Assessment Of Intra-coronary Stent Location And Extension In Intravascular Ultrasound Sequences.

Purpose An intraluminal coronary stent is a metal scaffold deployed in a stenotic artery during percutaneous coronary intervention (PCI). In order to have an effective deployment, a stent should be optimally placed with regard to anatomical structures such as bifurcations and stenoses. Intravascular ultrasound (IVUS) is a catheter-based imaging technique generally used for PCI guiding and assessing the correct placement of the stent. A novel approach that automatically detects the boundaries and the position of the stent along the IVUS pullback is presented. Such a technique aims at optimizing the stent deployment. Methods The method requires the identification of the stable frames of the sequence and the reliable detection of stent struts. Using these data, a measure of likelihood for a frame to contain a stent is computed. Then, a robust binary representation of the presence of the stent in the pullback is obtained applying an iterative and multiscale quantization of the signal to symbols using the Symbolic Aggregate approXimation algorithm. Results The technique was extensively validated on a set of 103 IVUS of sequences of in vivo coronary arteries containing metallic and bioabsorbable stents acquired through an international multicentric collaboration across five clinical centers. The method was able to detect the stent position with an overall F-measure of 86.4%, a Jaccard index score of 75% and a mean distance of 2.5 mm from manually annotated stent boundaries, and in bioabsorbable stents with an overall F-measure of 88.6%, a Jaccard score of 77.7 and a mean distance of 1.5 mm from manually annotated stent boundaries. Additionally, a map indicating the distance between the lumen and the stent along the pullback is created in order to show the angular sectors of the sequence in which the malapposition is present. Conclusions Results obtained comparing the automatic results vs the manual annotation of two observers shows that the method approaches the interobserver variability. Similar performances are obtained on both metallic and bioabsorbable stents, showing the flexibility and robustness of the method

Clinical follow-up of long nontapered sirolimus-eluting coronary stent in real-world patients with de novo lesions. The Billar registry

Introduction and objectives: Coronary lesions with stent overlapping are associated with higher neointimal proliferation that leads to more restenosis. Furthermore, the tapering of coronary arteries is a major challenge when treating long coronary lesions. This study attempted to assess the safety and clinical level of performance of long nontapered sirolimus-eluting coronary stent systems (> 36 mm) to treat long and diffused de novo coronary lesions in real-world scenarios. Methods: This was a prospective, non-randomized, multicentre study that included 696 consecutive patients treated with the long nontapered BioMime sirolimus-eluting coronary stent system in long and diffused de novo coronary lesions. The safety endpoint was major adverse cardiovascular events defined as a composite of cardiac death, myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, and major bleeding at the 12-month follow-up. Results: Of a total of 696 patients, 38.79% were diabetic. The mean age of all the patients was 64.6 +/- 14 years, and 80% were males. The indication for revascularization was acute coronary syndrome in 63.1%. A total of 899 lesions were identified out of which 742 were successfully treated with long BioMime stents (37 mm, 40 mm, 44 mm, and 48 mm). The cumulative incidence of major adverse cardiovascular events was 8.1% at the 12-month follow-up including cardiac death (2.09%), myocardial infarction (1.34%), and total stent thrombosis (0.5%). Conclusions: This study confirms the safety and good performance of long nontapered BioMime coronary stents to treat de novo coronary stenosis. Therefore, it can be considered a safe and effective treatment for long and diffused de novo coronary lesions in the routine clinical practice

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Search for supersymmetry in events with one lepton and multiple jets in proton-proton collisions at root s=13 TeV

Peer reviewe

Search for anomalous couplings in boosted WW/WZ -> l nu q(q)over-bar production in proton-proton collisions at root s=8TeV

Peer reviewe

Search for new phenomena in final states with two opposite-charge, same-flavor leptons, jets, and missing transverse momentum in pp collisions at √s=13 TeV

