Computed axial tomography evidence of left atrial enlargement: a predictor of elevated pulmonary capillary wedge pressure in pulmonary hypertension

Z Safdar, MF Katz, AE FrostDivision of Pulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USABackground: One of the commonest causes of pulmonary hypertension (PH) is left heart dysfunction associated with elevated pulmonary capillary wedge pressure (PCWP). In contrast, the pathology of pulmonary arterial hypertension (PAH) originates in the pulmonary vascular bed. Accurate diagnosis of PAH requires right heart catheterization (RHC) with normal PCWP. This study examines the role of computed tomography of the chest (CT chest) in evaluating left atrial (LA) size as an indicator of elevated PCWP in patients undergoing PH evaluation.Methods: CT chest and RHC data were reviewed in 37 subjects at the Baylor PH Center. Both subjective estimates and objective measurements of left atrial size from the CT chest were recorded separately by 3 investigators. Patients were categorized as Group I (small-normal LA) and Group II (large LA) and RHC results compared.The objective and subjective measurements were compared by receiver operator characteristic (ROC).Results: The mean PCWP was 12 ± 6 mmHg in Group I and 21 ± 7 mmHg in Group II (P = 0.001). The estimated LA area was 19.4 ± 4.9 cm2 in Group I and 39.9 ± 7.6 cm2 in Group II (mean ± SD; P < 0.001). The estimated LA area, corrected for the chest wall length, was 0.78 ± 0.19 cm2 and 1.65 ± 0.26 cm2 in Groups I and II, respectively (P < 0.001). Significant correlations were found between uncorrected PCWP and LA area (R = 0.45, P = 0.005), corrected PCWP and LA area (R = 0.47, P = 0.003), and the subjective observer impression of LA enlargement and measured PCWP (R = 0.51, P = 0.001).Conclusion: In this pilot study, enlarged LA area on the CT chest was associated with an elevated PCWP on RHC. For patients undergoing PH evaluation, increased LA area on CT chest could suggest left heart dysfunction in patients as a possible cause of PH.Keywords: pulmonary capillary wedge pressure, diastolic dysfunction, right heart catheterization, radiology, left atrial are

Evidence for the classical integrability of the complete AdS(4) x CP(3) superstring

We construct a zero-curvature Lax connection in a sub-sector of the superstring theory on AdS(4) x CP(3) which is not described by the OSp(6|4)/U(3) x SO(1,3) supercoset sigma-model. In this sub-sector worldsheet fermions associated to eight broken supersymmetries of the type IIA background are physical fields. As such, the prescription for the construction of the Lax connection based on the Z_4-automorphism of the isometry superalgebra OSp(6|4) does not do the job. So, to construct the Lax connection we have used an alternative method which nevertheless relies on the isometry of the target superspace and kappa-symmetry of the Green-Schwarz superstring.Comment: 1+26 pages; v2: minor typos corrected, acknowledgements adde

Scaling in Athletic World Records

World records in athletics provide a measure of physical as well as physiological human performance. Here we analyse running records and show that the mean speed as a function of race time can be described by two scaling laws that have a breakpoint at about 150-170 seconds (corresponding to the ~1,000 m race). We interpret this as being the transition time between anaerobic and aerobic energy expenditure by athletes.Comment: published in the Brief Communication section of Natur

British Valued Life Activities Scale [British VLAs]

Background The Valued Life Activities Scale (VLAs) measures difficulty in daily activities and social participation. With various versions involving a different number of items, we have linguistically and culturally adopted the full VLAs (33-items) and psychometrically tested it in adults with rheumatic and musculoskeletal diseases in the United Kingdom. Methods Participants with Rheumatoid Arthritis, Ankylosing Spondylitis, Chronic Pain/ Fibromyalgia, Chronic Hand/ Upper Limb Conditions, Osteoarthritis, Systemic Lupus, Systemic Sclerosis and Primary Sjogren’s Syndrome were recruited from out-patient clinics in National Health Service Hospitals, General Practice and patient organisations in the UK. Phase1 involved linguistic and cultural adaptation: forward translation to British English; synthesis; expert panel review and cognitive debriefing interviews. In Phase2 participants completed postal questionnaires to assess internal construct validity using (i) Confirmatory Factor Analysis (CFA) (ii) Mokken scaling and (iii) Rasch model. Results Responders (n = 1544) had mean age of 59 years (SD13.3) and 77.2% women. A CFA failed to support a total score from the 33-items (Chi Square 3552:df 464: p < 0.0001). Mokken scaling indicated a strong non-parametric association between items. Fit to the Rasch model indicated that the VLAs was characterised by multidimensionality and item misfit, which may have been influenced by clusters of residual item correlations. An item banking approach resolved a 25-item calibrated set whose application could accommodate the ‘does not apply to me’ response option. Conclusions The UK version of the VLAs failed to satisfy classical and modern psychometric standards for complete item sets. However, as the scale is not usually applied in complete format, an item bank approach calibrated 25 items with fit to the Rasch model. Suitable Computer Adaptive Testing (CAT) software could implement the item set, giving patients the choice of whether an item applies to them, or not

