effect of high-dose rosuvastatin loading before percutaneous coronary intervention in Chinese patients with acute coronary syndrome: A systematic review and meta-analysis

    PubMed Central

    Su, Qiang; Guo, Wenqin; Dai, Weiran; Li, Hongqing; Yang, Huafeng; Li, Lang

    2017-01-01

    Background Acute coronary syndrome (ACS) is an important disease threatening human life and health. Many studies have shown that the loading dose of atorvastatin can significantly improve the prognosis of patients with ACS, and reduce the mortality. However, this conclusion is not consistent. Thus, we aimed to evaluate the effect of high-dose rosuvastatin loading before percutaneous coronary intervention (PCI) in Chinese patients with ACS using a meta-analysis based on a systematic review of published articles. Methods We systematically reviewed published studies, evaluating the effect of high-dose rosuvastatin loading before percutaneous coronary intervention in Chinese patients with ACS. The retrieval time is limited from inception to 2 November 2016, and the retrieved databases included PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, the VIP database and the Wang Fang database. Two researchers independently assessed the quality of the included studies and then extracted the data. Stata 11.0 was used for data analysis. Results In total, 11 articles, which included 802 patients, were included in our meta-analysis. Among these patients, 398 patients were in the high-dose group (20 mg/day) and 404 patients were in the conventional dose group (10 mg/day). Meta-analysis results showed that compared with the conventional dose group: 1) The loading dose of rosuvastatin can significantly reduce the hs-CRP level after PCI, including at 24 hours (SMD = -0.65, 95%CI -0.84 ~ -0.47, P = 0.000), 48 hours (SMD = -0.40, 95%CI -0.68 ~ -0.11, P = 0.006), and four weeks (SMD = -1.64, 95%CI -2.01 ~ -1.26, P = 0.000). 2) The loading dose of rosuvastatin can significantly reduce the levels of LDL-C and cTnT, including the level of LDL-C at 30 d after PCI (SMD = -0.89, 95%CI -1.10 ~ -0.69, P = 0.000), and the level of cTnT at 24 h after PCI (SMD = -1.93, 95%CI -2.28 ~ -1.59, P = 0.000), and increase the level of HDL-C at 48 h after PCI (SMD = 0.61, 95%CI 0.34 ~ 0.88, P

  5. High-resolution tangential absolute extreme ultraviolet arrays for radiated power density measurements on NSTX-U

    SciTech Connect

    Delgado-Aparicio, L.; Bell, R. E.; Diallo, A.; Gerhardt, S. P.; Kozub, T. A.; LeBlanc, B. P.; Stratton, B. C.; Faust, I.; Tritz, K.

    2014-11-15

    The radiated-power-density diagnostic on the equatorial midplane for the NSTX-U tokamak will be upgraded to measure the radial structure of the photon emissivity profile with an improved radial resolution. This diagnostic will enhance the characterization and studies of power balance, impurity transport, and MHD. The layout and response expected of the new system is shown for different plasma conditions and impurity concentrations. The effect of toroidal rotation driving poloidal asymmetries in the core radiation from high-Z impurities is also addressed.

  6. A high-performance liquid chromatography-electronic circular dichroism online method for assessing the absolute enantiomeric excess and conversion ratio of asymmetric reactions

    PubMed Central

    Zhang, Xiang; Wang, Mingchao; Li, Li; Yin, Dali

    2017-01-01

    Asymmetric reactions often need to be evaluated during the synthesis of chiral compounds. However, traditional evaluation methods require the isolation of the individual enantiomer, which is tedious and time-consuming. Thus, it is desirable to develop simple, practical online detection methods. We developed a method based on high-performance liquid chromatography-electronic circular dichroism (HPLC-ECD) that simultaneously analyzes the material conversion ratio and absolute optical purity of each enantiomer. In particular, only a reverse-phase C18 column instead of a chiral column is required in our method because the ECD measurement provides a g-factor that describes the ratio of each enantiomer in the mixtures. We used our method to analyze the asymmetric hydrosilylation of β-enamino esters, and we discussed the advantage, feasibility, and effectiveness of this new methodology. PMID:28252028

  7. A high-performance liquid chromatography-electronic circular dichroism online method for assessing the absolute enantiomeric excess and conversion ratio of asymmetric reactions

    NASA Astrophysics Data System (ADS)

    Zhang, Xiang; Wang, Mingchao; Li, Li; Yin, Dali

    2017-03-01

    Asymmetric reactions often need to be evaluated during the synthesis of chiral compounds. However, traditional evaluation methods require the isolation of the individual enantiomer, which is tedious and time-consuming. Thus, it is desirable to develop simple, practical online detection methods. We developed a method based on high-performance liquid chromatography-electronic circular dichroism (HPLC-ECD) that simultaneously analyzes the material conversion ratio and absolute optical purity of each enantiomer. In particular, only a reverse-phase C18 column instead of a chiral column is required in our method because the ECD measurement provides a g-factor that describes the ratio of each enantiomer in the mixtures. We used our method to analyze the asymmetric hydrosilylation of β-enamino esters, and we discussed the advantage, feasibility, and effectiveness of this new methodology.

  8. A high-performance liquid chromatography-electronic circular dichroism online method for assessing the absolute enantiomeric excess and conversion ratio of asymmetric reactions.

    PubMed

    Zhang, Xiang; Wang, Mingchao; Li, Li; Yin, Dali

    2017-03-02

    Asymmetric reactions often need to be evaluated during the synthesis of chiral compounds. However, traditional evaluation methods require the isolation of the individual enantiomer, which is tedious and time-consuming. Thus, it is desirable to develop simple, practical online detection methods. We developed a method based on high-performance liquid chromatography-electronic circular dichroism (HPLC-ECD) that simultaneously analyzes the material conversion ratio and absolute optical purity of each enantiomer. In particular, only a reverse-phase C18 column instead of a chiral column is required in our method because the ECD measurement provides a g-factor that describes the ratio of each enantiomer in the mixtures. We used our method to analyze the asymmetric hydrosilylation of β-enamino esters, and we discussed the advantage, feasibility, and effectiveness of this new methodology.

  9. Optically based quantification of absolute cerebral metabolic rate of oxygen (CMRO2) with high spatial resolution in rodents

    NASA Astrophysics Data System (ADS)

    Yaseen, Mohammad A.; Srinivasan, Vivek J.; Sakadžić, Sava; Vinogradov, Sergei A.; Boas, David A.

    2010-02-01

    Measuring oxygen delivery in brain tissue is important for identifying the pathophysiological changes associated with brain injury and various diseases such as cancer, stroke, and Alzheimer's disease. We have developed a multi-modal imaging system for minimally invasive measurement of cerebral oxygenation and blood flow in small animals with high spatial resolution. The system allows for simultaneous measurement of blood flow using Fourier-domain optical coherence tomography, and oxygen partial pressure (pO2) using either confocal or multiphoton phosphorescence lifetime imaging with exogenous porphyrin-based dyes sensitive to dissolved oxygen. Here we present the changes in pO2 and blood flow in superficial cortical vessels of Sprague Dawley rats in response to conditions such as hypoxia, hyperoxia, and functional stimulation. pO2 measurements display considerable heterogeneity over distances that cannot be resolved with more widely used oxygen-monitoring techniques such as BOLD-fMRI. Large increases in blood flow are observed in response to functional stimulation and hypoxia. Our system allows for quantification of cerebral metabolic rate of oxygen (CMRO2) with high spatial resolution, providing a better understanding of metabolic dynamics during functional stimulation and under various neuropathologies. Ultimately, better insight into the underlying mechanisms of neuropathologies will facilitate the development of improved therapeutic strategies to minimize damage to brain tissue.

  10. Association between plasma high-molecular-weight adiponectin and coronary plaque characteristics assessed by computed tomography angiography in conditions of visceral adipose accumulation.

    PubMed

    Kunita, Eiji; Yamamoto, Hideya; Kitagawa, Toshiro; Ohashi, Norihiko; Utsunomiya, Hiroto; Oka, Toshiharu; Horiguchi, Jun; Awai, Kazuo; Kihara, Yasuki

    2012-01-01

    Our group has previously reported that visceral adipose tissue (VAT) accumulation was associated with the extent and vulnerable characteristics of coronary plaques using coronary computed tomography angiography (CTA). An investigation of the associations between these coronary lesions with plasma adiponectin and leptin was performed. A total of 394 patients (220 men and 174 women) in the study were referred for CTA. Plain abdominal scanning was simultaneously performed to evaluate VAT areas. The median level of plasma high-molecular-weight (HMW) adiponectin in patients with CTA-based obstructive coronary artery disease was significantly lower than that in patients without (men: 1.45 vs. 1.88 µg/ml, P=0.002; women: 2.49 vs. 3.44 µg/ml, P<0.001). Multivariate analyses revealed that a lower HMW adiponectin concentration was significantly associated with the presence (men: P=0.019; women: P=0.018) and involved segment numbers (men: P=0.001; women: P=0.003) of coronary plaques. Furthermore, it was significantly related to coronary plaque with all 3 vulnerable characteristics of positive remodeling, low CT density (≤38 Hounsfield units), and adjacent spotty calcium (men: P=0.019; women: P=0.016). These associations were also observed with VAT areas, but not with plasma leptin concentrations, in both genders. Lower plasma HMW adiponectin is associated with the presence, extent, and vulnerable characteristics of coronary plaques assessed by CTA in both genders.

  11. First evidence of biogenic habitat from tubeworms providing a near-absolute habitat requirement for high-intertidal Ulva macroalgae.

    PubMed

    Liversage, Kiran

    2017-01-01

    Disturbances in ecological systems can cause new resources to become available and can free the resources held by strongly competitive species. In intertidal boulder fields, wave-action causes disturbance by overturning boulders and freeing space for re-colonisation. In this study, mensurative experiments showed that boulder disturbance may also cause new biogenic-habitat resources to become available, if pre-disturbance boulders originally had tubeworm encrustations on their undersides. On the high-shore of a South Australian rocky coast, a small proportion of boulders had extensive encrustations of serpulid and spirorbid worm-tubes on their uppersides, and were likely to have recently been overturned, as spirorbid tubeworms are almost always only underneath boulders while living. Ulva macroalgae was absent from all boulders, except those with worm-tubes, where up to 61% Ulva cover was observed. Many boulders with tubes did not, however, have much algae, and this was likely caused by grazing. While limpets were seldom observed attached to tube encrustations, snails such as Nerita atramentosa and Bembicium nanum were equally abundant on and off tubes. N. atramentosa was likely the main grazer, as its densities were negatively correlated with Ulva cover. The mechanism causing association of Ulva and worm-tubes is unknown, but may be related to retention of moisture or algal spores within the complex topography of the tubes. Alternatively, some tubes may still have been living and providing nutrients for Ulva from excretory products. This study takes the first step towards understanding a very distinct habitat requirement which allows an important alga to persist in the hostile environment of the rocky-intertidal high shore.

  12. Small high-density lipoprotein is associated with monocyte subsets in stable coronary artery disease

    PubMed Central

    Krychtiuk, Konstantin A.; Kastl, Stefan P.; Pfaffenberger, Stefan; Pongratz, Thomas; Hofbauer, Sebastian L.; Wonnerth, Anna; Katsaros, Katharina M.; Goliasch, Georg; Gaspar, Ludovit; Huber, Kurt; Maurer, Gerald; Dostal, Elisabeth; Oravec, Stanislav; Wojta, Johann; Speidl, Walter S.

    2014-01-01

    Objective: High-density lipoprotein (HDL) particles are heterogeneous in structure and function and the role of HDL subfractions in atherogenesis is not well understood. It has been suggested that small HDL may be dysfunctional in patients with coronary artery disease (CAD). Monocytes are considered to play a key role in atherosclerotic diseases. Circulating monocytes can be divided into three subtypes according to their surface expression of CD14 and CD16. Our aim was to examine whether monocyte subsets are associated with HDL subfractions in patients with atherosclerosis. Methods: We included 90 patients with angiographically stable CAD. Monocyte subsets were defined as classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14+CD16++; NCM). HDL subfractions were measured by electrophoresis on polyacrylamide gel. Results: Serum levels of small HDL correlated with circulating pro-inflammatory NCM and showed an inverse relationship to circulating CM independently from other lipid parameters, risk factors, inflammatory parameters or statin treatment regime, respectively. IM were not associated with small HDL. In particular, patients with small HDL levels in the highest tertile showed dramatically increased levels of NCM (14.7 ± 7% vs. 10.7 ± 5% and 10.8 ± 5%; p = 0.006) and a decreased proportion of CM (79.3 ± 7% vs. 83.7 ± 6% and 83.9 ± 6%; p = 0.004) compared to patients in the two lower tertiles. In contrast, intermediate HDL, large HDL and total HDL were not associated with monocyte subset distribution. Conclusion: Small HDL levels are associated with pro-inflammatory NCM and inversely correlated with CM. This may suggest that small HDL could have dysfunctional anti-inflammatory properties in patients with established CAD. PMID:25463093

  13. Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries.

    PubMed

    Shimony, Avi; Grandi, Sonia M; Pilote, Louise; Joseph, Lawrence; O'Loughlin, Jennifer; Paradis, Gilles; Rinfret, Stéphane; Sarrafzadegan, Nizal; Adamjee, Nasreen; Yadav, Rakesh; Gamra, Habib; Diodati, Jean G; Eisenberg, Mark J

    2014-03-01

    Limited data exist regarding the management of patients with acute coronary syndrome (ACS) in high-income countries compared with low/middle-income countries. We aimed to compare in-hospital trends of revascularization and prescription of medications at discharge in patients with ACS from high-income (Canada and United States) and low/middle-income (India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind, placebo-controlled, randomized trial investigating the effect of bupropion on smoking cessation in patients after an enzyme-positive ACS was used for our study. A total of 392 patients, 265 and 127 from high-income and from low/middle-income countries, respectively, were enrolled. Patients from high-income countries were older, and were more likely to have diagnosed hypertension and dyslipidemia. During the index hospitalization, patients from high-income countries were more likely to be treated by percutaneous coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI] 10.5 to 37.0). Patients with ST elevation myocardial infarction from high-income countries were more often treated by primary percutaneous coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from high-income countries were also more likely to receive evidence-based medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of aspirin, clopidogrel, and statin). In conclusion, patients with ACS in low/middle-income countries were less likely to be revascularized and to receive evidence-based medications at discharge. Further studies are needed to understand the underutilization of procedures and evidence-based medications in low/middle-income countries. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio With Presence and Severity of Isolated Coronary Artery Ectasia.

    PubMed

    Kundi, Harun; Gok, Murat; Kiziltunc, Emrullah; Cetin, Mustafa; Cicekcioglu, Hulya; Cetin, Zehra Guven; Karayigit, Orhan; Ornek, Ender

    2015-12-01

    The aim of this study was to investigate an easily available inflammatory and oxidative stress marker and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with coronary artery ectasia (CAE). The study population included 405 patients of which 135 patients had isolated CAE, 135 patients had obstructive coronary artery disease (CAD), and 135 patients had normal coronary angiograms (NCAs). The severity of isolated CAE was determined according to the Markis classification. The MHR was significantly greater in patients with isolated CAE than those with obstructive CAD and NCAs: 14.8 (11.6 to 19.8), 11.4 (9.6 to 13.5), 9.8 (7.5 to 11.9), respectively. Linear regression analyses showed that MHR and C-reactive protein were significantly related with the severity of isolated CAE. In conclusion, the MHR is significantly greater in patients with CAE compared to controls with obstructive CAD and NCAs, and MHR is associated with the severity of CAE. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. [Coronary artery ectasia: etiopathogenesis, diagnosis and treatment].

    PubMed

    Dendramis, Gregory; Paleologo, Claudia; Lo Presti, Alfonso; Piraino, Davide; Lo Greco, Vito; Grassedonio, Emanuele; La Grutta, Ludovico; Midiri, Massimo; Assennato, Pasquale; Novo, Salvatore

    2014-03-01

    Coronary ectasia is a dilation of coronary arteries, angiographically defined if the diameter of the artery is ≥ 1.5 times greater than that of the intact adjacent vascular segment. An association has been found between coronary artery ectasia and a broad spectrum of different diseases, first of all atherosclerotic coronary artery disease. The mechanisms that determine the abnormal dilatation of the vascular lumen and the etiology of coronary artery ectasia are still poorly understood. Various hypotheses have been formulated over the time, the most accredited between these recognizes as main responsible an uncontrolled activity of a particular family of enzymes that degrade the extracellular matrix, the metalloproteinases. This exaggerated activity can be due to an increase in the absolute sense of these enzymes and/or a reduction in the levels of their natural specific inhibitors. Coronary ectasia may have a variable clinical presentation. It is often an occasional finding detected at coronary angiography or following the occurrence of atypical chest pain, stable angina or even acute coronary syndrome. The frequent coexistence of coronary artery ectasia and atherosclerotic coronary artery disease and their common histopathological features have led to hypothesize that coronary ectasia may represent a variant of atherosclerosis. However, some significant differences between these two diseases leave open the hypothesis that coronary artery ectasia may be a pathological entity per se.

  16. Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk.

    PubMed

    Urban, Philip; Meredith, Ian T; Abizaid, Alexandre; Pocock, Stuart J; Carrié, Didier; Naber, Christoph; Lipiecki, Janusz; Richardt, Gert; Iñiguez, Andres; Brunel, Philippe; Valdes-Chavarri, Mariano; Garot, Philippe; Talwar, Suneel; Berland, Jacques; Abdellaoui, Mohamed; Eberli, Franz; Oldroyd, Keith; Zambahari, Robaayah; Gregson, John; Greene, Samantha; Stoll, Hans-Peter; Morice, Marie-Claude

    2015-11-19

    Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month. In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization. We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001). Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).

  17. Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery.

    PubMed

    Sheriff, Mohammed J; Mouline, Omar; Hsu, Chijen; Grieve, Stuart M; Wilson, Michael K; Bannon, Paul G; Vallely, Michael P; Puranik, Rajesh

    2016-06-01

    The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (high euroSCORE II (>16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated. The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications. Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  18. Absolute and relative blindsight.

    PubMed

    Balsdon, Tarryn; Azzopardi, Paul

    2015-03-01

    The concept of relative blindsight, referring to a difference in conscious awareness between conditions otherwise matched for performance, was introduced by Lau and Passingham (2006) as a way of identifying the neural correlates of consciousness (NCC) in fMRI experiments. By analogy, absolute blindsight refers to a difference between performance and awareness regardless of whether it is possible to match performance across conditions. Here, we address the question of whether relative and absolute blindsight in normal observers can be accounted for by response bias. In our replication of Lau and Passingham's experiment, the relative blindsight effect was abolished when performance was assessed by means of a bias-free 2AFC task or when the criterion for awareness was varied. Furthermore, there was no evidence of either relative or absolute blindsight when both performance and awareness were assessed with bias-free measures derived from confidence ratings using signal detection theory. This suggests that both relative and absolute blindsight in normal observers amount to no more than variations in response bias in the assessment of performance and awareness. Consideration of the properties of psychometric functions reveals a number of ways in which relative and absolute blindsight could arise trivially and elucidates a basis for the distinction between Type 1 and Type 2 blindsight.

  19. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients: Results with Use of a High Sensitivity Polymerase Chain Reaction Assay.

    PubMed

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik; Holmstrup, Palle; Helqvist, Steffen; Tolker-Nielsen, Tim; Givskov, Michael; Hansen, Peter Riis

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25-125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon.

  20. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients: Results with Use of a High Sensitivity Polymerase Chain Reaction Assay

    PubMed Central

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik; Holmstrup, Palle; Helqvist, Steffen; Tolker-Nielsen, Tim; Givskov, Michael; Hansen, Peter Riis

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25–125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon. PMID:26695491

  1. Monolithically integrated absolute frequency comb laser system

    SciTech Connect

    Wanke, Michael C.

    2016-07-12

    Rather than down-convert optical frequencies, a QCL laser system directly generates a THz frequency comb in a compact monolithically integrated chip that can be locked to an absolute frequency without the need of a frequency-comb synthesizer. The monolithic, absolute frequency comb can provide a THz frequency reference and tool for high-resolution broad band spectroscopy.

  2. Absolute optical metrology : nanometers to kilometers

    NASA Technical Reports Server (NTRS)

    Dubovitsky, Serge; Lay, O. P.; Peters, R. D.; Liebe, C. C.

    2005-01-01

    We provide and overview of the developments in the field of high-accuracy absolute optical metrology with emphasis on space-based applications. Specific work on the Modulation Sideband Technology for Absolute Ranging (MSTAR) sensor is described along with novel applications of the sensor.

  3. Pioglitazone inhibits high glucose-induced expression of receptor for advanced glycation end products in coronary artery smooth muscle cells

    PubMed Central

    DI, BEI-BING; LI, HONG-WEI; LI, WEI-PING; SHEN, XU-HUA; SUN, ZHI-JUN; WU, XING

    2015-01-01

    Receptor for advanced glycation end products (RAGE) is critical in inflammatory diseases, including diabetes and atherosclerosis. The mechanism underlying the effect of peroxisome proliferator-activated receptor γ (PPARγ) agonist pioglitazone (PIO) on RAGE expression in coronary artery smooth muscle cells (SMCs) stimulated by high glucose concentrations remains to be elucidated. In the present study, the effect and mechanism of action of PIO on RAGE expression in SMCs was investigated following treatment with high glucose concentrations. Rat coronary artery SMCs were pretreated with PIO alone, PIO and GW9662 (a PPARγ antagonist), diphenyleneiodonium (DPI; a nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor) or the antioxidant pyrrolidine dithiocarbamate (PDTC; a nuclear factor-κB (NF-κB) inhibitor), followed by treatment with high glucose. RAGE mRNA and protein expression, reactive oxygen species (ROS) production and NF-κB nuclear translocation were investigated. Glucose induced RAGE expression in a dose-dependent manner, with maximal effect at a concentration of 25 mmol/l following treatment for 48 h. PIO, DPI and PDTC reduced high glucose-induced increases in RAGE protein and mRNA expression. PIO prominently downregulated RAGE expression and inhibited high glucose-induced increases in ROS production and NF-κB activation (P<0.05). Pretreatment with PIO and GW9662 did not exhibit this inhibitory effect. High glucose may stimulate RAGE expression in coronary artery SMCs through NADPH oxidase-mediated ROS generation and NF-κB activation. PIO downregulated RAGE expression and inhibited ROS production and NF-κB activation via PPARγ activation, which may prevent the inflammatory effect of AGE/RAGE system in diabetes. PMID:25523934

  4. High frequency of DQB1*05 and absolute absence of DRB1*13 in muscle-specific tyrosine kinase positive myasthenia gravis.

    PubMed

    Nikolic, A V; Andric, Z P; Simonovic, R B; Rakocevic Stojanovic, V M; Basta, I Z; Bojic, S D; Lavrnic, D V

    2015-01-01

    Myasthenia gravis (MG) is an autoimmune disease but certain genetic factors predispose its development. Since susceptibility to different forms of MG is linked to a number of allelic variants, the aim of this study was to explore the human leukocyte antigen (HLA) profile of our patients with muscle-specific tyrosine kinase (MuSK) MG. Human leukocyte antigen (HLA) typing was performed in our cohort of 31 MuSK MG patients available for the study. The allele groups of DRB1* and DQB1* loci were typed with sequence-specific oligonucleotide probes and high resolution typing for DQB1* was performed using sequence-specific primers. HLA frequencies were compared with unrelated healthy bone marrow donors. Significant association of MuSK MG with alleles DRB1*14 [odds ratio (OR) 3.8], DRB1*16 (OR 3.3) (P < 0.01) and DQB1*05 (OR 2.2) (P < 0.05) was found. In our patients the most frequent DQB1* allele was DQB1*05:02. An absolute absence of DRB1*13 in our cohort of MuSK MG patients was also found, whilst this allele was present in 25% (495/1992) of control subjects (OR 0) (P < 0.01). The HLA DRB1*16-DQB1*05 (OR 2.9) haplotype was found to be associated with MuSK MG (P < 0.05). The strong association of MuSK MG with DQB1*05 alleles observed in patient series from other countries was confirmed. The novel finding in our cohort of MuSK MG patients was the absolute absence of DRB1*13 allele, which might have a protective role in the development of MuSK MG, at least in our population. © 2014 EAN.

  5. Impact of High Risk for Obstructive Sleep Apnea on Survival after Acute Coronary Syndrome: Insights from the ERICO Registry

    PubMed Central

    Maia, Flavia C; Goulart, Alessandra C.; Drager, Luciano F.; Staniak, Henrique L.; Santos, Itamar de Souza; Lotufo, Paulo Andrade; Bensenor, Isabela M.

    2017-01-01

    Background Obstructive sleep apnea (OSA) is a very often clinical condition that can be associated with high mortality risk, particularly in coronary heart disease (CHD). The diagnosis of OSA is not always accessible via the gold-standard method polysomnography. Objective To evaluate long-term influence of the high risk for OSA on fatal and non-fatal outcomes after acute coronary syndrome (ACS) in the Acute Coronary Syndrome Registry Strategy (ERICO) Study using the Berlin questionnaire as a surrogate. Methods Berlin questionnaire, a screening questionnaire for OSA, was applied in 639 cases of ACS 30 days after the index event. Cox regression proportional-hazards model was used to calculate the hazard ratio (HR) of all-cause, cardiovascular and CHD (myocardial infarction) mortality, as well as, the combined endpoint of fatal or recurrent non-fatal CHD. Results The high-risk group for OSA had higher frequencies of previous personal/family history of CHD and diabetes, in addition to a poorer event-free survival, as compared to the low-risk group (p-log-rank=0.03). The HR for fatal or recurrent non-fatal CHD was 4.26 (95% confidence interval, 1.18 - 15.36) in patients at high risk for OSA compared to those at low risk for OSA after a 2.6-year mean follow-up. Conclusions Using Berlin questionnaire, we were able to identify high risk for OSA as an independent predictor of non-fatal reinfarction or CHD mortality in post-ACS individuals in a long-term follow-up. PMID:28146212

  6. Absolute radiation detector

    NASA Astrophysics Data System (ADS)

    Martin, John E.

    1996-11-01

    An absolute radiation detector (a cryogenic radiometer) is being developed to replace the existing UK primary national standard cryogenic radiometer with an improved uncertainty. The cryogenic radiometer will be capable of measuring black body radiation and laser radiation with an uncertainty approaching 10 ppm. From these measurements it will be possible to determine the fundamental constant, the Stefan Boltzmann constant, confirming the radiometer as an absolute detector, and link this determination to the SI unit of luminous intensity, the candela. Thus detector and source based scales/standards will be tied to an invariant physical quantity ensuring their long-term stability.

  7. The absolute path command

    SciTech Connect

    Moody, A.

    2012-05-11

    The ap command traveres all symlinks in a given file, directory, or executable name to identify the final absolute path. It can print just the final path, each intermediate link along with the symlink chan, and the permissions and ownership of each directory component in the final path. It has functionality similar to "which", except that it shows the final path instead of the first path. It is also similar to "pwd", but it can provide the absolute path to a relative directory from the current working directory.

  8. High sensitivity-troponin elevation secondary to non-coronary diagnoses and death and recurrent myocardial infarction: An examination against criteria of causality.

    PubMed

    Chew, Derek P; Briffa, Tom G; Alhammad, Nasser J; Horsfall, Matt; Zhou, Julia; Lou, Pey W; Coates, Penelope; Scott, Ian; Brieger, David; Quinn, Stephen J; French, John

    2015-10-01

    Myonecrosis provoked by illness unrelated to unstable coronary plaque is common, but uncertainty about a cause-effect relationship with future events challenges the appropriateness of initiating therapies known to be effective in cardiac conditions. We examined the causal relationship between troponin elevation in non-coronary diagnoses and late cardiac events using the Bradford Hills criteria for causality. Patients presenting acutely to South Australian public hospitals receiving at least one troponin between September 2011-September 2012 were included. Diagnoses were classified as coronary, non-coronary cardiac and non-cardiac using the International Classification of Diseases, version 10 Australian Modified, codes. The relationship between peak in-hospital troponin, using a high-sensitivity troponin T assay and adjudicated cardiac and non-cardiac mortality, and subsequent myocardial infarction (MI) was assessed using competing-risk flexible parametric survival models. Troponin results were available for 38,161 patients of whom, 12,645 (33.6%), 3237 (8.5%), and 22,079 (57.9%) patients were discharged with coronary, non-coronary cardiac and non-cardiac diagnoses, respectively. Troponin >14 ng/l was observed in 43.6%. The relationship between troponin and cardiac mortality was stronger among the non-coronary diagnosis group (troponin 1000 ng/l: coronary hazard ratio: 5.1 (95% confidence interval (CI) 4.0-6.6) vs non-coronary hazard ratio: 16.3 (95% CI 12.6-22.4)). The temporal hazard for cardiac death was marked within 30 days in both groups. Among non-coronary diagnoses, the hazard for recurrent MI was higher but did not vary with time. Consistency with causal criteria between secondary myonecrosis and cardiac events suggest the potential benefit for extending cardiac specific interventions to this population if supported in trials appropriately designed to address competing risks. Troponin elevation precipitated by non-coronary events is common and demonstrates

  9. [Treatment of hypertension in patients with coronary arterial disease].

    PubMed

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    Reports of randomized controlled trials and prospective observational studies provide the most reliable data on the association between blood pressure and coronary heart disease (CHD). The totality of the evidence indicate a strong association between blood pressure and coronary heart disease, which is continuous at levels of less than 115 mm Hg of systolic. In general, 60 to 69 years of age, 10 lower mm Hg systolic blood pressure is associated with lower risk of one-fifth of a coronary heart disease event. The size and shape of this Association are consistent in all regions, for men and women and life-threatening events such as stroke and myocardial infarction. Trials that compared active treatment with placebo or no treatment have shown that the benefits of reducing blood pressure with different classes of drugs (e.g., diuretics, beta-blockers, ACE inhibitors, calcium antagonists) are quite similar, with about a fifth of reduction in coronary heart disease. The important points in this review are: First, that the relative benefit to the decline in blood pressure for the prevention of coronary heart disease appears to be constant in a range of different populations. Second, it is likely that considerable benefit with blood pressure low below thresholds of "traditional" blood pressure (140/90 mm Hg), especially in those with high absolute risk. Third, start, reduce with caution -especially in adult- and keep the maximum tolerance of blood pressure reduction is an issue more important than the choice of the initial agent.

  10. Angiotensin converting enzyme gene polymorphism is associated with severity of coronary artery disease in men with high total cholesterol levels.