Search results are presented for physics beyond the standard model in final states with two opposite-charge, same-flavor leptons, jets, and missing transverse momentum. The data sample corresponds to an integrated luminosity of 35.9 fb−1 of proton-proton collisions at s√=13 TeV collected with the CMS detector at the LHC in 2016. The analysis uses the invariant mass of the lepton pair, searching for a kinematic edge or a resonant-like excess compatible with the Z boson mass. The search for a kinematic edge targets production of particles sensitive to the strong force, while the resonance search targets both strongly and electroweakly produced new physics. The observed yields are consistent with the expectations from the standard model, and the results are interpreted in the context of simplified models of supersymmetry. In a gauge mediated supersymmetry breaking (GMSB) model of gluino pair production with decay chains including Z bosons, gluino masses up to 1500–1770 GeV are excluded at the 95% confidence level depending on the lightest neutralino mass. In a model of electroweak chargino-neutralino production, chargino masses as high as 610 GeV are excluded when the lightest neutralino is massless. In GMSB models of electroweak neutralino-neutralino production, neutralino masses up to 500-650 GeV are excluded depending on the decay mode assumed. Finally, in a model with bottom squark pair production and decay chains resulting in a kinematic edge in the dilepton invariant mass distribution, bottom squark masses up to 980–1200 GeV are excluded depending on the mass of the next-to-lightest neutralino

Search for electroweak production of charginos and neutralinos in multilepton final states in proton-proton collisions at root s=13 TeV

Results are presented from a search for the direct electroweak production of charginos and neutralinos in signatures with either two or more leptons (electrons or muons) of the same electric charge, or with three or more leptons, which can include up to two hadronically decaying tau leptons. The results are based on a sample of protonproton collision data collected at p s = 13TeV, recorded with the CMS detector at the LHC, corresponding to an integrated luminosity of 35.9 fb1. The observed event yields are consistent with the expectations based on the standard model. The results are interpreted in simpli ed models of supersymmetry describing various scenarios for the production and decay of charginos and neutralinos. Depending on the model parameters chosen, mass values between 180GeV and 1150 GeV are excluded at 95% CL. These results signi cantly extend the parameter space probed for these particles in searches at the LHC. In addition, results are presented in a form suitable for alternative theoretical interpretations.Sponsoring Consortium for Open Access Publishing in Particle Physic

Diagnóstico y pronóstico de la cardiopatía isquémica asociada al consumo de cocaína

