Intracerebral Haemorrhage Following Carotid Endarterectomy

AbstractObjectives. To determine risk factors for the development of hyperperfusion and intra-cerebral haemorrhage following carotid endarterectomy and formulate potential protocols for prevention.Methods. MEDLINE database search of the English language literature (1966–2002) was performed using the words ‘cerebral haemorrhage’, ‘intracranial haemorrhage’ and ‘carotid endarterectomy’. Other articles were cross-referenced by hand.Results. There are no data from randomised trials confirming the significance of any single risk factor. The evidence suggests that the following may have a role: pre-operative hypertension, recent ipsilateral non-haemorrhagic stroke, previous ischaemic cerebral infarction, surgery for a >90% ipsilateral internal carotid artery (ICA) stenosis, impaired cerebrovascular reserve, intra-operative haemodynamic or embolic ischaemia, post-operative hypertension, an ipsilateral increase of ≥175% in peak middle cerebral artery velocity (MCAV) and/or a ≥100% increase in pulsatility index.Conclusions. A critical ICA stenosis with impaired cerebrovascular reserve resulting in maximal intracerebral vasodilatation and post-operative hyperperfusion (impaired autoregulation) appear to be central to the development of ICH. Appropriate pre-operative screening and post-operative monitoring in high risk patients might identify those who would benefit from manipulation of the haemodynamic events that appear to promote ICH

Influence of Warfarin on the Success of Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein (GSV)

AbstractBackgroundAlthough warfarin is routinely stopped prior to varicose vein surgery the absence of incisions may make this unnecessary prior to EVLA. Nevertheless continuing therapy may compromise ablation rates resulting in treatment failure. Since EVLA is particularly suitable for older patients with co-morbidities this study investigates whether warfarin influences outcome.MethodA prospective observational cohort study was designed to assess ablation rates (1 year, duplex ultrasound), Aberdeen varicose vein symptom severity scores (AVVSS) and patient satisfaction following GSV EVLA in 22 patients (“warfarin group”: 12 female, 10 male; 24 limbs) taking warfarin and 24 age/sex and disease-severity matched controls who were not taking anticoagulants (“no-warfarin group”).ResultsComplete ablation of the treated-length of GSV was achieved in 20/24 (83%) limbs in the “warfarin group” versus 23/24 (96%) in the “no-warfarin” group (p=0.347, chi squared). Suboptimal energy densities were delivered to 3/4 failures in the “warfarin group”. A similar, significant (p<0.001, Wilcoxon) improvement in AVVSS occurred in both groups [warfarin: median 14.6 (inter-quartile range 8.9–19.1) to 3.8 (1.9–6.2), no-warfarin: median 13.9 (IQR 7.6–20.1) to 3.5 (2.2–6.4)]. Patients were equally satisfied with outcomes (warfarin=92%, no-warfarin=90%; p=0.391, Mann–Whitney). No major complications occurred.ConclusionsEVLA in patients taking warfarin is safe and effective. Since cessation of therapy is unnecessary it should provide a valuable alternative to surgery in these patients

How to Undertake a Clinically Relevant Systematic Review in a Rapidly Evolving Field: Magnetic Resonance Angiography