    PubMed

    Borzyszkowska, Joanna; Stanislawska-Sachadyn, Anna; Wirtwein, Marcin; Sobiczewski, Wojciech; Ciecwierz, Dariusz; Targonski, Radoslaw; Gruchala, Marcin; Rynkiewicz, Andrzej; Limon, Janusz

    2012-05-01

    This study examines whether renin-angiotensin-aldosterone system gene polymorphisms: ACE (encoding for angiotensin converting enzyme) c.2306-117_404 I/D, AGTR1 (encoding for angiotensin II type-1 receptor) c.1080*86A>C and CYP11B2 (encoding for aldosterone synthase) c.-344C>T are associated with the extension of coronary atherosclerosis in a group of 647 patients who underwent elective coronary angiography. The extension of CAD was evaluated using the Gensini score. The polymorphisms were determined by PCR and RFLP assays. The associations between genotypes and the extent of coronary atherosclerosis were tested by the Kruskal-Wallis test, followed by pairwise comparisons using Wilcoxon test. The population has been divided into groups defined by: sex, smoking habit, past myocardial infarction, BMI (>, ≤ 25), age (>, ≤ 55), diabetes mellitus, level of total cholesterol (>, ≤ 200 mg/dl), LDL cholesterol (>, ≤ 130 mg/dl), HDL cholesterol (>, ≤ 40 mg/dl), triglycerides (>, ≤ 150 mg/dl). Significant associations between the ACE c.2306-117_404 I/D polymorphism and the Gensini score in men with high total cholesterol levels (P(Kruskal-Wallis) = 0.008; P(adjusted) = 0.009), high level of LDL cholesterol (P(Kruskal-Wallis) = 0.016; P(adjusted) = 0.028) and low level of HDL cholesterol (P(Kruskal-Wallis) = 0.04; P(adjusted) = 0.055) have been found. No association between the AGTR1 c.1080*86A>C and CYP11B2 c.-344C>T and the Gensini score has been found. These results suggest that men who carry ACE c.2306-117_404 DD genotype and have high total cholesterol, high LDL cholesterol and low HDL cholesterol levels may be predisposed to the development of more severe CAD.

  11. High-sensitivity C-reactive protein and exercise-induced changes in subjects suspected of coronary artery disease

    PubMed Central

    Mouridsen, Mette Rauhe; Nielsen, Olav Wendelboe; Carlsen, Christian Malchau; Mattsson, Nick; Ruwald, Martin H; Binici, Zeynep; Sajadieh, Ahmad

    2014-01-01

    Background Inflammation plays a major role in the development of atherosclerosis. We wanted to investigate the effects of exercise on high-sensitivity (hs) C-reactive protein (CRP) in subjects who were suspected of having coronary artery disease (CAD). Methods Blood samples were obtained before, 5 minutes after, and 20 hours after an exercise test in 155 subjects who were suspected of CAD. Coronary anatomy was evaluated by computed tomography coronary angiography and/or coronary angiography. Results Median baseline hs-CRP was higher in subjects with ≥50% coronary artery lumen diameter stenosis (n=41), compared with non-CAD-subjects (n=114), 2.93 mg/L (interquartile range 1.03–5.06 mg/L) and 1.30 mg/L (interquartile range 0.76–2.74 mg/L), respectively, P=0.007. In multivariate analyses testing conventional risk factors, hs-CRP proved borderline significant, odds ratio =2.32, P=0.065. Adding baseline hs-CRP to the results of the exercise test did not improve the diagnostic evaluation. Baseline natural logarithm (Ln) hs-CRP was positively associated with body mass index and baseline Ln-transformed hs troponin T levels, and negatively associated with the daily life activity level. An increase in hs-CRP of 0.13 mg/L (interquartile range 0.05–0.24 mg/L) from baseline to 5 minutes after peak exercise was found (P<0.0001), but the increase was not associated with presence of CAD. From baseline to 20 hours after exercise, no increase in hs-CRP was found. Conclusion In conclusion, hs-CRP was not independently associated with CAD. Hs-CRP increased immediately as a response to the exercise, and the increase was modest and not associated with CAD. The results indicate that exercise has potential to cause unwanted variations in hs-CRP and that exercise prior to hs-CRP measurements in subjects included in epidemiological studies, therefore, should be avoided. PMID:24715762

  12. Estimating Absolute Site Effects

    SciTech Connect

    Malagnini, L; Mayeda, K M; Akinci, A; Bragato, P L

    2004-07-15

    The authors use previously determined direct-wave attenuation functions as well as stable, coda-derived source excitation spectra to isolate the absolute S-wave site effect for the horizontal and vertical components of weak ground motion. They used selected stations in the seismic network of the eastern Alps, and find the following: (1) all ''hard rock'' sites exhibited deamplification phenomena due to absorption at frequencies ranging between 0.5 and 12 Hz (the available bandwidth), on both the horizontal and vertical components; (2) ''hard rock'' site transfer functions showed large variability at high-frequency; (3) vertical-motion site transfer functions show strong frequency-dependence, and (4) H/V spectral ratios do not reproduce the characteristics of the true horizontal site transfer functions; (5) traditional, relative site terms obtained by using reference ''rock sites'' can be misleading in inferring the behaviors of true site transfer functions, since most rock sites have non-flat responses due to shallow heterogeneities resulting from varying degrees of weathering. They also use their stable source spectra to estimate total radiated seismic energy and compare against previous results. they find that the earthquakes in this region exhibit non-constant dynamic stress drop scaling which gives further support for a fundamental difference in rupture dynamics between small and large earthquakes. To correct the vertical and horizontal S-wave spectra for attenuation, they used detailed regional attenuation functions derived by Malagnini et al. (2002) who determined frequency-dependent geometrical spreading and Q for the region. These corrections account for the gross path effects (i.e., all distance-dependent effects), although the source and site effects are still present in the distance-corrected spectra. The main goal of this study is to isolate the absolute site effect (as a function of frequency) by removing the source spectrum (moment-rate spectrum) from

  13. Efficacy of high intensity atorvastatin versus moderate intensity atorvastatin for acute coronary syndrome patients with diabetes mellitus.

    PubMed

    Liu, Zhi; Xu, Yueqiao; Hao, Hengjian; Yin, Chunlin; Xu, Ji; Li, Jing; Wang, Yanling; Xu, Dong

    2016-11-01

    To investigate whether more benefits can be achieved through high intensity atorvastatin compared with moderate intensity atorvastatin in acute coronary syndrome (ACS) patients with diabetes mellitus (DM). This was a randomized controlled trail. Total 591 ACS patients with DM who underwent percutaneous coronary intervention were enrolled, 297 in high intensity atorvastatin group (40mg/day) and 294 in moderate intensity atorvastatin group (20mg/day). The primary end point was one-year incidence of major adverse cardiovascular events (MACE, including cardiovascular death, spontaneous myocardial infarction, unplanned revascularization). Cox proportional hazard regression models were used to analyze the association between clinical endpoints and atorvastatin treatment. At the end of one-year, low-density lipoprotein cholesterol level was lower in high intensity group than in moderate group (1.6±0.6 vs 1.8±0.6, p=0.041). MACE in high intensity group decreased 44.5% than moderate group (8.4% vs. 14.6%, p=0.018). The adjusted hazard ratio (HR) for MACE in patients with atorvastatin 40mg/d was lower compared to patients with atorvastatin 20mg/d (HR [95% CI] 0.61 [0.36 to 0.91], p=0.026). The rates of adverse events were no significantly different between the two groups. For ACS patients with DM, high intensity atorvastatin induced better long-term outcomes compared with moderate intensity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Meta-Analysis of Usefulness of Percutaneous Left Ventricular Assist Devices for High-Risk Percutaneous Coronary Interventions.

    PubMed

    Briasoulis, Alexandros; Telila, Tesfaye; Palla, Mohan; Mercado, Nestor; Kondur, Ashok; Grines, Cindy; Schreiber, Theodore

    2016-08-01

    High-risk percutaneous coronary intervention (PCI) is often offered to patients with extensive coronary artery disease, decreased left ventricular function, and co-morbid conditions that increase surgical risk. In these settings, percutaneous left ventricular assist devices (PVADs) can be used for hemodynamic support. To assess the effects of PVAD use on mortality, myocardial infarction, and complication rates in patients undergoing high-risk PCI, we systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective controlled trials and cohort studies of patients that received hemodynamic support with PVADs for high-risk PCI. The primary outcome measures were 30-day all-cause mortality, 30-day myocardial infarction rates, periprocedural major bleeding, and vascular complications. We included 12 studies with 1,346 participants who underwent Impella 2.5 L device placement and 8 cohort studies with 205 patients that received TandemHeart device for high-risk PCI. Short-term mortality rates were 3.5% and 8% and major bleeding rates were 7.1% and 3.6% with Impella and TandemHeart, respectively. Both devices are associated with comparable periprocedural outcomes in patients undergoing high-risk PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Risk of Cardiovascular Events After an Acute Coronary Event Remains High, Especially During the First Year, Despite Revascularization.

    PubMed

    Abu-Assi, Emad; López-López, Andrea; González-Salvado, Violeta; Redondo-Diéguez, Alfredo; Peña-Gil, Carlos; Bouzas-Cruz, Noelia; Raposeiras-Roubín, Sergio; Riziq-Yousef Abumuaileq, Rami; García-Acuña, José M; González-Juanatey, José R

    2016-01-01

    There is little information on the incidence and predictors of infarction, stroke, or cardiovascular death after acute coronary syndrome. We investigated these aspects and developed tools for predicting these events according to the time of their occurrence. A retrospective study was conducted of 4858 patients who survived an acute coronary event. We analyzed the incidence and predictors of acute myocardial infarction, stroke, or cardiovascular death during the first year (n=4858) vs successive years (n=4345 patients free of composite events during the first year). There were 329 events in the first year (cumulative incidence function: 7.3% person-years) and 616 in successive years (21.5% person-years; follow-up 4.9±2.4 years). The risk of events during the first year per tertile was 2.5% person-years in the low-risk tertile (< 3 points), 4.8% person-years in the intermediate-risk tertile (3-6 points), and 15.5% person-years in the high-risk tertile (> 6 points) (P<.001). The risk of events in the cohort that had a combined event in successive years increased from 10.7% person-years in the low-risk tertile (< 3 points) to 40.3% person-years in the high-risk tertile (> 6 points) (P<.001). The 2 scales showed the following predictive indexes: C statistic, 0.74 and 0.69, respectively; P (Hosmer-Lemeshow test)≥0.44 CONCLUSION: The risk of recurrence of cardiovascular events remains high after acute coronary syndrome. The level of risk can be easily quantified with acceptable predictive ability. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Cyclic Bending Contributes to High Stress in a Human Coronary Atherosclerotic Plaque and Rupture Risk

    PubMed Central

    Yang, Chun; Tang, Dalin; Kobayashi, Shunichi; Zheng, Jie; Woodard, Pamela K.; Teng, Zhongzhao; Bach, Richard; Ku, David N.

    2009-01-01

    Many acute cardiovascular syndromes such as heart attack and stroke are caused by atherosclerotic plaque ruptures which often happen without warning. MRI-based models with fluid-structure interactions (FSI) have been introduced to perform flow and stress/strain analysis for atherosclerotic plaques and identify possible mechanical and morphological indices for accurate plaque vulnerability assessment. In this paper, cyclic bending was added to 3D FSI coronary plaque models for more accurate mechanical predictions. Curvature variation was prescribed using the data of a human left anterior descending (LAD) coronary artery. Five computational models were constructed based on ex vivo MRI human coronary plaque data to assess the effects of cyclic bending, pulsating pressure, plaque structure, and axial stretch on plaque stress/strain distributions. In vitro experiments using a hydrogel stenosis model with cyclical bending were performed to observe effect of cyclical bending on flow conditions. Our results indicate that cyclical bending may cause more than 100% or even up to more than 1000% increase in maximum principal stress values at locations where the plaque is bent most. Stress increase is higher when bending is coupled with axial stretch, non-smooth plaque structure, or resonant pressure conditions (zero phase angle shift). Effects of cyclic bending on flow behaviors are more modest (21.6% decrease in maximum velocity, 10.8% decrease in flow rate, maximum flow shear stress changes were < 5%). Computational FSI models including cyclic bending, plaque components and structure, axial stretch, accurate in vivo measurements of pressure, curvature, and material properties should lead to significant improvement on stress-based plaque mechanical analysis and more accurate coronary plaque vulnerability assessment. PMID:19412353

  17. New experimental methodology, setup and LabView program for accurate absolute thermoelectric power and electrical resistivity measurements between 25 and 1600 K: application to pure copper, platinum, tungsten, and nickel at very high temperatures.

    PubMed

    Abadlia, L; Gasser, F; Khalouk, K; Mayoufi, M; Gasser, J G

    2014-09-01

    In this paper we describe an experimental setup designed to measure simultaneously and very accurately the resistivity and the absolute thermoelectric power, also called absolute thermopower or absolute Seebeck coefficient, of solid and liquid conductors/semiconductors over a wide range of temperatures (room temperature to 1600 K in present work). A careful analysis of the existing experimental data allowed us to extend the absolute thermoelectric power scale of platinum to the range 0-1800 K with two new polynomial expressions. The experimental device is controlled by a LabView program. A detailed description of the accurate dynamic measurement methodology is given in this paper. We measure the absolute thermoelectric power and the electrical resistivity and deduce with a good accuracy the thermal conductivity using the relations between the three electronic transport coefficients, going beyond the classical Wiedemann-Franz law. We use this experimental setup and methodology to give new very accurate results for pure copper, platinum, and nickel especially at very high temperatures. But resistivity and absolute thermopower measurement can be more than an objective in itself. Resistivity characterizes the bulk of a material while absolute thermoelectric power characterizes the material at the point where the electrical contact is established with a couple of metallic elements (forming a thermocouple). In a forthcoming paper we will show that the measurement of resistivity and absolute thermoelectric power characterizes advantageously the (change of) phase, probably as well as DSC (if not better), since the change of phases can be easily followed during several hours/days at constant temperature.

  18. New experimental methodology, setup and LabView program for accurate absolute thermoelectric power and electrical resistivity measurements between 25 and 1600 K: Application to pure copper, platinum, tungsten, and nickel at very high temperatures

    NASA Astrophysics Data System (ADS)

    Abadlia, L.; Gasser, F.; Khalouk, K.; Mayoufi, M.; Gasser, J. G.

    2014-09-01

    In this paper we describe an experimental setup designed to measure simultaneously and very accurately the resistivity and the absolute thermoelectric power, also called absolute thermopower or absolute Seebeck coefficient, of solid and liquid conductors/semiconductors over a wide range of temperatures (room temperature to 1600 K in present work). A careful analysis of the existing experimental data allowed us to extend the absolute thermoelectric power scale of platinum to the range 0-1800 K with two new polynomial expressions. The experimental device is controlled by a LabView program. A detailed description of the accurate dynamic measurement methodology is given in this paper. We measure the absolute thermoelectric power and the electrical resistivity and deduce with a good accuracy the thermal conductivity using the relations between the three electronic transport coefficients, going beyond the classical Wiedemann-Franz law. We use this experimental setup and methodology to give new very accurate results for pure copper, platinum, and nickel especially at very high temperatures. But resistivity and absolute thermopower measurement can be more than an objective in itself. Resistivity characterizes the bulk of a material while absolute thermoelectric power characterizes the material at the point where the electrical contact is established with a couple of metallic elements (forming a thermocouple). In a forthcoming paper we will show that the measurement of resistivity and absolute thermoelectric power characterizes advantageously the (change of) phase, probably as well as DSC (if not better), since the change of phases can be easily followed during several hours/days at constant temperature.

  19. New experimental methodology, setup and LabView program for accurate absolute thermoelectric power and electrical resistivity measurements between 25 and 1600 K: Application to pure copper, platinum, tungsten, and nickel at very high temperatures

    SciTech Connect

    Abadlia, L.; Mayoufi, M.; Gasser, F.; Khalouk, K.; Gasser, J. G.

    2014-09-15

    In this paper we describe an experimental setup designed to measure simultaneously and very accurately the resistivity and the absolute thermoelectric power, also called absolute thermopower or absolute Seebeck coefficient, of solid and liquid conductors/semiconductors over a wide range of temperatures (room temperature to 1600 K in present work). A careful analysis of the existing experimental data allowed us to extend the absolute thermoelectric power scale of platinum to the range 0-1800 K with two new polynomial expressions. The experimental device is controlled by a LabView program. A detailed description of the accurate dynamic measurement methodology is given in this paper. We measure the absolute thermoelectric power and the electrical resistivity and deduce with a good accuracy the thermal conductivity using the relations between the three electronic transport coefficients, going beyond the classical Wiedemann-Franz law. We use this experimental setup and methodology to give new very accurate results for pure copper, platinum, and nickel especially at very high temperatures. But resistivity and absolute thermopower measurement can be more than an objective in itself. Resistivity characterizes the bulk of a material while absolute thermoelectric power characterizes the material at the point where the electrical contact is established with a couple of metallic elements (forming a thermocouple). In a forthcoming paper we will show that the measurement of resistivity and absolute thermoelectric power characterizes advantageously the (change of) phase, probably as well as DSC (if not better), since the change of phases can be easily followed during several hours/days at constant temperature.

  20. Prevalence of high risk Tl-201 scintigraphic findings in patients with coronary artery disease: Relation to coronary anatomy and ECG stress test findings

    SciTech Connect

    Ryan, J.M.; Nygaard, T.W.; Gibson, R.S.; Gascho, J.A.; Watson, D.D.; Beller, G.A.

    1984-01-01

    The prevalence of a high risk exercise (Ex) Tl-201 (Tl) scintigram (scint) was determined in 295 consecutive patients (pts) with angiographic (angio) (>50% stenosis) coronary artery disease (CAD) and correlated with extent of CAD and Ex stress test findings. A high risk scint by quantitative criteria was defined as either: 1) a typical left main (LM) CAD pattern showing greater than or equal to 25% homogenous disease in Tl activity in septal and posterolateral walls; 2) a multivessel disease (MVD) pattern showing abnormal Tl uptake and/or washout in multiple vascular scan segments; 3) increased lung Tl uptake. The typical LMCAD pattern was observed in 6 of 43 pts (14%) with LMCAD compared to 2% of 53 pts with 3VD (p=0.03), 3% of 99 pts with 2VD (p=0.02) and 2% of 100 pts with 1VD (p-0.01). The MVD scint pattern was seen in 67% of pts with LMCAD compared to 49% (p=0.05) in 3VD pts, 41% (p=0.004) in 2VD pts and 24% (p=<0.0001) in 1VD pts. Prevalence of abnormal lung Tl was comparable in LMCAD (42%), 3VD (38%) and 2VD (34%) pts, but greater than observed in 1VD pts (26%; p=0.05). High risk ECG stress test was defined as 2 or more of: 1) >2.0 mm of ST decreasing; 2) greater than or equal to1.0 mm ST decreasing persisting >5 min post-EX; 3) ST decreasing at less than or equal to5 METS; 4) greater than or equal to10 mm Hg decreasing in Ex blood pressure. A high risk ECG stress test was observed in 58% of LMCAD pts compared to 32% of 3VD pts (p=0.009), 31% of 2VD pts (p=0.003) and 16% of 1VD pts (p<0.0001). Eighty-six % of LMCAD and 70% of 2 and 3VD pts had either a high risk Ex scint or stress test. Thus, EX Tl-201 scint appears useful in identifying high risk CAD pts.

  1. [Pregnancy and coronary artery dissection].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  2. Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients

    PubMed Central

    Adademir, Taylan; Tasar, Mehmet; Ecevit, Ata Niyazi; Karaca, Okay Guven; Salihi, Salih; Buyukbayrak, Fuat; Ozkokeli, Mehmet

    2014-01-01

    Introduction Determining operative mortality risk is mandatory for adult cardiac surgery. Patients should be informed about the operative risk before surgery. There are some risk scoring systems that compare and standardize the results of the operations. These scoring systems needed to be updated recently, which resulted in the development of EuroSCORE II. In this study, we aimed to validate EuroSCORE II by comparing it with the original EuroSCORE risk scoring system in a group of high-risk octogenarian patients who underwent coronary artery bypass grafting (CABG). Material and methods The present study included only high-risk octogenarian patients who underwent isolated coronary artery bypass grafting in our center between January 2000 and January 2010. Redo procedures and concomitant procedures were excluded. We compared observed mortality with expected mortality predicted by EuroSCORE (logistic) and EuroSCORE II scoring systems. Results We considered 105 CABG operations performed in octogenarian patients between January 2000 and January 2010. The mean age of the patients was 81.43 ± 2.21 years (80-89 years). Thirty-nine (37.1%) of them were female. The two scales showed good discriminative capacity in the global patient sample, with the AUC (area under the curve) being higher for EuroSCORE II (AUC 0.772, 95% CI: 0.673-0.872). The goodness of fit was good for both scales. Conclusions We conclude that EuroSCORE II has better AUC (area under the ROC curve) compared to the original EuroSCORE, but both scales showed good discriminative capacity and goodness of fit in octogenarian patients undergoing isolated coronary artery bypass grafting. PMID:26336431

  3. Value of Coronary Computed Tomography Angiography in Tailoring Aspirin Therapy for Primary Prevention of Atherosclerotic Events in Patients at High Risk With Diabetes Mellitus.

    PubMed

    Dimitriu-Leen, Aukelien C; Scholte, Arthur J H A; van Rosendael, Alexander R; van den Hoogen, Inge J; Kharagjitsingh, Aantje V; Wolterbeek, Ron; Knuuti, Juhani; Kroft, Lucia J M; Delgado, Victoria; Jukema, J Wouter; de Graaf, Michiel A; Bax, Jeroen J

    2016-03-15

    Aspirin use for primary prevention in patients at high risk with diabetes mellitus (DM) is often recommended under the assumption that most patients with DM have coronary artery disease (CAD). However, not all patients may have CAD. The present study evaluated, in 425 patients at high risk with DM (without chest pain syndrome or a history of cardiac disease), the prevalence of CAD on coronary computed tomography angiography (CTA). Moreover, the association between the presence and number of traditional cardiovascular (CV) risk factors and CAD (on coronary CTA) was evaluated. The median coronary artery calcium score was 29 (interquartile range 0 to 298). On coronary CTA, 116 patients (27%) had no CAD (defined as <30% stenosis). Of the 309 patients (73%) with any CAD (≥30% stenosis), 35% had obstructive CAD (≥50% stenosis). The number of traditional CV risk factors was not associated with the presence of any CAD (≥30% stenosis; p = 0.18) or obstructive CAD (≥50% stenosis; p = 0.13). Hypertension was the only traditional CV risk factor associated with a higher frequency of any CAD (≥30% stenosis; odds ratio = 2.21, 95% CI 1.43 to 3.41, p <0.001) and obstructive CAD (≥50% stenosis; odds ratio 2.03, 95% CI 1.33 to 3.11, p = 0.001). In conclusion, in patients at high risk with DM without chest pain syndrome, any CAD was ruled out by coronary CTA in 27%, whereas 65% of the patients did not have obstructive CAD. The number of CV risk factors was not associated with the presence of CAD. Hypertension was the only traditional CV risk factor that was associated with a higher frequency of CAD. These observations support potential use of coronary CTA to tailor aspirin therapy in patients at high risk with DM.

  4. Percutaneous Coronary Intervention of Hidden Coronary Artery-Unusual Type of Isolated Single Coronary Artery

    PubMed Central

    Patil, Shivanand; Ramalingam, Rangaraj; Manjunath, Cholenahally Nanjappa; Subramanyam, Kasamsetty

    2016-01-01

    Single coronary artery is a rare congenital coronary artery anomaly, the incidence of which is 0.024-0.066% as described in literature. Report of cases having single coronary artery along with acute myocardial infarction are scanty and reports of percutaneous intervention in such a situation are even fewer, technically challenging and potentially cataclysmic. As single coronary artery supplies the entire myocardium, occlusion of this can result in significant ischemic insult, resulting in severe biventricular dysfunction. Percutaneous Coronary Intervention (PCI) of single coronary artery is technically challenging and carries high risk which may be equated to left main intervention. We report a rare interesting case of L1 variety of single coronary artery which presented as acute inferoposterior myocardial infarction with successful rescue PCI to Left Circumflex Artery (LCx). PMID:27656488

  5. How calibration and reference spectra affect the accuracy of absolute soft X-ray solar irradiance measured by the SDO/EVE/ESP during high solar activity

    NASA Astrophysics Data System (ADS)

    Didkovsky, Leonid

    2016-10-01

    The Extreme ultraviolet Spectrophotometer (ESP), one of the channels of SDO’s Extreme ultraviolet Variability Experiment (EVE), measures solar irradiance in several EUV and soft x-ray (SXR) bands isolated using thin-film filters and a transmission diffraction grating, and includes a quad-diode detector positioned at the grating zeroth-order to observe in a wavelength band from about 0.1 to 7.0 nm. The quad diode signal also includes some contribution from shorter wavelength in the grating’s first-order and the ratio of zeroth-order to first-order signal depends on both source geometry, and spectral distribution. For example, radiometric calibration of the ESP zeroth-order at the NIST SURF BL-2 with a near-parallel beam provides a different zeroth-to-first-order ratio than modeled for solar observations. The relative influence of “uncalibrated” first-order irradiance during solar observations is a function of the solar spectral irradiance and the locations of large Active Regions or solar flares. We discuss how the “uncalibrated” first-order “solar” component and the use of variable solar reference spectra affect determination of absolute SXR irradiance which currently may be significantly overestimated during high solar activity.

  6. Unexpected patterns of Epstein-Barr virus transcription revealed by a high throughput PCR array for absolute quantification of viral mRNA.

    PubMed

    Tierney, Rosemary J; Shannon-Lowe, Claire D; Fitzsimmons, Leah; Bell, Andrew I; Rowe, Martin

    2015-01-01

    We have validated a flexible, high-throughput and relatively inexpensive RT-QPCR array platform for absolute quantification of Epstein-Barr virus transcripts in different latent and lytic infection states. Several novel observations are reported. First, during infection of normal B cells, Wp-initiated latent gene transcripts remain far more abundant following activation of the Cp promoter than was hitherto suspected. Second, EBNA1 transcript levels are remarkably low in all forms of latency, typically ranging from 1 to 10 transcripts per cell. EBNA3A, -3B and -3C transcripts are likewise very low in Latency III, typically at levels similar to or less than EBNA1 transcripts. Thirdly, a subset of lytic gene transcripts is detectable in Burkitt lymphoma lines at low levels, including: BILF1, which has oncogenic properties, and the poorly characterized LF1, LF2 and LF3 genes. Analysis of seven African BL biopsies confirmed this transcription profile but additionally revealed significant expression of LMP2 transcripts.

  7. High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus: results from the Swedish coronary angiography and angioplasty registry.

    PubMed

    Ritsinger, Viveca; Saleh, Nawsad; Lagerqvist, Bo; Norhammar, Anna

    2015-06-01

    Patients with diabetes mellitus have reduced longevity after acute coronary syndromes and revascularization. However, knowledge of the long-term complication rates and patterns from an everyday life setting is lacking. Consecutive patients undergoing percutaneous coronary intervention included in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006 and 2010 and with no previous revascularization were prospectively followed up for combined cardiovascular events (first of all-cause mortality, myocardial infarction, stroke, and heart failure) until December 31, 2010. The mean follow-up period was 920 days (SD, 530 days). Differences in background and procedural characteristics were adjusted for in a multivariate Cox regression model. Of 58 891 patients, mean age 67 years, 19% had diabetes mellitus; 27% of them were on diet treatment, 33% on oral glucose lowering, and 40% on insulin treatment. At admission, cardiovascular risk factors, multiple coronary vessel, and left main stem disease were more frequent in patients with diabetes mellitus and their revascularization was less often complete. The adjusted risk for combined cardiovascular events was higher in patients on insulin (hazard ratio [95% confidence interval], 1.63 [1.55-1.72]), on oral treatment (1.23 [1.15-1.31]), and on diet alone (1.21 [1.12-1.29]) compared with patients without diabetes mellitus. Insulin-treated patients ran an increased risk of restenosis (1.54 [1.39-1.71]) and stent thrombosis (1.56 [1.25-1.96]). The prognosis after a first percutaneous coronary intervention is more severe in patients with diabetes mellitus, in particular, in patients treated with insulin, with higher rates of mortality, cardiovascular events, and stent thrombosis over the following 5 years. © 2015 American Heart Association, Inc.

  8. High coronary heart disease rates among Dutch women of the baby boom, born 1945-1959: age-cohort analysis and projection.

    PubMed

    Bonneux, L; Looman, C W N

    2003-09-01

    After a steep decline in older generations, coronary heart disease mortality is stagnating in female cohorts born after the Second World War. We analysed past trends and predicted future health care needs for coronary heart disease in the Dutch population. A loglinear age-cohort model relates numbers of deaths and hospital admissions for coronary heart disease to sex, age, birth cohort and population size, and projects age-cohort changes over the future population. Population size, population forecasts and coronary heart disease mortality (period 1970-1999) are from vital statistics. Numbers of hospitalised acute coronary events are from the nationwide hospital register (period 1980-1999). Among men, the rate ratios of deaths and hospital admissions were, respectively, 0.21 (death) and 0.78 (survivors at discharge) in the cohorts born in the period 1948-1962 compared to the period 1918-1922. Among women, the same rate ratios were 0.41 and 1.89. The projection model predicts 22% less deaths from coronary heart disease and 22% more survivors of an infarction in 2015, among men. Among women, there will be 5% less deaths and 70% more survivors of an infarction, most of these being middle age members of the baby boom cohorts. Stagnating all-cause mortality is correlated with an upward trend in coronary heart disease risk in the female baby boomers. Heart health care needs among middle-aged women will increase sharply. These changes are correlated to high lung cancer mortality and high smoking rates in these cohorts.

  9. Accuracy of Pooled-Cohort Equation and SCORE cardiovascular risk calculators to identify individuals with high coronary atherosclerotic burden - implications for statin treatment.

    PubMed

    Tralhão, António; Ferreira, António M; Gonçalves, Pedro de Araújo; Rodrigues, Rita; Costa, Cátia; Guerreiro, Sara; Cardim, Nuno; Marques, Hugo

    2016-11-01

    Different cardiovascular risk calculators and risk-based thresholds for initiating statin therapy are currently in use. Using coronary computed tomography angiography, we sought to compare the Pooled-Cohort Equation [atherosclerotic cardiovascular disease (ASCVD) score] with the Systematic COronary Risk Evaluation (SCORE) in the identification of patients with high coronary atherosclerotic burden. In a single-center prospective registry of patients undergoing coronary computed tomography angiography, we identified individuals aged 40-75 years without diabetes or known cardiovascular disease. Cardiovascular risk and eligibility for statin therapy were determined individually on the basis of the two calculators and the guidelines that endorse them. Coronary atherosclerotic burden was assessed by coronary calcium score, presence of stenosis greater than or equal to 50%, and several measures of plaque severity and extension. In the 327 patients assessed (181 men, mean age 59±9 years), the median SCORE and ASCVD values were 2.6 and 9.7%, respectively. Compared with SCORE, the ASCVD calculator showed greater discriminative power to identify patients with calcium score greater than or equal to 300 [C-statistic 0.74, 95% confidence interval (CI) 0.67-0.82 vs. 0.69, 95% CI 0.61-0.78, P=0.008] and showed a trend toward better identification of patients with obstructive stenosis (C-statistic 0.72, 95% CI 0.64-0.80 vs. 0.68, 95% CI 0.60-0.76, P=0.053). The proportion of statin-eligible patients would be higher with the SCORE-based criteria, particularly among individuals with little or no detectable coronary atherosclerosis. The SCORE calculator seems to be less discriminative than the ASCVD equation in identifying patients with high atherosclerotic burden. Current SCORE-based criteria would assign statin therapy to a larger proportion of patients with low-risk features, which could result in a lower yield of cholesterol-reducing strategies.

