Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience

AIMS: To evaluate the accuracy of low-dose computed tomography coronary angiography (CTCA) using prospective ECG-triggering for the assessment of coronary artery disease (CAD). METHODS AND RESULTS: A total of 30 patients (19 males, 11 females, mean age 58.8 +/- 9.9 years) underwent low-dose CTCA and invasive coronary angiography (CA) [median 2 days (0, 41)]. Before CT scanning, intravenous beta-blocker was administered in 18 of 30 patients as heart rate (HR) was >65 b.p.m., achieving a mean HR of 55.7 +/- 7.9 b.p.m. CAD was defined as coronary artery narrowing > or =50%, using CA as standard of reference. The estimated mean effective radiation dose was 2.1 +/- 0.7 mSv (range: 1.0-3.3), yielding 96.0% (383/399) of evaluable segments. On an intention-to-diagnose-base, all non-evaluative segments were included in the analysis. Vessels with a non-evaluative segment and no further finding were censored as false positive. Patient-based analysis revealed sensitivity, specificity, positive predictive value, and negative predictive value of 100, 83.3, 90.0, and 100%, respectively. The respective values per vessel were 100, 88.9, 85.7, and 100%, respectively. CONCLUSION: Prospective ECG-triggering allows low-dose CTCA and provides high diagnostic accuracy in the assessment of CAD in patients with stable sinus rhythm and a low heart rat

Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry

Background: Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice. Design and methods: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests. Results: Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence. Conclusions: Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combinatio

Carotid Artery Stenting: A Single Center “Real World” Experience

BACKGROUND:Percutaneous carotid artery stenting (CAS) became a widely used procedure in patients with symptomatic and asymptomatic carotid artery stenosis. However its role compared to carotid endarterectomy (CAD) remains questioned. We analysed the safety of carotid artery stenting program of a prospective CAS register program of a tertiary teaching hospital. METHOD:Between July 2003 and December 2010, 208 patients underwent CAS procedure. Baseline, procedural and follow-up data were prospectively collected. Primary peri-interventional outcome was defined as 30-day major adverse events (MAE), including death, stroke or myocardial infarction, and mid- to long-term follow-up outcome included ipsilateral stroke, myocardial infarction or death. Secondary outcome was restenosis rate ≥ 50% per lesion. RESULTS:Unilateral carotid artery interventions were performed in 186 patients. In 22 patients CAS was performed bilaterally as stages procedures. The 30-day MAE rate was 1.9% consisting of two contralateral strokes and two ipsilateral stroke. Mean clinically follow-up was 22 months. Mid- to long-term MAE was 8.1% with 6.3% (n = 13) deaths, 1.9% (n = 4) myocardial infarctions and 0.9% (n = 2) ipsilateral stroke. The restenosis rate ≥ 50% per lesion was 4.3% at a mean follow-up of 22 months. Target lesion revascularization was performed in one patient, because of restenosis at 9 months follow-up after first CAS. CONCLUSION:Implementation of a carotid artery stenting program at a tertiary, teaching hospital is a safe method for treatment of carotid artery stenosis. The adverse event rate during mid-to-long-term follow-up suggests an appropriate patient selection

Doping a semiconductor to create an unconventional metal

Landau Fermi liquid theory, with its pivotal assertion that electrons in metals can be simply understood as independent particles with effective masses replacing the free electron mass, has been astonishingly successful. This is true despite the Coulomb interactions an electron experiences from the host crystal lattice, its defects, and the other ~1022/cm3 electrons. An important extension to the theory accounts for the behaviour of doped semiconductors1,2. Because little in the vast literature on materials contradicts Fermi liquid theory and its extensions, exceptions have attracted great attention, and they include the high temperature superconductors3, silicon-based field effect transistors which host two-dimensional metals4, and certain rare earth compounds at the threshold of magnetism5-8. The origin of the non-Fermi liquid behaviour in all of these systems remains controversial. Here we report that an entirely different and exceedingly simple class of materials - doped small gap semiconductors near a metal-insulator transition - can also display a non-Fermi liquid state. Remarkably, a modest magnetic field functions as a switch which restores the ordinary disordered Fermi liquid. Our data suggest that we have finally found a physical realization of the only mathematically rigourous route to a non-Fermi liquid, namely the 'undercompensated Kondo effect', where there are too few mobile electrons to compensate for the spins of unpaired electrons localized on impurity atoms9-12.Comment: 17 pages 4 figures supplemental information included with 2 figure

Scaling of the Conductivity with Temperature and Uniaxial Stress in Si:B at the Metal-Insulator Transition

