Abstract
Aims
High-risk plaque (HRP) and non-obstructive coronary artery disease independently predict adverse events, but their importance to future culprit lesions has not been resolved. We sought ...to determine in patients prior to confirmed acute coronary syndrome (ACS) the association between lesion percent diameter stenosis (%DS), and the absolute number and prevalence of HRP. The secondary objective was to examine the relative importance of non-obstructive HRP in future culprit lesions.
Methods and results
Within the ICONIC study, a nested case–control study of patients undergoing coronary computed tomographic angiography (coronary CT), we included ACS cases with culprit lesions confirmed by invasive coronary angiography and coregistered to baseline coronary CT. Quantitative CT was used to evaluate obstructive (≥50%) and non-obstructive (<50%) diameter stenosis, with HRP defined as ≥2 features of spotty calcification, positive remodelling, or low-attenuation plaque at baseline. A total of 234 patients with downstream ACS over 54 (interquartile range 5–525.5) days exhibited 198/898 plaques with HRP on coronary CT. While HRP was less prevalent in non-obstructive (19.7%, 161/819) than obstructive lesions (46.8%, 37/79, P < 0.001), non-obstructive plaque comprised 81.3% (161/198) of HRP lesions overall. Among the 128 patients with identifiable culprit lesion precursors, the adjusted hazard ratio (HR) was 1.85 95% confidence interval (CI) 1.26–2.72 for HRP, with no interaction between %DS and HRP (P = 0.82). Compared to non-obstructive HRP lesions, obstructive lesions without HRP exhibited a non-significant HR of 1.41 (95% CI 0.61–3.25, P = 0.42).
Conclusions
While HRP is more prevalent among obstructive lesions, non-obstructive HRP lesions outnumber those that are obstructive and confer risk clinically approaching that of obstructive lesions without HRP.
Mitral valve disease affects more than 4 million people in the United States and it is the second most prevalent valvulopathy in Europe. The gold standard of treatment in these patients is surgical ...repair or mitral valve replacement. In the last decade, numerous transcatheter therapies have been developed to overcome the increased number of subjects with symptomatic severe mitral regurgitation and high surgical risk. The Mitraclip (Abbott Vascular, Menlo Park, CA), PASCAL (Edwards Lifesciences, Irvine, CA, USA), the Carillon™ Mitral Contour System™ (Cardiac Dimension Inc., Kirkland, WA, USA), the Mitralign™ (Mitralign, Tewksbury, Massachusetts), and the Cardioband (Edwards Lifesciences, Irvine, CA) are the principal percutaneous devices for mitral valve repair. We present an evidence-based clinical update that provides an overview of these technologies and their potential complications.
The purpose of this study is to evaluate observer detection and volume measurement of small irregular solid artificial pulmonary nodules on 64-MDCT in an anthropomorphic thoracic phantom.
Forty ...in-house-made solid pulmonary nodules (lobulated and spiculated; actual volume, 5.1-88.4 mm3; actual CT densities, -51 to 157 HU) were randomly placed inside an anthropomorphic thoracic phantom with pulmonary vasculature. The phantom was examined on two 64-MDCT scanners, using a scan protocol as applied in lung cancer screening. Two independent blinded observers screened for pulmonary nodules. Nodule volume was evaluated semiautomatically using dedicated software and was compared with the actual volume using an independent-samples t test. The interscanner and interobserver agreement of volumetry was assessed using Bland-Altman analysis.
Observer detection sensitivity increased along with increasing size of irregular nodules. Sensitivity was 100% when the actual volume was at least 69 mm3, regardless of specific observer, scanner, nodule shape, and density. Overall, nodule volume was underestimated by (mean±SD) 18.9±11.8 mm3 (39%±21%; p<0.001). The relative interscanner difference of volumetry was 3.3% (95% CI, -33.9% to 40.4%). The relative interobserver difference was 0.6% (-33.3% to 34.5%).
Small irregular solid pulmonary nodules with an actual volume of at least 69 mm3 are reliably detected on 64-MDCT. However, CT-derived volume of those small nodules is largely underestimated, with considerable variation.
The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and ...36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.
Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.
Nineteen hospitals in The Netherlands.
The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.
None.
After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 95% CI, 0.62-1.18; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d 3-7 d vs 3 d 2-5 d; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.
In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.
We report on the development of time-resolved Raman thermography to measure transient temperatures in semiconductor devices with submicrometer spatial resolution. This new technique is illustrated ...for AlGaN/GaN HFETs and ungated devices grown on SiC and sapphire substrates. A temporal resolution of 200 ns is demonstrated. Temperature changes rapidly within sub-200 ns after switching the devices on or off, followed by a slower change in device temperature with a time constant of ~10 and ~140 mus for AlGaN/GaN devices grown on SiC and sapphire substrates, respectively. Heat diffusion into the device substrate is also demonstrated
We report the discovery of WTS-2 b, an unusually close-in 1.02-d hot Jupiter (M
P
= 1.12M
J, R
P
= 1.30R
J) orbiting a K2V star, which has a possible gravitationally bound M-dwarf companion at 0.6 ...arcsec separation contributing ∼20 per cent of the total flux in the observed J-band light curve. The planet is only 1.5 times the separation from its host star at which it would be destroyed by Roche lobe overflow, and has a predicted remaining lifetime of just ∼40 Myr, assuming a tidal dissipation quality factor of
.
is a key factor in determining how frictional processes within a host star affect the orbital evolution of its companion giant planets, but it is currently poorly constrained by observations. We calculate that the orbital decay of WTS-2 b would correspond to a shift in its transit arrival time of T
shift ∼ 17 s after 15 yr assuming
. A shift less than this would place a direct observational constraint on the lower limit of
in this system. We also report a correction to the previously published expected T
shift for WASP-18 b, finding that T
shift = 356 s after 10 yr for
, which is much larger than the estimated 28 s quoted in WASP-18 b discovery paper. We attempted to constrain
via a study of the entire population of known transiting hot Jupiters, but our results were inconclusive, requiring a more detailed treatment of transit survey sensitivities at long periods. We conclude that the most informative and straightforward constraints on
will be obtained by direct observational measurements of the shift in transit arrival times in individual hot Jupiter systems. We show that this is achievable across the mass spectrum of exoplanet host stars within a decade, and will directly probe the effects of stellar interior structure on tidal dissipation.