  10. Absolute quantitation of protein posttranslational modification isoform.

    PubMed

    Yang, Zhu; Li, Ning

    2015-01-01

    Mass spectrometry has been widely applied in characterization and quantification of proteins from complex biological samples. Because the numbers of absolute amounts of proteins are needed in construction of mathematical models for molecular systems of various biological phenotypes and phenomena, a number of quantitative proteomic methods have been adopted to measure absolute quantities of proteins using mass spectrometry. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) coupled with internal peptide standards, i.e., the stable isotope-coded peptide dilution series, which was originated from the field of analytical chemistry, becomes a widely applied method in absolute quantitative proteomics research. This approach provides more and more absolute protein quantitation results of high confidence. As quantitative study of posttranslational modification (PTM) that modulates the biological activity of proteins is crucial for biological science and each isoform may contribute a unique biological function, degradation, and/or subcellular location, the absolute quantitation of protein PTM isoforms has become more relevant to its biological significance. In order to obtain the absolute cellular amount of a PTM isoform of a protein accurately, impacts of protein fractionation, protein enrichment, and proteolytic digestion yield should be taken into consideration and those effects before differentially stable isotope-coded PTM peptide standards are spiked into sample peptides have to be corrected. Assisted with stable isotope-labeled peptide standards, the absolute quantitation of isoforms of posttranslationally modified protein (AQUIP) method takes all these factors into account and determines the absolute amount of a protein PTM isoform from the absolute amount of the protein of interest and the PTM occupancy at the site of the protein. The absolute amount of the protein of interest is inferred by quantifying both the absolute amounts of a few PTM

  11. Stellar model chromospheres. XII - High-resolution, absolute flux profiles of the CA II H and K lines in dMe and non-dMe stars

    NASA Astrophysics Data System (ADS)

    Giampapa, M. S.; Worden, S. P.; Schneeberger, T. J.; Cram, L. E.

    1981-06-01

    We present 142 mÅ resolution spectra of the cores and wings of the Ca II H and K lines in three dMe and four comparison dwarf M stars, obtained with the KPNO 4 m echelle spectrograph and blue image tube. The narrow-band photometry of Willstrop and the Barnes and Evans relations for stellar angular diameters convert the observed relative flux to absolute surface flux units with an estimated uncertainty of ± 15 %. We derive chromospheric radiative loss rates in the H and K lines and discuss trends in these loss rates with effective temperature. Monochromatic surface fluxes are tabulated for different features in the H and K lines, and radiation temperatures are derived from the mean surface fluxes at K1 and H1, respectively. We find TR(H1) > TR(K1), consistent with partial redistribution theory. The TR(K1)/Teff ratio is higher in these M dwarfs than the giants studied in Paper X, and it is anomalously high for the dMe flare star YZ CMi. If TR(K1)/Teff is an empirical age indicator, then the result for YZ CMi implies that flare activity and youth are directly correlated, as has been suggested by other investigators. Moreover, the result implies that a high degree of nonradiative heating is present in the upper photospheres of dMe stars. Measurements of line widths at H1 and K1 are presented together with FWHM data for the H and K lines. We find that the scaling law proposed by Ayres generally agrees with the observed trend exhibited by the K1 widths. We also discuss chromospheric radiative loss rates in the Hɛ line compared with loss rates in the H and K lines, and present corrected FWHM(K) widths and compare them to the widths predicted by the Wilson-Bappu relation as calibrated by Lutz.

  12. Patch testing with serial dilutions and thin-layer chromatograms of oak moss absolutes containing high and low levels of atranol and chloroatranol.

    PubMed

    Mowitz, Martin; Zimerson, Erik; Svedman, Cecilia; Bruze, Magnus

    2013-12-01

    Oak moss absolute (Evernia prunastri extract) contains a large number of substances, among them the potent allergens atranol and chloroatranol. Since 2008, their content in oak moss absolute has been restricted by the International Fragrance Association to a maximum level of 100 ppm each. To compare the elicitation capacities of a traditional (sample A) and a treated (sample B) oak moss absolute containing, in total, 27 000 and 66 ppm of atranol and chloroatranol, respectively, and to investigate reactions to components of oak moss absolute separated by thin-layer chromatography (TLC). Fifteen oak moss-allergic subjects were patch tested with serial dilutions and TLC strips of samples A and B. Fifteen subjects reacted to sample A at concentrations ≤ 2.0%, and 2 subjects reacted to sample B at 2.0% but not to lower concentrations. Among 13 subjects reacting to the TLC strip of sample A, 11 reacted to spots with retardation factor values corresponding to those of atranol and/or chloroatranol, and 11 reacted to other areas on the TLC strip. Only one subject reacted to the TLC strip of sample B. The patch test reactivity of sample B was significantly lower than that of sample A. The TLC patch tests indicate the presence of sensitizers other than atranol and chloroatranol in oak moss absolute. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. High Prevalence of Low Serum Paraoxonase-1 in Subjects with Coronary Artery Disease

    PubMed Central

    Jayakumari, Narayani; Thejaseebai, Gopalan

    2009-01-01

    Paraoxonase-1 (PON-1), an HDL-associated enzyme has been shown to possess antioxidant/anti-inflammatory properties and protect against atherogenesis. The aim of the study was to explore the association of PON-1, with lipids, antioxidant-vitamins and lifestyle in male subjects with and without angiographically documented coronary artery disease (CAD) and in healthy volunteers. PON-1 activity was measured spectrophotometrically using phenyl acetate as substrate. PON-1 and HDL-Cholesterol were significantly lower and lipid peroxides and triglycerides were higher in CAD patients than in normal coronary and control subjects. PON-1 activity showed positive association with HDL-C and inverse relation with lipid peroxides and no association with antioxidant vitamins in healthy subjects. Smoking habit, alcohol intake and diabetes mellitus did not seem to influence PON-1 activity. Serum levels of PON-1 and HDL-C showed inverse association with the presence of CAD but are not related to the severity of disease in terms of number of diseased vessels. Interventional means by diet/drugs to enhance PON-1 activity may contribute to attenuation of atherosclerosis. PMID:19902017

  14. High clopidogrel dose in patients with chronic kidney disease having clopidogrel resistance after percutaneous coronary intervention.

    PubMed

    Liang, Jing; Wang, Zhijian; Shi, Dongmei; Liu, Yuyang; Zhao, Yingxin; Han, Hongya; Li, Yueping; Liu, Wei; Zhang, Linlin; Yang, Lixia; Zhou, Yujie

    2015-04-01

    We evaluated the impact of clopidogrel 150 mg/d in patients with chronic kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous coronary intervention (PCI); 1076 consecutive patients with coronary artery disease (CAD) having CKD were enrolled. Maximal platelet aggregation (MPA) was assessed before, 24 hours, and 30 days after a 300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150 mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac events (MACEs), and bleeding were analyzed after 1 month. Patients in the 150 mg group had significant lower rates of ST and MACE. There was no significant difference in major or minor bleeding. Patients in the 150 mg group had lower MPA and greater inhibition of platelet aggregation. One-month administration of 150 mg/d of clopidogrel decreases the rate of ST and MACE without increasing bleeding in patients with CKD having CR after PCI.

  15. Relation of black race between high density lipoprotein cholesterol content, high density lipoprotein particles and coronary events (from the Dallas Heart Study).

    PubMed

    Chandra, Alvin; Neeland, Ian J; Das, Sandeep R; Khera, Amit; Turer, Aslan T; Ayers, Colby R; McGuire, Darren K; Rohatgi, Anand

    2015-04-01

    Therapies targeting high-density lipoprotein cholesterol content (HDL-C) have not improved coronary heart disease (CHD) outcomes. High-density lipoprotein particle concentration (HDL-P) may better predict CHD. However, the impact of race/ethnicity on the relations between HDL-P and subclinical atherosclerosis and incident CHD events has not been described. Participants from the Dallas Heart Study (DHS), a multiethnic, probability-based, population cohort of Dallas County adults, underwent the following baseline measurements: HDL-C, HDL-P by nuclear magnetic resonance imaging, and coronary artery calcium by electron-beam computed tomography. Participants were followed for a median of 9.3 years for incident CHD events (composite of first myocardial infarction, stroke, coronary revascularization, or cardiovascular death). The study comprised 1,977 participants free of CHD (51% women, 46% black). In adjusted models, HDL-C was not associated with prevalent coronary artery calcium (p = 0.13) or incident CHD overall (hazard ratio [HR] per 1 SD 0.89, 95% confidence interval [CI] 0.76 to 1.05). However, HDL-C was inversely associated with incident CHD among nonblack (adjusted HR per 1 SD 0.67, 95% CI 0.46 to 0.97) but not black participants (HR 0.94, 95% CI 0.78 to 1.13, pinteraction = 0.05). Conversely, HDL-P, adjusted for risk factors and HDL-C, was inversely associated with prevalent coronary artery calcium (p = 0.009) and with incident CHD overall (adjusted HR per 1 SD 0.73, 95% CI 0.62 to 0.86), with no interaction by black race/ethnicity (pinteraction = 0.57). In conclusion, in contrast to HDL-C, the inverse relation between HDL-P and incident CHD events is consistent across ethnicities. These findings suggest that HDL-P is superior to HDL-C in predicting prevalent atherosclerosis as well as incident CHD events across a diverse population and should be considered as a therapeutic target. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Absolute High-Precision Localisation of an Unmanned Ground Vehicle by Using Real-Time Aerial Video Imagery for Geo-referenced Orthophoto Registration

    NASA Astrophysics Data System (ADS)

    Kuhnert, Lars; Ax, Markus; Langer, Matthias; Nguyen van, Duong; Kuhnert, Klaus-Dieter

    This paper describes an absolute localisation method for an unmanned ground vehicle (UGV) if GPS is unavailable for the vehicle. The basic idea is to combine an unmanned aerial vehicle (UAV) to the ground vehicle and use it as an external sensor platform to achieve an absolute localisation of the robotic team. Beside the discussion of the rather naive method directly using the GPS position of the aerial robot to deduce the ground robot's position the main focus of this paper lies on the indirect usage of the telemetry data of the aerial robot combined with live video images of an onboard camera to realise a registration of local video images with apriori registered orthophotos. This yields to a precise driftless absolute localisation of the unmanned ground vehicle. Experiments with our robotic team (AMOR and PSYCHE) successfully verify this approach.

  17. Amlodipine reduces predicted risk of coronary heart disease in high-risk patients with hypertension in Spain (The CORONARIA Study).

    PubMed

    Zamorano, J; Rodriguez Padial, L; Cosín, J; Hernandiz, A; Gutierrez-Chico, J L; Pérez de Isla, L; Arístegui, R; Masramon, X

    2008-01-01

    We evaluated the efficacy and safety of amlodipine besylate alone or in combination with other antihypertensive agents in high-risk hypertensive patients in Spanish primary care. In this 1-year, open-label, prospective cohort study, 7468 patients were treated with amlodipine 5 - 10 mg as a monotherapy or as an add-on therapy to attain blood pressure control (target of < 140/90 mmHg or, in patients with conditions such as diabetes or chronic kidney disease, < 130/85 mmHg). At 12 months, the primary outcome (change from baseline in predicted 10-year coronary heart disease risk) was -8.6%, down from 24.7% at baseline (relative risk reduction, 31.6%). Change in blood pressure from baseline (162.5/95.3 mmHg) was -26.7/-14.6 mmHg, and 38.6% of patients achieved their blood pressure target. In summary, significant reductions in predicted coronary heart disease risk and blood pressure were observed with amlodipine both as a monotherapy and as an add-on therapy. Amlodipine was well tolerated and compliance with treatment was good.

  18. Pathogenetic mechanisms of coronary ectasia.

    PubMed

    Antoniadis, Antonios P; Chatzizisis, Yiannis S; Giannoglou, George D

    2008-11-28

    Coronary ectasia is defined as local or generalized aneurysmal dilatation of the coronary arteries. The present review summarizes the molecular, cellular and vascular mechanisms which are involved in the pathobiology of coronary ectasia. Coronary ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth. Enzymatic degradation of the extracellular matrix of the media is the major pathophysiologic process that leads to ectasia. Atherosclerotic lesions within ectatic regions of the coronary arteries appear to be highly inflamed high-risk plaques with proclivity to rupture. Better understanding of the pathogenetic processes involved in coronary ectasia is anticipated that will provide a further insight into the clinical significance and natural history of this entity, and may also have direct clinical implications in the management and follow-up strategy of this condition.

  19. Absolute airborne gravimetry

    NASA Astrophysics Data System (ADS)

    Baumann, Henri

    This work consists of a feasibility study of a first stage prototype airborne absolute gravimeter system. In contrast to relative systems, which are using spring gravimeters, the measurements acquired by absolute systems are uncorrelated and the instrument is not suffering from problems like instrumental drift, frequency response of the spring and possible variation of the calibration factor. The major problem we had to resolve were to reduce the influence of the non-gravitational accelerations included in the measurements. We studied two different approaches to resolve it: direct mechanical filtering, and post-processing digital compensation. The first part of the work describes in detail the different mechanical passive filters of vibrations, which were studied and tested in the laboratory and later in a small truck in movement. For these tests as well as for the airborne measurements an absolute gravimeter FG5-L from Micro-G Ltd was used together with an Inertial navigation system Litton-200, a vertical accelerometer EpiSensor, and GPS receivers for positioning. These tests showed that only the use of an optical table gives acceptable results. However, it is unable to compensate for the effects of the accelerations of the drag free chamber. The second part describes the strategy of the data processing. It is based on modeling the perturbing accelerations by means of GPS, EpiSensor and INS data. In the third part the airborne experiment is described in detail, from the mounting in the aircraft and data processing to the different problems encountered during the evaluation of the quality and accuracy of the results. In the part of data processing the different steps conducted from the raw apparent gravity data and the trajectories to the estimation of the true gravity are explained. A comparison between the estimated airborne data and those obtained by ground upward continuation at flight altitude allows to state that airborne absolute gravimetry is feasible and

  20. Electronic Absolute Cartesian Autocollimator

    NASA Technical Reports Server (NTRS)

    Leviton, Douglas B.

    2006-01-01

    An electronic absolute Cartesian autocollimator performs the same basic optical function as does a conventional all-optical or a conventional electronic autocollimator but differs in the nature of its optical target and the manner in which the position of the image of the target is measured. The term absolute in the name of this apparatus reflects the nature of the position measurement, which, unlike in a conventional electronic autocollimator, is based absolutely on the position of the image rather than on an assumed proportionality between the position and the levels of processed analog electronic signals. The term Cartesian in the name of this apparatus reflects the nature of its optical target. Figure 1 depicts the electronic functional blocks of an electronic absolute Cartesian autocollimator along with its basic optical layout, which is the same as that of a conventional autocollimator. Referring first to the optical layout and functions only, this or any autocollimator is used to measure the compound angular deviation of a flat datum mirror with respect to the optical axis of the autocollimator itself. The optical components include an illuminated target, a beam splitter, an objective or collimating lens, and a viewer or detector (described in more detail below) at a viewing plane. The target and the viewing planes are focal planes of the lens. Target light reflected by the datum mirror is imaged on the viewing plane at unit magnification by the collimating lens. If the normal to the datum mirror is parallel to the optical axis of the autocollimator, then the target image is centered on the viewing plane. Any angular deviation of the normal from the optical axis manifests itself as a lateral displacement of the target image from the center. The magnitude of the displacement is proportional to the focal length and to the magnitude (assumed to be small) of the angular deviation. The direction of the displacement is perpendicular to the axis about which the

  1. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease.

    PubMed

    Wenger, Nanette K; Lewis, Sandra J; Herrington, David M; Bittner, Vera; Welty, Francine K

    2007-07-03

    Increased life expectancy is associated with an increase in the burden of chronic cardiovascular disease. To assess the efficacy and safety of high-dose atorvastatin in patients 65 years of age or older. A prespecified secondary analysis of the Treating to New Targets study, a randomized, double-blind clinical trial. 256 sites in 14 countries participating in the Treating to New Targets study. 10,001 patients (3809 patients > or =65 years of age) with coronary heart disease (CHD) and low-density lipoprotein cholesterol levels less than 3.4 mmol/L (<130 mg/dL). Patients were randomly assigned to receive atorvastatin, 10 or 80 mg/d. The primary end point was the occurrence of a first major cardiovascular event (death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke). In patients 65 years of age or older, absolute risk was reduced by 2.3% and relative risk by 19% for major cardiovascular events in favor of the high-dose atorvastatin group (hazard ratio, 0.81 [95% CI, 0.67 to 0.98]; P = 0.032). Among the components of the composite outcome, the mortality rates from CHD, nonfatal non-procedure-related myocardial infarction, and fatal or nonfatal stroke (ischemic, embolic, hemorrhagic, or unknown origin) were all lower in older patients who received high-dose atorvastatin, although the difference was not statistically significant for each individual component. The improved clinical outcome in patients 65 years of age or older was not associated with persistent elevations in creatine kinase levels. Because the study was a secondary analysis, the findings should be interpreted within the context of the main study results. The analysis suggests that additional clinical benefit can be achieved by treating older patients with CHD more aggressively to reduce low-density lipoprotein cholesterol levels to less than 2.6 mmol/L (<100 mg/dL). The findings support the use of intensive low-density lipoprotein

  2. Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience.

    PubMed

    Morsbach, Fabian; Gordic, Sonja; Desbiolles, Lotus; Husarik, Daniela; Frauenfelder, Thomas; Schmidt, Bernhard; Allmendinger, Thomas; Wildermuth, Simon; Alkadhi, Hatem; Leschka, Sebastian

    2014-08-01

    To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). First, a cardiac motion phantom simulating heart rates (HRs) from 60-90 bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250 ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50 years) undergoing clinically indicated CCTA were included. In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1 mm or less. Distortion increased above 1 mm at HR of 80-90 bpm. Patients had a mean HR of 66 bpm (47-78 bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73 bpm. Average effective radiation dose in patients was 0.6 ± 0.3 mSv. Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75 bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6 mSv. • CCTA is feasible with the turbo high-pitch mode. • Turbo high-pitch CCTA provides diagnostic image quality up to 73 bpm. • The radiation dose of high-pitch CCTA is 0.6 mSv on average.

  3. Animal models of coronary heart disease.

    PubMed

    Liao, Jiawei; Huang, Wei; Liu, George

    2015-08-20

    Cardiovascular disease, predominantly coronary heart disease and stroke, leads to high morbidity and mortality not only in developed worlds but also in underdeveloped regions. The dominant pathologic foundation for cardiovascular disease is atherosclerosis and as to coronary heart disease, coronary atherosclerosis and resulting lumen stenosis, even total occlusions. In translational research, several animals, such as mice, rabbits and pigs, have been used as disease models of human atherosclerosis and related cardiovascular disorders. However, coronary lesions are either naturally rare or hard to be fast induced in these models, hence, coronary heart disease induction mostly relies on surgical or pharmaceutical interventions with no or limited primary coronary lesions, thus unrepresentative of human coronary heart disease progression and pathology. In this review, we will describe the progress of animal models of coronary heart disease following either spontaneous or diet-accelerated coronary lesions.

  4. Changes in ischaemia as assessed with single-photon emission computed tomography myocardial perfusion imaging in high-risk patients with diabetes without cardiac symptoms: relation with coronary atherosclerosis on computed tomography coronary angiography.

    PubMed

    de Graaf, Michiel A; Roos, Cornelis J; Mansveld, Josanne M; Kharagjitsingh, Aan V; Dibbets-Schneider, Petra; Kroft, Lucia J; Jukema, J Wouter; Ficaro, Edward P; Bax, Jeroen J; Scholte, Arthur J

    2015-08-01

    The study aims (i) to evaluate changes in myocardial ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) after 2 years in a cohort of high-risk patients with diabetes without cardiac symptoms or known coronary artery disease (CAD) and (ii) to assess the value of baseline computed tomography coronary angiography (CTA)-derived coronary atherosclerosis parameters to predict changes in myocardial ischaemia. The population consisted of 100 high-risk patients with diabetes without cardiac symptoms referred for cardiovascular risk stratification. All patients underwent coronary artery calcium (CAC) scoring, CTA, and SPECT MPI. After 2 years of follow-up, SPECT MPI was repeated to evaluate potential progression of ischaemia.In total, 20% of patients presented with ischaemia at baseline. Of these 20 patients, 7 (35%) still had ischaemia at follow-up, whereas 13 (65%) showed resolution and 4 (20%) showed progression of ischaemia at follow-up. Of the 80 patients without ischaemia at baseline, 65 (81%) had a normal MPI at follow-up and 15 patients (19%) presented with new ischaemia. There were no significant differences in the CAC score or the extent, severity, and composition of CAD on CTA between patients with and without ischaemia at baseline. Similarly, no differences could be demonstrated between patients with and without ischaemia at follow-up or between patients with and without progression of ischaemia. The rate of progression of ischaemia in high-risk patients with diabetes without cardiac symptoms is limited. Few patients presented with new ischaemia, whereas some patients showed resolution of ischaemia. Atherosclerosis parameters on CTA were not predictive of new-onset ischaemia or progression of ischaemia. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  5. Absolute-structure reports.

    PubMed

    Flack, Howard D

    2013-08-01

    All the 139 noncentrosymmetric crystal structures published in Acta Crystallographica Section C between January 2011 and November 2012 inclusive have been used as the basis of a detailed study of the reporting of absolute structure. These structure determinations cover a wide range of space groups, chemical composition and resonant-scattering contribution. Defining A and D as the average and difference of the intensities of Friedel opposites, their level of fit has been examined using 2AD and selected-D plots. It was found, regardless of the expected resonant-scattering contribution to Friedel opposites, that the Friedel-difference intensities are often dominated by random uncertainty and systematic error. An analysis of data collection strategy is provided. It is found that crystal-structure determinations resulting in a Flack parameter close to 0.5 may not necessarily be from crystals twinned by inversion. Friedifstat is shown to be a robust estimator of the resonant-scattering contribution to Friedel opposites, very little affected by the particular space group of a structure nor by the occupation of special positions. There is considerable confusion in the text of papers presenting achiral noncentrosymmetric crystal structures. Recommendations are provided for the optimal way of treating noncentrosymmetric crystal structures for which the experimenter has no interest in determining the absolute structure.

  6. Clinical and economic effectiveness of percutaneous ventricular assist devices for high-risk patients undergoing percutaneous coronary intervention.

    PubMed

    Shah, Atman P; Retzer, Elizabeth M; Nathan, Sandeep; Paul, Jonathan D; Friant, Janet; Dill, Karin E; Thomas, Joseph L

    2015-03-01

    Comparative effectiveness research (CER) is taking a more prominent role in formalizing hospital treatment protocols and health-care coverage policies by having health-care providers consider the impact of new devices on costs and outcomes. CER balances the need for innovation with fiscal responsibility and evidence-based care. This study compared the clinical and economic impact of percutaneous ventricular assist devices (pVAD) with intraaortic balloon pumps for high-risk patients undergoing percutaneous coronary intervention (PCI). This study conducted a review of all comparative randomized control trials of the pVADS (Impella and TandemHeart) vs IABP for patients undergoing high-risk percutaneous coronary intervention (PCI). A retrospective analysis of the 2010 and 2011 Medicare MEDPAR data files was also performed to compare procedural costs and hospital length of stay (LOS). Readmission rates between the devices were also studied. Based on available trials, there is no significant clinical benefit with pVAD compared to IABP. Use of pVADs is associated with increased length of Intensive Care Unit stay and a total longer LOS. The incremental budget impact for pVADs was $33,957,839 for the United States hospital system (2010-2011). pVADs are not associated with improved clinical outcomes, reduced hospital length of stay, or reduced readmission rates. Management of high-risk PCI and cardiogenic shock patients with IABP is more cost effective than a routine use of pVADS. Use of IABP as initial therapy in high-risk PCI and cardiogenic shock patients may result in savings of up to $2.5 billion annually of incremental costs to the hospital system.

  7. Spontaneous Coronary Dissection Masquerading as Benign Fascicular Ventricular Tachycardia.

    PubMed

    Ho, Sara Wei-Fen; Lin, Weiqin; Chan, Koo Hui; Seow, Swee-Chong

    2016-01-01

    Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome. Diagnosis of coronary artery dissection is made on coronary angiogram and prompt revascularisation is the key in management. We present a case of coronary artery dissection with an atypical presentation of cardiac arrhythmia mimicking benign fascicular ventricular tachycardia. A high index of suspicion and early coronary angiogram allowed us to diagnose and treat this potentially life-threatening disease.

  8. High-risk Plaque Detected on Coronary Computed Tomography Angiography Predicts Acute Coronary Syndrome Independent of Significant Stenosis in Patients with Acute Chest Pain – Results from ROMICAT II Trial

    PubMed Central

    Puchner, Stefan B.; Liu, Ting; Mayrhofer, Thomas; Truong, Quynh A.; Lee, Hang; Fleg, Jerome L.; Nagurney, John T.; Udelson, James E.; Hoffmann, Udo; Ferencik, Maros

    2014-01-01

    Background To determine whether high-risk plaque as detected by coronary computed tomography angiography (CTA) permits improved early diagnosis of acute coronary syndrome (ACS) independent to the presence of significant CAD in acute chest pain patients. Objectives The primary aim was to determine whether high-risk plaque features, as detected by CTA in the emergency department, may improve diagnostic certainty of ACS independent and incremental to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction. Methods We included patients randomized to the CCTA arm of ROMICAT II trial. Readers assessed coronary CTA qualitatively for the presence of non-obstructive CAD (1-49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low < 30 Hounsfield Units plaque, napkin-ring sign, spotty calcium). In logistic regression analysis, we determined the association of high-risk plaque with ACS [myocardial infarction (MI) or unstable angina pectoris (UAP)] during the index hospitalization and whether this was independent of significant CAD and clinical risk assessment. Results Overall 37 of 472 patients who underwent coronary CTA with diagnostic image quality (mean age 53.9±8.0 years, 52.8% men) had ACS (7.8%; MI n=5, UAP n=32)]. CAD was present in 262 (55.5%) patients [non-obstructive CAD 217 (46.0%) patients, significant CAD with ≥50% stenosis 45 (9.5%) patients]. High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (OR 8.9, 95% CI 1.8-43.3, p=0.006) after adjusting for ≥50% stenosis (OR 38.6, 95% CI 14.2-104.7, p<0.001) and clinical risk assessment (age, gender, number of cardiovascular risk factors). Similar results were observed after adjusting for ≥70% stenosis. Conclusions In patients presenting to the ED with acute

  9. Rescue coronary stenting in acute myocardial infarction

    NASA Astrophysics Data System (ADS)

    Barbieri, Enrico; Meneghetti, Paolo; Molinari, Gionata; Zardini, Piero

    1996-01-01

    Failed rescue coronary angioplasty is a high risk situation because of high mortality. Coronary stent has given us the chance of improving and maintaining the patency of the artery. We report our preliminary experience of rescue stenting after unsuccessful coronary angioplasty.

  10. A Conceptual Approach to Absolute Value Equations and Inequalities

    ERIC Educational Resources Information Center

    Ellis, Mark W.; Bryson, Janet L.

    2011-01-01

    The absolute value learning objective in high school mathematics requires students to solve far more complex absolute value equations and inequalities. When absolute value problems become more complex, students often do not have sufficient conceptual understanding to make any sense of what is happening mathematically. The authors suggest that the…

  11. Coronary CT angiography using low concentrated contrast media injected with high flow rates: Feasible in clinical practice.

    PubMed

    Mihl, Casper; Kok, Madeleine; Wildberger, Joachim E; Altintas, Sibel; Labus, David; Nijssen, Estelle C; Hendriks, Babs M F; Kietselaer, Bas L J H; Das, Marco

    2015-11-01

    Aim of this study was to test the hypothesis that peak injection pressures and image quality using low concentrated contrast media (CM) (240 mg/mL) injected with high flow rates will be comparable to a standard injection protocol (CM: 300 mg/mL) in coronary computed tomographic angiography (CCTA). One hundred consecutive patients were scanned on a 2nd generation dual-source CT scanner. Group 1 (n=50) received prewarmed Iopromide 240 mg/mL at an injection rate of 9 mL/s, followed by a saline chaser. Group 2 (n=50) received the standard injection protocol: prewarmed Iopromide 300 mg/mL; flow rate: 7.2 mL/s. For both protocols, the iodine delivery rate (IDR, 2.16 gI/s) and the total iodine load (22.5 gI) were kept identical. Injection pressure (psi) was continuously monitored by a data acquisition program. Contrast enhancement was measured in the thoracic aorta and all proximal and distal coronary segments. Subjective and objective image quality was evaluated between both groups. No significant differences in peak injection pressures were found between both CM groups (121 ± 5.6 psi vs. 120 ± 5.3 psi, p=0.54). Flow rates of 9 mL/s were safely injected without any complications. No significant differences in contrast-to-noise ratio, signal-to-noise ratio and subjective image quality were found (all p>0.05). No significant differences in attenuation levels were found in the thoracic aorta and all segments of the coronary arteries (all p>0.05). Usage of low iodine concentration CM and injection with high flow rates is feasible. High flow rates (9 mL/s) of Iopromide 240 were safely injected without complications and should not be considered a drawback in clinical practice. No significant differences in peak pressure and image quality were found. This creates a doorway towards applicability of a broad variety in flow rates and IDRs and subsequently more individually tailored injection protocols. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Off-pump coronary artery bypass grafting versus optimal medical therapy alone: effectiveness of incomplete revascularization in high risk patients

    PubMed Central

    Prestipino, Filippo; Spadaccio, Cristiano; Nenna, Antonio; Sutherland, Fraser WH; Beattie, Gwyn W; Lusini, Mario; Nappi, Francesco; Chello, Massimo

    2016-01-01

    Background Geriatric patients with multivessel coronary artery disease (CAD) are a challenging group to treat; these cases elicit discussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass (OPCAB) provides good quality graft on left anterior descending (LAD) without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy. Methods We retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included: 42 were treated with incomplete off-pump revascularization using left internal mammary artery (LIMA) on LAD; 41 were discharged in optimal medical therapy (OMT), having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events (MACEs). Results During follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those discharged in OMT (Log Rank < 0.001), and OMT group carries a propensity score-adjusted hazard ratio of 3.862 (P < 0.001). With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in

  13. Impact of red blood cells count on the relationship between high density lipoproteins and the prevalence and extent of coronary artery disease: a single centre study [corrected].

