The High-Risk Plaque Initiative: Primary Prevention of Atherothrombotic Events in the Asymptomatic Population

The High-Risk Plaque (HRP) Initiative is a research and development effort to advance the understanding, recognition, and management of asymptomatic individuals at risk for a near-term atherothrombotic event such as myocardial infarction or stroke. Clinical studies using the newest technologies have been initiated, including the BioImage Study in which novel approaches are tested in a typical health plan population. Asymptomatic at-risk individuals were enrolled, including a survey-only group (n = 865), a group undergoing traditional risk factor scoring (n = 718), and a group in which all were assessed for both risk factors and subclinical atherosclerosis (n = 6104). The latter two groups underwent baseline examination in a dedicated mobile facility equipped with advanced imaging tools suitable for noninvasive screening for subclinical atherosclerosis (coronary artery calcium by computed tomography [CT], carotid and aortic disease by ultrasound, and ankle-brachial index). Selected participants were offered advanced imaging (contrast-enhanced CT, magnetic resonance imaging, and positron emission tomography/CT). Plasma, PAXgene RNA, and DNA samples were obtained for biomarker discovery studies. All individuals will be followed until 600 major atherothrombotic events have occurred in those undergoing imaging

The Taylor expansion of the exponential map and geometric applications

The final publication is available at Springer via http://dx.doi.org/10.1007/s13398-013-0149-zIn this work we consider the Taylor expansion of the exponential map of a submanifold immersed in Rn up to order three, in order to introduce the concepts of lateral and frontal deviation. We compute the directions of extreme lateral and frontal deviation for surfaces in R3. Also we compute, by using the Taylor expansion, the directions of high contact with hyperspheres of a surface immersed in R4 and the asymptotic directions of a surface immersed in RnThis work was partially supported by DGCYT grant no. MTM2009-08933.Monera, M.; Montesinos Amilibia, Á.; Sanabria Codesal, E. (2014). The Taylor expansion of the exponential map and geometric applications. Revista de la Real Academia de Ciencias Exactas, Físicas y Naturales. Serie A: Matemáticas (RACSAM). 108(2):881-906. https://doi.org/10.1007/s13398-013-0149-zS8819061082Arnol’d, V.I., Gusein-zade, V.I., Varchenko, A.N.: Singularities of Differentiable Maps. Monographs in Mathematics, vol. 82. Birkhäuser, Boston (1985)Chen, B.-Y., Li, S.-J.: The contact number of a Euclidean submanifold. Proc. Edinburgh Math. Soc. 47, 69–100 (2004)Fessler, W.: $$\ddot{U}$$ U ¨ ber die normaltorsion von Fl $$\ddot{a}$$ a ¨ chen im vierdimensionalen euklidischen. Raum. Comm. Math. Helv. 33(2), 89–108 (1959)García, R., Sotomayor, J.: Geometric mean curvature lines on surfaces immersed in $$\mathbb{R}^3$$ R 3 . Annales de la faculté des sciences de Toulouse, $$6^e$$ 6 e ser, vol. 11, No. 3, pp. 377–401 (2002)García, R., Sotomayor, J.: Lines of axial curvature on surfaces immersed in $$R^4$$ R 4 . Differ. Geom. Appl. 12, 253–269 (2000)Golubitsky, M., Gillemin, V.: Stable Mappings and their Singularities. Springer, Berlin (1973)Hartmann, F., Hanzen, R.: Apollonius’s Ellipse and Evolute Revisited–The Discriminant of the Related Quartic. http://www3.villanova.edu/maple/misc/ellipse/Apollonius2004.pdfLlibre, J., Yanquian, Y.: On the dynamics of surface vector fields and homeomofphisms (preprint)Looijenga, E.J.N.: Structural stability of smooth families of $$C^{\infty }$$ C ∞ -functions. University of Amsterdam, Doctoral Thesis (1974)Mochida, D.K.H., Romero-Fuster, M.C., Ruas, M.A.S.: Inflection points and nonsingular embeddings of surfaces in $$\mathbb{R}^5$$ R 5 . Rocky Mt. J. Math. 33, 3 (2003)Mochida, D.K.H., Romero-Fuster, M.C., Ruas, M.A.S.: Osculating hyperplanes and asymptotic directions of codimension two submanifolds of Euclidean spaces. Geom. Dedicata 77(3), 305–315 (1999)Mochida, D.K.H., Romero Fuster, M.C., Ruas, M.A.S.: The geometry of surfaces in 4-space from a contact viewpoint. Geom. Dedicata 54, 323–332 (1995)Monera, G.M., Montesinos-Amilibia, A., Moraes, S.M., Sanabria-Codesal, E.: Critical points of higher order for the normal map of immersions in $$\mathbb{R}^d$$ R d . Topol. Appl. 159, 537–544 (2012)Montaldi, J.A.: Contact with application to submanifolds, PhD Thesis, University of Liverpool (1983)Montaldi, J.A.: On contact between submanifolds. Michigan Math. J. 33, 195–199 (1986)Montesinos-Amilibia, A.: Parametricas4, computer program freely available from http://www.uv.es/montesinMontesinos-Amilibia, A.: Parametricas5, computer program freely available from http://www.uv.es/montesinMoraes, S., Romero-Fuster, M.C., Sánchez-Bringas, F.: Principal configurations and umbilicity of submanifolds in $$I\!\! R^n$$ I R n . Bull. Bel. Math. Soc. 10, 227–245 (2003)Porteous, I.R.: The normal singularities of a submanifold. J. Differ. Geom. 5, 543–564 (1971)Romero-Fuster, M.C., Ruas, M.A.S., Tari, F.: Asymptotic curves on surfaces in $$R^5$$ R 5 . Commun. Contemp. Math. 10, 309–335 (2008)Romero-Fuster, M.C., Sánchez-Bringas, F.: Umbilicity of surfaces with orthogonal asymptotiv lines in $$R^4$$ R 4 . Differ. Geom. Appl. 16, 213–224 (2002)Tari, F.: On pairs of geometric foliations on a cross-cap. Tohoku Math. J. 59(2), 233–258 (2007