Major depressive disorder (MDD) is a common, complex psychiatric disorder and a leading cause of disability worldwide. Despite twin studies indicating its modest heritability (~30-40%), extensive ...heterogeneity and a complex genetic architecture have complicated efforts to detect associated genetic risk variants. We combined single-nucleotide polymorphism (SNP) summary statistics from the CONVERGE and PGC studies of MDD, representing 10 502 Chinese (5282 cases and 5220 controls) and 18 663 European (9447 cases and 9215 controls) subjects. We determined the fraction of SNPs displaying consistent directions of effect, assessed the significance of polygenic risk scores and estimated the genetic correlation of MDD across ancestries. Subsequent trans-ancestry meta-analyses combined SNP-level evidence of association. Sign tests and polygenic score profiling weakly support an overlap of SNP effects between East Asian and European populations. We estimated the trans-ancestry genetic correlation of lifetime MDD as 0.33; female-only and recurrent MDD yielded estimates of 0.40 and 0.41, respectively. Common variants downstream of GPHN achieved genome-wide significance by Bayesian trans-ancestry meta-analysis (rs9323497; log
Bayes Factor=8.08) but failed to replicate in an independent European sample (P=0.911). Gene-set enrichment analyses indicate enrichment of genes involved in neuronal development and axonal trafficking. We successfully demonstrate a partially shared polygenic basis of MDD in East Asian and European populations. Taken together, these findings support a complex etiology for MDD and possible population differences in predisposing genetic factors, with important implications for future genetic studies.
We sought to determine who is involved in the care of a trauma patient.
We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. ...Hospital personnel were delineated by professional background and role.
We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range IQR, 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 IQR, 47.5-67.0 vs 25.0 IQR, 22.0-30.5;
< 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 IQR, 41.5-63.0 vs 27.5 IQR, 24.0-30.0;
< 0.0001). No differences existed in total personnel by Injury Severity Score (
= 0.1266), day (
= 0.7270), or time of admission (
= 0.2098).
A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.
The aetiology of suicidal behaviour is complex, and knowledge about its neurobiological mechanisms is limited. Neuroimaging methods provide a noninvasive approach to explore the neural correlates of ...suicide vulnerability in vivo. The ENIGMA-MDD Working Group is an international collaboration evaluating neuroimaging and clinical data from thousands of individuals collected by research groups from around the world. Here we present analyses in a subset sample (n=3097) for whom suicidality data were available. Prevalence of suicidal symptoms among major depressive disorder (MDD) cases ranged between 29 and 69% across cohorts. We compared mean subcortical grey matter volumes, lateral ventricle volumes and total intracranial volume (ICV) in MDD patients with suicidal symptoms (N=451) vs healthy controls (N=1996) or MDD patients with no suicidal symptoms (N=650). MDD patients reporting suicidal plans or attempts showed a smaller ICV (P=4.12 × 10
) or a 2.87% smaller volume compared with controls (Cohen's d=-0.284). In addition, we observed a nonsignificant trend in which MDD cases with suicidal symptoms had smaller subcortical volumes and larger ventricular volumes compared with controls. Finally, no significant differences (P=0.28-0.97) were found between MDD patients with and those without suicidal symptoms for any of the brain volume measures. This is by far the largest neuroimaging meta-analysis of suicidal behaviour in MDD to date. Our results did not replicate previous reports of association between subcortical brain structure and suicidality and highlight the need for collecting better-powered imaging samples and using improved suicidality assessment instruments.
A series of thiophene oligomers bearing core phenylene and fluorinated phenylene units has been synthesized as potential semiconductor materials for organic field-effect transistors (OFETs). ...Polymerization of these compounds has been achieved using Stille and oxidative coupling methods. Functionalization of the phenylene unit with fluorine atoms has a marked effect on the self-assembly and electronic properties of the parent materials: the optical band gaps and highest occupied molecular orbital levels are affected with the introduction of fluorine atoms as a result of a combination of inductive effects and rigidification of the main chain. The design of these materials has focused on the self-assembly and solution processability of the materials. All the polymers are readily soluble in common organic solvents. Self-assembly and planarization of the fluorinated materials in the solid state are identified by a combination of X-ray diffraction studies, absorption spectroscopy, and cyclic voltammetry. The organizational behavior of the films is in contrast to the conformational freedom observed in solution (absorption spectroscopy) and in the gas phase (computational studies). Thin-film OFETs have been fabricated for the entire polymer series. Hole mobilities have been measured up to 10-3 cm2/(V·s), with high current modulation (on/off ratios up to 105) and low turn-on voltages (down to 2 V). For the Stille coupled polymers, replacement of the bridging thiophene unit with selenophene generally increases the hole mobility of the polymers.
PDF