    PubMed

    Schaffer, Alon; Verdoia, Monica; Cassetti, Ettore; Barbieri, Lucia; Perrone-Filardi, Pasquale; Marino, Paolo; De Luca, Giuseppe

    2015-07-01

    We have hypothesized that high red blood cells (RBC) count can potentially play an atheroprotective role in patients with coronary atherosclerosis. We, therefore, have investigated the relationship between high density lipoproteins cholesterol (HDL-C) and RBC levels in patients undergoing coronary angiography. Coronary artery disease (CAD) is a major cause of mortality. Impaired lipid profile represents a major risk factor for atherosclerosis. High density lipoprotein (HDL) is a key factor in atherosclerosis disease development. RBC can mimic HDL's reverse cholesterol transportation with a potential atheroprotective role. Coronary angiography has been evaluated in 3,534 patients. Fasting samples were collected for haematology and lipids levels assessment. Coronary disease was defined for at least 1 vessel stenosis >50 %. Patients were divided according to HDL-C and RBC tertiles. Lower HDL-C was significantly associated to the prevalence of CAD (84.8 vs 78.5 vs 67.3 %, p ≤ 0.001; adjusted OR [95 % CI] = 1.55 [1.3-1.8], p < 0.001) and severe CAD (30 % vs 30 % vs 24.4 %, p = 0.002; adjusted OR [95 % CI] = 1.08 [1.01-1.16], p = 0.02), this relationship was maintained even dividing our population according to RBC tertiles (p < 0.001).In conclusion, HDL-C levels are directly related to RBC count and inversely to the prevalence and extent of coronary disease. Higher RBC levels can reduce the risk of CAD in patients with lower HDL-C levels, suggesting an important atheroprotective role.

  14. Coronary Slow Flow Phenomenon Leads to ST Elevation Myocardial Infarction.

    PubMed

    Sen, Taner

    2013-03-01

    The exact etiology of the coronary slow flow phenomenon (CSFP) is not certain. CSFP is not a normal variant as it is an absolutely pathological entity. Furthermore, CSFP not only leads to myocardial ischemia but it can also cause classical acute ST elevation myocardial infarction, which necessitates coronary angiography for a definite diagnosis.

  15. Absolute Equilibrium Entropy

    NASA Technical Reports Server (NTRS)

    Shebalin, John V.

    1997-01-01

    The entropy associated with absolute equilibrium ensemble theories of ideal, homogeneous, fluid and magneto-fluid turbulence is discussed and the three-dimensional fluid case is examined in detail. A sigma-function is defined, whose minimum value with respect to global parameters is the entropy. A comparison is made between the use of global functions sigma and phase functions H (associated with the development of various H-theorems of ideal turbulence). It is shown that the two approaches are complimentary though conceptually different: H-theorems show that an isolated system tends to equilibrium while sigma-functions allow the demonstration that entropy never decreases when two previously isolated systems are combined. This provides a more complete picture of entropy in the statistical mechanics of ideal fluids.

  16. Coronary heart disease in the elderly--underwriting and pricing issues.

    PubMed

    Pokorski, Robert J

    2005-01-01

    The purpose of this analysis was to estimate the degree of excess mortality in elderly people with coronary heart disease. Pertinent studies were found via an Internet search of English language articles in the National Library of Medicine. Excess mortality was estimated by the traditional calculations used in mortality methodology. Mortality ratios for coronary heart disease were very high at young ages and tapered with advancing age, reaching levels at ages 80 and older of 130% to 180%. Comparison with other mortality studies indicated that this pattern was typical for most impairments. Present value calculations showed that relative risk (mortality ratio) was lower at older ages, but absolute risk (mortality cost) was much higher. Mortality ratios for coronary heart disease and most common impairments are generally lower in elderly people. This has important underwriting and pricing implications. Disregarding what might be considered "low" mortality ratios in the elderly means that large additional risks are accepted with no additional premium.

  17. Impact of high-dose statins on vitamin D levels and platelet function in patients with coronary artery disease.

    PubMed

    Verdoia, Monica; Pergolini, Patrizia; Rolla, Roberta; Nardin, Matteo; Schaffer, Alon; Barbieri, Lucia; Daffara, Veronica; Marino, Paolo; Bellomo, Giorgio; Suryapranata, Harry; De Luca, Giuseppe

    2017-02-01

    Statins represent a pivotal treatment in coronary artery disease, offering a reduction in cardiovascular risk even beyond their lipid-lowering action. However, the mechanism of these "pleiotropic" benefits of statins is poorly understood. Vitamin D has been suggested as a potential mediator of the anti-inflammatory, anti-thrombotic and vascular protecting effects of statins. Aim of present study was to assess the impact of a high-intensity statin therapy on vitamin D levels and platelet function in patients with coronary artery disease. Patients discharged on dual antiplatelet therapy and high-intensity statins after an ACS or elective PCI were scheduled for main chemistry and vitamin D levels assessment at 30-90days post-discharge. Vitamin D (25-OHD) dosing was performed by chemiluminescence method through the LIAISON® Vitamin D assay (Diasorin Inc). Platelet function was assessed by Multiplate® (multiple platelet function analyser; Roche Diagnostics AG). Among 246 patients included, 142 were discharged on a new statin therapy or with an increase in previous dose (Inc-S), while 104 were already receiving a high-dose statin at admission, that remained unchanged (Eq-S). Median follow-up was 75.5days. Patients in the Inc-S group were younger (p=0.01), smokers (p<0.001), with a less frequent history of hypercholesterolemia (p=0.05), diabetes (p=0.03), hypertension (p=0.02), or previous cardiovascular events (p<0.001). They were more often admitted for an acute coronary syndrome (p<0.001) and used less anti-hypertensive drugs or nitrates. Higher total circulating calcium was observed in the Inc-S group (p=0.004), while baseline vitamin D levels were similar in the 2 groups (p=0.30). A significant reduction in the circulating low-density lipoprotein (LDL) cholesterol was observed in the Inc-S group. Vitamin D levels increased in the Inc-S patients but not in the Eq-S group (delta-25OHD: 23.2±20.5% vs 3.1±4.7%, p=0.003), with a linear relationship between the

  18. Absolute Bioavailability of Tasimelteon.

    PubMed

    Torres, Rosarelis; Dressman, Marlene A; Kramer, William G; Baroldi, Paolo

    2015-01-01

    Tasimelteon is a novel dual melatonin receptor agonist and is the first treatment approved by the US Food and Drug Administration for Non-24-Hour Sleep-Wake Disorder. This study was conducted to assess the absolute bioavailability of tasimelteon and to further assess the single-dose pharmacokinetics, safety, and tolerability of oral and intravenous (IV) routes of administration of the drug. This study was an open-label, single-dose, randomized, 2-period, 2-treatment, 2-sequence, crossover study in which 14 healthy volunteers were randomly administered tasimelteon as either a 20-mg capsule or IV administration of 2 mg infused over 30 minutes. Each subject received both treatments in a random order, separated by a washout period of 5 ± 2 days. The total clearance and volume of distribution of tasimelteon, from the IV treatment, were 505 mL per minute and 42.7 L, respectively. Based on the statistical comparison of dose-corrected area under the curve to infinity, the absolute bioavailability was 38%, with a 90% confidence interval of 27%-54%. The mean elimination half-life was the same for the oral and IV routes. The exposure ratios, oral-to-IV, for metabolites M9, M11, M12, and M13, were 133.27%, 118.28%, 138.76%, and 112.36%, respectively, suggesting presystemic or first-pass metabolism. Three (21.4%) subjects experienced a treatment-emergent adverse event (TEAE) during the study. All TEAEs were mild, considered related to study medication, and consistent with what has been seen in other studies. There were no deaths, serious adverse events, or discontinuations due to TEAEs. Both tasimelteon treatments were well tolerated during the study.

  19. Cost effectiveness of statins in coronary heart disease

    PubMed Central

    Franco, O.; Peeters, A.; Looman, C.; Bonneux, L.

    2005-01-01

    Introduction: Statin therapy reduces the rate of coronary heart disease, but high costs in combination with a large population eligible for treatment ask for priority setting. Although trials agree on the size of the benefit, economic analyses of statins report contradictory results. This article reviewed cost effectiveness analyses of statins and sought to synthesise cost effectiveness ratios for categories of risk of coronary heart disease and age. Methods: The review searched for studies comparing statins with no treatment for the prevention of either cardiovascular or coronary heart disease in men and presenting cost per years of life saved as outcome. Estimates were extracted, standardised for calendar year and currency, and stratified by categories of risk, age, and funding source Results: 24 studies were included (from 50 retrieved), yielding 216 cost effectiveness ratios. Estimated ratios increase with decreasing risk. After stratification by risk, heterogeneity of ratios is large varying from savings to $59 000 per life year saved in the highest risk category and from $6500 to $490 000 in the lowest category. The pooled estimates show values of $21571 per life year saved for a 10 year coronary heart disease risk of 20% and $16862 per life year saved for 10 year risk of 30%. Conclusion: Statin therapy is cost effective for high levels of risk, but inconsistencies exist at lower levels. Although the cost effectiveness of statins depends mainly on absolute risk, important heterogeneity remains after adjusting for absolute risk. Economic analyses need to increase their transparency to reduce their vulnerability to bias and increase their reproducibility. PMID:16234419

  20. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

    PubMed Central

    Scheffel, Hans; Plass, André; Vachenauer, Robert; Desbiolles, Lotus; Gaemperli, Oliver; Schepis, Tiziano; Frauenfelder, Thomas; Schertler, Thomas; Husmann, Lars; Grunenfelder, Jürg; Genoni, Michele; Kaufmann, Philipp A.; Marincek, Borut; Leschka, Sebastian

    2006-01-01

    The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9 kg/m2 (range 22.4–36.3 kg/m2), mean heart rate during CT was 70.3±14.2 bpm (range 47–102 bpm), and mean Agatston score was 821±904 (range 0–3,110). Image quality was diagnostic (scores 1–3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control. PMID:17031451

  1. Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium.

    PubMed

    Snell-Bergeon, J K; Chartier-Logan, C; Maahs, D M; Ogden, L G; Hokanson, J E; Kinney, G L; Eckel, R H; Ehrlich, J; Rewers, M

    2009-05-01

    Coronary heart disease is the leading cause of mortality among people with type 1 diabetes. Diet is an important lifestyle factor that relates to risk of CHD. The aim of this study was to examine how diet and adherence to dietary guidelines differ between adults with and without type 1 diabetes, and their correlation with CHD risk factors and coronary artery calcium (CAC). The study involved 571 people with type 1 diabetes and 696 controls, aged 19 to 56 years, who were asymptomatic for CHD. CAC was measured by electron-beam computed tomography. Compared with the controls, adults with type 1 diabetes reported a diet higher in fat, saturated fat and protein but lower in carbohydrates. Fewer than half of those with type 1 diabetes met dietary guidelines for fat and carbohydrate intake, and only 16% restricted saturated fat to less than 10% of daily energy intake. Adults with type 1 diabetes were significantly less likely to meet dietary guidelines than controls. Fat and saturated fat intakes were positively correlated, but carbohydrate intake was negatively correlated with CHD risk factors and HbA(1c). A high-fat diet and higher intake of protein were associated with greater odds of CAC, while higher carbohydrate intake was associated with reduced odds of CAC. Adults with type 1 diabetes reported consuming higher than recommended levels of fat and saturated fat. High fat intake was associated with increased CHD risk factors, worse glycaemic control and CAC. An atherogenic diet may contribute to the risk of CHD in adults with type 1 diabetes.

  2. Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention.

    PubMed

    Patel, Vardhaman; Lin, Fang-Ju; Ojo, Olaitan; Rao, Sapna; Yu, Shengsheng; Zhan, Lin; Touchette, Daniel R

    2014-07-01

    Prasugrel is recommended over clopidogrel in poor/intermediate CYP2C19 metabolizers with acute coronary syndrome (ACS) and planned percutaneous coronary intervention (PCI), reducing the risk of ischemic events. CYP2C19 genetic testing can guide antiplatelet therapy in ACS patients. The purpose of this study was to evaluate the cost-utility of genotype-guided treatment, compared with prasugrel or generic clopidogrel treatment without genotyping, from the US healthcare provider's perspective. A decision model was developed to project lifetime economic and humanistic burden associated with clinical outcomes (myocardial infarction [MI], stroke and major bleeding) for the three strategies in patients with ACS. Probabilities, costs and age-adjusted quality of life were identified through systematic literature review. Incremental cost-utility ratios (ICURs) were calculated for the treatment strategies, with quality-adjusted life years (QALYs) as the primary effectiveness outcome. Relative risk of developing myocardial infarction and stroke between patients with and without variant CYP2C19 when receiving clopidogrel were estimated to be 1.34 and 3.66, respectively. One-way and probabilistic sensitivity analyses were performed. Clopidogrel cost USD19,147 and provided 10.03 QALYs versus prasugrel (USD21,425, 10.04 QALYs) and genotype-guided therapy (USD19,231, 10.05 QALYs). The ICUR of genotype-guided therapy compared with clopidogrel was USD4,200. Genotype-guided therapy provided more QALYs at lower costs compared with prasugrel. Results were sensitive to the cost of clopidogrel and relative risk of myocardial infarction and stroke between CYP2C19 variant vs. non-variant. Net monetary benefit curves showed that genotype-guided therapy had at least 70% likelihood of being the most cost-effective alternative at a willingness-to-pay of USD100,000/QALY. In comparison with clopidogrel, prasugrel therapy was more cost-effective with <21% certainty at willingness-to-pay of >USD170

  3. Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention

    PubMed Central

    Patel, Vardhaman; Lin, Fang-Ju; Ojo, Olaitan; Rao, Sapna; Yu, Shengsheng; Zhan, Lin; Touchette, Daniel R.

    2014-01-01

    Background Prasugrel is recommended over clopidogrel in poor/intermediate CYP2C19 metabolizers with acute coronary syndrome (ACS) and planned percutaneous coronary intervention (PCI), reducing the risk of ischemic events. CYP2C19 genetic testing can guide antiplatelet therapy in ACS patients. Objective The purpose of this study was to evaluate the cost-utility of genotype-guided treatment, compared with prasugrel or generic clopidogrel treatment without genotyping, from the US healthcare provider’s perspective. Methods A decision model was developed to project lifetime economic and humanistic burden associated with clinical outcomes (myocardial infarction [MI], stroke and major bleeding) for the three strategies in patients with ACS. Probabilities, costs and age-adjusted quality of life were identified through systematic literature review. Incremental cost-utility ratios (ICURs) were calculated for the treatment strategies, with quality-adjusted life years (QALYs) as the primary effectiveness outcome. Relative risk of developing myocardial infarction and stroke between patients with and without variant CYP2C19 when receiving clopidogrel were estimated to be 1.34 and 3.66, respectively. One-way and probabilistic sensitivity analyses were performed. Results Clopidogrel cost USD19,147 and provided 10.03 QALYs versus prasugrel (USD21,425, 10.04 QALYs) and genotype-guided therapy (USD19,231, 10.05 QALYs). The ICUR of genotype-guided therapy compared with clopidogrel was USD4,200. Genotype-guided therapy provided more QALYs at lower costs compared with prasugrel. Results were sensitive to the cost of clopidogrel and relative risk of myocardial infarction and stroke between CYP2C19 variant vs. non-variant. Net monetary benefit curves showed that genotype-guided therapy had at least 70% likelihood of being the most cost-effective alternative at a willingness-to-pay of USD100,000/QALY. In comparison with clopidogrel, prasugrel therapy was more cost-effective with <21

  4. Changes in remnant and high-density lipoproteins associated with hormone therapy and progression of coronary artery disease in postmenopausal women

    USDA-ARS?s Scientific Manuscript database

    The effect of hormone therapy (HT) on the plasma concentration of remnant lipoprotein cholesterol (RLP-C) and high density lipoprotein (HDL) subpopulations and the contribution of HT-related changes in these lipoproteins to the progression of coronary heart disease (CHD) were examined in 256 postmen...

  5. A Health Education Program for Parents and Children Who Exhibit High Risk Factors of Coronary Heart Disease.

    ERIC Educational Resources Information Center

    Hopp, Joyce W.; And Others

    This study demonstrated the feasibility of joint parent-child education to change the behaviors known to be associated with increased risk of coronary heart disease. Earlier studies have shown that parents who are at increased risk of coronary heart disease can be identified by studying certain factors in the children. Utilizing a combined risk…

  6. A Health Education Program for Parents and Children Who Exhibit High Risk Factors of Coronary Heart Disease.

    ERIC Educational Resources Information Center

    Hopp, Joyce W.; And Others

    This study demonstrated the feasibility of joint parent-child education to change the behaviors known to be associated with increased risk of coronary heart disease. Earlier studies have shown that parents who are at increased risk of coronary heart disease can be identified by studying certain factors in the children. Utilizing a combined risk…

  7. Effects of the novel high-affinity 5-HT(1B/1D)-receptor ligand frovatriptan in human isolated basilar and coronary arteries.

    PubMed

    Parsons, A A; Raval, P; Smith, S; Tilford, N; King, F D; Kaumann, A J; Hunter, J

    1998-08-01

    The contractile actions of the novel high-affinity 5-hydroxytryptamine (5-HT(1B/1D)) ligand, frovatriptan (formerly VML 251/SB-209509) were investigated in human isolated basilar and coronary arteries in which the endothelium had been removed. Basilar arteries were obtained post mortem, and coronary arteries were obtained from patients undergoing heart transplant (recipient) or from donor hearts that were not suitable for transplant. Frovatriptan was a potent contractile agent in isolated basilar artery with a -log mean effective concentration (EC50) value of 7.86 +/- 0.07 and intrinsic activity of 1.25 +/- 0.10 relative to 5-HT (n = 4). Frovatriptan was 8.5-fold more potent than sumatriptan, which produced a -log EC50 value of 6.93 +/- 0.09 and intrinsic activity 11.1 +/- 0.08 relative to 5-HT (n = 4). In coronary arteries, frovatriptan produced contraction with -log EC50 values of 7.38 +/- 0.12 and 7.81 +/- 0.2 in recipient (n = 7) and donor (n = 3) arteries, respectively. The relative degree of contraction of frovatriptan was lower than that of 5-HT, with relative intrinsic activities of 0.42 +/- 0.06 and 0.40 +/- 0.09, respectively. Sumatriptan produced contraction of human recipient and donor arteries with -log EC50 values (intrinsic activity) of 6.57 +/- 0.13 (0.79 +/- 0.27; n = 6) and 7.35 (1.41; n = 2), respectively. Furthermore, marked bell-shaped responses were apparent for frovatriptan in coronary arteries, with relaxation occurring at concentrations >6 microM in some tissues. In contrast, no bell-shaped concentration-response curves were apparent for sumatriptan or 5-HT. Threshold concentrations for frovatriptan-induced contractions were also different between basilar (>2 nM) and coronary arteries (>20 nM). No separation of threshold activity was observed with sumatriptan or 5-HT. These data show that frovatriptan produces constriction of human isolated basilar and coronary arteries. However, frovatriptan produces a complex pharmacologic response in the

  8. Absolute calibration of photostimulable image plate detectors used as (0.5-20 MeV) high-energy proton detectors

    NASA Astrophysics Data System (ADS)

    Mančić, A.; Fuchs, J.; Antici, P.; Gaillard, S. A.; Audebert, P.

    2008-07-01

    In this paper, the absolute calibration of photostimulable image plates (IPs) used as proton detectors is presented. The calibration is performed in a wide range of proton energies (0.5-20MeV) by exposing simultaneously the IP and calibrated detectors (radiochromic films and solid state detector CR39) to a source of broadband laser-accelerated protons, which are spectrally resolved. The final result is a calibration curve that enables retrieving the proton number from the IP signal.

  9. Staged High-Risk Percutaneous Coronary Intervention with Impella Support after On-Pump Transcatheter Aortic Valve Replacement

    PubMed Central

    Bahekar, Amol A.

    2016-01-01

    The management of concomitant obstructive coronary artery disease and severe aortic stenosis in poor surgical candidates is an evolving topic. Although the typical current practice is to perform percutaneous revascularization before transcatheter aortic valve replacement (TAVR), some data have emerged regarding revascularization after performing TAVR. We present the case of a 90-year-old man with multivessel coronary artery disease who was at prohibitive risk for surgical aortic valve replacement. We first performed TAVR with use of hemodynamic support, then Impella-assisted multivessel percutaneous coronary intervention on the patient's unprotected left main coronary artery. We describe this complex case and review the medical literature on percutaneous coronary intervention after TAVR PMID:27777528

  10. Technical note: Electrocardiogram electrode repositioning for 320-row coronary CT angiography in patients with regular and recurrent premature ventricular contractions.

    PubMed

    Kondo, Takeshi; Matsutani, Hideyuki; Groarke, John; Takamura, Kazuhisa; Fujimoto, Shinichiro; Rybicki, Frank J; Kumamaru, Kanako K

    2014-01-01

    Arrhythmias can compromise image quality and increase radiation exposure during coronary CT angiography (CTA). However, premature ventricular contractions (PVCs) can occur in a predictable recurrent and regular pattern (ie, bigeminy, trigeminy, quadrigeminy) with post-PVC compensatory pauses. Electrocardiographic (ECG) electrode repositioning can achieve relative amplification of the R waves of PVCs compared with R waves of sinus beats. This technical note describes how simple ECG electrode repositioning, combined with an absolute-delay strategy, facilitated selective R waves of PVC ECG triggering of image acquisition in 6 patients with PVC bigeminy or quadrigeminy at the time of 320-row coronary CTA. All 6 studies were single heartbeat acquisition scans with excellent image quality and a median effective radiation dose of 2.9 mSv (interquartile range, 2.1-3.8 mSv). Standard ECG electrode positions used for 2 patients with PVC bigeminy undergoing coronary CTA were associated with an acquisition over 2 heartbeats and effective radiation doses of 6.8 and 10.3 mSv, respectively. In conclusion, ECG electrode repositioning combined with an absolute-delay strategy for regularly recurring PVCs, such as ventricular bigeminy, facilitates high image quality and lower radiation dose during coronary CTA. This simple and straightforward technique can be considered for all patients with regular and recurrent PVCs undergoing coronary CTA. Copyright © 2014 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  11. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.

    PubMed

    Saskin, Hüseyin; Serhan Ozcan, Kazim; Yilmaz, Seyhan

    2017-03-01

    The monocyte to high-density lipoprotein ratio has recently emerged as an indicator of inflammation and oxidative stress. The aim of this study was to evaluate the association of the monocyte to high-density lipoprotein ratio with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Six hundred and sixty-two patients who were in sinus rhythm preoperatively and who had isolated coronary artery bypass grafting were retrospectively included in the study. Patients who had atrial fibrillation in the early postoperative period were enrolled in group 1 ( n  = 153); patients who remained in sinus rhythm in the early postoperative period were included in group 2 ( n  = 509). The clinical and demographic data of the patients, biochemical and complete blood count parameters, preoperative monocyte count/high-density lipoprotein cholesterol ratio, and operative and postoperative data were recorded. Preoperative monocyte counts ( P  = 0.0001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and C-reactive protein levels ( P  = 0.0001) were significantly increased in group 1. In the first month, 8 patients in group 1 (5.2%) and 5 patients in group 2 (1.0%) died, which was statistically significant ( P  = 0.003). In univariate and multivariate logistic regression analyses, an elevated preoperative monocyte count/high-density lipoprotein cholesterol ratio ( P  = 0.03) and C-reactive protein levels ( P  = 0.0001) were predictors of postoperative atrial fibrillation. Preoperative monocyte counts ( P  = 0.001), monocyte count/high-density lipoprotein cholesterol ratio ( P  = 0.0001) and the use of inotropic support ( P  = 0.0001) were also predictors of mortality in the early postoperative period. We have observed that high preoperative monocyte count/ high-density lipoprotein ratio was associated with postoperative atrial fibrillation and mortality after coronary artery bypass grafting

  12. Incremental prognostic value of coronary computed tomographic angiography high-risk plaque characteristics in newly symptomatic patients.

    PubMed

    Fujimoto, Shinichiro; Kondo, Takeshi; Takamura, Kazuhisa; Baber, Usman; Shinozaki, Tomohiro; Nishizaki, Yuji; Kawaguchi, Yuko; Matsumori, Rie; Hiki, Makoto; Miyauchi, Katsumi; Daida, Hiroyuki; Hecht, Harvey; Stone, Gregg W; Narula, Jagat

    2016-06-01

    The incremental prognostic value of the plaque features in coronary computed tomographic angiography (CTA) has not been well assessed. This study was designed to determine whether CTA high-risk plaques have prognostic value incremental to the Framingham risk score (FRS) and the severity of luminal obstruction. A total of 628 newly symptomatic patients without known coronary artery disease underwent CTA. They were followed for a median of 677 days during which there were 26 cardiac events, including cardiac death, acute myocardial infarction, and hospitalization for unstable angina. Incremental prognostic value of adding plaque characteristics to the number of diseased vessels and the FRS was evaluated using 3 Cox models and net reclassification indexes. The discrimination index was significantly increased by adding the number of diseased vessels to the FRS (change in c-statistic from 65.8% to 78.6%, p=0.028) but not significantly by further adding plaque characteristics (change in c-statistic from 78.6% to 80.0%, p=0.812). However, improved model-fitting by adding plaque characteristics into the linear combination with risk score and the number of diseased vessels (p=0.007 from likelihood ratio test) and the lowest value of Akaike's information criteria of that model indicated that plaque characteristics improved both predictive accuracy and discrimination perspective. More subjects reclassified by plaque characteristics were moved to directions consistent with their subsequent cardiac event status than in an inconsistent direction. Evaluation of CTA plaque characteristics may provide incremental prognostic value to the number of diseased vessels and the FRS. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography.

    PubMed

    Zhang, Long Jiang; Wang, Yining; Schoepf, U Joseph; Meinel, Felix G; Bayer, Richard R; Qi, Li; Cao, Jian; Zhou, Chang Sheng; Zhao, Yan E; Li, Xie; Gong, Jian Bin; Jin, Zhengyu; Lu, Guang Ming

    2016-03-01

    To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard. Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality. At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv. Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population. Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.

  14. Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  15. Coronary artery anomalies in Turner Syndrome.

    PubMed

    Viuff, Mette H; Trolle, Christian; Wen, Jan; Jensen, Jesper M; Nørgaard, Bjarne L; Gutmark, Ephraim J; Gutmark-Little, Iris; Mortensen, Kristian H; Gravholt, Claus Højbjerg; Andersen, Niels H

    Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. Coronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

  16. HDL cholesterol, leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain.

    PubMed

    Caselli, Chiara; De Graaf, Michiel A; Lorenzoni, Valentina; Rovai, Daniele; Marinelli, Martina; Del Ry, Silvia; Giannessi, Daniela; Bax, Jeroen J; Neglia, Danilo; Scholte, Arthur J

    2015-07-01

    Coronary computed tomography angiography (CTA) describes several features of coronary plaques, i.e. location, severity, and composition. Integrated CTA scores are able to identify individual patterns of higher risk. We sought to test whether circulating biomarkers related with metabolism and inflammation could predict high risk coronary anatomy at CTA in patients with stable chest pain. We evaluated a panel of 17 biomarkers in 429 patients (60.3 ± 0.4 years, 268 males) with stable chest pain who underwent coronary CTA having been enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. The individual CTA risk score was calculated combining plaque extent, severity, composition, and location. The presence and distribution of non-calcified, mixed and calcified plaques were analyzed in each patient. After adjustment for age, sex and medical treatment, high-density lipoprotein (HDL) cholesterol, leptin, and interleukin-6 (IL-6) were independent predictors of CTA risk score at multivariate analysis (P = 0.050, 0.002, and 0.007, respectively). Integrating these biomarkers with common clinical variables, a model was developed which showed a better discriminating ability than the Framingham Risk Score and the Euro-SCORE in identifying the patients with higher CTA risk score (area under the receiver-operating characteristics curve = 0.81, 0.63 and 0.71, respectively, P < 0.001). These three biomarkers were significantly altered in patients with mixed or non-calcified plaques. In patients with stable chest pain, low HDL cholesterol, low leptin and high IL-6 are independent predictors of high risk coronary anatomy as defined by an integrated CTA risk score. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study.

    PubMed

    Cheng, Jin M; Garcia-Garcia, Hector M; de Boer, Sanneke P M; Kardys, Isabella; Heo, Jung Ho; Akkerhuis, K Martijn; Oemrawsingh, Rohit M; van Domburg, Ron T; Ligthart, Jurgen; Witberg, Karen T; Regar, Evelyn; Serruys, Patrick W; van Geuns, Robert-Jan; Boersma, Eric

    2014-03-01

    Acute coronary syndromes (ACS) are mostly caused by plaque rupture. This study aims to investigate the prognostic value of in vivo detection of high-risk coronary plaques by intravascular ultrasound (IVUS) in patients undergoing coronary angiography. Between November 2008 and January 2011, IVUS of a non-culprit coronary artery was performed in 581 patients who underwent coronary angiography for ACS (n = 318) or stable angina (n = 263). Primary endpoint was major adverse cardiac events (MACEs) defined as mortality, ACS, or unplanned coronary revascularization. Culprit lesion-related events were not counted. Cumulative Kaplan-Meier incidence of 1-year MACE was 7.8%. The presence of IVUS virtual histology-derived thin-cap fibroatheroma (TCFA) lesions (present 10.8% vs. absent 5.6%; adjusted HR: 1.98, 95% CI: 1.09-3.60; P = 0.026) and lesions with a plaque burden of ≥70% (present 16.2% vs. absent 5.5%; adjusted HR: 2.90, 95% CI: 1.60-5.25; P < 0.001) were independently associated with a higher MACE rate. Thin-cap fibroatheroma lesions were also independently associated with the composite of death or ACS only (present 7.5% vs. absent 3.0%; adjusted HR: 2.51, 95% CI: 1.15-5.49; P = 0.021). Thin-cap fibroatheroma lesions with a plaque burden of ≥70% were associated with a higher MACE rate within (P = 0.011) and after (P < 0.001) 6 months of follow-up, while smaller TCFA lesions were only associated with a higher MACE rate after 6 months (P = 0.033). In patients undergoing coronary angiography, the presence of IVUS virtual histology-derived TCFA lesions in a non-culprit coronary artery is strongly and independently predictive for the occurrence of MACE within 1 year, particularly of death and ACS. Thin-cap fibroatheroma lesions with a large plaque burden carry higher risk than small TCFA lesions, especially on the short term.

  18. High resolution three-dimensional visualization and characterization of coronary atherosclerosis in vitro by synchrotron radiation x-ray microtomography and highly localized x-ray diffraction

    NASA Astrophysics Data System (ADS)

    Jin, Hua; Ham, Kyungmin; Chan, Julia Y.; Butler, Leslie G.; Kurtz, Richard L.; Thiam, Serigne; Robinson, James W.; Agbaria, Rezik A.; Warner, Isiah M.; Tracy, Richard E.