Paroxysmal atrial fibrillation developed during incomplete epidural anesthesia -A case report-

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia, and occurs in organic heart disease such as rheumatic, atherosclerotic and hypertensive heart disease. In recent studies, the sympathetic and parasympathetic nervous systems have been shown to have important roles in initiating paroxysmal AF. We report here a patient who developed paroxysmal AF that might be a result of an imbalance of the sympathetic-parasympathetic systems due to epidural anesthesia, and that was potentiated by pain with inadequate analgesia. A 69-year-old woman was scheduled for operation of a right-sided ankle fracture. Twenty minutes after epidural drug injection, paroxysmal AF occurred. Even after intravenous administration of esmolol and digoxin, AF continued. After transfer to the intensive care unit, her heart rate gradually decreased and AF disappeared. During perioperative anesthetic management, the proper preoperative prevention and intraoperative treatment are needed in AF high-risk patients

The effect of iterative model reconstruction on coronary artery calcium quantification

Coronary artery calcium (CAC) scoring with computed tomography (CT) is an established tool for quantifying calcified atherosclerotic plaque burden. Despite the widespread use of novel image reconstruction techniques in CT, the effect of iterative model reconstruction on CAC score remains unclear. We sought to assess the impact of iterative model based reconstruction (IMR) on coronary artery calcium quantification as compared to the standard filtered back projection (FBP) algorithm and hybrid iterative reconstruction (HIR). In addition, we aimed to simulate the impact of iterative reconstruction techniques on calcium scoring based risk stratification of a larger asymptomatic population. We studied 63 individuals who underwent CAC scoring. Images were reconstructed with FBP, HIR and IMR and CAC scores were measured. We estimated the cardiovascular risk reclassification rate of IMR versus HIR and FBP in a larger asymptomatic population (n = 504). The median CAC scores were 147.7 (IQR 9.6-582.9), 107.0 (IQR 5.9-526.6) and 115.1 (IQR 9.3-508.3) for FBP, HIR and IMR, respectively. The HIR and IMR resulted in lower CAC scores as compared to FBP (both p < 0.001), however there was no difference between HIR and IMR (p = 0.855). The CAC score decreased by 7.2 % in HIR and 7.3 % in IMR as compared to FBP, resulting in a risk reclassification rate of 2.4 % for both HIR and IMR. The utilization of IMR for CAC scoring reduces the measured calcium quantity. However, the CAC score based risk stratification demonstrated modest reclassification in IMR and HIR versus FBP

Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study

PURPOSE: Previous studies have shown that atherosclerosis of the descending aorta detected by transesophageal echocardiography (TEE) is a good marker of coexisting coronary artery disease. The aim of our study was to evaluate whether the presence of atherosclerosis on the descending aorta during TEE has any prognostic impact in predicting cardiovascular events. MATERIAL AND METHODS: The study group consisted of 238 consecutive in-hospital patients referred for TEE testing (135 males, 103 females, mean age 58 +/- 11 years) with a follow up of 24 months. The atherosclerotic lesions of the descending aorta were scored from 0 (no atherosclerosis) to 3 (plaque >5 mm and/or "complex" plaque with ulcerated or mobile parts). RESULTS: Atherosclerosis was observed in 102 patients, (grade 3 in 16, and grade 2 in 86 patients) whereas 136 patients only had an intimal thickening or normal intimal surface. There were 57 cardiovascular events in the follow-up period. The number of events was higher in the 102 patients with (n = 34) than in the 136 patients without atherosclerosis (n = 23, p < 0.01). The frequency of events was in close correlation with the severity of the atherosclerosis of the descending aorta. Fifty percent of the patients with grade 3 experienced cardiovascular events. Excluding patients with subsequent revascularization, the multivariate analysis only left ventricular function with EF < 40% (HR 3.0, CI 1.3–7.1) and TEE atherosclerotic plaque >=2 (HR 2.4, CI 1.0–5.5) predicted hard cardiovascular events. CONCLUSION: Atherosclerosis of the descending aorta observed during transesophageal echocardiography is a useful predictor of cardiovascular events

Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK

BACKGROUND: Natural history of paroxysmal atrial fibrillation (AF) is not very well documented. Clinical experience suggests that paroxysmal AF could progress to chronic AF with estimates ranging between 15 and 30% over a period of 1–3 years. We performed an epidemiologic study to elucidate the natural history of paroxysmal AF, this study estimated its incidence in a general practice setting, identified associated factors and analyzed the progression into chronic AF as well as the mortality rate. METHODS: Using the UK General Practice Research Database (GPRD), we identified patients aged 40–89 years with a first-recorded episode of paroxysmal AF during 1996. Risk factors were assessed using 525 incident paroxysmal AF cases confirmed by the general practitioner (GP) and a random sample of controls. We follow-up paroxysmal AF patients and estimated their mortality rate and progression to chronic AF. RESULTS: The incidence of paroxysmal AF was 1.0 per 1,000 person-years. Major risk factors for paroxysmal AF were age and prior valvular heart disease, ischaemic heart disease, heart failure and hyperthyroidism. During a mean follow-up of 2.7 years, 70 of 418 paroxysmal AF patients with complete information progressed to chronic AF. Risk factors associated with progression were valvular heart disease (OR 2.7, 95% CI 1.2–6.0) and moderate to high alcohol consumption (OR 3.0, 95% CI 1.1–8.0). Paroxysmal AF patients did not carry an increased risk of mortality, compared to an age and sex matched sample of the general population. There was a suggestion of a small increased risk among patients progressing to chronic AF (RR 1.5, 96% CI 0.8–2.9). CONCLUSION: Paroxysmal AF is a common arrhythmia in the general practice setting, increasing with age and commonly associated with other heart diseases. It sometimes is the initial presentation and then progress to chronic AF. A history of valvular heart disease and alcohol consumption are associated with this progression

Observation of associated near-side and away-side long-range correlations in √sNN=5.02 TeV proton-lead collisions with the ATLAS detector