Introducción: El consumo recreacional de cocaína ha aumentado en los últimos años en Europa, siendo España uno de los principales países consumidores de cocaína. La cocaína tiene múltiples efectos sobre el sistema cardiovascular, entre ellos ser desencadenante de un Síndrome Coronario Agudo (SCA). Método: Estudio observacional prospectivo, entre 2001 y 2014, en pacientes con SCA menores de 50 años que ingresaban en la unidad coronaria. Se realizó una anamnesis específica del consumo de cocaína y una determinación de los metabolitos de cocaína en orina. Nuestra hipótesis de trabajo fue “El consumo reciente de cocaína asociado a un síndrome coronario agudo (SCA-ACC) tiene un impacto pronóstico deletéreo a corto y largo plazo respecto al SCA no debido a cocaína”. Se definió el SCA-ACC en aquellos pacientes con SCA y determinación positiva de metabolitos de cocaína en orina o consumo reciente de cocaína por anamnesis. Resultados: Se incluyeron 1002 pacientes menores de 50 años con SCA. El 15.1% reconocían haber consumido cocaína alguna vez en su vida (el 41.7% eran exconsumidores, el 33.1% eran consumidores ocasionales y el 25.2% eran consumidores habituales de cocaína). Observamos un incremento en la prevalencia de consumo de cocaína des del 6.6% en 2002 hasta un pico del 21.7% y 20.5% en 2008 y 2009. Obtuvimos una determinación de metabolitos en orina en 864 pacientes (86.2%), siendo positiva en 52 (6%). Presentaban un SCA-ACC 59 pacientes (6.8%). Los pacientes con antecedentes de consumo de cocaína presentaban un mayor consumo de tóxicos además de cocaína como el tabaco, el alcohol y las otras drogas. En los pacientes con SCA-ACC observamos una mayor frecuencia de presentación como SCA con elevación del segmento ST (SCAEST). Los pacientes con SCA-ACC recibieron menos tratamiento con betabloqueantes en la fase aguda (40.7 contra 78.1%, p<0.001) y también al alta (59.6 contra 84.2%, p<0.001). Sin diferencias en los tratamientos de reperfusión realizados a los pacientes con SCAEST, únicamente una menor utilización de stents farmacoactivos (17.6 contra 34.5%, p=0.043). Durante la fase hospitalaria los SCA-ACC presentaron mayores complicaciones hospitalarias como la taquicardia ventricular (16.9 contra 4.7%, p<0.001), shock cardiogénico (6.8 contra 2.2%,p=0.032) y trastorno agudo de la conducción intraventricular (6.8 contra 1.5%,p=0.004) y una tendencia a mayor mortalidad hospitalaria (3.4 contra 1.0,p=0.097). El seguimiento realizado al 92.4% de los pacientes (mediana de 2381 días) observamos una mayor mortalidad en los pacientes con SCA-ACC (12.3 contra 5%,p=0.020) y también mortalidad cardiaca (7 contra 1.2%,p<0.001). El evento combinado de muerte, infarto o revascularización (MACE) también fue superior en SCA-ACC (35.1 contra 18.8%,p=0.003). El análisis multivariado de supervivencia por Coxx ajustado por la clasificación de killip y el tratamiento al alta presentó una HR de 2.126 ([IC 0.926-4.881],p=0.075) para mortalidad global, 4.038 ([IC 1.151-14.168],p=0.029) para mortalidad cardiaca y 2.015 ([IC 1.247-3.255],p=0.004) para MACE. Conclusiones: El tratamiento administrado en los pacientes con SCA-ACC es diferente al SCA-NACC, utilizando una menor proporción de fármacos betabloqueantes, así como de stents liberadores de fármaco en los procedimientos de intervencionismo coronario. Los pacientes con SCA-ACC tienen una peor evolución al seguimiento que los pacientes con SCA-NACC con una mayor incidencia de trombosis del stent, una mayor mortalidad (global y especialmente la de causa cardiaca) y tienen mayores eventos isquémicos, principalmente el infarto de miocardio. En nuestro medio se confirma nuestra hipótesis y los pacientes con síndrome coronario agudo asociado al consumo reciente de cocaína presentan un peor pronostico hospitalario con mayor numero de complicaciones hospitalarias y un peor pronostico a largo plazo con mayor mortalidad y infarto de miocardio al seguimiento.Background: Recreational cocaine consumption in European countries has increased in recent years, and Spain is one of the main cocaine-using country in Europe. Cocaine has several effects on the cardiovascular system, being a trigger for Acute Coronary Syndrome (ACS). Methods: A prospective observational study was conducted between 2001 and 2014 in patients admitted to our coronary unit younger than 50 years old who suffered from an ACS. A detailed history of cocaine use and a determination of the metabolites of cocaine in urine were performed. Our working hypothesis was "Recent cocaine use associated with an acute coronary syndrome (ACS-ACC) has a deleterious short- and long-term prognostic impact on ACS not due to cocaine." Recent cocaine use associated with ACS (ACS-ACC) was defined as positive determination of cocaine metabolites in urine or admitting recent cocaine consumption prior to admission in the anamnesis in those patients who suffered an ACS. Results: 1002 patients younger than 50 years with ACS were included. 15.1% reported having consumed cocaine at least once in their lifetime (41.7% were former users, 33.1% occasional users and 25.2% current users). We observed an increase in prevalence of cocaine use from 6.6% in 2002 to a peak of 21.7% and 20.5% in 2008 and 2009. Determination of metabolites was obtained in 864 patients (86.2%), being positive in 52 (6%). A total of 59 patients (6.8%) presented a ACS-ACC. Patients with a history of cocaine use had a higher consumption of other substances, such as tobacco, alcohol, and other. Higher frequency of ACS with ST segment elevation was observed in cocaine users. The group of patients with ACS-ACC received less treatment with beta-blockers in the acute phase (40.7 vs 78.1%, p<0.001) and also at discharge (59.6 vs 84.2%, p<0.001). Differences in reperfusion treatments for patients with ACS-ACS were not observed in spite of a lower lower use of drug-eluting stents (17.6 vs 34.5%, p=0.043). During hospitalization, patients with ACS-ACC presented higher complications such as ventricular tachycardia (16.9 vs 4.7%, p<0.001), cardiogenic shock (6.8% vs 2.2%, p=0.032) and acute intraventricular conduction abnormalities (6.8 vs 1.5%,p=0.004) as well as a trend towards a higher hospital mortality (3.4 vs 1.0, p=0.097). Higher mortality in patients with ACS-ACC was observed (12.3% vs 5%, p=0.020) and also cardiac mortality (7% vs. 1.2%, p<0.001). The combined event of death, infarction or revascularization (MACE) was also higher in ACS-ACC (35.1 vs 18.8%, p = 0.003). Coxx survival multivariate analysis adjusted for killip classification and treatment at discharge showed a HR of 2.126 ([IC 0.926-4.881], p = 0.075) for overall mortality, 4,038 ([1,151-14,168], p = 0.029) for cardiac mortality and 2.015 ([1.247-3.255], p=0.004) for MACE. Conclusions: The treatment given in patients with ACS-ACC differs from patients with ACS-NACC, with lower proportion of beta-blocking drugs being used during admission and at discharge as well as a higher implantation of drug-eluting stents in coronary intervention procedures. Patients with ACS-ACC have a worse outcome at follow-up than patients with ACS-NACC with more incidence of stent thrombosis, higher mortality (overall and especially cardiac cause) and higher ischemic events, mainly miocardial infarction. Our hypothesis is confirmed in our setting, and patients with acute coronary syndrome associated with recent cocaine use have worse hospital prognosis with greater number of hospital complications, worse long-term prognosis with higher mortality and myocardial infarction at follow-up