    2002-12-01

    Human atherosclerotic plaques in both native and bypass arteries have been visualized using microtomography to provide additional information on the nature of coronary artery disease. Plaques contained within arteries removed from three white males aged 51, 55 and 70 are imaged in three-dimensions with monochromatic synchrotron x-ray radiation. Fields of view are 658 × 658 × 517 voxels, with cubic voxels ranging from 12 to 13 µm on a side. X-ray energies range from 11 to 15 keV (bandpass approximately 10 eV). At lower energies, high local absorption tends to generate reconstruction artefacts, while at higher energies the arterial wall is scarcely visible. At all energies, calcifications are clearly visible and differences are observed between plaques in native arteries (lifetime accumulations) versus bypass arteries (plaques developing in the interval between the heart bypass operation and the autopsy). In order to characterize coronary calcification, a micro-focused, 50 µm2, 25 keV x-ray beam was used to acquire powder diffraction data from selected calcifications. Also, large calcifications were removed from the native arteries and imaged with 25 keV x-ray energy. Calcifications are composed of hydroxyapatite crystallites and an amorphous phase. In summary, native calcifications are larger and have a higher fraction of hydroxyapatite than calcifications from the bypass arteries.

  19. Feasibility of low-dose contrast medium high pitch CT angiography for the combined evaluation of coronary, head and neck arteries.

    PubMed

    Wang, Zhiwei; Chen, Yu; Wang, Yining; Xue, Huadan; Jin, Zhengyu; Kong, Lingyan; Cao, Jian; Li, Shuo

    2014-01-01

    To evaluate the image quality and radiation dose of combined heart, head, and neck CT angiography (CTA) using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol, compared with single coronary CTA. 151 consecutive patients were prospectively included and randomly divided into three groups. Group 1 (n = 47) underwent combined heart, neck, and head CTA using prospectively ECG-triggered high-pitch spiral (Flash) scan protocol with a single-phase intravenous injection of iodinated contrast and saline flush; Group 2 (n = 51) underwent single coronary CTA with Flash scan protocol; and Group 3 (n = 53) underwent single coronary CTA with prospective sequence scan protocol. All patients were examined on a dual source CT (Definition FLASH). The image quality was determined for each CT study. Patients of scanning protocol Group 1, 2, and 3 showed no significant differences in age, sex, heart rates, and BMI. Evaluation of coronary artery image quality showed comparable results in the three scanning protocol groups on a per patient-based analysis. In group 1, image quality was found to be sufficient to be diagnostic in all arterial segments of carotid arteries. The mean dose-length product (DLP) for group 1 was 256.3±24.5 mGy×cm and was significantly higher in comparison with group 2 (93.4±19.9 mGy×cm; p < 0.001). However, there was no significant difference of DLP between group 1 and group 3 (254.1±69.9 mGy×cm). The combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose.

  20. The Incremental Diagnostic Performance of Coronary Computed Tomography Angiography Added to Myocardial Perfusion Imaging in Patients with Intermediate-to-High Cardiovascular Risk

    PubMed Central

    Hsu, Pei-Ying; Lee, Wen-Jeng; Cheng, Mei-Fang; Yen, Ruoh-Fang; Tzen, Kai-Yuan; Wu, Yen-Wen

    2016-01-01

    Purpose Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. Methods A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and 201Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. Results Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. Conclusions CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk. PMID:27122945

  1. Absolute cross section for loss of supercoiled topology induced by 10 eV electrons in highly uniform /DNA/1,3-diaminopropane films deposited on highly ordered pyrolitic graphite

    PubMed Central

    Boulanouar, Omar; Fromm, Michel; Bass, Andrew D.; Cloutier, Pierre; Sanche, Léon

    2013-01-01

    It was recently shown that the affinity of doubly charged, 1–3 diaminopropane (Dap2+) for DNA permits the growth on highly ordered pyrolitic graphite (HOPG) substrates, of plasmid DNA films, of known uniform thickness [O. Boulanouar, A. Khatyr, G. Herlem, F. Palmino, L. Sanche, and M. Fromm, J. Phys. Chem. C 115, 21291–21298 (2011)]. Post-irradiation analysis by electrophoresis of such targets confirms that electron impact at 10 eV produces a maximum in the yield of single strand breaks that can be associated with the formation of a DNA− transient anion. Using a well-adapted deterministic survival model for the variation of electron damage with fluence and film thickness, we have determined an absolute cross section for strand-break damage by 10 eV electrons and inelastic scattering attenuation length in DNA-Dap complex films. PMID:23927289

  2. Absolute cross section for loss of supercoiled topology induced by 10 eV electrons in highly uniform /DNA/1,3-diaminopropane films deposited on highly ordered pyrolitic graphite

    SciTech Connect

    Boulanouar, Omar; Fromm, Michel; Bass, Andrew D.; Cloutier, Pierre; Sanche, Léon

    2013-08-07

    It was recently shown that the affinity of doubly charged, 1-3 diaminopropane (Dap{sup 2+}) for DNA permits the growth on highly ordered pyrolitic graphite (HOPG) substrates, of plasmid DNA films, of known uniform thickness [O. Boulanouar, A. Khatyr, G. Herlem, F. Palmino, L. Sanche, and M. Fromm, J. Phys. Chem. C 115, 21291–21298 (2011)]. Post-irradiation analysis by electrophoresis of such targets confirms that electron impact at 10 eV produces a maximum in the yield of single strand breaks that can be associated with the formation of a DNA{sup −} transient anion. Using a well-adapted deterministic survival model for the variation of electron damage with fluence and film thickness, we have determined an absolute cross section for strand-break damage by 10 eV electrons and inelastic scattering attenuation length in DNA-Dap complex films.

  3. Absolute cross section for loss of supercoiled topology induced by 10 eV electrons in highly uniform /DNA/1,3-diaminopropane films deposited on highly ordered pyrolitic graphite

    NASA Astrophysics Data System (ADS)

    Boulanouar, Omar; Fromm, Michel; Bass, Andrew D.; Cloutier, Pierre; Sanche, Léon

    2013-08-01

    It was recently shown that the affinity of doubly charged, 1-3 diaminopropane (Dap2+) for DNA permits the growth on highly ordered pyrolitic graphite (HOPG) substrates, of plasmid DNA films, of known uniform thickness [O. Boulanouar, A. Khatyr, G. Herlem, F. Palmino, L. Sanche, and M. Fromm, J. Phys. Chem. C 115, 21291-21298 (2011)]. Post-irradiation analysis by electrophoresis of such targets confirms that electron impact at 10 eV produces a maximum in the yield of single strand breaks that can be associated with the formation of a DNA- transient anion. Using a well-adapted deterministic survival model for the variation of electron damage with fluence and film thickness, we have determined an absolute cross section for strand-break damage by 10 eV electrons and inelastic scattering attenuation length in DNA-Dap complex films.

  4. Absolute cross section for loss of supercoiled topology induced by 10 eV electrons in highly uniform /DNA/1,3-diaminopropane films deposited on highly ordered pyrolitic graphite.

    PubMed

    Boulanouar, Omar; Fromm, Michel; Bass, Andrew D; Cloutier, Pierre; Sanche, Léon

    2013-08-07

    It was recently shown that the affinity of doubly charged, 1-3 diaminopropane (Dap(2+)) for DNA permits the growth on highly ordered pyrolitic graphite (HOPG) substrates, of plasmid DNA films, of known uniform thickness [O. Boulanouar, A. Khatyr, G. Herlem, F. Palmino, L. Sanche, and M. Fromm, J. Phys. Chem. C 115, 21291-21298 (2011)]. Post-irradiation analysis by electrophoresis of such targets confirms that electron impact at 10 eV produces a maximum in the yield of single strand breaks that can be associated with the formation of a DNA(-) transient anion. Using a well-adapted deterministic survival model for the variation of electron damage with fluence and film thickness, we have determined an absolute cross section for strand-break damage by 10 eV electrons and inelastic scattering attenuation length in DNA-Dap complex films.

  5. Absolute, high resolution water transpiration rate measurements on single plant leaves via tunable diode laser absorption spectroscopy (TDLAS) at 1.37 μm

    NASA Astrophysics Data System (ADS)

    Hunsmann, S.; Wunderle, K.; Wagner, S.; Rascher, U.; Schurr, U.; Ebert, V.

    2008-09-01

    A new sampling-free and calibration-free multi-channel hygrometer using near infrared (NIR) tunable diode laser absorption spectroscopy (TDLAS) at 1.37 μm was developed and used to determine absolute transpiration rates of single plant leafs. Four 8×6× 4 cm3, fiber-coupled absorption cells are used to simultaneously measure absolute water vapor concentrations with an absolute accuracy of about 5% and a temporal resolution of about 2 s. Two chambers (BOTTOM, TOP) are directly attached to the leaf surface, while two chambers (IN, OUT) analyze the purge gas supplied to the plant leaf and the total outflow of the leaf chambers. The BOTTOM-TOP comparison provided a direct, leaf-side resolved ratio of stomatal conductance and-by taking into account the purge gas flow and the leaf area exposed-leaf side resolved water transpiration rates. The OUT-IN-difference yielded the total leaf transpiration rate with 2 μmol/m2/s resolution. The new multi-point hygrometer was validated by monitoring of the transpiration dynamics of a plant of the species Epipremnum pinnatum (L.) Engl. during diurnal variation of the leaf irradiation. During these experiments the differential H2O concentration resolution between two chambers was determined to be better than 3 ppm at Δt= 2 s (i.e. better than 711 ppb m Hz1/2). This performance was verified by an Allan analysis over a 30 min time period using CH4 as a surrogate absorber and yielded an average optimum optical resolution of 4.9×10-6 for 83 s measurement time, i.e. a CH4 resolution of 892 ppb, which corresponds to the optical resolution needed for a water sensitivity of 454 ppb m Hz1/2.

  6. Dispersive white light combined with a frequency-modulated continuous-wave interferometer for high-resolution absolute measurements of distance.

    PubMed

    Rovati, L; Minoni, U; Docchio, F

    1997-06-15

    A nonincremental interferometer for the absolute measurement of distances is presented. The measuring technique is based on both dispersive white-light (DWL) interferometry and frequency-modulated continuous-wave (FMCW) interferometry. The proposed configuration integrates both techniques in the same interferometer by use of a single laser diode. This solution enables the results from the coarse measurements from the FMCW interferometer to be combined with the fine readouts from the DWL interferometer. Preliminary experimental results confirm the capability of the system to combine the advantages of the two techniques.

  7. Successful management of grade III coronary perforation after percutaneous angioplasty in a high-risk patient: a case report.

    PubMed

    Coloma Araniya, Ricardo; Beas, Renato; Maticorena-Quevedo, Jesús; Anduaga-Beramendi, Alexander; Pastrana Castillo, Marco Antonio

    2016-03-03

    Coronary perforation is a rare complication in patients undergoing percutaneous coronary angioplasty. The mortality of this complication varies depending on factors related to the patient and the procedure performed, reaching 44% in patients with Ellis type III perforation. We report the case of an 81 year old male with multiple cardiovascular risk factors, who underwent percutaneous angioplasty for unstable angina management. The patient developed grade III coronary perforation in the anterior descending artery, which was successfully managed with balloon inflation to 6 atmospheres for 10 minutes twice in the affected area, with an interval of 5 minutes between each dilatation. The patient improved and was discharged.

  8. Excess coronary artery disease risk in South Asian immigrants: Can dysfunctional high-density lipoprotein explain increased risk?

    PubMed Central

    Dodani, Sunita

    2008-01-01

    Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the United States (US), and South Asian immigrants (SAIs) have a higher risk of CAD compared to Caucasians. Traditional risk factors may not completely explain high risk, and some of the unknown risk factors need to be explored. This short review is mainly focused on the possible role of dysfunctional high-density lipoprotein (HDL) in causing CAD and presents an overview of available literature on dysfunctional HDL. Discussion: The conventional risk factors, insulin resistance parameters, and metabolic syndrome, although important in predicting CAD risk, may not sufficiently predict risk in SAIs. HDL has antioxidant, antiinflammatory, and antithrombotic properties that contribute to its function as an antiatherogenic agent. Recent Caucasian studies have shown HDL is not only ineffective as an antioxidant but, paradoxically, appears to be prooxidant, and has been found to be associated with CAD. Several causes have been hypothesized for HDL to become dysfunctional, including Apo lipoprotein A-I (Apo A-I) polymorphisms. New risk factors and markers like dysfunctional HDL and genetic polymorphisms may be associated with CAD. Conclusions: More research is required in SAIs to explore associations with CAD and to enhance early detection and prevention of CAD in this high risk group. PMID:19183743

  9. Goal-directed Therapy Improves the Outcome of High-risk Cardiac Patients Undergoing Off-pump Coronary Artery Bypass

    PubMed Central

    Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder Singh; Mehta, Yatin; Taneja, Sameer; Ravi, R; Hote, Milind P

    2017-01-01

    Background: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Material and Method: Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO2), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™, PreSep™, and EV-1000® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Result: Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. Conclusion: The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89

  10. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass.

    PubMed

    Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder Singh; Mehta, Yatin; Taneja, Sameer; Ravi, R; Hote, Milind P

    2017-01-01

    There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower

  11. Increased carotid intima-media thickness associated with high hs-CRP levels is a predictor of unstable coronary artery disease.

    PubMed

    Abhashi, Sejran Ahmet; Kryeziu, Fadil Uke; Nazreku, Feim Durak

    2013-08-01

    Increased values of carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (hs-CRP) are predictors of acute coronary events. We analysed the link between CIMT and hs-CRP in cases with coronary artery disease (CAD). From 1 January to 30 June 2012, we evaluated 43 patients with acute coronary syndrome (group A), 50 patients with stable coronary artery disease (group B) and 50 healthy volunteers (group C). All were analysed for CIMT and hs-CRP levels. CIMT values were higher in groups A and B (0.94 ± 0.21 mm, 0.89 ± 0.19 mm, respectively) and lower in group C (0.64 ± 0.09 mm), and this was statistically significant (p < 0.0001). However the values of hs-CRP were higher in group A (1.87 ± 0.36 mg/l) and lower in groups B and C (1.07 ± 0.28 mg/l, 0.97 ± 0.45 mg/l, respectively) and this was also statistically significant (p < 0.0001).

  12. Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

    PubMed

    Raphael, Claire E; Keegan, Jennifer; Parker, Kim H; Simpson, Robin; Collinson, Julian; Vassiliou, Vass; Wage, Ricardo; Drivas, Peter; Strain, Stephen; Cooper, Robert; de Silva, Ranil; Stables, Rod H; Di Mario, Carlo; Frenneaux, Michael; Pennell, Dudley J; Davies, Justin E; Hughes, Alun D; Firmin, David; Prasad, Sanjay K

    2016-12-09

    Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA of the coronary arteries using CMR and compared this to invasive data. CMR scans were undertaken in a serial cohort of patients who had undergone invasive WIA. Velocity maps were acquired in the proximal left anterior descending and proximal right coronary artery using a retrospectively-gated breath-hold spiral phase velocity mapping sequence with high temporal resolution (19 ms). A breath-hold segmented gradient echo sequence was used to acquire through-plane cross sectional area changes in the proximal ascending aorta which were used as a surrogate of an aortic pressure waveform after calibration with brachial blood pressure measured with a sphygmomanometer. CMR-derived aortic pressures and CMR-measured velocities were used to derive wave intensity. The CMR-derived wave intensities were compared to invasive data in 12 coronary arteries (8 left, 4 right). Waves were presented as absolute values and as a % of total wave intensity. Intra-study reproducibility of invasive and non-invasive WIA was assessed using Bland-Altman analysis and the intraclass correlation coefficient (ICC). The combination of the CMR-derived pressure and velocity data produced the expected pattern of forward and backward compression and expansion waves. The intra-study reproducibility of the CMR derived wave intensities as a % of the total wave intensity (mean ± standard deviation of differences) was 0.0 ± 6.8%, ICC = 0.91. Intra-study reproducibility for the corresponding invasive data was 0.0 ± 4

  13. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction

    PubMed Central

    Twerenbold, Raphael; Jaeger, Cedric; Rubini Gimenez, Maria; Wildi, Karin; Reichlin, Tobias; Nestelberger, Thomas; Boeddinghaus, Jasper; Grimm, Karin; Puelacher, Christian; Moehring, Berit; Pretre, Gil; Schaerli, Nicolas; Campodarve, Isabel; Rentsch, Katharina; Steuer, Stephan; Osswald, Stefan; Mueller, Christian

    2016-01-01

    Aims High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI. Methods and results We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002). Conclusion The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge. Clinical Trial Registration Information www.clinicaltrials.gov. Identifier, NCT00470587. PMID:27357358

  14. Association between non-high-density lipoprotein cholesterol concentrations and mortality from coronary heart disease among Japanese men and women: the Ibaraki Prefectural Health Study.

    PubMed

    Noda, Hiroyuki; Iso, Hiroyasu; Irie, Fujiko; Sairenchi, Toshimi; Ohtaka, Emiko; Ohta, Hitoshi

    2010-02-01

    The aim of this study was to examine whether non-high-density lipoprotein cholesterol (non-HDL-cholesterol) raises the risk of coronary heart disease in a dose-response fashion in a non-obese population with low total cholesterol levels and high HDL-cholesterol levels, such as Japanese. A total of 30,802 men and 60,417 women, aged 40 to 79 years with no history of stroke or coronary heart disease, completed a baseline risk factor survey in 1993 under the auspices of the Ibaraki Prefectural Health Study. Systematic mortality surveillance through 2003 identified 539 coronary heart disease deaths. The mean values for non-HDL-cholesterol were 140 mg/dL for men and 151 mg/dL for women. The corresponding mean values were 193 mg/dL and 208 mg/dL total cholesterol and 52 mg/dL and 57 mg/dL HDL-cholesterol, respectively. Men with non-HDL-cholesterol > or = 180 mg/dL had a two-fold higher age-adjusted risk of mortality from coronary heart disease than did those with non-HDL-cholesterol <100 mg/dL, whereas no such association was found for women. The multivariable hazard ratio for > or = 180 mg/dL versus <100 mg/dL of non-HDL-cholesterol was 2.22 (95% confidence interval: 1.37 to 3.62) for men and 0.71 (0.37 to 1.34) for women. Higher concentrations of non-HDL-cholesterol were associated with an increased risk of mortality from coronary heart disease for men, but not for women.

  15. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores.

    PubMed

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P; Lima, J A C

    2006-05-01

    To show an overall diagnostic accuracy > or = 90% for detection of > or = 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including > or = 1.5 mm branches, and bypass grafts were screened for > or = 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of > or = 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Coronary 32 x 0.5-MDCTA accurately excludes > or = 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

  16. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction.

    PubMed

    Twerenbold, Raphael; Jaeger, Cedric; Rubini Gimenez, Maria; Wildi, Karin; Reichlin, Tobias; Nestelberger, Thomas; Boeddinghaus, Jasper; Grimm, Karin; Puelacher, Christian; Moehring, Berit; Pretre, Gil; Schaerli, Nicolas; Campodarve, Isabel; Rentsch, Katharina; Steuer, Stephan; Osswald, Stefan; Mueller, Christian

    2016-11-21

    High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI. We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002). The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge. www.clinicaltrials.gov. Identifier, NCT00470587. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  17. Absolute Identification by Relative Judgment

    ERIC Educational Resources Information Center

    Stewart, Neil; Brown, Gordon D. A.; Chater, Nick

    2005-01-01

    In unidimensional absolute identification tasks, participants identify stimuli that vary along a single dimension. Performance is surprisingly poor compared with discrimination of the same stimuli. Existing models assume that identification is achieved using long-term representations of absolute magnitudes. The authors propose an alternative…

  18. High-density lipoprotein associations with coronary heart disease: Does measurement of cholesterol content give the best result?

    PubMed

    Cromwell, William C

    2007-03-01

    The protective role played by high-density lipoprotein (HDL) in atherogenesis is well-accepted, as is the significant inverse association of HDL cholesterol (HDL-C) with coronary heart disease (CHD) risk. What remains controversial is whether we are using the best measure(s) of HDL to identify and manage HDL-related cardiovascular risk. Measuring particle number has been postulated to offer additional and possibly more specific information regarding risk. Although HDL-C is thought to indicate the quantity of circulating HDL particles, it is underappreciated that the amount of cholesterol carried inside lipoprotein particles is highly variable among individuals with the same HDL-C. Numerous trials have investigated the relations of CHD with various measures of HDL other than those based on cholesterol content of the particles present. Studies regarding the association of alternate measures of HDL with CHD risk have been mixed, possibly due to diversity in clinical characteristics accompanying low HDL-C states, variability in cholesterol content of HDL particles, and substantial inter-correlations of HDL with other lipoprotein particles. Additional research is needed to assess the clinical settings in which individual HDL tests, after multivariate adjustment for confounding factors, provide superior independent prediction of CHD events beyond HDL-C. Such studies show promise in defining measures of particle number that will prove useful in future strategies to enhance management of CHD risk and assess response to therapy at an individual patient level.

  19. Antiplatelet efficacy of prasugrel in patients with high on-clopidogrel treatment platelet reactivity and a history of coronary stenting.

    PubMed

    Bernlochner, Isabell; Mayer, Katharina; Morath, Tanja; Orban, Martin; Schulz, Stefanie; Schömig, Albert; Braun, Siegmund; Kastrati, Adnan; Sibbing, Dirk

    2013-03-01

    Little is known about the antiplatelet action of the 3 rd generation thienopyridine prasugrel in patients showing high platelet reactivity (PR) levels on clopidogrel. Thus, we aimed to determine the antiplatelet efficacy of prasugrel loading (LD) and maintenance dose (MD) treatment in a registry of patients with high PR levels on clopidogrel and a consecutive switch over to prasugrel in a setting of routine platelet function testing. In our registry of patients treated by percutaneous coronary intervention (n=73) with high levels of PR on clopidogrel, the ADP-induced platelet aggregation (PA, in AU x min) was assessed on a Multiplate analyser 1) after clopidogrel LD, 2) after prasugrel LD and 3) on prasugrel MD (5 vs. 10 mg/day). In patients with high PR levels on clopidogrel, prasugrel LD resulted in significantly lower PA values (574 [462-698] vs. 156 [89-234] AU x min; p<0.0001). Only 2.7% of patients showed high PR (HPR, ≥468 AU x min) following prasugrel LD. On prasugrel MD, PA was significantly higher as compared to prasugrel LD (248 [145-406] vs. 156 [89-234] AU x min; p<0.0001) with more patients showing HPR on MD vs. LD (16.4% vs. 2.7%; p=0.009). For prasugrel MD, HPR rates were higher in 5 vs. 10 mg/day treated patients (46.2% vs. 10.0%; p=0.006). In conclusion, for patients with high PR levels on clopidogrel, prasugrel LD abolished this status in the majority of patients. However, prasugrel response variability was detected, being more pronounced on prasugrel MD vs. LD treatment. The clinical impact of these findings warrants further investigation.

  20. Autosomal genome-wide scan for coronary artery calcification loci in sibships at high risk for hypertension.

    PubMed

    Lange, Leslie A; Lange, Ethan M; Bielak, Lawrence F; Langefeld, Carl D; Kardia, Sharon L; Royston, Patrick; Turner, Stephen T; Sheedy, Patrick F; Boerwinkle, Eric; Peyser, Patricia A

    2002-03-01

    Coronary artery disease (CAD) is the leading cause of mortality in the developed world. Although several CAD risk factors, including measures of lipid metabolism, obesity, and blood pressure, have a genetic basis, many genes for CAD susceptibility have yet to be identified. Coronary atherosclerosis is the major cause of CAD, but many with coronary atherosclerosis lack symptoms. Thus, a major limitation of using symptomatic CAD endpoints (eg, sudden coronary death, myocardial infarction) as a study outcome is substantial disease misclassification. Coronary artery calcification (CAC) is part of the atherosclerotic process and is an independent predictor of CAD endpoints. In the present study, CAC was noninvasively quantified by electron beam computed tomography. We performed genome-wide multipoint mode-of-inheritance-free linkage analysis on affected sib pairs, defined as being > or = the 70th sex- and age-specific percentile for CAC quantity, in a sample of 29 families enriched for hypertension. Almost 95% of participants were asymptomatic for CAD. Our LOD score (log10 odds in favor of linkage) results provide evidence that chromosomal regions 6p21.3 (maximum LOD score=2.22, P=0.00070) and 10q21.3 (maximum LOD score=3.24, P=0.000057) may harbor genes associated with subclinical coronary atherosclerosis.

  1. Human pericoronary adipose tissue as storage and possible supply site for oxidized low-density lipoprotein and high-density lipoprotein in coronary artery.

    PubMed

    Uchida, Yasumi; Uchida, Yasuto; Shimoyama, Ei; Hiruta, Nobuyuki; Kishimoto, Toshihoko; Watanabe, Soichiro

    2017-01-01

    Thickening of the pericoronary adipose tissue (PCAT) is a proven risk factor for coronary artery disease, but it is poorly understood whether PCAT stores pro-atherogenic substances with oxidized low-density lipoprotein (oxLDL) and low-density lipoprotein (LDL), and an anti-atherogenic substance with high-density lipoprotein (HDL) and supply them to the coronary intima. Using immunohistochemical techniques, the localization of oxLDL, LDL and HDL in PCAT and its adjacent coronary segments was examined in 30 epicardial coronary arteries excised from 11 human autopsy cases. PCAT stored oxLDL and HDL in all, but LDL rarely, in 77 specimens examined, irrespective of the presence or absence of coronary plaques and underlying disease. The percentage (%) incidence of oxLDL, HDL and LDL deposits in intima was, respectively, 28, 10, 35 in 29 normal segments, 80 (p<0.05 vs. normal segments), 12, 75 in 19 white plaques (growth stage), 57, 36, 90 in 15 yellow plaques without necrotic core (NC; mature stage), and 40, 21, 100 (p<0.05 vs. normal segments) in 14 yellow plaques with NC (end-stage of maturation) as classified by angioscopy and histology. In coronary intima, oxLDL deposited in either a dotted or diffuse pattern whereas HDL and LDL showed diffuse patterns. Dotted oxLDL deposits were contained in CD68(+)-macrophages traversing the border of PCAT and adventitia, external and internal elastic laminae. Diffuse oxLDL and HDL deposits colocalized with intimal vasa vasorum. The results suggested that, as a hitherto unrecognized supplying route, the human PCAT stores oxLDL and HDL and oxLDL is supplied to coronary intima either by CD68(+)-macrophages or vasa vasorum and HDL by vasa vasorum, and that deposition of oxLDL and HDL in the intima increased with plaque growth but the former decreased while the latter increased further with plaque maturation. Molecular therapy targeting PCAT before plaque maturation could be effective in preventing atherosclerosis. Copyright © 2016

  2. Localization of Coronary High-Intensity Signals on T1-Weighted MR Imaging: Relation to Plaque Morphology and Clinical Severity of Angina Pectoris.

    PubMed

    Matsumoto, Kenji; Ehara, Shoichi; Hasegawa, Takao; Sakaguchi, Mikumo; Otsuka, Kenichiro; Yoshikawa, Junichi; Shimada, Kenei

    2015-10-01

    This study sought to investigate the relationship between localization of high-intensity signals (HISs) on T1-weighted imaging (T1WI) with the noncontrast magnetic resonance technique and plaque morphology detected on optical coherence tomography, and the clinical severity of angina pectoris. Since the introduction of the T1WI noncontrast magnetic resonance technique for plaque imaging, some groups have reported that HISs in the coronary artery on T1WI are associated with a vulnerable morphology and future cardiac events. However, the association between the localization of HISs, such as coronary intrawall or intraluminal, and plaque morphology has not been investigated. One hundred lesions with either stable or unstable angina were included and divided into 3 groups according to the following criteria using T1WI. First, the plaques with the ratio between the signal intensities of coronary plaque and cardiac muscle ≤1.0 were classified as non-HISs (n = 39). Then, HISs with the ratio between the signal intensities of coronary plaque and cardiac muscle >1.0 were classified into 2 types by using cross-sectional T1WI. Those localized within the coronary wall when the lumen was identified were defined as intrawall HISs (n = 37), whereas those occupying the lumen when the lumen was not, or even if only partly, identified, were defined as intraluminal HISs (n = 24). Multivariate analysis revealed that intrawall HISs were associated with macrophage accumulation and the absence of calcification assessed by using optical coherence tomography. In contrast, thrombus and intimal vasculature were independent factors associated with intraluminal HISs. Furthermore, 50% of patients with intraluminal HISs experienced rest angina, such as Braunwald class II or III. This study shows that intrawall and intraluminal HISs on T1WI in patients with angina are related to the different types of vulnerable plaque morphology and the clinical severity. Copyright © 2015 American College of

  3. Evaluation of coronary endothelial function by catheter-type NO sensor in high-fat-diet-induced obese dogs.

    PubMed

    Kume, Teruyoshi; Kawamoto, Takahiro; Okura, Hiroyuki; Neishi, Yoji; Hashimoto, Ken; Hayashida, Akihiro; Watanabe, Nozomi; Kanda, Yukiko; Mochizuki, Seiichi; Goto, Masami; Yoshida, Kiyoshi

    2009-03-01

    Direct measurement of plasma nitric oxide (NO) concentration is possible with a newly developed catheter-type sensor. Adult mongrel dogs (n=5) were fed a high-fat diet (120 kcal . kg(-1) . day(-1)) for 8 months, then endothelial function was assessed by the change in NO concentration induced by acetylcholine (ACh) (DeltaNO). Simultaneously, average peak velocity (APV) was obtained by Doppler guide wire. Although fasting plasma glucose levels did not change after high-fat diet, fasting plasma insulin levels increased significantly (103+/-36 vs 106+/-27 mg/dl, P=0.89 and 0.15+/-0.15 vs 0.26+/-0.07 ng/ml, P=0.04, respectively). ACh-induced peak APV after high-fat feeding was not significantly different from that at baseline (ACh 0.1 microg/kg; 43+/-17 vs 51+/-7 cm/s, P=NS, ACh 0.4 microg/kg; 45+/-20 vs 47+/-16 cm/s, P=NS, respectively). The DeltaNO was significantly smaller after high-fat diet than at baseline (ACh 0.1 microg/kg; 2.6+/-1.6 vs 1.0+/-0.5 nmol/L, P=0.03, ACh 0.4 microg/kg; 3.8+/-2.3 vs 1.8+/-1.1 nmol/L, P=0.04, respectively). In high-fat-diet-induced obese dogs NO production was impaired in the early stage when the coronary flow response to ACh may be preserved.

  4. Associations of high HDL cholesterol level with all-cause mortality in patients with heart failure complicating coronary heart disease.

