386 research outputs found
PEE6: PROSTAMIDES VS. COMBINATION PRODUCTS FOR GLAUCOMA TREATMENT: EFFECTIVENESS AND COST CONSIDERATIONS
Effects of low energy electron irradiation on formation of nitrogen-vacancy centers in single-crystal diamond
Exposure to beams of low energy electrons (2 to 30 keV) in a scanning
electron microscope locally induces formation of NV-centers without thermal
annealing in diamonds that have been implanted with nitrogen ions. We find that
non-thermal, electron beam induced NV-formation is about four times less
efficient than thermal annealing. But NV-center formation in a consecutive
thermal annealing step (800C) following exposure to low energy electrons
increases by a factor of up to 1.8 compared to thermal annealing alone. These
observations point to reconstruction of nitrogen-vacancy complexes induced by
electronic excitations from low energy electrons as an NV-center formation
mechanism and identify local electronic excitations as a means for spatially
controlled room-temperature NV-center formation
Aortic calcification and femoral bone density are independently associated with left ventricular mass in patients with chronic kidney disease
Background
Vascular calcification and reduced bone density are prevalent in chronic kidney disease and linked to increased cardiovascular risk. The mechanism is unknown. We assessed the relationship between vascular calcification, femoral bone density and left ventricular mass in patients with stage 3 non-diabetic chronic kidney disease in a cross-sectional observational study.
Methodology and Principal Findings
A total of 120 patients were recruited (54% male, mean age 55±14 years, mean glomerular filtration rate 50±13 ml/min/1.73 m2). Abdominal aortic calcification was assessed using lateral lumbar spine radiography and was present in 48%. Mean femoral Z-score measured using dual energy x-ray absorptiometry was 0.60±1.06. Cardiovascular magnetic resonance imaging was used to determine left ventricular mass. One patient had left ventricular hypertrophy. Subjects with aortic calcification had higher left ventricular mass compared to those without (56±16 vs. 48±12 g/m2, P = 0.002), as did patients with femoral Z-scores below zero (56±15 vs. 49±13 g/m2, P = 0.01). In univariate analysis presence of aortic calcification correlated with left ventricular mass (r = 0.32, P = 0.001); mean femoral Z-score inversely correlated with left ventricular mass (r = −0.28, P = 0.004). In a multivariate regression model that included presence of aortic calcification, mean femoral Z-score, gender and 24-hour systolic blood pressure, 46% of the variability in left ventricular mass was explained (P<0.001).
Conclusions
In patients with stage 3 non-diabetic chronic kidney disease, lower mean femoral Z-score and presence of aortic calcification are independently associated with increased left ventricular mass. Further research exploring the pathophysiology that underlies these relationships is warranted
Progressive breathlessness in an Afro Caribbean hypertensive subject
The sensitivity and specificity of structural assessment of the heart by echocardiography in
black hypertensive patients presenting with symptoms of heart failure is often incomplete.
Cardiovascular magnetic resonance, mainly by virtue of its ability to characterize myocardial
tissue composition, may be of value in differentiating some of the common pathologies
noninvasively. We present an illustrative case of hypertrophic cardiomyopathy in a British
Afro Caribbean hypertensive patient where at least some features of familial amyloidosis were
present on screening echocardiography. Cardiovascular magnetic resonance examination of
this case established not only the usefulness of this technique, but also highlighted the importance
of recognizing the variations and departure from the usual which one associates with hypertrophic
cardiomyopathy, so as to arrive at the final diagnosis
Effects of Space Charge, Dopants, and Strain Fields on Surfaces and Grain Boundaries in YBCO Compounds
Statistical thermodynamical and kinetically-limited models are applied to
study the origin and evolution of space charges and band-bending effects at low
angle [001] tilt grain boundaries in YBaCuO and the effects of Ca
doping upon them. Atomistic simulations, using shell models of interatomic
forces, are used to calculate the energetics of various relevant point defects.
