Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance

<p>Abstract</p> <p>Background</p> <p>Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies.</p> <p>The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.</p> <p>Methods</p> <p>A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.</p> <p>Results</p> <p>Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72–0.89) and 0.91 (0.83–0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13–0.32) and 9.34 (4.68–18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.</p> <p>Conclusion</p> <p>The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.</p

Survival and long-term maintenance of tertiary trees in the Iberian Peninsula during the Pleistocene. First record of Aesculus L.

The Italian and Balkan peninsulas have been places traditionally highlighted as Pleistocene glacial refuges. The Iberian Peninsula, however, has been a focus of controversy between geobotanists and palaeobotanists as a result of its exclusion from this category on different occasions. In the current paper, we synthesise geological, molecular, palaeobotanical and geobotanical data that show the importance of the Iberian Peninsula in the Western Mediterranean as a refugium area. The presence of Aesculus aff. hippocastanum L. at the Iberian site at Cal Guardiola (Tarrasa, Barcelona, NE Spain) in the Lower– Middle Pleistocene transition helps to consolidate the remarkable role of the Iberian Peninsula in the survival of tertiary species during the Pleistocene. The palaeodistribution of the genus in Europe highlights a model of area abandonment for a widely-distributed species in the Miocene and Pliocene, leading to a diminished and fragmentary presence in the Pleistocene and Holocene on the southern Mediterranean peninsulas. Aesculus fossils are not uncommon within the series of Tertiary taxa. Many appear in the Pliocene and suffer a radical impoverishment in the Lower–Middle Pleistocene transition. Nonetheless some of these tertiary taxa persisted throughout the Pleistocene and Holocene up to the present in the Iberian Peninsula. Locating these refuge areas on the Peninsula is not an easy task, although areas characterised by a sustained level of humidity must have played an predominant role

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Influence of microvascular obstruction on regional myocardial deformation in the acute phase of myocardial infarction: a speckle-tracking echocardiography study

International audienceBACKGROUND: In the acute phase of myocardial infarction (MI), infarct size and microvascular obstruction (MVO) are important prognostic factors for cardiovascular outcome. MI size is a major determinant of myocardial function, but the specific effect of MVO is less documented. The aim of this study was to evaluate the impact of MVO on longitudinal myocardial strain assessed by speckle-tracking echocardiography. METHOD: Speckle-tracking echocardiography and contrast-enhanced cardiac magnetic resonance studies were performed in 69 patients 72 hours after first acute MI. Segmental and global longitudinal systolic strain (epsilonL) was measured using speckle-tracking echocardiography. Transmural extent of MI, MI size, and the presence or absence of MVO were assessed using contrast-enhanced cardiac magnetic resonance. Left ventricular (LV) ejection fraction was assessed at 6 months using echocardiography. RESULTS: The mean infarct size was 23 +/- 13% of LV mass. MVO was present in 64% of patients. MVO was significantly associated with epsilonL impairment (-7.8 +/- 4.9% vs -16.3 +/- 6.4%, P \textless .001), and epsilonL remained significantly worse in MVO-positive segments after adjustment for transmural extent of MI. A epsilonL value \textgreater -12.5% predicted the presence of MVO with 83% sensitivity and 75% specificity. On multivariate analysis, global epsilonL and MI size, but not MVO, were identified as independent predictors of LV ejection fraction at follow-up (beta = -0.9, P = .023, and beta = -0.2, P = .034, respectively). CONCLUSION: In the acute phase of MI, segmental and global epsilonL is significantly altered by the presence of MVO, in addition to MI size. However, MI size but not MVO independently predicts LV ejection fraction at follow-up

Mission Caucase. Arménie : La Préhistoire du Petit Caucase

International audienc

Early Pleistocene climate cycles in continental deposits of the Lesser Caucasus of Armenia inferred from palynology, magnetostratigraphy, and Ar-40/Ar-39 dating

Plio-Pleistocene diatomitic sequences in the Shamb paleo-lake (South Armenia, Lessee Caucasus) offer a rare opportunity to give new insights on the paleo-climate of Western Asia. We present an integrated palynological, Ar-40/Ar-39 geochronologic and magnetostratigraphic study for the most complete section in the sedimentary deposits of the Shamb paleo-lake. Ar-40/Ar-39 dating of two volcaniclastic layers provided ages of 1.24 +/- 0.03 and 1.16 +/- 0.02 Ma (2 sigma). Magnetostratigraphic data show that the entire Shamb section is of reversed polarity which, combined with Ar-40/Ar-39 dating, suggests that the entire section correlates with part of the Matuyama period (1.785-1.070 Ma). Pollen assemblages and macroremains diversity clearly show an alternation of glacial and interglacial phases. Age calibrations and accumulation rate extrapolation allow a direct correlation of climate changes with the global isotopic curve, and show that the Shamb section probably ranges from approximately 1.300 to 1.080 Ma (marine isotopic stages 40 to 31). The vegetation of the Lesser Caucasus developed in a mosaic pattern in a Pleistocene continental, mostly and climate. comparable to the present-day climate. The observed vegetation changes record a dominant climate response to the obliquity orbital parameter, but the influence of precession could not be established from the Shamb data. Pollen and macroflora both indicate that glacial periods were cold and dry and that interglacials were warm with local humidity. The Early Pleistocene climatic model for Western Asia is thus similar to the climatic model for the Mediterranean area