    PubMed

    Cai, Anping; Li, Xida; Zhong, Qi; Li, Minming; Wang, Rui; Liang, Yingcong; Chen, Wenzhong; Huang, Tehui; Li, Xiaohong; Zhou, Yingling; Li, Liwen

    2016-07-01

    The aim of the present study was to evaluate the association between HDL cholesterol level and all-cause mortality in patients with ejection fraction reduced heart failure (EFrHF) complicating coronary heart disease (CHD).A total of 323 patients were retrospectively recruited. Patients were divided into low and high HDL cholesterol groups. Between-group differences and associations between HDL cholesterol level and all-cause mortality were assessed.Patients in the high HDL cholesterol group had higher HDL cholesterol level and other lipid components (P <0.05 for all comparison). Lower levels of alanine aminotransferase (ALT), high-sensitivity C-reactive protein (Hs-CRP), and higher albumin (ALB) level were observed in the high HDL cholesterol group (P <0.05 for all comparison). Although left ventricular ejection fraction (LVEF) were comparable (28.8 ± 4.5% vs 28.4 ± 4.6%, P = 0.358), mean mortality rate in the high HDL cholesterol group was significantly lower (43.5% vs 59.1%, P = 0.007). HDL cholesterol level was positively correlated with ALB level, while inversely correlated with ALT, Hs-CRP, and NYHA classification. Logistic regression analysis revealed that after extensively adjusted for confounding variates, HDL cholesterol level remained significantly associated with all-cause mortality although the magnitude of association was gradually attenuated with odds ratio of 0.007 (95% confidence interval 0.001-0.327, P = 0.012).Higher HDL cholesterol level is associated with better survival in patients with EFrHF complicating CHD, and future studies are necessary to demonstrate whether increasing HDL cholesterol level will confer survival benefit in these populations of patients.

  5. Enhanced diagnostic value for coronary CT angiography of calcified coronary arteries using dual energy and a novel high-Z contrast material: a phantom study

    NASA Astrophysics Data System (ADS)

    Lambert, Jack W.; Ordovas, Karen G.; Sun, Yuxin; Yeh, Benjamin M.

    2016-03-01

    Dual-energy CT is emerging as a dose-saving tool for coronary CT angiography that allows calcium-scoring without the need for a separate unenhanced scan acquisition. Unfortunately the similar attenuation coefficient profiles of iodine and calcium limits the accuracy of their decomposition in the material basis images. We evaluate a tungsten-based contrast material with a more distinct attenuation profile from calcium, and compare its performance to a conventional iodinated agent. We constructed a custom thorax phantom containing simulated sets of vessels 3, 6 and 9 mm in diameter. The vessel sets were walled with concentric and eccentric calcifications ("plaque") with concentrations of 0, 20, 30 and 40% weight calcium hydroxyapatite (HAP). The phantom was filled sequentially with iodine and tungsten contrast material, and scanned helically using a fast-kV-switching DECT scanner. At material decomposition, both iodine and tungsten vessel lumens were separable from the HAP vessel walls, but separation was superior with tungsten which showed minimal false positive signal in the HAP image. Assessing their relative performance using line profiles, the HAP signal was greater in the tungsten separation in 6/9 of the vessel sets, and within 15% of the iodine separation for the remaining 3/9 sets. The robust phantom design enabled systematic evaluation of dual-energy material separation for calcium and a candidate non-iodinated vascular contrast element. This approach can be used to screen further agents and also refine dual energy CT material decomposition approaches.

  6. Absolute atomic oxygen and nitrogen densities in radio-frequency driven atmospheric pressure cold plasmas: Synchrotron vacuum ultra-violet high-resolution Fourier-transform absorption measurements

    SciTech Connect

    Niemi, K.; O'Connell, D.; Gans, T.; Oliveira, N. de; Joyeux, D.; Nahon, L.; Booth, J. P.

    2013-07-15

    Reactive atomic species play a key role in emerging cold atmospheric pressure plasma applications, in particular, in plasma medicine. Absolute densities of atomic oxygen and atomic nitrogen were measured in a radio-frequency driven non-equilibrium plasma operated at atmospheric pressure using vacuum ultra-violet (VUV) absorption spectroscopy. The experiment was conducted on the DESIRS synchrotron beamline using a unique VUV Fourier-transform spectrometer. Measurements were carried out in plasmas operated in helium with air-like N{sub 2}/O{sub 2} (4:1) admixtures. A maximum in the O-atom concentration of (9.1 {+-} 0.7) Multiplication-Sign 10{sup 20} m{sup -3} was found at admixtures of 0.35 vol. %, while the N-atom concentration exhibits a maximum of (5.7 {+-} 0.4) Multiplication-Sign 10{sup 19} m{sup -3} at 0.1 vol. %.

  7. A Concise and Highly Enantioselective Total Synthesis of (+)-anti- and (-)-syn-Mefloquine Hydrochloride: Definitive Absolute Stereochemical Assignment of the Mefloquines.

    PubMed

    Rastelli, Ettore J; Coltart, Don M

    2015-11-16

    A concise asymmetric (>99:1 e.r.) total synthesis of (+)-anti- and (-)-syn-mefloquine hydrochloride from a common intermediate is described. The key asymmetric transformation is a Sharpless dihydroxylation of an olefin that is accessed in three steps from commercially available materials. The Sharpless-derived diol is converted into either a trans or cis epoxide, and these are subsequently converted into (+)-anti- and (-)-syn-mefloquine, respectively. The synthetic (+)-anti- and (-)-syn-mefloquine samples were derivatized with (S)-(+)-mandelic acid tert-butyldimethylsilyl ether, and a crystal structure of each derivative was obtained. These are the first X-ray structures for mefloquine derivatives that were obtained by coupling to a known chiral, nonracemic compound, and provide definitive confirmation of the absolute stereochemistry of (+)-anti- as well as (-)-syn-mefloquine.

  8. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

    PubMed Central

    Shah, Anoop S V; Anand, Atul; Sandoval, Yader; Lee, Kuan Ken; Smith, Stephen W; Adamson, Philip D; Chapman, Andrew R; Langdon, Timothy; Sandeman, Dennis; Vaswani, Amar; Strachan, Fiona E; Ferry, Amy; Stirzaker, Alexandra G; Reid, Alan; Gray, Alasdair J; Collinson, Paul O; McAllister, David A; Apple, Fred S; Newby, David E; Mills, Nicholas L

    2015-01-01

    Summary Background Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits. Methods We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123). Findings 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3–99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8–99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21–0·80; p<0·0001). Interpretation Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from

  9. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study.

    PubMed

    Shah, Anoop S V; Anand, Atul; Sandoval, Yader; Lee, Kuan Ken; Smith, Stephen W; Adamson, Philip D; Chapman, Andrew R; Langdon, Timothy; Sandeman, Dennis; Vaswani, Amar; Strachan, Fiona E; Ferry, Amy; Stirzaker, Alexandra G; Reid, Alan; Gray, Alasdair J; Collinson, Paul O; McAllister, David A; Apple, Fred S; Newby, David E; Mills, Nicholas L

    2015-12-19

    Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits. We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123). 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001). Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially

  10. Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease.

    PubMed

    Herrera, V M; Casas, J P; Miranda, J J; Perel, P; Pichardo, R; González, A; Sanchez, J R; Ferreccio, C; Aguilera, X; Silva, E; Oróstegui, M; Gómez, L F; Chirinos, J A; Medina-Lezama, J; Pérez, C M; Suárez, E; Ortiz, A P; Rosero, L; Schapochnik, N; Ortiz, Z; Ferrante, D; Diaz, M; Bautista, L E

    2009-05-01

    Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

  11. Iterative reconstruction improves detection of in-stent restenosis by high-pitch dual-source coronary CT angiography.

    PubMed

    Yang, Junjie; Yang, Xiaobo; De Cecco, Carlo N; Duguay, Taylor M; Chen, Zhiye; Tesche, Christian; Schoepf, U Joseph; Chen, Yundai

    2017-07-31

    Recent studies demonstrated that sinogram affirmed iterative reconstructions (SAFIRE) can produce higher-resolution images with greater robustness for the reduction of various imaging artefacts. Eighty-five patients were prospectively evaluated and underwent a high-pitch spiral acquisition CT scan. In-stent noise, signal-to-noise ratio(SNR), stent-lumen attenuation increase ratio (SAIR), and subjective image quality score were measured and compared between the SAFIRE and Filter back projection (FBP) reconstructions. Conventional coronary angiography served as the standard of reference. In 159 evaluated stents, SAFIRE was superior to FBP with regards to in-stent noise, SNR, SAIR, and image quality score. On per-stent analysis, SAFIRE vs. FBP reconstruction yielded 85% vs. 85%sensitivity, 89% vs. 78%specificity, 73% vs. 57%positive predictive value, 95% vs. 94%negative predictive value, and 0.87 vs. 0.82 area under curve, although these improvements did not reach statistical significance (P > 0.05). However, in the subgroup of small diameter stents (≤3 mm; n = 95), specificity(82% vs. 62%), positive predictive value(66% vs. 50%) and area under curve (0.81 vs. 0.70) improved significantly (P < 0.05) with SAFIRE. SAFIRE image reconstruction can thus improve the evaluation for ISR, especially in smaller stents.

  12. Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

    2004-01-01

    Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

  13. Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

    2004-01-01

    Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

  14. Plasma activity of endothelial lipase impacts high-density lipoprotein metabolism and coronary risk factors in humans.

    PubMed

    Sun, Li; Ishida, Tatsuro; Miyashita, Kazuya; Kinoshita, Noriaki; Mori, Kenta; Yasuda, Tomoyuki; Toh, Ryuji; Nakajima, Katsuyuki; Imamura, Shigeyuki; Hirata, Ken-ichi

    2014-01-01

    Endothelial lipase (EL) is a determinant of plasma levels of high-density lipoprotein cholesterol (HDL-C). However, little is known about the impact of EL activity on plasma lipid profile. We aimed to establish a new method to evaluate EL-specific phospholipase activity in humans. Plasma samples were obtained from 115 patients with coronary artery disease (CAD) and 154 patients without CAD. Plasma EL protein was immunoprecipitated using an anti-EL monoclonal antibody after plasma non-specific immunoglobulins were removed by incubation with ProteinA. The phospholipase activity of the immunoprecipitated samples was measured using a fluorogenic phospholipase substrate, Bis-BODIPY FL C11-PC. The EL-specific phospholipase assay revealed that plasma EL activity was inversely correlated with HDL-C levels (R = -0.3088, p<0.0001). In addition, the EL activity was associated with cigarette smoking. Furthermore, EL activity in CAD patients was significantly higher than that in nonCAD patients. Concomitantly, the HDL-C level in CAD patients were significantly lower than that in non-CAD patients. We have established a method for human plasma EL-specific phospholipase activity by combination of EL immunoprecipitation and a fluorogenic phospholipid substrate. Plasma EL activity was associated with not only plasma HDL-C levels but also the risks for CAD.

  15. Relation of Black Race between High Density Lipoprotein Cholesterol Content, High Density Lipoprotein Particles and Coronary Events (From the Dallas Heart Study)

    PubMed Central

    Chandra, Alvin; Neeland, Ian J.; Das, Sandeep R.; Khera, Amit; Turer, Aslan T.; Ayers, Colby R.; McGuire, Darren K.; Rohatgi, Anand

    2015-01-01

    Therapies targeting high density lipoprotein cholesterol content (HDL-C) have not improved coronary heart disease (CHD) outcomes. HDL particle concentration (HDL-P) may better predict CHD. However, the impact of race/ethnicity on the relations between HDL-P and subclinical atherosclerosis/ incident CHD events has not been described. Participants from the Dallas Heart Study, a multiethnic, probability-based, population cohort of Dallas County adults had the following baseline measurements: HDL-C, HDL-P by nuclear magnetic resonance imaging (NMR), and coronary artery calcium (CAC) by electron beam computed tomography. Participants were followed for a median of 9.3 years for incident CHD events (composite of first myocardial infarction, stroke, coronary revascularization, or cardiovascular death). The study comprised 1977 participants free from CHD (51% women, 46% Black). In adjusted models, HDL-C was not associated with prevalent CAC (p=0.13) or incident CHD overall (HR per 1SD: 0.89, 95% CI 0.76–1.05). However, HDL-C was inversely associated with incident CHD among non-Black (adjusted HR per 1SD 0.67, 95% CI 0.46–0.97) but not Black participants (HR 0.94, 95% CI 0.78–1.13, pinteraction = 0.05). Conversely, HDL-P, adjusted for risk factors and HDL-C, was inversely associated with prevalent CAC (p=0.009) and with incident CHD overall (adjusted HR per 1SD: 0.73, 95% CI 0.62–0.86) with no interaction by Black race/ethnicity (pinteraction = 0.57). In conclusion, in contrast to HDL-C, the inverse relationship between HDL-P and incident CHD events is consistent across ethnicities. These findings suggest that HDL-P is superior to HDL-C in predicting both prevalent atherosclerosis as well as incident CHD events across a diverse population and should be considered as a therapeutic target. PMID:25661572

  16. Negative Association of Circulating MicroRNA-126 with High-sensitive C-reactive Protein and Vascular Cell Adhesion Molecule-1 in Patients with Coronary Artery Disease Following Percutaneous Coronary Intervention

    PubMed Central

    Wang, Jun-Nan; Yan, You-You; Guo, Zi-Yuan; Jiang, Ya-Juan; Liu, Lu-Lu; Liu, Bin

    2016-01-01

    Background: Percutaneous coronary intervention (PCI) causes endothelial damage, resulting in an inflammatory response with elevation of markers such as high-sensitive C-reactive protein (hs-CRP) and vascular cell adhesion molecule-1 (VCAM-1), which are associated with restenosis after PCI. Evidence suggests that microRNA-126 (miR-126) plays an important role in vascular inflammation, but its correlation with PCI-mediated inflammation has not been investigated. In this study, we investigated the effect of PCI on circulating miR-126 and inflammation markers such as hs-CRP and VCAM-1. Methods: We enrolled 130 patients with coronary artery disease (CAD) in the Second Hospital of Jilin University from October 2015 to December 2015. Among them, 82 patients with CAD, defined as at least one major epicardial vessel with >70% stenosis who planned to undergo PCI, were divided into acute coronary syndrome (ACS) group (46 patients) and stable angina (SA) group (36 patients). Forty-eight patients confirmed by coronary angiography without PCI were used as controls. The plasmas of all patients were collected prior to PCI and at 30 min, 24 h, and 72 h after PCI. The plasma VCAM-1 and hs-CRP were detected by enzyme-linked immunosorbent assay, and the miR-126 was evaluated by quantitative reverse transcription-polymerase chain reaction. Results: Plasma concentrations of hs-CRP and VCAM-1 in patients with either ACS (n = 46) or SA (n = 36) were significantly higher than in controls (n = 48) (P < 0.01) prior to PCI, and increased further at 24 h and 72 h after PCI, compared with prior PCI. Moreover, VCAM-1 was positively correlated with balloon time and pressure. In contrast, the plasma concentration of miR-126 was significantly lower in patients with CAD than in controls, and further decreased with time post-PCI. A negative correlation was observed between miR-126 and hs-CRP and VCAM-1 at 72 h after PCI. Conclusion: There was a negative correlation of miR-126 with the PCI

  17. New method to measure coronary velocity and coronary flow reserve.

    PubMed

    Zhang, Z-D; Svendsen, M; Choy, J S; Sinha, A K; Huo, Y; Yoshida, K; Molloi, S; Kassab, G S

    2011-07-01

    Coronary flow reserve (CFR) is an important index of coronary microcirculatory function. The objective of this study was to validate the reproducibility and accuracy of intravascular conductance catheter-based method for measurements of baseline and hyperemic coronary flow velocity (and hence CFR). The absolute coronary blood velocity was determined by measuring the time of transit of a saline injection between two pairs of electrodes (known distance) on a conductance catheter during a routine saline injection without the need for reference flow. In vitro validation was made in the velocity range of 5 to 70 cm/s in reference to the volume collection method. In 10 swine, velocity measurements were compared with those from a flow probe in coronary arteries at different CFR attained by microsphere embolization. In vitro, the mean difference between the proposed method and volume collection was 0.7 ± 1.34 cm/s for steady flow and -0.77 ± 2.22 cm/s for pulsatile flow. The mean difference between duplicate measurements was 0 ± 1.4 cm/s. In in vivo experiments, the flow (product of velocity and lumen cross-sectional area that is also measured by the conductance catheter) was determined in both normal and stenotic vessels and the mean difference between the proposed method and flow probe was -1 ± 12 ml/min (flow ranged from 10 to 130 ml/min). For CFR, the mean difference between the two methods was 0.06 ± 0.28 (range of 1 to 3). Our results demonstrate the reproducibility and accuracy of velocity and CFR measurements with a conductance catheter by use of a standard saline injection. The ability of the combined measurement of coronary lumen area (as previously validated) and current velocity and CFR measurements provides an integrative diagnostic tool for interventional cardiology.

  18. Absolute intensity calibration of flat-field space-resolved extreme ultraviolet spectrometer using radial profiles of visible and extreme ultraviolet bremsstrahlung continuum emitted from high-density plasmas in Large Helical Device

    SciTech Connect

    Dong Chunfeng; Wang Erhui; Morita, Shigeru; Goto, Motoshi

    2011-11-15

    A precise absolute intensity calibration of a flat-field space-resolved extreme ultraviolet (EUV) spectrometer working in wavelength range of 60-400 A is carried out using a new calibration technique based on radial profile measurement of the bremsstrahlung continuum in Large Helical Device. A peaked vertical profile of the EUV bremsstrahlung continuum has been successfully observed in high-density plasmas (n{sub e}{>=} 10{sup 14} cm{sup -3}) with hydrogen ice pellet injection. The absolute calibration can be done by comparing the EUV bremsstrahlung profile with the visible bremsstrahlung profile of which the absolute value has been already calibrated using a standard lamp. The line-integrated profile of measured visible bremsstrahlung continuum is firstly converted into the local emissivity profile by considering a magnetic surface distortion due to the plasma pressure, and the local emissivity profile of EUV bremsstrahlung is secondly calculated by taking into account the electron temperature profile and free-free gaunt factor. The line-integrated profile of the EUV bremsstrahlung continuum is finally calculated from the local emissivity profile in order to compare with measured EUV bremsstrahlung profile. The absolute intensity calibration can be done by comparing measured and calculated EUV bremsstrahlung profiles. The calibration factor is thus obtained as a function of wavelength with excellent accuracy. It is also found in the profile analysis that the grating reflectivity of EUV emissions is constant along the direction perpendicular to the wavelength dispersion. Uncertainties on the calibration factor determined with the present method are discussed including charge-coupled device operation modes.

  19. Eosinophil count - absolute

    MedlinePlus

    ... Abnormal Results Mean A high number of eosinophils (eosinophilia) are often linked to a variety of disorders. ... Accessed March 29, 2017. Klion AD, Weller PF. Eosinophilia and eosinophil-related disorders. In: Adkinson NF, Bochner ...

  20. Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test

    PubMed Central

    Setianto, Budi Yuli; Hartopo, Anggoro Budi; Gharini, Putrika Prastuti Ratna; Taufiq, Nahar

    2016-01-01

    Anomalous origination of coronary artery from the opposite sinus (ACAOS) is a rare coronary artery anomaly. Right ACAOS with interarterial course is a type of ACAOS, which conveys a high risk for myocardial ischemia or sudden death. We reported a case of right ACAOS with interarterial course in otherwise healthy young male. He was asymptomatic, until an obligatory medical check-up with treadmill test showed a sign of positive ischemic response. Further work-up revealed that he had right ACAOS with interarterial course. Watchful observation was applied to him, while strenuous physical activity and competitive sport were absolutely prohibited. PMID:26885410

  1. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients.

    PubMed

    Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J

    2016-10-24

    Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting.

  2. Paradoxical coronary artery disease in humans with hyperalphalipoproteinemia is associated with distinct differences in the high-density lipoprotein phosphosphingolipidome.

    PubMed

    Hancock-Cerutti, William; Lhomme, Marie; Dauteuille, Carolane; Lecocq, Sora; Chapman, M John; Rader, Daniel J; Kontush, Anatol; Cuchel, Marina

    Plasma high-density lipoprotein cholesterol (HDL-C) levels are inversely associated with risk of coronary artery disease (CAD) in epidemiologic studies. Despite this, the directionality of this relationship and the underlying biology behind it remain to be firmly established, especially at the extremes of HDL-C levels. We investigated differences in the HDL phosphosphingolipidome in a rare population of subjects with premature CAD despite high HDL-C levels to gain insight into the association between the HDL lipidome and CAD disease status in this unusual phenotype. We sought to assess differences in HDL composition that are associated with CAD in subjects with HDL-C >90th percentile. We predicted that quantitative lipidomic analysis of HDL particles would reveal novel differences between CAD patients and healthy subjects with matched HDL-C levels. We collected plasma samples from 25 subjects with HDL-C >90th percentile and clinically manifest CAD and healthy controls with HDL-C >90th percentile and without self-reported CAD. More than 140 individual HDL phospholipid and sphingolipid species were analyzed by LC/MS/MS. Significant reductions in HDL phosphatidylcholine (-2.41%, Q value = 0.025) and phosphatidylinositol (-10.7%, Q value = 0.047) content, as well as elevated sphingomyelin (+10.0%, Q value = 0.025) content, and sphingomyelin/phosphatidylcholine ratio (+12.8%, P value = .005) were associated with CAD status in subjects with high HDL-C. These differences may lay the groundwork for further analysis of the relationship between the HDL lipidome and disease states, as well as for the development of biomarkers of CAD status and HDL function. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  3. Coronary arteriography and angioplasty

    SciTech Connect

    King, S.B.; Douglas, J.S.

    1985-01-01

    This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.

  4. Noninvasive detection of coronary artery wall thickening with age in healthy subjects using high resolution MRI with beat-to-beat respiratory motion correction.

    PubMed

    Scott, Andrew D; Keegan, Jennifer; Mohiaddin, Raad H; Firmin, David N

    2011-10-01

    To demonstrate coronary artery wall thickening with age in a small healthy cohort using a highly efficient, reliable, and reproducible high-resolution MR technique. A 3D cross-sectional MR vessel wall images (0.7 × 0.7 × 3 mm resolution) with retrospective beat-to-beat respiratory motion correction (B2B-RMC) were obtained in the proximal right coronary artery of 21 healthy subjects (age, 22-62 years) with no known cardiovascular disease. Lumen and outer wall (lumen + vessel wall) areas were measured in one central slice from each subject and average wall thickness and wall area/outer wall area ratio (W/OW) calculated. Imaging was successful in 18 (86%) subjects with average respiratory efficiency 99.3 ± 1.7%. Coronary vessel wall thickness and W/OW significantly correlate with subject age, increasing by 0.088 mm and 0.031 per decade respectively (R = 0.53, P = 0.024 and R = 0.48, P = 0.046). No relationship was found between lumen area and vessel wall thickness (P = NS), but outer wall area increased significantly with vessel wall thickness at 19 mm(2) per mm (P = 0.046). This is consistent with outward vessel wall remodeling. Despite the small size of our healthy cohort, using high-resolution MR imaging and B2B-RMC, we have demonstrated increasing coronary vessel wall thickness and W/OW with age. The results obtained are consistent with outward vessel wall remodeling. Copyright © 2011 Wiley-Liss, Inc.

  5. High resolution absolute absorption cross sections of the B ̃(1)A'-X ̃(1)A' transition of the CH2OO biradical.

    PubMed

    Foreman, Elizabeth S; Kapnas, Kara M; Jou, YiTien; Kalinowski, Jarosław; Feng, David; Gerber, R Benny; Murray, Craig

    2015-12-28

    Carbonyl oxides, or Criegee intermediates, are formed from the gas phase ozonolysis of alkenes and play a pivotal role in night-time and urban area atmospheric chemistry. Significant discrepancies exist among measurements of the strong B ̃(1)A'-X ̃(1)A' electronic transition of the simplest Criegee intermediate, CH2OO in the visible/near-UV. We report room temperature spectra of the B ̃(1)A'-X ̃(1)A' electronic absorption band of CH2OO acquired at higher resolution using both single-pass broadband absorption and cavity ring-down spectroscopy. The new absorption spectra confirm the vibrational structure on the red edge of the band that is absent from ionization depletion measurements. The absolute absorption cross sections over the 362-470 nm range are in good agreement with those reported by Ting et al. Broadband absorption spectra recorded over the temperature range of 276-357 K were identical within their mutual uncertainties, confirming that the vibrational structure is not due to hot bands.

  6. Absolute measurement of optical attenuation

    NASA Astrophysics Data System (ADS)

    Wetsel, Grover C., Jr.; Stotts, Steven A.

    1983-06-01

    We have discovered that laser beam deflection spectroscopy can be used for the absolute measurement of wave or particle beam attenuation in condensed matter. The concept has been experimentally evaluated by successfully measuring the absolute optical attenuation in a crystal of U3+:CaF2 at 514 nm. A theoretical model that explains the experiment and characterizes the range of applicability of the method has been developed.

  7. Prediction of high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndromes.

    PubMed

    Podda, G M; Grossi, E; Palmerini, T; Buscema, M; Femia, E A; Della Riva, D; de Servi, S; Calabrò, P; Piscione, F; Maffeo, D; Toso, A; Palmieri, C; De Carlo, M; Capodanno, D; Genereux, P; Cattaneo, M

    2017-08-01

    About 40% of clopidogrel-treated patients display high platelet reactivity (HPR). Alternative treatments of HPR patients, identified by platelet function tests, failed to improve their clinical outcomes in large randomized clinical trials. A more appealing alternative would be to identify HPR patients a priori, based on the presence/absence of demographic, clinical and genetic factors that affect PR. Due to the complexity and multiplicity of these factors, traditional statistical methods (TSMs) fail to identify a priori HPR patients accurately. The objective was to test whether Artificial Neural Networks (ANNs) or other Machine Learning Systems (MLSs), which use algorithms to extract model-like 'structure' information from a given set of data, accurately predict platelet reactivity (PR) in clopidogrel-treated patients. A complete set of fifty-nine demographic, clinical, genetic data was available of 603 patients with acute coronary syndromes enrolled in the prospective GEPRESS study, which showed that HPR after 1month of clopidogrel treatment independently predicted adverse cardiovascular events in patients with Syntax Score >14. Data were analysed by MLSs and TSMs. ANNs identified more variables associated PR at 1month, compared to TSMs. ANNs overall accuracy in predicting PR, although superior to other MLSs was 63% (95% CI 59-66). PR phenotype changed in both directions in 35% of patients across the 3 time points tested (before PCI, at hospital discharge and at 1month). Despite their ability to analyse very complex non-linear phenomena, ANNs or MLS were unable to predict PR accurately, likely because PR is a highly unstable phenotype. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A Splice Region Variant in LDLR Lowers Non-high Density Lipoprotein Cholesterol and Protects against Coronary Artery Disease.

    PubMed

    Gretarsdottir, Solveig; Helgason, Hannes; Helgadottir, Anna; Sigurdsson, Asgeir; Thorleifsson, Gudmar; Magnusdottir, Audur; Oddsson, Asmundur; Steinthorsdottir, Valgerdur; Rafnar, Thorunn; de Graaf, Jacqueline; Daneshpour, Maryam S; Hedayati, Mehdi; Azizi, Fereidoun; Grarup, Niels; Jørgensen, Torben; Vestergaard, Henrik; Hansen, Torben; Eyjolfsson, Gudmundur; Sigurdardottir, Olof; Olafsson, Isleifur; Kiemeney, Lambertus A; Pedersen, Oluf; Sulem, Patrick; Thorgeirsson, Gudmundur; Gudbjartsson, Daniel F; Holm, Hilma; Thorsteinsdottir, Unnur; Stefansson, Kari

    2015-09-01

    Through high coverage whole-genome sequencing and imputation of the identified variants into a large fraction of the Icelandic population, we found four independent signals in the low density lipoprotein receptor gene (LDLR) that associate with levels of non-high density lipoprotein cholesterol (non-HDL-C) and coronary artery disease (CAD). Two signals are novel with respect to association with non-HDL-C and are represented by non-coding low frequency variants (between 2-4% frequency), the splice region variant rs72658867-A in intron 14 and rs17248748-T in intron one. These two novel associations were replicated in three additional populations. Both variants lower non-HDL-C levels (rs72658867-A, non-HDL-C effect = -0.44 mmol/l, Padj = 1.1 × 10⁻⁸⁰ and rs17248748-T, non-HDL-C effect = -0.13 mmol/l, Padj = 1.3 × 10⁻¹²) and confer protection against CAD (rs72658867-A, OR = 0.76 and Padj = 2.7 × 10⁻⁸ and rs17248748-T, OR = 0.92 and Padj = 0.022). The LDLR splice region variant, rs72658867-A, located at position +5 in intron 14 (NM_000527:c.2140+5G>A), causes retention of intron 14 during transcription and is expected to produce a truncated LDL receptor lacking domains essential for function of the receptor. About half of the transcripts generated from chromosomes carrying rs72658867-A are characterized by this retention of the intron. The same variant also increases LDLR mRNA expression, however, the wild type transcripts do not exceed levels in non-carriers. This demonstrates that sequence variants that disrupt the LDL receptor can lower non-HDL-C and protect against CAD.

  9. Quantitative severity of stress thallium-201 myocardial perfusion single-photon emission computed tomography defects in one-vessel coronary artery disease.

    PubMed

    Matzer, L; Kiat, H; Van Train, K; Germano, G; Papanicolaou, M; Silagan, G; Eigler, N; Maddahi, J; Berman, D S

    1993-08-01

    The relation between the quantitative myocardial perfusion defect severity of exercise thallium-201 single-photon emission computed tomography (SPECT) and the quantitative degree of coronary stenosis was examined in 18 patients with 1-vessel disease (> or = 50% diameter stenosis), and abnormal thallium-201 SPECT. A total of 26 vessels were analyzed. Thallium-201 SPECT quantitative defect severity score was derived by summing the number of pixels in a coronary territory in which counts fell below the normal mean and multiplied by the number of SDs by which they fell below the normal mean. The thallium-201 defect severity score was significantly (p < 0.001) related to the maximal percent luminal diameter narrowing (r = 0.93), percent area narrowing (r = 0.89), absolute stenotic area (r = 0.79), and absolute stenotic diameter (r = 0.81). As expected, the strongest relation between thallium-201 defect severity and quantitative angiographic indexes was in the low and high ranges of coronary stenosis, with more variability and lower correlation coefficients (percent diameter: r = 0.75, p < 0.02, percent area stenosis: r = 0.63, p < 0.05) in the middle ranges (50 to 80% diameter stenosis). This observation is likely to be due to the complex flow characteristics across stenotic lesions. The findings suggest that in a select population, thallium-201 defect severity is potentially useful for noninvasive characterization of the functional severity of coronary artery stenosis and may complement coronary angiography in predicting functionally significant stenosis.

  10. Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction.