The intrinsic space charge profiles at ideal surfaces are calculated for two
limits of oxygen contents, i.e. YBaCuO and YBaCuO. At
one limit, O, the system is an insulator, while at O, a metal. This is
analogous to the intrinsic and doping cases of semiconductors. The site
selections for doping calcium and creating holes are also investigated by
calculating the heat of solution. In a continuum treatment, the volume of
formation of doping calcium at Y-sites is computed. It is then applied to study
the segregation of calcium ions to grain boundaries in the Y-123 compound. The
influences of the segregation of calcium ions on space charge profiles are
finally studied to provide one guide for understanding the improvement of
transport properties by doping calcium at grain boundaries in Y-123 compound.Comment: 13 pages, 5 figure
Diagnosis and Treatment of the Cardiovascular Consequences of Fabry Disease
Fabry Disease (FD) has been a diagnostic challenge since it was first recognised in 1898, with patients traditionally suffering from considerable delay before a diagnosis is made. Cardiac involvement is the current leading cause of death in FD. A combination of improved enzyme assays, availability of genetic profiling, together with more organised clinical services for rare diseases, has led to a rapid growth in the prevalence of FD. The earlier and more frequent diagnosis of asymptomatic individuals before development of the phenotype has focussed attention on early detection of organ involvement and closer monitoring of disease progression. The high cost of enzyme replacement therapy at a time of constraint within many health economies moreover, has challenged clinicians to target treatment effectively. This article provides an outline of FD for the general physician and summarises the aetiology and pathology of FD, the cardiovascular (CV) consequences thereof, modalities used in diagnosis, and then discusses current indications for treatment, including pharmacotherapy and device implantation
Increased cardiac involvement in Fabry disease using blood-corrected native T1 mapping
Fabry disease (FD) is a rare lysosomal storage disorder resulting in myocardial sphingolipid accumulation which is detectable by cardiovascular magnetic resonance as low native T1. However, myocardial T1 contains signal from intramyocardial blood which affects variability and consequently measurement precision and accuracy. Correction of myocardial T1 by blood T1 increases precision. We therefore deployed a multicenter study of FD patients (n = 218) and healthy controls (n = 117) to investigate if blood-correction of myocardial native T1 increases the number of FD patients with low T1, and thus reclassifies FD patients as having cardiac involvement. Cardiac involvement was defined as a native T1 value 2 standard deviations below site-specific means in healthy controls for both corrected and uncorrected measures. Overall low T1 was 135/218 (62%) uncorrected vs. 145/218 (67%) corrected (p = 0.02). With blood-correction, 13/83 previously normal patients were reclassified to low T1. This reclassification appears clinically relevant as 6/13 (46%) of reclassified had focal late gadolinium enhancement or left ventricular hypertrophy as signs of cardiac involvement. Blood-correction of myocardial native T1 increases the proportion of FD subjects with low myocardial T1, with blood-corrected results tracking other markers of cardiac involvement. Blood-correction may potentially offer earlier detection and therapy initiation, but merits further prospective studies
Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease
INTRODUCTION: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by enzyme deficiency, leading to glycosphingolipid accumulation. Cardiac accumulation triggers local tissue injury, electrical instability and arrhythmia. Bradyarrhythmia and atrial fibrillation (AF) incidence are reported in up to 16% and 13%, respectively. OBJECTIVE: We conducted a systematic review evaluating AF burden and bradycardia requiring permanent pacemaker (PPM) implantation and report any predictive risk factors identified. METHODS: We conducted a literature search on studies in adults with FD published from inception to July 2019. Study outcomes included AF or bradycardia requiring therapy. Databases included Embase, Medline, PubMed, Web of Science, CINAHL and Cochrane. The Risk of Bias Agreement tool for Non-Randomised Studies (RoBANS) was utilised to assess bias across key areas. RESULTS: 11 studies were included, eight providing data on AF incidence or PPM implantation. Weighted estimate of event rates for AF were 12.2% and 10% for PPM. Age was associated with AF (OR 1.05–1.20 per 1-year increase in age) and a risk factor for PPM implantation (composite OR 1.03). Left ventricular hypertrophy (LVH) was associated with AF and PPM implantation. CONCLUSION: Evidence supporting AF and bradycardia requiring pacemaker implantation is limited to single-centre studies. Incidence is variable and choice of diagnostic modality plays a role in detection rate. Predictors for AF (age, LVH and atrial dilatation) and PPM (age, LVH and PR/QRS interval) were identified but strength of association was low. Incidence of AF and PPM implantation in FD are variably reported with arrhythmia burden likely much higher than previously thought
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