Coronary Artery Perforation and Regrowth of a Side Branch Occluded by a Polytetrafluoroethylene-Covered Stent Implantation

Stenting of the right coronary artery stenosis caused coronary perforation and profound dye (blood) extravasation in a 69-year-old female patient. Instantaneous balloon inflation followed by implantation of a polytetrafluoroethylene- (PTFE-)covered stent sealed the coronary perforation, restored the blood flow, and perceivably caused acute occlusion of a large side branch (SB). The immediate in situ balloon inflation prevented the development of cardiac tamponade. Surprisingly, followup coronary angiography 4 and 11 months later showed spontaneous recanalization of the SB occluded by PTFE-covered stent. The SB was filled through a channel beginning at the end of the covered stent streaming retrogradely beneath it toward the SB ostium. Up to the best of our knowledge, this is the first described case of late spontaneous recanalization of as SB occluded by a PTFE-covered stent

Carotid Plaque Age Is a Feature of Plaque Stability Inversely Related to Levels of Plasma Insulin

C-declination curve (a result of the atomic bomb tests in the 1950s and 1960s) to determine the average biological age of carotid plaques.C content by accelerator mass spectrometry. The average plaque age (i.e. formation time) was 9.6±3.3 years. All but two plaques had formed within 5–15 years before surgery. Plaque age was not associated with the chronological ages of the patients but was inversely related to plasma insulin levels (p = 0.0014). Most plaques were echo-lucent rather than echo-rich (2.24±0.97, range 1–5). However, plaques in the lowest tercile of plaque age (most recently formed) were characterized by further instability with a higher content of lipids and macrophages (67.8±12.4 vs. 50.4±6.2, p = 0.00005; 57.6±26.1 vs. 39.8±25.7, p<0.0005, respectively), less collagen (45.3±6.1 vs. 51.1±9.8, p<0.05), and fewer smooth muscle cells (130±31 vs. 141±21, p<0.05) than plaques in the highest tercile. Microarray analysis of plaques in the lowest tercile also showed increased activity of genes involved in immune responses and oxidative phosphorylation.C, can improve our understanding of carotid plaque stability and therefore risk for clinical complications. Our results also suggest that levels of plasma insulin might be involved in determining carotid plaque age

Impaired glucose tolerance in ischemic heart disease

Background: Diabetes mellitus (DM) and impaired glucose tolerance test (IGT) are well known risk factors for cardiovascular disease (CVD). Individuals with IGT, a prediabetic state, are asymptomatic during many years and they often remain undiagnosed until they have developed overt diabetes or cardiovascular complications. Patients and methods: A total 123 patients, aged 31-80 years with a previous acute myocardial infarction (MI) but without a known DM were examined. A standard oral glucose test (OGTT) was performed. Calculated intimamedia (clMa) of the brachial and common carotid arteries, flow-mediated dilation (FMD) of the brachial artery, left ventricular dimensions and systolic function were examined. Left ventricular diastolic function was evaluated by tissue velocity echocardiography. Microalbuminuria (MA) was defined as excretion of 20-200 mug albumin/min. Results: The prevalence of DM and IGT in patients discharged from the CCU after MI without known DM diagnosis was high (38%). A fasting plasma glucose (PG) alone failed to identify more than 80% of the patients with abnormal glucose metabolism in this study. A multiple stepwise regression analysis revealed an independent and significant association between 2h PG and CRP (P <0.05). In the whole group calculated intimamedia area was associated with 2h PG after the glucose load (P <0.05). Both cIMa of the common carotid artery and the cIMa of the brachial artery were independently and significantly associated with left ventricular septum thickness. Microalbuminuria (MA) was present in 11% of patients. Patients with MA had significantly higher levels of 2h PG, lower displacement of the atrioventricular (AV) plane by M-mode echocardiography, thicker LV septum wall and a higher prevalence of impaired glucose tolerance compared with those with normoalbuminuria (p<0.05). Urinary albumin excretion (UAE) was significantly and positively associated with cIMa in both brachial and common carotid arteries, age and interventricular septum thickness. 2-h PG was significantly and negatively associated with diastolic TDI parameters such as early diastolic filling velocity (E-v), ratio of the early to late diastolic filling velocity (E'/A') and positively associated with Tei index (p<0.05). Left ventricular ejection time and Teiindex were significantly higher, E'/A' and E-v were significantly lower in patients with disturbed glucose metabolism compared with patients with normal glucose tolerance (p<0.01). These differences also remained significant when patients with DM were excluded from analysis. Conclusions: The prevalence of abnormal glucose tolerance was high in patients discharged after MI without known DM. Glucose intolerance was associated with inflammation, surrogate variables for atherosclerosis, microalbuminuria and LV diastolic dysfunction. In this population FMD was probably not a reliable marker, since FMD is a functional parameter of the arterial system, particularly well suited for the study of the earlier stages of atherosclerosis in children and young adults without stiff arteries