    PubMed

    Yin, Wei-Hua; Lu, Bin; Hou, Zhi-Hui; Li, Nan; Han, Lei; Wu, Yong-Jian; Niu, Hong-Xia; Silverman, Justin R; Nicola De Cecco, Carlo; Schoepf, U Joseph

    2013-11-01

    To evaluate the diagnostic accuracy of sub-milliSievert (mSv) coronary CT angiography (cCTA) using prospectively ECG-triggered high-pitch spiral CT acquisition combined with iterative image reconstruction. Forty consecutive patients (52.9 ± 8.7 years; 30 men) underwent dual-source cCTA using prospectively ECG-triggered high-pitch spiral acquisition. The tube current-time product was set to 50 % of standard-of-care CT examinations. Images were reconstructed with sinogram-affirmed iterative reconstruction. Image quality was scored and diagnostic performance for detection of ≥50 % stenosis was determined with catheter coronary angiography (CCA) as the reference standard. CT was successfully performed in all 40 patients. Of the 601 assessable coronary segments, 543 (90.3 %) had diagnostic image quality. Per-patient sensitivity for detection of ≥50 % stenosis was 95.7 % [95 % confidence interval (CI), 76.0-99.8 %] and specificity was 94.1 % (95 % CI, 69.2-99.7 %). Per-vessel sensitivity was 89.5 % (95 % CI, 77.8-95.6 %) with 93.2 % specificity (95 % CI, 86.0-97.0 %). The area under the receiver-operating characteristic curve on per-patient and per-vessel levels was 0.949 and 0.913. Mean effective dose was 0.58 ± 0.17 mSv. Mean size-specific dose estimate was 3.14 ± 1.15 mGy. High-pitch prospectively ECG-triggered cCTA combined with iterative image reconstruction provides high diagnostic accuracy with a radiation dose below 1 mSv for detection of coronary artery stenosis. • Cardiac CT with sub-milliSievert radiation dose is feasible in many patients • High-pitch spiral CT acquisition with iterative reconstruction detects coronary stenosis accurately. • Iterative reconstruction increases who can benefit from low-radiation cardiac CT.

  11. High-resolution 3D coronary vessel wall imaging with near 100% respiratory efficiency using epicardial fat tracking: reproducibility and comparison with standard methods.

    PubMed

    Scott, Andrew D; Keegan, Jennifer; Firmin, David N

    2011-01-01

    To quantitatively assess the performance and reproducibility of 3D spiral coronary artery wall imaging with beat-to-beat respiratory-motion-correction (B2B-RMC) compared to navigator gated 2D spiral and turbo-spin-echo (TSE) acquisitions. High-resolution (0.7 × 0.7 mm) cross-sectional right coronary wall acquisitions were performed in 10 subjects using four techniques (B2B-RMC 3D spiral with alternate (2RR) and single (1RR) R-wave gating, navigator-gated 2D spiral (2RR) and navigator-gated 2D TSE (2RR)) on two occasions. Wall thickness measurements were compared with repeated measures analysis of variance (ANOVA). Reproducibility was assessed with the intraclass correlation coefficient (ICC). In all, 91% (73/80) of acquisitions were successful (failures: four TSE, two 3D spiral (1RR) and one 3D spiral (2RR)). Respiratory efficiency of the B2B-RMC was less variable and substantially higher than for navigator gating (99.6 ± 1.2% vs. 39.0 ± 7.5%, P < 0.0001). Coronary wall thicknesses (± standard deviation [SD]) were not significantly different: 1.10 ± 0.14 mm (3D spiral (2RR)), 1.20 ± 0.16 mm (3D spiral (1RR)), 1.14 ± 0.15 mm (2D spiral), and 1.21 ± 0.17 mm (TSE). Wall thickness reproducibility ranged from good (ICC = 0.65, 3D spiral (1RR)) to excellent (ICC = 0.87, 3D spiral (2RR)). High-resolution 3D spiral imaging with B2B-RMC permits coronary vessel wall assessment over multiple thin contiguous slices in a clinically feasible duration. Excellent reproducibility of the technique potentially enables studies of disease progression/regression. Copyright © 2010 Wiley-Liss, Inc.

  12. The Duration of Impella 2.5 Circulatory Support and Length of Hospital Stay of Patients Undergoing High-risk Percutaneous Coronary Interventions

    PubMed Central

    Anusionwu, Obiora; Fischman, Daniel; Cheriyath, Pramil

    2012-01-01

    Background To evaluate the impact of duration of Impella 2.5 support (Abiomed, Danvers, MA) on hospitalization of patients after high-risk percutaneous coronary intervention (PCI). There has been a continuous increase in prevalence of coronary artery disease with more patients needing PCI during acute myocardial infarction. Some of these patients have to undergo high-risk revascularization with circulatory support like the Impella 2.5 device. Methods This study was a single center retrospective study of patients admitted to our hospital who required Impella circulatory support during percutaneous coronary intervention. Patients’ medical records, cardiac catheterization laboratory and 2-D echocardiography reports were reviewed to ascertain left ventricular ejection fraction, duration of Impella support, Coronary Care Unit (CCU) days and the length of stay in the hospital. A P-value of ≤ 0.05 was considered statistically significant. Results Over a 15-month period, we had 25 patients with 19 males and 6 females. Mean age of the patient cohort was 68 ± 10 years. Mean LVEF of the group was 32 ± 16%. Mean length of hospital stay was 8 ± 8 days and mean CCU stay was 4 ± 4 days. The Impella was successfully inserted in all cases with a median duration of support of 70 minutes (range, 4 - 5760 minutes). Bleeding complication occurred in 8%. Spearman's rank correlation coefficient between the duration of Impella support and hospital stay was 0.49 (P = 0.023) while it was 0.71 (P = 0.001) between Impella support duration and CCU days. Conclusions Our study suggests that there is a positive correlation between the duration of Impella 2.5 circulatory support and hospital stay and/or CCU days. The correlation seems to be stronger with CCU days.

  13. Prognostic impact of absolute lymphocyte count/absolute monocyte count ratio and prognostic score in patients with nasal-type, extranodal natural killer/T-cell lymphoma.

    PubMed

    Li, Na; Zhang, Li; Song, Hao-Lan; Zhang, Jing; Weng, Hua-Wei; Zou, Li-Qun

    2017-05-01

    Nasal-type, extranodal natural killer/T-cell lymphoma is a heterogeneous disorder with poor prognosis, requiring risk stratification in this population. The combined value of baseline absolute lymphocyte count and absolute monocyte count provided prognostic information in some malignancies. However, the evidence requires validation in extranodal natural killer/T-cell lymphoma. Aiming to investigate the prognostic significance of absolute lymphocyte count/absolute monocyte count ratio and absolute lymphocyte count/absolute monocyte count prognostic score for extranodal natural killer/T-cell lymphoma, a retrospective research was carried out. A total of 264 patients with newly diagnosed extranodal natural killer/T-cell lymphoma were analyzed in this study. The patients' absolute lymphocyte count and absolute monocyte count tested at initial diagnosis were collected. Receiver operating curve analysis showed that the optimal cut-off values for absolute lymphocyte count and absolute monocyte count were 1.0 × 10(9) and 0.5 × 10(9)L(-1), respectively, and for absolute lymphocyte count/absolute monocyte count ratio was 2.85. After a median follow-up of 27 months (range 1-87 months), the 3-year overall survival and progression-free survival was 75.4% and 67.6%, respectively. Patients with absolute lymphocyte count/absolute monocyte count ratio ≥ 2.85 had better 3-year overall survival and progression-free survival than those with absolute lymphocyte count/absolute monocyte count ratio <2.85 (p < 0.001). According to absolute lymphocyte count/absolute monocyte count prognostic score, significant difference has been noticed in 3-year overall survival and progression-free survival (p < 0.001) and high absolute lymphocyte count/absolute monocyte count prognostic score was associated with poorer survival. The International Prognostic Index and Korean Prognostic Index were used for prognosis and showed no significant difference. When adding absolute lymphocyte count/absolute

  14. Measurement of Absolute Magnetic Moment

    NASA Astrophysics Data System (ADS)

    Shull, R. D.; Swartzendruber, L. J.

    1998-03-01

    In the past NIST has issued a number of magnetic moment and magnetic susceptibility standards. One of the most popular has been the Ni magnetic moment standard in the form a 2.38 mm diameter sphere of annealed, high-purity nickel, issued in 1978. However, the supply of all the magnetic standards has been exhausted for several years now and the equipment used for their certification no longer exists. Currently, NIST is assembling a precision absolute magnetometer closely resembling the force-based system used earlier by Candela and Mundy (G.A. Candela and R.E. Mundy, Rev. Sci. Instr. 32, 1056 (1959).), but which will have improved accuracy. This magnetometer will be used to certify a new series of magnetic standards, the first of which will be a replacement nickel sphere. A sphere has the advantage that it has uniform magnetization and a known demagnetizing factor, and approximates a point dipole. Nickel has the advantage of saturation at low field, a small temperature dependence at room temperature, and a relatively small field dependence. Other standards with smaller moments and other geometries are also being considered. These, and the current state of the equipment development will be described.

  15. Image quality and radiation dose of a prospectively electrocardiography-triggered high-pitch data acquisition strategy for coronary CT angiography: The multicenter, randomized PROTECTION IV study.

    PubMed

    Deseive, Simon; Pugliese, Francesca; Meave, Aloha; Alexanderson, Erick; Martinoff, Stefan; Hadamitzky, Martin; Massberg, Steffen; Hausleiter, Jörg

    2015-01-01

    Concerns have been raised about radiation dose of coronary CT angiography. Although high-pitch acquisition technique yields high potential for radiation dose savings, it is more vulnerable to artifacts, which impair diagnostic image quality. The purpose of this study was to compare 2 scan strategies for coronary CT angiography: a high-pitch helical scan first or a conventional scan first strategy. In this prospective, multicenter trial, we randomized 303 consecutive patients with a low and stable heart rate to either of the aforementioned mentioned strategies. Intravenous β-blockers were administered to achieve target heart rates. All scans were performed on a second-generation dual-source CT scanner. In case of nondiagnostic image quality, coronary CT angiography was allowed to be repeated. The primary end point was to demonstrate noninferior image quality in the high-pitch group. Image quality was assessed on a 4-point scale (1: nondiagnostic, 4: excellent). Secondary end point was total radiation dose. In the high-pitch helical first group, repeat scanning was necessary in 21 patients compared with 14 patients in the conventional first scan group (P = .25). Image quality in the high-pitch group was noninferior compared to the conventional scan group (3.81 ± 0.35 vs. 3.83 ± 0.37; P for noninferiority <.0001). The total effective radiation dose estimate was 58% lower in the high-pitch group (2.0 ± 2.4 vs. 4.7 ± 4.8 mSv; P < .0001). In patients with a low and stable heart rate diagnostic image quality can be maintained with a high-pitch helical scan first strategy while 58% of radiation dose can be saved. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  16. Mass variation in outcome to high production activity in Kamojang Geothermal Field, Indonesia: A reservoir monitoring with relative and absolute gravimetry

    NASA Astrophysics Data System (ADS)

    Sofyan, Y.; Kamah, Y.; Nishijima, J.; Fujimitsu, Y.; Ehara, S.; Fukuda, Y.; Taniguchi, M.

    2011-11-01

    The Kamojang Geothermal Field (KGF) is a typical vapor dominated hydrothermal system in west Java, Indonesia. This geothermal field is the oldest exploited geothermal field in Indonesia. From 1983 to 2005, more than 160 million tons of steam has been exploited from the KGF and more than 30 million tons of condensed water and river water were injected to the reservoir system. Regarding to the electricity demand, installed capacity of KGF increased from 30 MWe to 140 MWe in 1987 and 200 MWe in 2007. Mass variation in the geothermal reservoir can be measured by using the map of the gravity changes. Gravity changes observed in the KGF between 1999 and 2005 at 51 benchmarks are interpreted in terms of a change of mass. Concerning to the production mass increase, gravity changes also observed between 1999 and 2008 at 30 benchmarks. The recent gravity measurement was conducted using absolute gravimeter in 2009 and 2010 at 12 gravity benchmarks. Mass variation in the reservoir was caused by production and injection activities. Mass variation in KGF from 1999 to 2005 is about -3.34 Mt/year while is about -3.78 Mt/year from 1999 to 2008. Another period between 2009 and 2010, mass variation decreased about -8.24 Mt. According to the history of production and injection, natural recharge to the KGF's reservoir is estimated at about 2.77 Mt/year from 1999 to 2005 and 2.75 Mt/year from 1999 to 2008. Between 2009 and 2010, KGF has a bigger mass deficiency rate throughout 200 MWe maintain production.

  17. Toward absolute chemical composition distribution measurement of polyolefins by high-temperature liquid chromatography hyphenated with infrared absorbance and light scattering detectors.

    PubMed

    Lee, Dean; Shan, Colin Li Pi; Meunier, David M; Lyons, John W; Cong, Rongjuan; deGroot, A Willem

    2014-09-02

    Chemical composition distribution (CCD) is a fundamental metric for representing molecular structures of copolymers in addition to molecular weight distribution (MWD). Solvent gradient interaction chromatography (SGIC) is commonly used to separate copolymers by chemical composition in order to obtain CCD. The separation of polymer in SGIC is, however, not only affected by chemical composition but also by molecular weight and architecture. The ability to measure composition and MW simultaneously after separation would be beneficial for understanding the impact of different factors and deriving true CCD. In this study, comprehensive two-dimensional chromatography (2D) was coupled with infrared absorbance (IR5) and light scattering (LS) detectors for characterization of ethylene-propylene copolymers. Polymers were first separated by SGIC as the first dimension chromatography (D1). The separated fractions were then characterized by the second dimension (D2) size exclusion chromatography (SEC) with IR5 and LS detectors. The concentrations and compositions of the separated fractions were measured online using the IR5 detector. The MWs of the fractions were measured by the ratio of LS to IR5 signals. A metric was derived from online concentration and composition data to represent CCD breadth. The metric was shown to be independent of separation gradients for an "absolute" measurement of CCD breadth. By combining online composition and MW data, the relationship of MW as a function of chemical composition was obtained. This relationship was qualitatively consistent with the results by SEC coupled to IR5, which measures chemical composition as a function of logMW. The simultaneous measurements of composition and MW give the opportunity to study the SGIC separation mechanism and derive chain architectural characteristics of polymer chains.

  18. Impact of high altitude on echocardiographically determined cardiac morphology and function in patients with coronary artery disease and healthy controls.

    PubMed

    de Vries, S T; Kleijn, S A; van 't Hof, A W J; Snaak, H; van Enst, G C; Kamp, O; Breeman, A

    2010-06-01

    To evaluate the impact of high altitude on cardiac morphology and function in patients with coronary artery disease (CAD) and healthy controls. Eight patients with a history of acute myocardial infarction [53 +/- 8 years, left ventricular (LV) ejection fraction 54 +/- 6%] and a low risk score were compared with seven healthy controls (41 +/- 16 years) during the Dutch Heart Expedition 2007 at the Aconcagua (6960 m) in Argentina. An exercise test and echocardiography were performed at sea level and at base camp (4200 m). In the apical four-chamber view, right ventricular (RV) diameter, tricuspid annular plane systolic excursion (TAPSE), early transmitral inflow peak velocity (E), atrial transmitral inflow peak velocity (A), and peak tissue velocity during early diastole (E') were obtained. Changes in global LV function and wall motion score index (WMSI) were used as markers of ischaemia. There were no significant differences in individual global LV function and WMSI at high altitude compared with sea level in both groups. A significant increase in RV diameter was observed in the patient group at 4200 m compared with sea level and a trend towards the same result in the control group. A decrease in TAPSE was observed. Measurements of the E' showed a significant decrease in the LV septum and lateral wall at high altitude compared with sea level in both groups. Symptoms and echocardiographic signs of myocardial ischaemia were absent in low-risk patients with a history of CAD during and after exercise up to an altitude of 4200 m. Patients and healthy controls showed comparable changes at high altitude compared with sea level with an increase in RV diameter, a decrease in TAPSE, and decreased E' as early signs of pulmonary hypertension and LV diastolic dysfunction. As these alterations are most likely physiological adaptation to high altitude, the results seem to affirm current guidelines. The safety of expanding previous recommendations to patients with low-risk CAD to

  19. [Acute coronary syndrome -- 2012].

    PubMed

    Becker, Dávid; Merkely, Béla

    2012-12-23

    The acute coronary syndrome is the most severe form of coronary artery disease. It is an immediate threat of life and the mortality rate can be high without proper therapy and patient management. Based on the first ECG, two different forms can be distinguished: acute coronary syndrome with and without ST elevation. Besides adequate medication, management of these patients is an essential part of treatment. In case of ST elevation, coronarography and percutaneous coronary intervention is needed in general, within 24 hours from the onset of symptoms. When ST elevation is not detected on the ECG, individual ischemic risk factors and predictable mortality of the patient may define the necessity and the date of the invasive examination. The Hungarian hemodynamic laboratory network covers almost the whole country and, therefore, practically each patient may receive a state-of-the-art therapy. Although indicators of cardiovascular diseases are still prominent, the mortality rate of myocardial Infarction is decreasing in Hungary due to the well-organized invasive care.

  20. Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk.

    PubMed

    Robinson, Jennifer G; Wang, Songfeng; Smith, Brian J; Jacobson, Terry A

    2009-01-27

    To determine the relationship between non-high-density lipoprotein cholesterol (HDL-C) lowering and coronary heart disease (CHD) risk reduction for various lipid-modifying therapies. Non-HDL-C is the second lipid target of therapy after low-density lipoprotein cholesterol (LDL-C). Randomized placebo or active-controlled trials were evaluated. The effect of mean non-HDL-C reduction on the relative risk of nonfatal myocardial infarction and CHD death was estimated using Bayesian random-effects meta-analysis models adjusted for study duration. Cochrane's Q was used to test for heterogeneity. Inclusion criteria were met by 14 statin (n = 100,827), 7 fibrate (n = 21,647), and 6 niacin (n = 4,445) trials, and 1 trial each of a bile acid sequestrant (n = 3,806), diet (n = 458), and ileal bypass surgery (n = 838). For statins, each 1% decrease in non-HDL-C resulted in an estimated 4.5-year CHD relative risk of 0.99 (95% Bayesian confidence interval: 0.98 to 1.00). The fibrate model did not differ from the statin model (Bayes factor K = 0.49) with no evidence of heterogeneity. The niacin model was moderately different from the statin model (K = 7.43), with heterogeneity among the trials (Q = 11.8, 5 df; p = 0.038). The only niacin monotherapy trial (n = 3,908) had a 1:1 relationship between non-HDL-C and risk reduction. No consistent relationships were apparent for the 5 small trials of niacin in combination. The 95% confidence intervals for the single trials of diet, bile acid sequestrants, and surgery also included the 1:1 relationship. Non-HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximately 1:1 relationship between percent non-HDL-C lowering and CHD reduction.

  1. Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Cardiovascular Events in Diabetics With Coronary Artery Disease.

    PubMed

    Yang, Sheng-Hua; Du, Ying; Li, Xiao-Lin; Zhang, Yan; Li, Sha; Xu, Rui-Xia; Zhu, Cheng-Gang; Guo, Yuan-Lin; Wu, Na-Qiong; Qing, Ping; Gao, Ying; Cui, Chuan-Jue; Dong, Qian; Sun, Jing; Li, Jian-Jun

    2017-08-01

    It has been demonstrated that an elevated ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) is a risk factor of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) and is also found to be associated with cardiovascular events (CVEs) in the general population. However, its prognostic value in patients with T2DM along with CAD remains to be determined. A total of 1,447 consecutive patients with T2DM with angiographic-proven stable CAD were enrolled in the present study and followed-up for an average of 20.3 months. The characteristics of all patients including fasting lipid profile were obtained at baseline and multivariate Cox proportional hazards models were constructed using log TG/HDL-C as a predictor variable. The relationships between CVEs and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apolipoprotein B/ apolipoprotein AI (apoB/apoAI) were also explored. Compared with patients without CVEs, the ones who experienced CVEs had a higher TG/HDL-C ratio. Univariable regression revealed a significant association of log TG/HDL-C with CVEs (hazard ratio = 2.5, P = 0.015). After adjusting for multiple traditional risk factors of cardiovascular disease, the association was still found (hazard ratio = 2.47, P = 0.047). Moreover, results suggested that the ratios of non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apoB/apoAI were not predictors for CVEs in T2DM. In our primary study, data suggested that elevated TG/HDL-C value might be a useful predictor for future CVEs in Chinese patients with T2DM with stable CAD. Further study is needed to confirm our findings. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  2. Role of high-resolution image integration to visualize left phrenic nerve and coronary arteries during epicardial ventricular tachycardia ablation.

    PubMed

    Yamashita, Seigo; Sacher, Frédéric; Mahida, Saagar; Berte, Benjamin; Lim, Han S; Komatsu, Yuki; Amraoui, Sana; Denis, Arnaud; Derval, Nicolas; Laurent, François; Montaudon, Michel; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre; Cochet, Hubert

    2015-04-01

    Epicardial ventricular tachycardia (VT) ablation is associated with risks of coronary artery (CA) and phrenic nerve (PN) injury. We investigated the role of multidetector computed tomography in visualizing CA and PN during VT ablation. Ninety-five consecutive patients (86 men; age, 57 ± 15) with VT underwent cardiac multidetector computed tomography. The PN detection rate and anatomic variability were analyzed. In 49 patients undergoing epicardial mapping, real-time multidetector computed tomographic integration was used to display CAs/PN locations in 3-dimensional mapping systems. Elimination of local abnormal ventricular activities (LAVAs) was used as ablation end point. The distribution of CAs/PN with respect to LAVA was analyzed and compared between VT etiologies. Multidetector computed tomography detected PN in 81 patients (85%). Epicardial LAVAs were observed in 44 of 49 patients (15 ischemic cardiomyopathy, 15 nonischemic cardiomyopathy, and 14 arrhythmogenic right ventricular cardiomyopathy) with a mean of 35 ± 37 LAVA points/patient. LAVAs were located within 1 cm from CAs and PN in 35 (80%) and 18 (37%) patients, respectively. The prevalence of LAVA adjacent to CAs was higher in nonischemic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy than in ischemic cardiomyopathy (100% versus 86% versus 53%; P < 0.01). The prevalence of LAVAs adjacent to PN was higher in nonischemic cardiomyopathy than in ischemic cardiomyopathy (93% versus 27%; P < 0.001). Epicardial ablation was performed in 37 patients (76%). Epicardial LAVAs could not be eliminated because of the proximity to CAs or PN in 8 patients (18%). The epicardial electrophysiological VT substrate is often close to CAs and PN in patients with nonischemic cardiomyopathy. High-resolution image integration is potentially useful to minimize risks of PN and CA injury during epicardial VT ablation. © 2015 American Heart Association, Inc.

  3. Association of high-density lipoprotein subclasses and incident coronary heart disease: The Jackson Heart and Framingham Offspring Cohort Studies

    PubMed Central

    Joshi, Parag H; Toth, Peter P; Lirette, Seth T; Griswold, Michael E; Massaro, Joseph M; Martin, Seth S; Blaha, Michael J; Kulkarni, Krishnaji R; Khokhar, Arif A; Correa, Adolfo; D’Agustino, Ralph B; Jones, Steven R

    2015-01-01

    Aims We aimed to clarify the associations of high-density lipoprotein cholesterol (HDL-C) subclasses with incident coronary heart disease (CHD) in two large primary prevention cohorts. Methods We measured cholesterol at baseline from the two major HDL subfractions (larger, more buoyant HDL2 and smaller, denser HDL3) separated by density gradient ultracentrifugation in 4114 (mean age 53.8 years; 64% female) African American participants from the Jackson Heart Study and 818 (mean age 57.3 years, 52% female) predominantly Caucasian participants from the Framingham Offspring Cohort Study. Multivariable adjusted hazard ratios (HRs) for HDL-C and its subclasses were derived from Cox proportional hazards regression models to estimate associations with incident CHD events including myocardial infarction, CHD death, and revascularization. Analyses were performed for each cohort separately and as a combined population. Results In models adjusted for cardiovascular risk factors for the combined population, HDL3-C (HR 0.76 per SD increase; 95% confidence interval (CI), 0.62–0.94; p = 0.01), rather than HDL2-C (HR 0.88 per SD; 95% CI, 0.72–1.09; p = 0.24) drove the inverse association of HDL-C (HR 0.79 per SD; 95% CI, 0.64–0.98; p = 0.03) with CHD. Similar associations were seen in multivariable analyses within each cohort including after adjusting for apolipoprotein A1 in the Jackson Heart Study. Conclusion Smaller, denser HDL3-C levels are primarily responsible for the inverse association between HDL-C and incident CHD in this diverse group of primary prevention subjects. These findings have important implications ranging from considerations of HDL biology to interpretations of clinical trials utilizing HDL-C therapeutics. PMID:25062744

  4. High sensitivity cardiac troponin T in patients not having an acute coronary syndrome: results from the TRAPID-AMI study.

    PubMed

    Nowak, Richard; Mueller, Christian; Giannitsis, Evangelos; Christ, Michael; Ordonez-Llanos, Jordi; DeFilippi, Christopher; McCord, James; Body, Richard; Panteghini, Mauro; Jernberg, Tomas; Plebani, Mario; Verschuren, Franck; French, John K; Christenson, Robert; Jacobsen, Gordon; Dinkel, Carina; Lindahl, Bertil

    2017-06-14

    To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis. hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients. Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses. Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.

  5. Does high intelligence improve prognosis? The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease.

    PubMed

    Sörberg Wallin, Alma; Falkstedt, Daniel; Allebeck, Peter; Melin, Bo; Janszky, Imre; Hemmingsson, Tomas

    2015-04-01

    Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. High-grade, nonmyogenic pulmonary artery sarcoma: rare findings on coronary angiography.

    PubMed

    Ramjee, Vimal; Lewis, Melinda M; Clements, Stephen D

    2011-01-01

    Pulmonary artery sarcomas are exceptionally rare, and they are often misdiagnosed as chronic pulmonary thromboemboli. Early and accurate diagnosis is crucial to the prognosis of patients who have pulmonary artery sarcomas.Herein, we describe the case of a 74-year-old man who presented with dyspnea and was initially thought to have a pulmonary embolus. Anticoagulation with unfractionated heparin was ineffective. Rare angiographic findings during routine cardiac catheterization led to the diagnosis of a high-grade, nonmyogenic, primary pulmonary artery sarcoma. This case illustrates the usefulness of angiographic findings as an adjunct to conventional diagnostic methods in correctly identifying this rare, aggressive malignancy.

  7. Point-of-care heart-type fatty acid binding protein versus high-sensitivity troponin T testing in emergency patients at high risk for acute coronary syndrome.

    PubMed

    Kellens, Sebastiaan; Verbrugge, Frederik H; Vanmechelen, Maxime; Grieten, Lars; Van Lierde, Johan; Dens, Joseph; Vrolix, Mathias; Vandervoort, Pieter

    2016-04-01

    High-sensitivity cardiac troponin testing is used to detect myocardial damage in patients with acute chest pain. Heart-type fatty acid binding protein (H-FABP) may be an alternative, available as point-of-care test. Patients (n=203) referred by general practitioners for suspected acute coronary syndrome or presenting with typical chest pain and one major cardiovascular risk factor at the emergency department were prospectively included in a single-centre cohort study. High-sensitivity cardiac troponin T (hs-TnT) and point-of-care H-FABP testing were concomitantly performed at admission and after 6h. Maximal hs-TnT levels above the 99th percentile were observed in 152 patients (75%) with 127 (63%) fulfilling criteria for myocardial infarction. Upon admission, hs-TnT and H-FABP were associated with an area under the curve (95% CI) of 0.83 (0.77-0.89) and 0.79 (0.73-0.85), respectively, to predict myocardial infarction, which increased to 0.93 (0.90-0.97) and 0.88 (0.84-0.93), respectively, after 6h. The diagnostic accuracy for non-ST-segment elevation myocardial infarction was somewhat lower with an area under the curve (95% CI) of 0.80 (0.72-0.87), 0.90 (0.84-0.96), 0.73 (0.64-0.81) and 0.77 (0.67-0.86), respectively. When assessment was performed within 3h of chest pain onset, diagnostic accuracy of H-FABP versus hs-TnT was similar. Each standard deviation increase in admission H-FABP was associated with a 68% relative risk increase of all-cause mortality (p-value=0.027) during 666 ± 155 days of follow-up. Point-of-care H-FABP testing has lower diagnostic accuracy compared with hs-TnT assessment in patients with high pre-test acute coronary syndrome probability, but might be of interest when assessment is possible early after chest pain onset. © The European Society of Cardiology 2015.

  8. Effect of serial infusions of reconstituted high-density lipoprotein (CER-001) on coronary atherosclerosis: rationale and design of the CARAT study

    PubMed Central

    Andrews, Jordan; Janssan, Alex; Nguyen, Tracy; Pisaniello, Anthony D.; Scherer, Daniel J.; Kastelein, John J. P.; Merkely, Bela; Nissen, Steven E.; Ray, Kausik; Schwartz, Gregory G.; Worthley, Stephen G.; Keyserling, Connie; Dasseux, Jean-Louis; Butters, Julie; Girardi, Jacinta; Miller, Rosemary

    2017-01-01

    Background High-density lipoprotein (HDL) is believed to have atheroprotective properties, but an effective HDL-based therapy remains elusive. Early studies have suggested that infusion of reconstituted HDL promotes reverse cholesterol transport and vascular reactivity. The CER-001 Atherosclerosis Regression Acute Coronary Syndrome Trial (CARAT) is investigating the impact of infusing an engineered pre-beta HDL mimetic containing sphingomyelin (SM) and dipalmitoyl phosphatidlyglycerol (CER-001) on coronary atheroma volume in patients with a recent acute coronary syndrome (ACS). Methods The CARAT is a phase 2, multicenter trial in which 292 patients with an ACS undergoing intracoronary ultrasonography and showing percent atheroma volume (PAV) greater than 30% are randomly assigned to treatment with ten infusions of CER-001 3 mg/kg or matching placebo, administered at weekly intervals. Intracoronary ultrasonography is repeated at the end of the treatment period. Results The primary endpoint is the nominal change in PAV. Safety and tolerability will also be evaluated. Conclusions CARAT will establish whether serial 3 mg/kg infusions of an engineered pre-beta HDL mimetic containing SM and dipalmitoyl phosphatidlyglycerol (CER-001) will regress atherosclerotic plaque in patients with a recent ACS. PMID:28164012

  9. Study to Improve Cardiovascular Outcomes in high-risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study

    PubMed Central

    Kunadian, Vijay; Neely, R Dermot G; Sinclair, Hannah; Batty, Jonathan A; Veerasamy, Murugapathy; Ford, Gary A; Qiu, Weiliang

    2016-01-01

    Introduction The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool. Methods and analysis Participants are recruited from 2 tertiary hospitals in the UK. Baseline evaluation includes frailty, comorbidity, cognition and quality-of-life measures, inflammatory status assessed by a biomarker panel, including microRNAs, senescence assessed by telomere length and telomerase activity, cardiovascular status assessed by arterial stiffness, endothelial function, carotid intima media thickness and left ventricular systolic and diastolic function, and coronary plaque assessed by virtual histology intravascular ultrasound and optical coherence tomography. The patients are followed-up at 30 days and at 1 year for primary outcome measures of death, myocardial infarction, stroke, unplanned revascularisation, bleeding and rehospitalisation. Ethics and dissemination The study has been approved by the regional ethics committee (REC 12/NE/016). Findings of the study will be presented in scientific sessions and will be published in peer-reviewed journals. Trial registration number NCT01933581: Pre-results. PMID:27554105

  10. Sudden cardiac death rate in an area characterized by high incidence of coronary artery disease and low hardness of drinking water.

