Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

BACKGROUND: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. METHODS: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. RESULTS: Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and carotid endarterectomy [2.43 (1.03-5.73), P = 0.04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1.68 (1.12-2.53), P = 0.01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. CONCLUSIONS: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials

Evolution of a Metal to Insulator Transition in Ca2−x_{2-x}Nax_{x}CuO2_{2}Cl2_{2}, as seen by ARPES

We present angle resolved photoemission (ARPES) data on Na-doped Ca$_2$CuO$_2$Cl$_2$. We demonstrate that the chemical potential shifts upon doping the system across the insulator to metal transition. The resulting low energy spectra reveal a gap structure which appears to deviate from the canonical $d_{x2-y2} ~ |cos(k_x a)-cos(k_y a)|$ form. To reconcile the measured gap structure with d-wave superconductivity one can understand the data in terms of two gaps, a very small one contributing to the nodal region and a very large one dominating the anti-nodal region. The latter is a result of the electronic structure observed in the undoped antiferromagnetic insulator. Furthermore, the low energy electronic structure of the metallic sample contains a two component structure in the nodal direction, and a change in velocity of the dispersion in the nodal direction at roughly 50 meV. We discuss these results in connection with photoemission data on other cuprate systems.Comment: 10 pages, 12 figures, accepted by PRB; a high quality pdf is available at http://helios.physics.utoronto.ca/~fronning/RonningNaCCOCResub.pdf (2.2MB

Quantification of myocardial creatine and triglyceride content in the human heart: precision and accuracy of in vivo proton magnetic resonance spectroscopy

Background Proton magnetic resonance spectroscopy (H-1-MRS) of the human heart is deemed to be a quantitative method to investigate myocardial metabolite content, but thorough validations of in vivo measurements against invasive techniques are lacking.Purpose To determine measurement precision and accuracy for quantifications of myocardial total creatine and triglyceride content with localized H-1-MRS.Study type Test-retest repeatability and measurement validation study.Subjects Sixteen volunteers and 22 patients scheduled for open-heart aortic valve replacement or septal myectomy.Field Strength/Sequence Prospectively ECG-triggered respiratory-gated free-breathing single-voxel point-resolved spectroscopy (PRESS) sequence at 3 T.Assessment Myocardial total creatine and triglyceride content were quantified relative to the total water content by fitting the H-1-MR spectra. Precision was assessed with measurement repeatability. Accuracy was assessed by validating in vivo H-1-MRS measurements against biochemical assays in myocardial tissue from the same subjects.Statistical Tests Intrasession and intersession repeatability was assessed using Bland-Altman analyses. Agreement between H-1-MRS measurements and biochemical assay was tested with regression analyses.Results The intersession repeatability coefficient for myocardial total creatine content was 41.8% with a mean value of 0.083% +/- 0.020% of the total water signal, and 36.7% for myocardial triglyceride content with a mean value of 0.35% +/- 0.13% of the total water signal. Ex vivo myocardial total creatine concentrations in tissue samples correlated with the in vivo myocardial total creatine content measured with H-1-MRS: n = 22, r = 0.44; P < 0.05. Likewise, ex vivo myocardial triglyceride concentrations correlated with the in vivo myocardial triglyceride content: n = 20, r = 0.50; P < 0.05.Data Conclusion We validated the use of localized H-1-MRS of the human heart at 3 T for quantitative assessments of in vivo myocardial tissue metabolite content by estimating the measurement precision and accuracy.Level of Evidence 2Technical Efficacy Stage 2Cardiovascular Aspects of Radiolog

Comparative Advertising Wars: An Historical Analysis of Their Causes and Consequences

This historical study contributes to the extensive literature on comparative advertising by examining the causes and consequences of comparative advertising wars; that is, when one advertiser responds to a direct or implied attack by another advertiser. Primary and secondary sources consist of articles published in historic and contemporary marketing and advertising trade journals, such as Printers’ Ink, Advertising & Selling, and Advertising Age. The findings reveal that well-publicized advertising wars occurred frequently between major U.S. advertisers throughout the twentieth century and into the twenty-first, and that they most often occurred in product and service markets characterized by intense competition. Many, if not most, advertisers’ principal motive for responding to a comparative advertising attack has been emotional rather than rational. The findings also reveal that advertising wars often became increasingly hostile, leading to negative consequences for all combatants, as well as a broad and negative social consequence in the form of potentially misleading advertising.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Identification of estrogen receptor modulators as inhibitors of flavivirus infection

Flaviviruses such as Zika virus (ZIKV), dengue virus (DENV) and West Nile virus (WNV) are major global pathogens for which safe and effective antiviral therapies are not currently available. To identify antiviral small molecules with well-characterized safety and bioavailability profiles we screened a library of 2,907 approved drugs and pharmacologically active compounds for inhibitors of ZIKV infection using a high-throughput cell-based immunofluorescence assay. Interestingly, estrogen receptor modulators raloxifene hydrochloride and quinestrol were amongst 15 compounds that significantly inhibited ZIKV infection in repeat screens. Subsequent validation studies revealed that these drugs effectively inhibit ZIKV, DENV and WNV (Kunjin strain) infection at low micromolar concentrations with minimal cytotoxicity in Huh-7.5 hepatoma cells and HTR-8 placental trophoblast cells. Since these cells lack detectable expression of estrogen receptors-α and -β (ER-α and ER-β) and similar antiviral effects were observed in the context of subgenomic DENV and ZIKV replicons, these compounds appear to inhibit viral RNA replication in a manner that is independent of their known effects on estrogen receptor signaling. Taken together, quinestrol, raloxifene hydrochloride and structurally related analogues warrant further investigation as potential therapeutics for treatment of flavivirus infections.Nicholas S. Eyre, Emily N. Kirby, Daniel R. Anfiteatro, Gustavo Bracho, Alice G. Russo, Peter A. White ... et al