Diagnóstico y pronóstico de la cardiopatía isquémica asociada al consumo de cocaína /

Introducción: El consumo recreacional de cocaína ha aumentado en los últimos años en Europa, siendo España uno de los principales países consumidores de cocaína. La cocaína tiene múltiples efectos sobre el sistema cardiovascular, entre ellos ser desencadenante de un Síndrome Coronario Agudo (SCA). Método: Estudio observacional prospectivo, entre 2001 y 2014, en pacientes con SCA menores de 50 años que ingresaban en la unidad coronaria. Se realizó una anamnesis específica del consumo de cocaína y una determinación de los metabolitos de cocaína en orina. Nuestra hipótesis de trabajo fue "El consumo reciente de cocaína asociado a un síndrome coronario agudo (SCA-ACC) tiene un impacto pronóstico deletéreo a corto y largo plazo respecto al SCA no debido a cocaína". Se definió el SCA-ACC en aquellos pacientes con SCA y determinación positiva de metabolitos de cocaína en orina o consumo reciente de cocaína por anamnesis. Resultados: Se incluyeron 1002 pacientes menores de 50 años con SCA. El 15.1% reconocían haber consumido cocaína alguna vez en su vida (el 41.7% eran exconsumidores, el 33.1% eran consumidores ocasionales y el 25.2% eran consumidores habituales de cocaína). Observamos un incremento en la prevalencia de consumo de cocaína des del 6.6% en 2002 hasta un pico del 21.7% y 20.5% en 2008 y 2009. Obtuvimos una determinación de metabolitos en orina en 864 pacientes (86.2%), siendo positiva en 52 (6%). Presentaban un SCA-ACC 59 pacientes (6.8%). Los pacientes con antecedentes de consumo de cocaína presentaban un mayor consumo de tóxicos además de cocaína como el tabaco, el alcohol y las otras drogas. En los pacientes con SCA-ACC observamos una mayor frecuencia de presentación como SCA con elevación del segmento ST (SCAEST). Los pacientes con SCA-ACC recibieron menos tratamiento con betabloqueantes en la fase aguda (40.7 contra 78.1%, p 0.001) y también al alta (59.6 contra 84.2%, p 0.001). Sin diferencias en los tratamientos de reperfusión realizados a los pacientes con SCAEST, únicamente una menor utilización de stents farmacoactivos (17.6 contra 34.5%, p=0.043). Durante la fase hospitalaria los SCA-ACC presentaron mayores complicaciones hospitalarias como la taquicardia ventricular (16.9 contra 4.7%, p 0.001), shock cardiogénico (6.8 contra 2.2%,p=0.032) y trastorno agudo de la conducción intraventricular (6.8 contra 1.5%,p=0.004) y una tendencia a mayor mortalidad hospitalaria (3.4 contra 1.0,p=0.097). El seguimiento realizado al 92.4% de los pacientes (mediana de 2381 días) observamos una mayor mortalidad en los pacientes con SCA-ACC (12.3 contra 5%,p=0.020) y también mortalidad cardiaca (7 contra 1.2%,p 0.001). El evento combinado de muerte, infarto o revascularización (MACE) también fue superior en SCA-ACC (35.1 contra 18.8%,p=0.003). El análisis multivariado de supervivencia por Coxx ajustado por la clasificación de killip y el tratamiento al alta presentó una HR de 2.126 ([IC 0.926-4.881],p=0.075) para mortalidad global, 4.038 ([IC 1.151-14.168],p=0.029) para mortalidad cardiaca y 2.015 ([IC 1.247-3.255],p=0.004) para MACE. Conclusiones: El tratamiento administrado en los pacientes con SCA-ACC es diferente al SCA-NACC, utilizando una menor proporción de fármacos betabloqueantes, así como de stents liberadores de fármaco en los procedimientos de intervencionismo coronario. Los pacientes con SCA-ACC tienen una peor evolución al seguimiento que los pacientes con SCA-NACC con una mayor incidencia de trombosis del stent, una mayor mortalidad (global y especialmente la de causa cardiaca) y tienen mayores eventos isquémicos, principalmente el infarto de miocardio. En nuestro medio se confirma nuestra hipótesis y los pacientes con síndrome coronario agudo asociado al consumo reciente