Flavor in Minimal Conformal Technicolor

We construct a complete, realistic, and natural UV completion of minimal conformal technicolor that explains the origin of quark and lepton masses and mixing angles. As in "bosonic technicolor", we embed conformal technicolor in a supersymmetric theory, with supersymmetry broken at a high scale. The exchange of heavy scalar doublets generates higher-dimension interactions between technifermions and quarks and leptons that give rise to quark and lepton masses at the TeV scale. Obtaining a sufficiently large top quark mass requires strong dynamics at the supersymmetry breaking scale in both the top and technicolor sectors. This is natural if the theory above the supersymmetry breaking also has strong conformal dynamics. We present two models in which the strong top dynamics is realized in different ways. In both models, constraints from flavor-changing effects can be easily satisfied. The effective theory below the supersymmetry breaking scale is minimal conformal technicolor with an additional light technicolor gaugino. We argue that this light gaugino is a general consequence of conformal technicolor embedded into a supersymmetric theory. If the gaugino has mass below the TeV scale it will give rise to an additional pseudo Nambu-Goldstone boson that is observable at the LHC.Comment: 37 pages; references adde

Dynamical completions of generalized O'Raifeartaigh models

We present gauge theory completions of Wess-Zumino models admitting supersymmetry breaking vacua with spontaneously broken R-symmetry. Our models are simple deformations of generalized ITIY models, a supersymmetric theory with gauge group Sp(N), N+1 flavors plus singlets, with a modified tree level superpotential which explicitly breaks (part of) the global symmetry. Depending on the nature of the deformation, we obtain effective O'Raifeartaigh-like models whose pseudomoduli space is locally stable in a neighborhood of the origin of field space, or in a region not including it. Hence, once embedded in direct gauge mediation scenarios, our models can give low energy spectra with either suppressed or unsuppressed gaugino mass.Comment: 21 pages, 1 figure; v3: reference adde

Safety and efficacy of fluticasone propionate in the topical treatment of skin diseases

Fluticasone propionate - the first carbothioate corticosteroid - has been classified as a potent anti-inflammatory drug for dermatological use. It is available as 0.05% cream and 0.005% ointment formulations for the acute and maintenance treatment of patients with dermatological disorders such as atopic dermatitis, psoriasis and vitiligo. This glucocorticoid is characterized by high lipophilicity, high glucocorticoid receptor binding and activation, and a rapid metabolic turnover in skin. Although skin blanching following fluticasone propionate exceeds that of corticosteroids of medium strength, several clinical trials demonstrate a low potential for cutaneous and systemic side-effects, even in difficult-to-treat areas like the face, the eyelids and intertriginous areas. Even among paediatric patients with atopic dermatitis, fluticasone propionate proved to be safe and effective. These pharmacological and clinical properties are reflected by the high therapeutic index of this glucocorticoid

A Hybrid Higgs

We construct composite Higgs models admitting a weakly coupled Seiberg dual description. We focus on the possibility that only the up-type Higgs is an elementary field, while the down-type Higgs arises as a composite hadron. The model, based on a confining SQCD theory, breaks supersymmetry and electroweak symmetry dynamically and calculably. This simultaneously solves the \mu/B_\mu problem and explains the smallness of the bottom and tau masses compared to the top mass. The proposal is then applied to a class of models where the same confining dynamics is used to generate the Standard Model flavor hierarchy by quark and lepton compositeness. This provides a unified framework for flavor, supersymmetry breaking and electroweak physics. The weakly coupled dual is used to explicitly compute the MSSM parameters in terms of a few microscopic couplings, giving interesting relations between the electroweak and soft parameters. The RG evolution down to the TeV scale is obtained and salient phenomenological predictions of this class of "single-sector" models are discussed.Comment: 56 pages, 7 figures, v2: discussion on FCNCs and references added, v3: JHEP versio

The Conformal Sector of F-theory GUTs

D3-brane probes of exceptional Yukawa points in F-theory GUTs are natural hidden sectors for particle phenomenology. We find that coupling the probe to the MSSM yields a new class of N = 1 conformal fixed points with computable infrared R-charges. Quite surprisingly, we find that the MSSM only weakly mixes with the strongly coupled sector in the sense that the MSSM fields pick up small exactly computable anomalous dimensions. Additionally, we find that although the states of the probe sector transform as complete GUT multiplets, their coupling to Standard Model fields leads to a calculable threshold correction to the running of the visible sector gauge couplings which improves precision unification. We also briefly consider scenarios in which SUSY is broken in the hidden sector. This leads to a gauge mediated spectrum for the gauginos and first two superpartner generations, with additional contributions to the third generation superpartners and Higgs sector.Comment: v2: 51 pages, 2 figures, remark added, typos correcte

Galaxy Harassment and the Evolution of Clusters of Galaxies

Disturbed spiral galaxies with high rates of star formation pervaded clusters of galaxies just a few billion years ago, but nearby clusters exclude spirals in favor of ellipticals. ``Galaxy harassment" (frequent high speed galaxy encounters) drives the morphological transformation of galaxies in clusters, provides fuel for quasars in subluminous hosts and leaves detectable debris arcs. Simulated images of harassed galaxies are strikingly similar to the distorted spirals in clusters at $z \sim 0.4$ observed by the Hubble Space Telescope.Comment: Submitted to Nature. Latex file, 7 pages, 10 photographs in gif and jpeg format included. 10 compressed postscript figures and text available using anonymous ftp from ftp://ftp-hpcc.astro.washington.edu/pub/hpcc/moore/ (mget *) Also available at http://www-hpcc.astro.washington.edu/papers