2-h postchallenge plasma glucose predicts cardiovascular events in patients with myocardial infarction without known diabetes mellitus

Background and purpose The incidence of cardiovascular events remains high in patients with myocardial infarction (MI) despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular (CV) events are needed. This study aimed to analyze the predictive value of an oral glucose tolerance test (OGTT) in patients with acute myocardial infarction without known diabetes mellitus (DM). Methods The prospective cohort study consisted of 123 men and women aged between 31–80 years who had suffered a previous MI 3–12 months before the examinations. The exclusion criteria were known diabetes mellitus. Patients were followed up over 6.03 ± 1.36 years for CV death, recurrent MI, stroke and unstable angina pectoris. A standard OGTT was performed at baseline. Results 2-h plasma glucose (HR, 1.27, 95% CI, 1.00 to 1.62; P < 0.05) and smoking (HR, 3.56, 95% CI, 1.02 to 12.38; P < 0.05) proved to be independent predictors of CV events in multivariate statistical analysis after adjustments for age, sex, total cholesterol, and other baseline characteristics. Conclusions In this study population, with previous MI and without known DM, 2-h PG and smoking were significant predictors of CV death, recurrent MI, stroke and unstable angina pectoris, independent of baseline characteristics and medical treatment

Spatial and temporal analysis of land cover and landscape structure change in Zagros Forests

The Zagros oak forests in Western Iran are critically important to the sustainability of the region. These forests have undergone dramatic declines in recent decades. We evaluated the utility of the non-parametric Random Forest classification algorithm for land cover classification of Zagros landscapes, and selected the best spatial and spectral predictive variables. The algorithm resulted in high overall classification accuracies (\u3e85%) and also equivalent classification accuracies for the datasets from the three different sensors. We evaluated the associations between trends in forest area and structure with trends in socioeconomic and climatic conditions, to identify the most likely driving forces creating deforestation and landscape structure change. We used available socioeconomic (urban and rural population, and rural income), and climatic (mean annual rainfall and mean annual temperature) data for two provinces in northern Zagros. The most correlated driving force of forest area loss was urban population, and climatic variables to a lesser extent. Landscape structure changes were more closely associated with rural population. We examined the effects of scale changes on the results from spatial pattern analysis. We assessed the impacts of eight years of protection in a protected area in northern Zagros at two different scales (both grain and extent). The effects of protection on the amount and structure of forests was scale dependent. We evaluated the nature and magnitude of changes in forest area and structure over the entire Zagros region from 1972 to 2009. We divided the Zagros region in 167 Landscape Units and developed two measures— Deforestation Sensitivity (DS) and Connectivity Sensitivity (CS) — for each landscape unit as the percent of the time steps that forest area and ECA experienced a decrease of greater than 10% in either measure. A considerable loss in forest area and connectivity was detected, but no sudden (nonlinear) changes were detected at the spatial and temporal scale of the study. Connectivity loss occurred more rapidly than forest loss due to the loss of connecting patches. More connectivity was lost in southern Zagros due to climatic differences and different forms of traditional land use