de cocaína presentan un peor pronostico hospitalario con mayor numero de complicaciones hospitalarias y un peor pronostico a largo plazo con mayor mortalidad y infarto de miocardio al seguimiento.Background: Recreational cocaine consumption in European countries has increased in recent years, and Spain is one of the main cocaine-using country in Europe. Cocaine has several effects on the cardiovascular system, being a trigger for Acute Coronary Syndrome (ACS). Methods: A prospective observational study was conducted between 2001 and 2014 in patients admitted to our coronary unit younger than 50 years old who suffered from an ACS. A detailed history of cocaine use and a determination of the metabolites of cocaine in urine were performed. Our working hypothesis was "Recent cocaine use associated with an acute coronary syndrome (ACS-ACC) has a deleterious short- and long-term prognostic impact on ACS not due to cocaine." Recent cocaine use associated with ACS (ACS-ACC) was defined as positive determination of cocaine metabolites in urine or admitting recent cocaine consumption prior to admission in the anamnesis in those patients who suffered an ACS. Results: 1002 patients younger than 50 years with ACS were included. 15.1% reported having consumed cocaine at least once in their lifetime (41.7% were former users, 33.1% occasional users and 25.2% current users). We observed an increase in prevalence of cocaine use from 6.6% in 2002 to a peak of 21.7% and 20.5% in 2008 and 2009. Determination of metabolites was obtained in 864 patients (86.2%), being positive in 52 (6%). A total of 59 patients (6.8%) presented a ACS-ACC. Patients with a history of cocaine use had a higher consumption of other substances, such as tobacco, alcohol, and other. Higher frequency of ACS with ST segment elevation was observed in cocaine users. The group of patients with ACS-ACC received less treatment with beta-blockers in the acute phase (40.7 vs 78.1%, p 0.001) and also at discharge (59.6 vs 84.2%, p 0.001). Differences in reperfusion treatments for patients with ACS-ACS were not observed in spite of a lower lower use of drug-eluting stents (17.6 vs 34.5%, p=0.043). During hospitalization, patients with ACS-ACC presented higher complications such as ventricular tachycardia (16.9 vs 4.7%, p 0.001), cardiogenic shock (6.8% vs 2.2%, p=0.032) and acute intraventricular conduction abnormalities (6.8 vs 1.5%,p=0.004) as well as a trend towards a higher hospital mortality (3.4 vs 1.0, p=0.097). Higher mortality in patients with ACS-ACC was observed (12.3% vs 5%, p=0.020) and also cardiac mortality (7% vs. 1.2%, p 0.001). The combined event of death, infarction or revascularization (MACE) was also higher in ACS-ACC (35.1 vs 18.8%, p = 0.003). Coxx survival multivariate analysis adjusted for killip classification and treatment at discharge showed a HR of 2.126 ([IC 0.926-4.881], p = 0.075) for overall mortality, 4,038 ([1,151-14,168], p = 0.029) for cardiac mortality and 2.015 ([1.247-3.255], p=0.004) for MACE. Conclusions: The treatment given in patients with ACS-ACC differs from patients with ACS-NACC, with lower proportion of beta-blocking drugs being used during admission and at discharge as well as a higher implantation of drug-eluting stents in coronary intervention procedures. Patients with ACS-ACC have a worse outcome at follow-up than patients with ACS-NACC with more incidence of stent thrombosis, higher mortality (overall and especially cardiac cause) and higher ischemic events, mainly miocardial infarction. Our hypothesis is confirmed in our setting, and patients with acute coronary syndrome associated with recent cocaine use have worse hospital prognosis with greater number of hospital complications, worse long-term prognosis with higher mortality and myocardial infarction at follow-up