The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm-Case Report and Review of the Literature

A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed

Amplitude and phase representation of quantum invariants for the time dependent harmonic oscillator

The correspondence between classical and quantum invariants is established. The Ermakov Lewis quantum invariant of the time dependent harmonic oscillator is translated from the coordinate and momentum operators into amplitude and phase operators. In doing so, Turski's phase operator as well as Susskind-Glogower operators are generalized to the time dependent harmonic oscillator case. A quantum derivation of the Manley-Rowe relations is shown as an example

Bayesian robustness for decision making problems: Applications in medical contexts

AbstractPractical implementation of Bayesian decision making is hindered by the fact that optimal decisions may be sensitive to the model inputs: the prior, the likelihood and/or the underlying utility function. Given the structure of a problem, the analyst has to decide which sensitivity measures are relevant and compute them efficiently. We address the issue of robustness of the optimal action in a decision making problem with respect to the prior model and the utility function. We discuss some general principles and apply novel computational strategies in the context of two relatively complex medical decision making problems

Toward an internally consistent astronomical distance scale

Accurate astronomical distance determination is crucial for all fields in astrophysics, from Galactic to cosmological scales. Despite, or perhaps because of, significant efforts to determine accurate distances, using a wide range of methods, tracers, and techniques, an internally consistent astronomical distance framework has not yet been established. We review current efforts to homogenize the Local Group's distance framework, with particular emphasis on the potential of RR Lyrae stars as distance indicators, and attempt to extend this in an internally consistent manner to cosmological distances. Calibration based on Type Ia supernovae and distance determinations based on gravitational lensing represent particularly promising approaches. We provide a positive outlook to improvements to the status quo expected from future surveys, missions, and facilities. Astronomical distance determination has clearly reached maturity and near-consistency.Comment: Review article, 59 pages (4 figures); Space Science Reviews, in press (chapter 8 of a special collection resulting from the May 2016 ISSI-BJ workshop on Astronomical Distance Determination in the Space Age

Clinical outcome following percutaneous coronary intervention in patients with acute coronary syndromes and optimal platelet inhibition: results from a prospective registry of 864 patients

Purpose: High on-treatment P2Y12 reactivity (PRU) is associated with thrombotic events following PCI for ACS. Low PRU is associated with increased bleeding rates. There may be an optimal PRU range within which adverse events are minimised. Methods: Patients who presented with ACS from a prospective PCI registry were studied for the presence of an optimal PRU (VerifyNow) range relative to an on-treatment combined adverse event (CAE) of death, clinical MI, stroke and BARC 2 to 5 bleeding. Results: There were 864 patients (25.0% female, mean (SD) age 63.4 (17) years, clopidogrel 94.5%, prasugrel 5.5%), followed over a median (IQR) of 3.5 (2.9) years. The optimal range proposed by the ARMYDA-PROVE investigators (PRU 178 to 239) was the most useful for identifying patients at low risk of CAEs. Applying this range, 185 (21.4%) patients had an optimal PRU, 465 (53.8%) were hypo- and 214 (24.8%) hyper-responders. Most MIs (29 of 30) occurred within the first year; rates were higher in hypo-responders (4.5% versus 2.0%, p = 0.041). In contrast there were few bleeding events by 12 months with no difference between groups, but long-term bleeding rate was higher in hyper-responders (8.4% versus 4.6%, p=0.035). In hyper-, optimal and hypo-responders, CAE rate at 12 months was 7.9%, 2.2% and 8.0%, p=0.020; and at long-term follow-up 12.6%, 2.7% and 10.1%, p=0.002 (see figure). Optimal PRU was significantly negatively associated with CAEs at 1 year (adjusted hazard ratio (aHR) 0.18, 95% CI 0.04 to 0.74, p=0.017) and at long-term follow-up (aHR 0.21, 95% CI 0.06 to 0.66, p=0.008). Conclusions: Following PCI for ACS, optimal PRU is associated with a low rate of adverse clinical events. However, only about one fifth of patients on clopidogrel naturally fall into this category