Objectives: The aim was to determine which generations of the evolving technology of magnetic resonance angiography (MRA) are currently of clinical relevance in two clinical applications. Our purpose was to plan a systematic review that would be valuable both to purchasers driven by cost-effectiveness and to practicing clinicians. Methods: Information was gathered from a search of major bibliographic databases, from a short questionnaire sent to 500 U.K. vascular radiologists and vascular surgeons, and from local clinical The authors thank A. Jackson and all those who completed a questionnaire. This work was carried out with the financial support of the Secretary of State for Health under the NHS Health Technology Assessment Programme, project 97/13/04. The views and opinions expressed do not necessarily reflect those of the Secretary of State for Health. In part, this work was undertaken by the Leeds Teaching Hospitals NHS Trust, which received funding from the NHS Executive. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive.experts. We asked which of the MRA techniques were currently used and, assuming availability, what would be their technique of choice. Results: There were 206 published articles that satisfied preliminary inclusion criteria: 69 discussed 2D time of flight (TOF); 47, 3D TOF; and 38, contrast-enhanced techniques. There were 162 questionnaires returned (60 radiologists, 102 surgeons). Of the total respondents, 77/162 (48%) used MRA in the assessment of carotid artery stenosis; 47/77 (61%) used 2D TOF; 32/77 (42%), 3D TOF; and 26/77 (34%), contrast-enhanced techniques. Thirty-five of 162 (22%) respondents used MRA in the assessment of peripheral vascular disease (PVD); 15/35 (43%) used 2D TOF, 4/35 (11%) used 3D TOF, and 22/35 (63%) used contrast-enhanced techniques. For those wishing to use MRA, contrast-enhanced techniques were the method of choice. Conclusions: The TOF methods that represent earlier generations of the technology remain clinically relevant, and will therefore be included in our systematic review. To ensure complete and relevant coverage in reviews of other evolving technologies, it would be advisable to obtain data for guidance in a similar way

Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review

Objective To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. Design Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1990-9. Main outcome measures Performance characteristics of diagnostic test. Results 126 potentially relevant articles were identified, but many articles failed to examine die performance of magnetic resonance angiography as a diagnostic test at the surgical decision thresholds used in major clinical trials on endarterectomy. 26 articles were included in a meta-analysis that showed a maximal joint sensitivity and specificity of 99% (95% confidence interval 98% to 100%) for identifying 70-99% stenosis and 90% (81% to 99%) for identifying 50-99% stenosis. Only four articles evaluated contrast enhanced magnetic resonance angiography. Conclusions Magnetic resonance angiography is accurate for selecting patients for carotid endarterectomy at the surgical decision thresholds established in the major endarterectomy trials, but the evidence is not very robust because of the heterogeneity of the studies included. Research is to determine the diagnostic performance of the most recent developments in magnetic resonance angiography, including contrast enhanced techniques, as well as to assess the impact of magnetic resonance angiography on surgical decision making and outcomes

Stellar turbulence and mode physics

An overview of selected topical problems on modelling oscillation properties in solar-like stars is presented. High-quality oscillation data from both space-borne intensity observations and ground-based spectroscopic measurements provide first tests of the still-ill-understood, superficial layers in distant stars. Emphasis will be given to modelling the pulsation dynamics of the stellar surface layers, the stochastic excitation processes and the associated dynamics of the turbulent fluxes of heat and momentum.Comment: Proc. HELAS Workshop on 'Synergies between solar and stellar modelling', eds M. Marconi, D. Cardini, M. P. Di Mauro, Astrophys. Space Sci., in the pres

Functional modularity of nuclear hormone receptors in a Caenorhabditis elegans metabolic gene regulatory network

We present the first gene regulatory network (GRN) that pertains to post-developmental gene expression. Specifically, we mapped a transcription regulatory network of Caenorhabditis elegans metabolic gene promoters using gene-centered yeast one-hybrid assays. We found that the metabolic GRN is enriched for nuclear hormone receptors (NHRs) compared with other gene-centered regulatory networks, and that these NHRs organize into functional network modules.The NHR family has greatly expanded in nematodes; C. elegans has 284 NHRs, whereas humans have only 48. We show that the NHRs in the metabolic GRN have metabolic phenotypes, suggesting that they do not simply function redundantly.The mediator subunit MDT-15 preferentially interacts with NHRs that occur in the metabolic GRN.We describe an NHR circuit that responds to nutrient availability and propose a model for the evolution and organization of NHRs in C. elegans metabolic regulatory networks

Влияние облучения и отжига на термическую стабильность радиационных дефектов в кремнии