    PubMed

    Bernardi, D; Dini, F L; Azzarelli, A; Giaconi, A; Volterrani, C; Lunardi, M

    1995-02-01

    From January 1992 to January 1993 the incidence of sudden cardiac death among the population of the Media Valle del Serchio area (Tuscany, Italy), composed of a population of 35,000, was found to be twice that of the European average; 32 cases have been reported over this period in that area (9 per 10,000 in the examined year), with a male/female (M/F) ratio of 2.5:1 (23 M, 9 F). In Italy the mean incidence of sudden death was calculated as 6/10,000 and in Europe 5/10,000. In the examined population hypertension was the coronary risk factor present most frequently (87%). A previous diagnosis of coronary artery disease was documented in 21 cases (66%); 5 of these exhibited previous myocardial infarction and 3 previous myocardial infarction associated with left ventricular heart failure. In 7 subjects no previous cardiovascular disorders were discovered. Prodromal symptoms had been reported in 20 cases (62%), which included chest pain in 8 and dyspnea in 8. In the examined geographic area a high prevalence of coronary artery disease was verified through the records of the Public Health Service, which documents the main causes of mortality in Tuscany, and through the hospitalization data and the services provided for ischemic heart disease at the local coronary care unit compared with the national average. Moreover, research was accomplished on physical and chemical properties of drinking water in the same area, and this revealed a very low total hardness due to the paucity of calcium and magnesium salts.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease

    PubMed Central

    Herrera, VM; Casas, JP; Miranda, JJ; Perel, P; Pichardo, R; González, A; Sanchez, JR; Ferreccio, C; Aguilera, X; Silva, E; Oróstegui, M; Gómez, LF; Chirinos, JA; Medina-Lezama, J; Pérez, CM; Suárez, E; Ortiz, AP; Rosero, L; Schapochnik, N; Ortiz, Z; Ferrante, D; Diaz, M; Bautista, LE

    2009-01-01

    Background Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. Objective To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. Methods We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk ≥20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. Results WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m2). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. Conclusion WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men. PMID:19238159

  12. Beating-heart coronary artery bypass surgery with the help of mini extracorporeal circulation for very high-risk patients.

    PubMed

    Munos, Emmanuel; Calderon, Joachim; Pillois, Xavier; Lafitte, Stéphane; Ouattara, Alexandre; Labrousse, Louis; Roques, Xavier; Barandon, Laurent

    2011-03-01

    Left ventricle dysfunction and co-morbidities are responsible for a large number of complications after coronary artery bypass graft (CABG) surgery. The best strategy for these patients, including the use or not and type of extracorporeal circulation (ECC), the use of minimized ECC (MECC), or conventional ECC (CECC), remains unclear. The aim of the present study was to investigate the potential effect of on-pump beating-heart (OPBH) surgery with the help of MECC for CABG in patients with a high-risk EuroSCORE and to compare this strategy to three other different procedures, including OPCAB and MECC or CECC with cardiac arrest. Patients were included if their EuroSCORE was strictly >" xbd="1427" xhg="1404" ybd="1477" yhg="1440"/>9. Four groups were retrospectively compared: an OPCAB, an OPBH, a MECC and a CECC group under cardiac arrest. 214 patients, mean age 74.26 ± 8.5 years, 68.7% male, were operated. Mean EuroSCORE was 12.1 ± 2.9, left ventricular (LV) function 37.4 ± 12.3%, recent myocardial infarction (MI) 49.5%, renal failure 48.1%, chronic obstructive pulmonary disease (COPD) 42.2%, and peripheral vascular disease (PVD) 55.6%. Mean number of grafts per patient was 2.4 ± 0.7. Our study showed that it was possible, in very high-risk patients, to carry out revascularisation with OPBH similar to that using MECC or CECC under cardiac arrest (p=NS). This technique reduces troponin release (3.23 vs 6.56, p<0.01), postoperative myocardial complications (2% vs 8%, p<0.01), cardiotonic drug prescription (15.7% vs 31.3%, p<0.01), ventilation time (4.57H vs 6.48H, p<0.01) and length of stay (LOS) in ICU (2.16 vs 2.53, p=0.02). The OPBH method seems to be safe, secure and effective in this population of very high-risk patients, reducing early complications and multi-organ failure. OPBH surgery, combining MECC without aortic cross-clamping, makes it possible to perform complete revascularization and is an interesting alternative for CABG in high-risk patients.

  13. Epicardial and Paracardial Adipose Tissue Volume and Attenuation – Association with High-Risk Coronary Plaque on Computed Tomographic Angiography in the ROMICAT II Trial

    PubMed Central

    Lu, Michael T.; Park, Jakob; Ghemigian, Khristine; Mayrhofer, Thomas; Puchner, Stefan B.; Liu, Ting; Fleg, Jerome L.; Udelson, James E.; Truong, Quynh A.; Ferencik, Maros; Hoffmann, Udo

    2016-01-01

    Background and aims To determine whether epicardial (EAT) and paracardial adipose tissue (PAT) volume and attenuation are associated with high-risk coronary plaque features. Methods In subjects with suspected acute coronary syndrome (ACS) enrolled in the ROMICAT II trial, EAT and PAT volumes indexed to body surface area (BSA) and attenuation were measured on noncontrast coronary artery calcium score (CACS) CT. High-risk plaque features (napkin-ring sign, positive remodeling, low density plaque, spotty calcium) and stenosis were assessed on coronary CT angiography (CTA). The association of EAT and PAT volume and attenuation with high-risk plaque and whether this was independent of clinical risk assessment, CACS and significant coronary artery disease (CAD) was determined. Results Of 467 (mean 54±8 yrs, 53% male) with CACS and CTA, 167 (36%) had high-risk plaque features. Those with high-risk plaque had significantly higher indexed EAT (median 59 (Q1–Q3:45–75) cc/m2 vs. 49 (35–65) cc/m2, p <0.001) and PAT volume (median:51 (36–73) cc/m2 vs. 33 (22–52) cc/m2, p <0.001). Higher indexed EAT volume was associated with high-risk plaque [univariate OR 1.02 (95%-CI:1.01 – 1.03) per cc/m2 of EAT, p <0.001], which remained significant [univariate OR 1.04 (95%-CI:1.00–1.08) per cc/m2 of EAT, p=0.040] after adjustment for risk factors, CACS, and stenosis ≥50%. Higher indexed PAT volume was associated with high-risk plaque in univariate analysis [OR 1.02 (1.01 – 1.03) per cc/m2 of PAT, p <0.001], though this was not significant in multivariate analysis. At a threshold of >62.3 cc/m2, EAT volume was associated with high-risk plaque [univariate OR 2.50 (95%-CI:1.69–3.72), p <0.001)], which remained significant [OR 1.83 (95%-CI:1.10–3.05), p=0.020] after adjustment. Subjects with high-risk plaque had lower mean attenuation EAT (−88.1 vs. −86.9 HU, p=0.008) and PAT (−106 vs. −103 HU, p <0.001), though this was not significant in multivariable analysis

  14. Cardiovascular, metabolic, and coronary dysfunction in high-fat-fed obesity-resistant/prone rats.

    PubMed

    Dake, Brian L; Oltman, Christine L

    2015-03-01

    Obesity is a global epidemic leading to several comorbidities including diabetes and cardiovascular disease. The hypothesis that the genetic background of the obesity-prone rat (OP) predisposes to physiologic, metabolic, and microvascular dysfunction which is exacerbated by a diet high in saturated fats was tested. Male OP and obesity-resistant (OR) rats were fed either a diet containing 10% (chow) or 45% kcal fat (HF) for 42 weeks. Weight of OP rats was greater than OR rats by 8 weeks on both diets. Blood pressure was increased in OP rats on chow and further augmented by HF diet compared to OR rats on similar diets. In contrast to weight and blood pressure, glucose clearance was similar in OR and OP rats on chow and impaired in both models on HF diet. Relaxation to acetylcholine was attenuated in OP rats compared to OR rats by 8 weeks and remained reduced throughout the study. A longer period of time was required to observe vascular dysfunction in HF-fed OR rats. When compared to OR rats, OP rats are prone to develop not only greater obesity but also hypertension and vascular dysfunction on a normal diet which is further augmented with HF diet. © 2015 The Obesity Society.

  15. Low protective PON1 lactonase activity in an Arab population with high rates of coronary heart disease and diabetes.

    PubMed

    Gugliucci, A; Caccavello, R; Nassar, H; Abu Ahmad, W; Sinnreich, R; Kark, J D

    2015-05-20

    Recent studies showing that high density lipoproteins (HDL) can effect plaque regression indicate that recent trial failures do not exclude an atheroprotective role of HDL. Instead, they highlight differences between HDL function and measured HDL-cholesterol (HDL-C). PON1 is one key functional activity of HDL. Urban Palestinians have lower HDL-C and a higher incidence and mortality of coronary heart disease than those of Israelis. We hypothesized that the cardioprotective PON1 lactonase and arylesterase activities and PON1 functional genotype may differ between Palestinians and Israelis. We measured PON1 activities in a cross-sectional population-based study of Palestinian (n=960) and Israeli (n=694) residents in Jerusalem, 1654 participants in all. Palestinians had high prevalences of obesity and diabetes and low mean concentrations of HDL-cholesterol (0.97 mmol/l in men and 1.19 mmol/l in women). Lactonase and arylesterase activities were lower by 10.8% (p=1.2∗10(-14)) and 2.7% (p<0.0005), respectively, in Palestinians as compared to Israelis. The functional genotype distribution, demonstrated by plotting paraoxonase vs lactonase activities, showed a modest between-group difference (p=0.024), with 12.1% RR in Palestinian Arabs vs 8.4% in Israeli Jews, but no overall difference in allele frequencies. Lactonase correlated inversely with age (Spearman's rho=-.156), weakly with BMI (-.059), positively with HDL-C (.173) and non-HDL-C (.103), but was not associated with triglycerides or fasting glucose. Palestinians showed consistently lower lactonase activity in logistic regression models adjusted for multiple covariates and for functional genotype (odds ratios of 1.81 and 1.98, respectively, for the lower fifth vs the upper 4 fifths of lactonase activity p<0.0001). We showed a lower physiologically-significant lactonase PON1 activity in an Arab population, a finding consistent with the high cardiovascular and diabetes risk of Palestinians. Copyright © 2015

  16. Clinical Utility of Measuring Epicardial Adipose Tissue Thickness with Echocardiography Using a High-Frequency Linear Probe in Patients with Coronary Artery Disease.

    PubMed

    Hirata, Yukina; Yamada, Hirotsugu; Kusunose, Kenya; Iwase, Takashi; Nishio, Susumu; Hayashi, Shuji; Bando, Mika; Amano, Rie; Yamaguchi, Koji; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

    2015-10-01

    The relationship between epicardial adipose tissue (EAT) and coronary artery disease (CAD) has recently attracted a great deal of attention in the medical community. The objective of this study was to determine whether measuring EAT thickness in the anterior interventricular groove (AIG) using echocardiography is feasible and whether this index can be a marker of CAD. A total of 311 patients (mean age, 67 ± 11 years; 208 men) who underwent coronary angiography between December 2011 and December 2013 were prospectively enrolled. EAT-AIG thickness and EAT thickness on the free wall of the right ventricle (RV) were measured in systole using a high-frequency linear probe. Seventy-one patients who underwent multidetector-row computed tomography were enrolled to validate the method for measuring EAT thickness using echocardiography. Subjects were divided into two groups, those with and without significant coronary stenosis, on the basis of findings on coronary angiography (≥ 75% luminal narrowing). EAT-AIG thickness measured using echocardiography was validated by computed tomography. EAT-AIG thickness was strongly correlated with EAT volume (r = 0.714, P < .001). The CAD group had thicker EAT-AIG than the non-CAD group (8.3 ± 3.0 vs 6.3 ± 2.5 mm, P < .001). EAT-RV thickness was greater in the CAD group than in the non-CAD group (5.0 ± 2.1 vs 4.4 ± 2.3 mm, P = .009) as well. The area under the curve on receiver operating characteristic curve analysis of EAT-AIG thickness for predicting CAD was 0.704, which was higher than the EAT-RV thickness. Measuring EAT thickness using echocardiography with a high-frequency linear probe was validated with computed tomography. EAT-AIG was thicker in the CAD group than in the non-CAD group, as was EAT-RV thickness. This noninvasive index may have potential as a diagnostic marker for predicting coronary atherosclerosis. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  17. Non‐invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores

    PubMed Central

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P

    2006-01-01

    Objective To show an overall diagnostic accuracy ⩾ 90% for detection of ⩾ 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 × 0.5‐MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. Methods ECG gated 32 × 0.5‐MDCTA (32 × 0.5 mm cross sections, 0.35 × 0.35 × 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including ⩾ 1.5 mm branches, and bypass grafts were screened for ⩾ 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 × 0.5‐MDCTA) was analysed by quantitative coronary angiography. Results Median Agatston calcium score was 510 (range 3–5066). Sensitivity, specificity, and positive and negative predictive values for detection of ⩾ 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter‐defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Conclusions Coronary 32 × 0.5‐MDCTA accurately excludes ⩾ 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%. PMID:16251224

  18. Database applicaton for absolute spectrophotometry

    NASA Astrophysics Data System (ADS)

    Bochkov, Valery V.; Shumko, Sergiy

    2002-12-01

    32-bit database application with multidocument interface for Windows has been developed to calculate absolute energy distributions of observed spectra. The original database contains wavelength calibrated observed spectra which had been already passed through apparatus reductions such as flatfielding, background and apparatus noise subtracting. Absolute energy distributions of observed spectra are defined in unique scale by means of registering them simultaneously with artificial intensity standard. Observations of sequence of spectrophotometric standards are used to define absolute energy of the artificial standard. Observations of spectrophotometric standards are used to define optical extinction in selected moments. FFT algorithm implemented in the application allows performing convolution (deconvolution) spectra with user-defined PSF. The object-oriented interface has been created using facilities of C++ libraries. Client/server model with Windows Socket functionality based on TCP/IP protocol is used to develop the application. It supports Dynamic Data Exchange conversation in server mode and uses Microsoft Exchange communication facilities.

  19. Impact of insulin like growth factor-1 in development of coronary artery ectasia.

    PubMed

    Akturk, Ibrahim Faruk; Biyik, Ismail; Yalcin, Ahmet Arif; Isiksacan, Nilgun; Celik, Omer; Ozturk, Derya; Erturk, Mehmet

    2014-09-12

    Coronary artery ectasia (CAE) is characterized by inappropriate dilatation of the coronary vasculature. The mechanisms of CAE are not well known. Insulin-like growth factor-1 (IGF-1) may make endothelial cells and smooth muscle cells more sensitive to the effects of growth hormone. In the present study, we hypothesized that IGF-1 may have an impact on the formation of ectasia and aneurysm in arterial system, and aimed to investigate the associations between the presence of CAE and serum IGF-1 levels in patients undergoing coronary angiography. The study included 2.980 subjects undergoing elective diagnostic coronary angiography. We selected 40 patients diagnosed with CAE as CAE group and 44 subjects with absolutely normal coronary arteries were assigned as normal control group. IGF-1 levels were measured in both groups of patients. Groups were similar in terms of age, sex and coronary artery disease risk factors. The serum IGF-1 levels were significantly higher in CAE patients with 109.64 ± 54.64 ng/mL than in controls with 84.76 ± 34.01 ng/mL (p=0.016). HDL levels were lower in ectasia group with 41.5 ± 10.7 mg/dL than controls with 47.7 ± 10.4 mg/dL (p=0.018). By means of logistic regression analysis, high IGF-1 and low HDL levels were found to be independent risk factors for the presence of CAE (p<0.02, p<0.016, respectively). The study revealed that there was a positive correlation between serum IGF-1 levels and presence of CAE, and high IGF-1 levels and low HDL levels were independent risk factors for the presence of CAE. Future studies are needed to confirm these results.

  20. Impact of insulin like growth factor-1 in development of coronary artery ectasia

    PubMed Central

    Akturk, Ibrahim Faruk; Biyik, Ismail; Yalcin, Ahmet Arif; Isiksacan, Nilgun; Celik, Omer; Ozturk, Derya; Erturk, Mehmet

    2014-01-01

    Coronary artery ectasia (CAE) is characterized by inappropriate dilatation of the coronary vasculature. The mechanisms of CAE are not well known. Insulin-like growth factor-1 (IGF-1) may make endothelial cells and smooth muscle cells more sensitive to the effects of growth hormone. In the present study, we hypothesized that IGF-1 may have an impact on the formation of ectasia and aneurysm in arterial system, and aimed to investigate the associations between the presence of CAE and serum IGF-1 levels in patients undergoing coronary angiography. The study included 2.980 subjects undergoing elective diagnostic coronary angiography. We selected 40 patients diagnosed with CAE as CAE group and 44 subjects with absolutely normal coronary arteries were assigned as normal control group. IGF-1 levels were measured in both groups of patients. Groups were similar in terms of age, sex and coronary artery disease risk factors. The serum IGF-1 levels were significantly higher in CAE patients with 109.64±54.64 ng/mL than in controls with 84.76±34.01 ng/mL (p=0.016). HDL levels were lower in ectasia group with 41.5±10.7 mg/dL than controls with 47.7±10.4 mg/dL (p=0.018). By means of logistic regression analysis, high IGF-1 and low HDL levels were found to be independent risk factors for the presence of CAE (p<0.02, p<0.016, respectively). The study revealed that there was a positive correlation between serum IGF-1 levels and presence of CAE, and high IGF-1 levels and low HDL levels were independent risk factors for the presence of CAE. Future studies are needed to confirm these results. PMID:25428678

  1. Absolute classification with unsupervised clustering

    NASA Technical Reports Server (NTRS)

    Jeon, Byeungwoo; Landgrebe, D. A.

    1992-01-01

    An absolute classification algorithm is proposed in which the class definition through training samples or otherwise is required only for a particular class of interest. The absolute classification is considered as a problem of unsupervised clustering when one cluster is known initially. The definitions and statistics of the other classes are automatically developed through the weighted unsupervised clustering procedure, which is developed to keep the cluster corresponding to the class of interest from losing its identity as the class of interest. Once all the classes are developed, a conventional relative classifier such as the maximum-likelihood classifier is used in the classification.

  2. Absolute brightness of fluorescent microspheres.

    PubMed

    Finger, Isaac; Phillips, Scott; Mobley, Elizabeth; Tucker, Robert; Hess, Henry

    2009-02-07

    The absolute brightness of fluorescent particles, such as dye-containing nano- and microspheres or quantum dots, is a critical design parameter for many applications relying on fluorescence detection. The absolute brightness, defined as the ratio of radiant intensity of emission to illumination intensity of excitation, of nile-red fluorescent microspheres with a 1 micrometre diameter is measured to be 4.2 +/- 1 x 10(-16) m(2)/sr, and the implications for the design of kinesin motor protein-powered "smart dust" devices and the remote detection of fluorescence are discussed.

  3. Absolute classification with unsupervised clustering

    NASA Technical Reports Server (NTRS)

    Jeon, Byeungwoo; Landgrebe, D. A.

    1992-01-01

    An absolute classification algorithm is proposed in which the class definition through training samples or otherwise is required only for a particular class of interest. The absolute classification is considered as a problem of unsupervised clustering when one cluster is known initially. The definitions and statistics of the other classes are automatically developed through the weighted unsupervised clustering procedure, which is developed to keep the cluster corresponding to the class of interest from losing its identity as the class of interest. Once all the classes are developed, a conventional relative classifier such as the maximum-likelihood classifier is used in the classification.

  4. Lipoprotein(a) and coronary atheroma progression rates during long-term high-intensity statin therapy: Insights from SATURN.

    PubMed

    Puri, Rishi; Ballantyne, Christie M; Hoogeveen, Ron C; Shao, Mingyuan; Barter, Philip; Libby, Peter; Chapman, M John; Erbel, Raimund; Arsenault, Benoit J; Raichlen, Joel S; Nissen, Steven E; Nicholls, Stephen J

    2017-08-01

    Lipoprotein(a) [Lp(a)] is a low-density lipoprotein (LDL)-like particle that associates with major adverse cardiovascular events (MACE). We examined relationships between Lp(a) measurements and changes in coronary atheroma volume following long-term maximally-intensive statin therapy in coronary artery disease patients. Study of coronary atheroma by intravascular ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. Baseline and follow-up Lp(a) levels were measured in 915 of the 1039 SATURN participants, and were correlated with changes in percent atheroma volume (ΔPAV). Mean age was 57.7 ± 8.6 years, 74% were men, 96% were Caucasian, with statin use prior to study enrolment occurring in 59.3% of participants. Baseline [median (IQR)] LDL-cholesterol (LDL-C) and measured Lp(a) levels (mg/dL) were 114 (99, 137) and 17.4 (7.6, 52.9) respectively; follow-up measures were 60 (47, 77), and 16.5 (6.7, 57.7) (change from baseline: p < 0.001, p = 0.31 respectively). At baseline, there were 676 patients with Lp(a) levels <50 mg/dL [median Lp(a) of 10.9 mg/dL], and 239 patients with Lp(a) levels ≥ 50 mg/dL [median Lp(a) of 83.2 mg/dL]. Quartiles of baseline and follow-up Lp(a) did not associate with ΔPAV. Irrespective of the achieved LDL-C ( 50 mg/dL. In coronary artery disease patients prescribed long-term maximally intensive statin therapy with low on-treatment LDL-C levels, measured Lp(a) levels (predominantly below the 50 mg/dL threshold) do not associate with coronary atheroma progression. Alternative biomarkers may

  5. High-dose aspirin in addition to daily low-dose aspirin decreases platelet activation in patients before and after percutaneous coronary intervention.

    PubMed

    ten Berg, Jurriën M; Gerritsen, Wim B M; Haas, Fred J L M; Kelder, Hans C; Verheugt, Freek W A; Plokker, H W Thijs

    2002-03-01

    Activated platelets play a major role in acute vessel closure after coronary angioplasty. Although aspirin is the routine therapy during angioplasty, it only incompletely prevents acute closure. This might be due to suboptimal dosing. First, to study the effect of additional high-dose aspirin on platelet activation during coronary angioplasty. Second, to assess the potential of the new PFA-100 analyzer to evaluate the effect of different doses of aspirin in patients undergoing angioplasty. Fifty-one patients on 100 mg aspirin/day for at least 1 month were randomized to continuation of 100 mg aspirin/day only (Group A=24 patients), or to this regime plus a bolus of 1000 mg of aspirin given 1 day before angioplasty (Group B=27 patients). Results were compared with 15 controls. Platelet function was measured before angioplasty by the PFA-100 analyzer; platelet activation was measured by flow cytometry just before and 1 h after angioplasty. At baseline, Group A had significantly more activated platelets than the control group (P<.001). High-dose aspirin in Group B resulted in significantly lower platelet activation as compared with both controls (P<.001) and Group A (P<.001). During angioplasty, the number of activated platelets decreased significantly in Group A (P<.001), while there was no change in Group B (P=.6). The PFA-100 analyzer was unable to detect differences between the two treatment groups. The addition of high-dose aspirin to daily low-dose aspirin, 1 day before coronary angioplasty, significantly reduced the platelet activation state before and after intervention. The PFA-100 analyzer did not detect differences in the effect of low- versus high-dose aspirin on platelet function.

  6. Partial Deletion of eNOS Gene Causes Hyperinsulinemic State, Unbalance of Cardiac Insulin Signaling Pathways and Coronary Dysfunction Independently of High Fat Diet

    PubMed Central

    Vecoli, Cecilia; Novelli, Michela; Pippa, Anna; Giacopelli, Daniela; Beffy, Pascale; Masiello, Pellegrino; L’Abbate, Antonio; Neglia, Danilo

    2014-01-01

    Abnormalities in eNOS gene, possibly interacting with high fat diet (HFD), affect peripheral vascular function and glucose metabolism. The relative role of eNOS gene, HFD and metabolic derangement on coronary function has not been fully elucidated. We test whether eNOS gene deficiency per se or in association with HFD modulates coronary function through mechanisms involving molecular pathways related to insulin signaling. Wild type (WT), eNOS−/− and eNOS+/− mice were studied. WT and eNOS+/− mice were fed with either standard or HF diet for 16 weeks and compared with standard diet fed eNOS−/−. Glucose and insulin tolerance tests were performed during the last week of diet. Coronary resistance (CR) was measured at baseline and during infusions of acetylcholine (Ach) or sodium-nitroprusside (SNP) to evaluate endothelium-dependent or independent vasodilation, in the Langendorff isolated hearts. Cardiac expression of Akt and ERK genes as evaluation of two major insulin-regulated signaling pathways involved in the control of vascular tone were assessed by western blot. HFD-fed mice developed an overt diabetic state. Conversely, chow-fed genetically modified mice (in particular eNOS−/−) showed a metabolic pattern characterized by normoglycemia and hyperinsulinemia with a limited degree of insulin resistance. CR was significantly higher in animals with eNOS gene deletions than in WT, independently of diet. Percent decrease in CR, during Ach infusion, was significantly lower in both eNOS−/− and eNOS+/− mice than in WT, independently of diet. SNP reduced CR in all groups except eNOS−/−. The cardiac ERK1-2/Akt ratio, increased in animals with eNOS gene deletions compared with WT, independently of diet. These results suggest that the eNOS genetic deficiency, associated or not with HFD, has a relevant effect on coronary vascular function, possibly mediated by increase in blood insulin levels and unbalance in insulin-dependent signaling in coronary

  7. Radiation dose measurements in coronary CT angiography

    PubMed Central

    Sabarudin, Akmal; Sun, Zhonghua

    2013-01-01

    Coronary computed tomography (CT) angiography is associated with high radiation dose and this has raised serious concerns in the literature. Awareness of various parameters for dose estimates and measurements of coronary CT angiography plays an important role in increasing our understanding of the radiation exposure to patients, thus, contributing to the implementation of dose-saving strategies. This article provides an overview of the radiation dose quantity and its measurement during coronary CT angiography procedures. PMID:24392190

  8. Absolute transition probabilities of phosphorus.

    NASA Technical Reports Server (NTRS)

    Miller, M. H.; Roig, R. A.; Bengtson, R. D.

    1971-01-01

    Use of a gas-driven shock tube to measure the absolute strengths of 21 P I lines and 126 P II lines (from 3300 to 6900 A). Accuracy for prominent, isolated neutral and ionic lines is estimated to be 28 to 40% and 18 to 30%, respectively. The data and the corresponding theoretical predictions are examined for conformity with the sum rules.-

  9. Absolute transition probabilities of phosphorus.

    NASA Technical Reports Server (NTRS)

    Miller, M. H.; Roig, R. A.; Bengtson, R. D.

    1971-01-01

    Use of a gas-driven shock tube to measure the absolute strengths of 21 P I lines and 126 P II lines (from 3300 to 6900 A). Accuracy for prominent, isolated neutral and ionic lines is estimated to be 28 to 40% and 18 to 30%, respectively. The data and the corresponding theoretical predictions are examined for conformity with the sum rules.-

  10. Absolute Standards for Climate Measurements

    NASA Astrophysics Data System (ADS)

    Leckey, J.

    2016-10-01

    In a world of changing climate, political uncertainty, and ever-changing budgets, the benefit of measurements traceable to SI standards increases by the day. To truly resolve climate change trends on a decadal time scale, on-orbit measurements need to be referenced to something that is both absolute and unchanging. One such mission is the Climate Absolute Radiance and Refractivity Observatory (CLARREO) that will measure a variety of climate variables with an unprecedented accuracy to definitively quantify climate change. In the CLARREO mission, we will utilize phase change cells in which a material is melted to calibrate the temperature of a blackbody that can then be observed by a spectrometer. A material's melting point is an unchanging physical constant that, through a series of transfers, can ultimately calibrate a spectrometer on an absolute scale. CLARREO consists of two primary instruments: an infrared (IR) spectrometer and a reflected solar (RS) spectrometer. The mission will contain orbiting radiometers with sufficient accuracy to calibrate other space-based instrumentation and thus transferring the absolute traceability. The status of various mission options will be presented.

  11. Relativistic Absolutism in Moral Education.

    ERIC Educational Resources Information Center

    Vogt, W. Paul

    1982-01-01

    Discusses Emile Durkheim's "Moral Education: A Study in the Theory and Application of the Sociology of Education," which holds that morally healthy societies may vary in culture and organization but must possess absolute rules of moral behavior. Compares this moral theory with current theory and practice of American educators. (MJL)

  12. Relativistic Absolutism in Moral Education.

    ERIC Educational Resources Information Center

    Vogt, W. Paul

    1982-01-01

    Discusses Emile Durkheim's "Moral Education: A Study in the Theory and Application of the Sociology of Education," which holds that morally healthy societies may vary in culture and organization but must possess absolute rules of moral behavior. Compares this moral theory with current theory and practice of American educators. (MJL)

  13. [Vascular complications of percutaneous transradial coronary angiography and coronary intervention].

    PubMed

    Prull, Magnus W; Brandts, Bodo; Rust, Henning; Trappe, Hans-Joachim

    2005-07-15

    Vascular complications following transradial coronary angiography and coronary intervention could severely compromise perfusion of the hand. Drastic complications after cannulation of the radial artery (ischemia of the hand with occlusion of the digital arteries) are published only in brief reports. This study investigates whether percutaneous transradial artery coronary angiography/intervention results in vascular complications. 93 patients were consecutively studied over a 4-month period. The following data were recorded before and after coronary angiography and/or intervention: diameter of the radial artery, blood volume, flow velocity, and occlusion pressure. Graduation of the stenosis after intervention was done according to the principle of the peak velocity ratio. A transradial coronary angiography/intervention was performed in 93 patients (75 men, mean age 62.5 years) in case of an unremarkable Allen test. Procedural success rate was 97.2%. The intervention could not be completed successfully in three patients (2.8%). Mean vessel diameter increased from 2.46 +/- 1.7 mm (standard deviation [SD]) before intervention to 2.78 +/- 0.69 mm (SD) after intervention; this increase was statistically significant (p = 0.002). Changes in blood flow, flow velocity and occlusion pressure did not reach significance. Vascular complications were seen in nine of 93 patients (10%) after the procedure. No patient mentioned discomfort. No perfusion deficit of the digital arteries was seen. The transradial coronary angiography and intervention is a safe method with a high procedural success rate.

  14. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials.

    PubMed

    Mega, J L; Stitziel, N O; Smith, J G; Chasman, D I; Caulfield, M; Devlin, J J; Nordio, F; Hyde, C; Cannon, C P; Sacks, F; Poulter, N; Sever, P; Ridker, P M; Braunwald, E; Melander, O; Kathiresan, S; Sabatine, M S

    2015-06-06

    Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy. A community-based cohort study (the Malmo Diet and Cancer Study) and four randomised controlled trials of both primary prevention (JUPITER and ASCOT) and secondary prevention (CARE and PROVE IT-TIMI 22) with statin therapy, comprising a total of 48,421 individuals and 3477 events, were included in these analyses. We studied the association of a genetic risk score based on 27 genetic variants with incident or recurrent coronary heart disease, adjusting for traditional clinical risk factors. We then investigated the relative and absolute risk reductions in coronary heart disease events with statin therapy stratified by genetic risk. We combined data from the different studies using a meta-analysis. When individuals were divided into low (quin