Using uniaxial stress to tune Si:B through the metal-insulator transition we find the conductivity at low temperatures shows an excellent fit to scaling with temperature and stress on both sides of the transition. The scaling functions yield the conductivity in the metallic and insulating phases, and allow a reliable determination of the temperature dependence in the critical regions on both sides of the transition

Linear magnetoresistance in commercial n-type silicon due to inhomogeneous doping

Free electron theory tells us that resistivity is independent of magnetic field. In fact, most observations match the semiclassical prediction of a magnetoresistance that is quadratic at low fields before saturating. However, a non-saturating linear magnetoresistance has been observed in exotic semiconductors such as silver chalcogenides, lightly-doped InSb, N-doped InAs, MnAs-GaAs composites, PrFeAsO, and epitaxial graphene. Here we report the observation of a large linear magnetoresistance in the ohmic regime in commonplace commercial n-type silicon wafer. It is well-described by a classical model of spatially fluctuating donor densities, and may be amplified by altering the aspect ratio of the sample to enhance current-jetting: increasing the width tenfold increased the magnetoresistance at 8 T from 445 % to 4707 % at 35 K. This physical picture may well offer insights into the large magnetoresistances recently observed in n-type and p-type Si in the non-ohmic regime.Comment: submitted to Nature Material

Measurement of gamma p --> K+ Lambda and gamma p --> K+ Sigma0 at photon energies up to 2.6 GeV

The reactions gamma p --> K+ Lambda and gamma p --> K+ Sigma0 were measured in the energy range from threshold up to a photon energy of 2.6 GeV. The data were taken with the SAPHIR detector at the electron stretcher facility, ELSA. Results on cross sections and hyperon polarizations are presented as a function of kaon production angle and photon energy. The total cross section for Lambda production rises steeply with energy close to threshold, whereas the Sigma0 cross section rises slowly to a maximum at about E_gamma = 1.45 GeV. Cross sections together with their angular decompositions into Legendre polynomials suggest contributions from resonance production for both reactions. In general, the induced polarization of Lambda has negative values in the kaon forward direction and positive values in the backward direction. The magnitude varies with energy. The polarization of Sigma0 follows a similar angular and energy dependence as that of Lambda, but with opposite sign.Comment: 21 pages, 25 figures, submitted to Eur. Phys. J.

Metal-insulator Crossover Behavior at the Surface of NiS_2

We have performed a detailed high-resolution electron spectroscopic investigation of NiS$_2$ and related Se-substituted compounds NiS$_{2-x}$Se$_x$, which are known to be gapped insulators in the bulk at all temperatures. A large spectral weight at the Fermi energy of the room temperature spectrum, in conjunction with the extreme surface sensitivity of the experimental probe, however, suggests that the surface layer is metallic at 300 K. Interestingly, the evolution of the spectral function with decreasing temperature is characterized by a continuous depletion of the single-particle spectral weight at the Fermi energy and the development of a gap-like structure below a characteristic temperature, providing evidence for a metal-insulator crossover behavior at the surfaces of NiS$_2$ and of related compounds. These results provide a consistent description of the unusual transport properties observed in these systems.Comment: 12 pages, 3 figure

Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography

Aims Although cardiac hybrid imaging, fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA), provides important complementary diagnostic information for coronary artery disease (CAD) assessment, no prognostic data exist on the predictive value of cardiac hybrid imaging. Hence, the aim of this study was to assess the prognostic value of hybrid SPECT/CCTA images. Methods and results Of 335 consecutive patients undergoing a 1-day stress/rest 99mTc-tetrofosmin SPECT and a CCTA, acquired on stand-alone scanners and fused to obtain cardiac hybrid images, follow-up was obtained in 324 patients (97%). Survival free of all-cause death or non-fatal myocardial infarction (MI) and free of major adverse cardiac events (MACE: death, MI, unstable angina requiring hospitalization, coronary revascularizations) was determined using the Kaplan-Meier method for the following groups: (i) stenosis by CCTA and matching reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; and (iii) normal finding by CCTA and SPECT. Cox's proportional hazard regression was used to identify independent predictors for cardiac events. At a median follow-up of 2.8 years (25th-75th percentile: 1.9-3.6), 69 MACE occurred in 47 patients, including 20 death/MI. A corresponding matched hybrid image finding was associated with a significantly higher death/MI incidence (P < 0.005) and proved to be an independent predictor for MACE. The annual death/MI rate was 6.0, 2.8, and 1.3% for patients with matched, unmatched, and normal findings. Conclusion Cardiac hybrid imaging allows risk stratification in patients with known or suspected CAD. A matched defect on hybrid image is a strong predictor of MAC