Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease

ObjectivesTo assess aortic arch morphology and aortic length in patients with dissection, traumatic injury, and aneurysm undergoing TEVAR, and to identify characteristics specific to different pathologies.MethodThis was a retrospective analysis of the aortic arch morphology and aortic length of dissection, traumatic injury, and aneurysmal patients. Computed tomography imaging was evaluated of 210 patients (49 dissection, 99 traumatic injury, 62 aneurysm) enrolled in three trials that received the conformable GORE TAG thoracic endoprosthesis. The mean age of trauma patients was 43 ± 19.6 years, 57 ± 11.7 years for dissection and 72 ± 9.6 years for aneurysm patients. A standardized protocol was used to measure aortic arch diameter, length, and take-off angle and clockface orientation of branch vessels. Differences in arch anatomy and length were assessed using ANOVA and independent t tests.ResultsOf the 210 arches evaluated, 22% had arch vessel common trunk configurations. The aortic diameter and the distance from the left main coronary (LMC) to the left common carotid (LCC) were greater in dissection patients than in trauma or aneurysm patients (p < .001). Aortic diameter in aneurysm patients was greater compared with trauma patients (p < .05). The distances from the branch vessels to the celiac artery (CA) were greater in dissection and aneurysm patients than in trauma patients (p < .001). The take-off angle of the innominate (I), LCCA, and left subclavian (LS) were greater, between 19% and 36%, in trauma patients than in dissection and aneurysm patients (p < .001). Clockface orientation of the arch vessels varies between pathologies.ConclusionsArch anatomy has significant morphologic differences when comparing aortic pathologies. Describing these differences in a large sample of patients is beneficial for device designs and patient selection

Simulation of Dimensionally Reduced SYM-Chern-Simons Theory

A supersymmetric formulation of a three-dimensional SYM-Chern-Simons theory using light-cone quantization is presented, and the supercharges are calculated in light-cone gauge. The theory is dimensionally reduced by requiring all fields to be independent of the transverse dimension. The result is a non-trivial two-dimensional supersymmetric theory with an adjoint scalar and an adjoint fermion. We perform a numerical simulation of this SYM-Chern-Simons theory in 1+1 dimensions using SDLCQ (Supersymmetric Discrete Light-Cone Quantization). We find that the character of the bound states of this theory is very different from previously considered two-dimensional supersymmetric gauge theories. The low-energy bound states of this theory are very ``QCD-like.'' The wave functions of some of the low mass states have a striking valence structure. We present the valence and sea parton structure functions of these states. In addition, we identify BPS-like states which are almost independent of the coupling. Their masses are proportional to their parton number in the large-coupling limit.Comment: 18pp. 7 figures, uses REVTe

Wave functions and properties of massive states in three-dimensional supersymmetric Yang-Mills theory

We apply supersymmetric discrete light-cone quantization (SDLCQ) to the study of supersymmetric Yang-Mills theory on R x S^1 x S^1. One of the compact directions is chosen to be light-like and the other to be space-like. Since the SDLCQ regularization explicitly preserves supersymmetry, this theory is totally finite, and thus we can solve for bound-state wave functions and masses numerically without renormalizing. We present an overview of all the massive states of this theory, and we see that the spectrum divides into two distinct and disjoint sectors. In one sector the SDLCQ approximation is only valid up to intermediate coupling. There we find a well defined and well behaved set of states, and we present a detailed analysis of these states and their properties. In the other sector, which contains a completely different set of states, we present a much more limited analysis for strong coupling only. We find that, while these state have a well defined spectrum, their masses grow with the transverse momentum cutoff. We present an overview of these states and their properties.Comment: RevTeX, 25 pages, 16 figure

Blowup Criterion for the Compressible Flows with Vacuum States

We prove that the maximum norm of the deformation tensor of velocity gradients controls the possible breakdown of smooth(strong) solutions for the 3-dimensional compressible Navier-Stokes equations, which will happen, for example, if the initial density is compactly supported \cite{X1}. More precisely, if a solution of the compressible Navier-Stokes equations is initially regular and loses its regularity at some later time, then the loss of regularity implies the growth without bound of the deformation tensor as the critical time approaches. Our result is the same as Ponce's criterion for 3-dimensional incompressible Euler equations (\cite{po}). Moreover, our method can be generalized to the full Compressible Navier-Stokes system which improve the previous results. In addition, initial vacuum states are allowed in our cases.Comment: 17 page

Properties of the Bound States of Super-Yang-Mills-Chern-Simons Theory

We apply supersymmetric discrete light-cone quantization (SDLCQ) to the study of supersymmetric Yang-Mills-Chern-Simons (SYM-CS) theory on R x S^1 x S^1. One of the compact directions is chosen to be light-like and the other to be space-like. Since the SDLCQ regularization explicitly preserves supersymmetry, this theory is totally finite, and thus we can solve for bound-state wave functions and masses numerically without renormalizing. The Chern-Simons term is introduced here to provide masses for the particles while remaining totally within a supersymmetric context. We examine the free, weak and strong-coupling spectrum. The transverse direction is discussed as a model for universal extra dimensions in the gauge sector. The wave functions are used to calculate the structure functions of the lowest mass states. We discuss the properties of Kaluza-Klein states and focus on how they appear at strong coupling. We also discuss a set of anomalously light states which are reflections of the exact Bogomol'nyi-Prasad-Sommerfield states of the underlying SYM theory.Comment: 20pp., 21 figure

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Pharmacologic Management of Aneurysms

Vascular Surger

Reoperative aortic surgery.

The presentation of long-term complications after conventional aortic surgery and the treatment of patients that have had reoperative aortic operations are reviewed. Ninety-seven consecutive patients that had 102 subsequent aortic operations at a tertiary referral center were studied. Presenting symptoms, demographics, risk factors, indications for initial and second procedures, operative techniques and outcomes were recorded in a computerized database. There were 70 men and 27 women studied, with an average age of 64 years. First operations were performed primarily for aneurysm (56%) and occlusive disease (44%). The interval between procedures ranged up to 23 years, with a mean of 6 years. Indications for reoperation were subsequent aneurysm (65), graft occlusions (25) and/or infections (24). Seventy-three percent of the subsequent aneurysms were true metachronous aneurysms; the others were associated with the graft or an anastomosis. Para-anastomotic aneurysms may be more common with a primary end-to-side graft configuration. One-third of subsequent aneurysms were not palpable and asymptomatic. Graft occlusion can be treated safely with elective repeat bypass (mortality 0%). Graft infections that require total graft removal remain a challenging problem (mortality 17%). Although surgical approach for reoperations utilized more extensive exposure and proximal clamping, 59 elective aneurysm cases had a 5.1% mortality rate; eight emergent procedures for ruptured aneurysms resulted in 88% mortality. Reoperation for graft occlusion or infection showed a similar high mortality rate with emergent cases. In this referral practice, graft occlusion and infection are relatively less frequent, whereas metachronous aneurysm formation is now the most common indication for reoperation. These aneurysms often remain undetected until symptoms occur; frank rupture is usually lethal. As elective repair with modern reoperative techniques can be safely performed, routine computed tomographic examination is advisable at least every 5 years after aortic operations