Genetic Variation in Superior Tomato Genotypes Collected from North West of Iran

Abstract. Heterogeneous landrace populations are important sources of genetic variation and are utilized for agronomic and genetic improvement of the crop in plant breeding programs. Therefore, thirty tomato landraces collected from North West of Iran with three commercial cultivars &quot;Korall, Fauna and Peto Early CH&quot; were studied in completely randomized design in four replications at the Kahriz Station of Agriculture and Natural Resources Research Center of West Azerbaijan. Analysis of variance has shown the significant difference among genotypes for all the evaluated characters. The highest and lowest of heritability were observed for number of seeds per fruit and number of flowers per inflorescence respectively. In principal component analysis, the first five components clarified 77% of total variations in tomato germplasm. These five components were entitled fruiıt pH, yield, vegetative growth, fruit size and fruit maturing respectively. In component yield, characters of fruit weight and fruit diameter had high positive coefficients. The cluster analysis located genotypes into five group

Analyzing effective protection for roe deer (Capreolus capreolus) habitat in Iranian Zagros forests at two scales

Background/Question/Methods Bozin and Marakhil forest was designated protected area in 1999 to restore habitat for roe deer (Capreolus capreolus). It is located in Kermanshah province, Iran, and covers 23724 ha of semi-arid Zagros forests. Research in Europe has identified the importance of landscape structural characteristics, such as patch edge and contiguity, as important determinants of home-range and population sizes of roe deer. We analyzed landscape changes from 2001 to 2009 inside and outside of this protected area at two scales (Landsat: 30m grain and ~ 6750000 ha extent; and IKONOS/GeoEye: 1m grain and ~16500ha extent). Radiometric corrections and orthorectification were followed by the classification of images to five cover classes using Random Forest algorithm. All available structure metrics were calculated at patch and class level for forests using a 8 cell neighborhood rule. A principal component analysis was applied on the structure metrics at patch level in order to avoid redundancy and select orthogonal metrics for comparison. The selected metrics were used to compare forest structure at general Zagros forests as well as protected and unprotected areas at the two time steps. The areas of the unprotected area located in Iraq were clipped out in order to eliminate the socioeconomic effects and the differences in national management policies. Results/Conclusions At the Landsat scale the selected orthogonal metrics with the highest loadings on the first two principal components (explaining 88% and 86% of the variation in 2001 and 2009, respectively) were patch area, shape index, and contiguity index. Class level metrics showed a 14.5 % forest loss and a 5.4 unit decrease in edge density for the general Zagros forest from 2001 to 2009. While there was no significant change in amount of forest in the protected area or the immediate area, there was an increase in patch connectivity inside of the protected area (p \u3c .01). However, no significance difference was found for the value of the selected patch level metrics for general Zagros structure at the two time steps. These analyses at the first scale suggest that either 1) the park is functioning to protect important roe deer habitat characteristics (and the protection has increased the spatial connectedness of habitats), or 2) the increased habitat connectedness is due to the higher initial forest cover in the protected area. This requires analyses at the fine scale

Grass trumps trees with fire

Ecologists have long assumed that forests, savannas, and grasslands change gradually over space and time, with tree cover responding linearly to gradients in precipitation, aridity, fire disturbance, and grazing pressure. However, a growing body of evidence suggests that these biomes are self-reinforcing and that transitions between them can be nonlinear, governed by feedbacks at local and regional scales (1–3). Two reports in this issue, by Staver et al. on page 230 (4) and by Hirota et al. on page 232 (5), find evidence for these feedbacks and transitions at the global scale. These results suggest that global climate change will be substantially influenced by nonlinear behaviors and feedbacks between biophysical and human systems