Two-particle correlations in relative azimuthal angle (Δϕ) and pseudorapidity (Δη) are measured in √sNN=5.02  TeV p+Pb collisions using the ATLAS detector at the LHC. The measurements are performed using approximately 1  μb-1 of data as a function of transverse momentum (pT) and the transverse energy (ΣETPb) summed over 3.1<η<4.9 in the direction of the Pb beam. The correlation function, constructed from charged particles, exhibits a long-range (2<|Δη|<5) “near-side” (Δϕ∼0) correlation that grows rapidly with increasing ΣETPb. A long-range “away-side” (Δϕ∼π) correlation, obtained by subtracting the expected contributions from recoiling dijets and other sources estimated using events with small ΣETPb, is found to match the near-side correlation in magnitude, shape (in Δη and Δϕ) and ΣETPb dependence. The resultant Δϕ correlation is approximately symmetric about π/2, and is consistent with a dominant cos⁡2Δϕ modulation for all ΣETPb ranges and particle pT

Measurement of the cross-section of high transverse momentum vector bosons reconstructed as single jets and studies of jet substructure in pp collisions at √s = 7 TeV with the ATLAS detector

This paper presents a measurement of the cross-section for high transverse momentum W and Z bosons produced in pp collisions and decaying to all-hadronic final states. The data used in the analysis were recorded by the ATLAS detector at the CERN Large Hadron Collider at a centre-of-mass energy of √s = 7 TeV;{\rm Te}{\rm V}$and correspond to an integrated luminosity of$4.6\;{\rm f}{{{\rm b}}^{-1}}$. The measurement is performed by reconstructing the boosted W or Z bosons in single jets. The reconstructed jet mass is used to identify the W and Z bosons, and a jet substructure method based on energy cluster information in the jet centre-of-mass frame is used to suppress the large multi-jet background. The cross-section for events with a hadronically decaying W or Z boson, with transverse momentum${{p}_{{\rm T}}}\gt 320\;{\rm Ge}{\rm V}$and pseudorapidity$|\eta |\lt 1.9$, is measured to be${{\sigma }_{W+Z}}=8.5\pm 1.7$ pb and is compared to next-to-leading-order calculations. The selected events are further used to study jet grooming techniques

A thalamic reticular networking model of consciousness

<p>Abstract</p> <p>[Background]</p> <p>It is reasonable to consider the thalamus a primary candidate for the location of consciousness, given that the thalamus has been referred to as the gateway of nearly all sensory inputs to the corresponding cortical areas. Interestingly, in an early stage of brain development, communicative innervations between the dorsal thalamus and telencephalon must pass through the ventral thalamus, the major derivative of which is the thalamic reticular nucleus (TRN). The TRN occupies a striking control position in the brain, sending inhibitory axons back to the thalamus, roughly to the same region where they receive afferents.</p> <p>[Hypotheses]</p> <p>The present study hypothesizes that the TRN plays a pivotal role in dynamic attention by controlling thalamocortical synchronization. The TRN is thus viewed as a functional networking filter to regulate conscious perception, which is possibly embedded in thalamocortical networks. Based on the anatomical structures and connections, modality-specific sectors of the TRN and the thalamus appear to be responsible for modality-specific perceptual representation. Furthermore, the coarsely overlapped topographic maps of the TRN appear to be associated with cross-modal or unitary conscious awareness. Throughout the latticework structure of the TRN, conscious perception could be accomplished and elaborated through accumulating intercommunicative processing across the first-order input signal and the higher-order signals from its functionally associated cortices. As the higher-order relay signals run cumulatively through the relevant thalamocortical loops, conscious awareness becomes more refined and sophisticated.</p> <p>[Conclusions]</p> <p>I propose that the thalamocortical integrative communication across first- and higher-order information circuits and repeated feedback looping may account for our conscious awareness. This TRN-modulation hypothesis for conscious awareness provides a comprehensive rationale regarding previously reported psychological phenomena and neurological symptoms such as blindsight, neglect, the priming effect, the threshold/duration problem, and TRN-impairment resembling coma. This hypothesis can be tested by neurosurgical investigations of thalamocortical loops via the TRN, while simultaneously evaluating the degree to which conscious perception depends on the severity of impairment in a TRN-modulated network.</p