Описан отжиг А-центров, дивакансий, А-центров, модифицированных водородом, в n-Si (P ≈ 10^14 см^-3), в отсутствие и при наличии примеси платины, после облучения протонами с энергией 1,8 МэВ. Показано, что энергия активации отжига радиационных дефектов при взаимодействии с водородно-вакансионными дефектами уменьшается с 1,1 до 0,8 эВ при увеличении концентрации платины в кремнии, так как деформационные поля, создаваемые атомами платины, уменьшают энергию переориентации дефектов. Уточнено энергетическое положение в запрещенной зоне кремния донорного уровня А-центра (ЕV + 0,415 эВ) на основании известных данных о положении А-центра, модифицированного атомом углерода (ЕV + 0,38 эВ) или водорода (ЕV + 0,28 эВ).Описано відпал А-центрів, дивакансій, А-центрів, модифікованих воднем, у n-Si (P ≈ 10^14 см^-3), за відсутності та при наявності домішки платини, після опромінення протонами з енергією 1,8 МеВ. Показано, що енергія активації відпалу радіаційних дефектів при взаємодії з воднево-вакансійними дефектами зменшується від 1,1 до 0,8 еВ зі збільшенням концентрації платини в кремнії, оскільки деформаційні поля, які створюються атомами платини, зменшують енергію переорієнтації дефектів. Уточнено енергетичне положення у забороненій зоні кремнію донорного рівня А-центра (ЕV + 0,415 еВ), виходячи із відомих даних щодо положення А-центра, модифікованого атомом вуглецю (ЕV + 0,38 еВ) або водню (ЕV + 0,28 еВ).The annealing of A-centers, divacancies, A-centers modified by hydrogen was described for n-Si (P ≈ 10^14 cm^-3), with and without platinum dopants, after the irradiation by protons with energy 1.8 MeV. It was shown that the activation energy of annealing for radiation defects under their interaction with hydrogen-vacancy defects is decreased from 1.1 to 0.8 eV with the increasing of platinum concentration in silicon, because the deformation fields, creating by platinum atoms, decrease the energy of the defect re-orientation. In the forbidden zone of silicon the energy state for the donor level of A-center (ЕV + 0.415 eV) was specified based on the data about the position of A-center modified by the carbon atom (ЕV + 0.38 eV) or the hydrogen atom (ЕV + 0.28 eV)

Stellar Inversion Techniques

Stellar seismic inversions have proved to be a powerful technique for probing the internal structure of stars, and paving the way for a better understanding of the underlying physics by revealing some of the shortcomings in current stellar models. In this lecture, we provide an introduction to this topic by explaining kernel-based inversion techniques. Specifically, we explain how various kernels are obtained from the pulsation equations, and describe inversion techniques such as the Regularised Least-Squares (RLS) and Optimally Localised Averages (OLA) methods.Comment: 20 pages, 8 figures. Lecture presented at the IVth Azores International Advanced School in Space Sciences on "Asteroseismology and Exoplanets: Listening to the Stars and Searching for New Worlds" (arXiv:1709.00645), which took place in Horta, Azores Islands, Portugal in July 201

Stochastic excitation of acoustic modes in stars

For more than ten years, solar-like oscillations have been detected and frequencies measured for a growing number of stars with various characteristics (e.g. different evolutionary stages, effective temperatures, gravities, metal abundances ...). Excitation of such oscillations is attributed to turbulent convection and takes place in the uppermost part of the convective envelope. Since the pioneering work of Goldreich & Keely (1977), more sophisticated theoretical models of stochastic excitation were developed, which differ from each other both by the way turbulent convection is modeled and by the assumed sources of excitation. We review here these different models and their underlying approximations and assumptions. We emphasize how the computed mode excitation rates crucially depend on the way turbulent convection is described but also on the stratification and the metal abundance of the upper layers of the star. In turn we will show how the seismic measurements collected so far allow us to infer properties of turbulent convection in stars.Comment: Notes associated with a lecture given during the fall school organized by the CNRS and held in St-Flour (France) 20-24 October 2008 ; 39 pages ; 11 figure