Computed Tomography During Experimental Balloon Dilatation For Calcific Aortic Stenosis. A Look into the Mechanism of Valvuloplasty

Thin‐slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12‐mm trefoil‐shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12‐mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm2 to 2.36 (range 0.95–3.14) cm2. The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon‐leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interven Cardiol 1988:1:2) Copyrigh

Hypofractionated radiotherapy has the potential for second cancer reduction

<p>Abstract</p> <p>Background and Purpose</p> <p>A model for carcinoma and sarcoma induction was used to study the dependence of carcinogenesis after radiotherapy on fractionation.</p> <p>Materials and methods</p> <p>A cancer induction model for radiotherapy doses including fractionation was used to model carcinoma and sarcoma induction after a radiation treatment. For different fractionation schemes the dose response relationships were obtained. Tumor induction was studied as a function of dose per fraction.</p> <p>Results</p> <p>If it is assumed that the tumor is treated up to the same biologically equivalent dose it was found that large dose fractions could decrease second cancer induction. The risk decreases approximately linear with increasing fraction size and is more pronounced for sarcoma induction. Carcinoma induction decreases by around 10% per 1 Gy increase in fraction dose. Sarcoma risk is decreased by about 15% per 1 Gy increase in fractionation. It is also found that tissue which is irradiated using large dose fractions to dose levels lower than 10% of the target dose potentially develop less sarcomas when compared to tissues irradiated to all dose levels. This is not observed for carcinoma induction.</p> <p>Conclusions</p> <p>It was found that carcinoma as well as sarcoma risk decreases with increasing fractionation dose. The reduction of sarcoma risk is even more pronounced than carcinoma risk. Hypofractionation is potentially beneficial with regard to second cancer induction.</p

The XMM-Newton Wide-Field Survey in the COSMOS field (XMM-COSMOS): demography and multiwavelength properties of obscured and unobscured luminous AGN

We report the final optical identifications of the medium-depth (~60 ksec), contiguous (2 deg^2) XMM-Newton survey of the COSMOS field. XMM-Newton has detected ~800 X-ray sources down to limiting fluxes of ~5x10^{-16}, ~3x10^{-15}, and ~7x10^{-15} erg/cm2/s in the 0.5-2 keV, 2-10 keV and 5-10 keV bands, respectively. The work is complemented by an extensive collection of multi-wavelength data from 24 micron to UV, available from the COSMOS survey, for each of the X-ray sources, including spectroscopic redshifts for ~50% of the sample, and high-quality photometric redshifts for the rest. The XMM and multiwavelength flux limits are well matched: 1760 (98%) of the X-ray sources have optical counterparts, 1711 (~95%) have IRAC counterparts, and 1394 (~78%) have MIPS 24micron detections. Thanks to the redshift completeness (almost 100%) we were able to constrain the high-luminosity tail of the X-ray luminosity function confirming that the peak of the number density of logL_X>44.5 AGN is at z~2. Spectroscopically-identified obscured and unobscured AGN, as well as normal and starforming galaxies, present well-defined optical and infrared properties. We devised a robust method to identify a sample of ~150 high redshift (z>1), obscured AGN candidates for which optical spectroscopy is not available. We were able to determine that the fraction of the obscured AGN population at the highest (L_X>10^{44} erg s^{-1}) X-ray luminosity is ~15-30% when selection effects are taken into account, providing an important observational constraint for X-ray background synthesis. We studied in detail the optical spectrum and the overall spectral energy distribution of a prototypical Type 2 QSO, caught in a stage transitioning from being starburst dominated to AGN dominated, which was possible to isolate only thanks to the combination of X-ray and infrared observations.Comment: ApJ, in press. 59 pages, 14 figures, 2 Tables. A few typos corrected and a reference added. Table 2 is also available at http://www.mpe.mpg.de/XMMCosmos/xmm53_release ; a version of the paper in ApJ format (27 pages) is available at http://www.mpe.mpg.de/XMMCosmos/xmm53_release/brusa_xmmcosmos_optid.pd

Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes

Importance: Approximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned. Objective: To evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography. Design, setting, and participants: This cross-sectional study used data from the PRIME-FFR study derived from the merger of the POST-IT study (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease [March 2012-November 2013]) and R3F study (French Study of FFR Integrated Multicenter Registries Implementation of FFR in Routine Practice [October 2008-June 2010]), 2 prospective multicenter registries that shared a common design. A population of all-comers for whom angiography disclosed ambiguous lesions was analyzed for rates, patterns, and outcomes associated with management reclassification, including revascularization deferral, in patients with vs without diabetes. Data analysis was performed from June to August 2018. Main outcomes and measures: Death from any cause, myocardial infarction, or unplanned revascularization (MACE) at 1 year. Results: Among 1983 patients (1503 [77%] male; mean [SD] age, 65 [10] years), 701 had diabetes, and FFR was performed for 1.4 lesions per patient (58.2% of lesions in the left anterior descending artery; mean [SD] stenosis, 56% [11%]; mean [SD] FFR, 0.81 [0.01]). Reclassification by FFR was high and similar in patients with and without diabetes (41.2% vs 37.5%, P = .13), but reclassification from medical treatment to revascularization was more frequent in the former (142 of 342 [41.5%] vs 230 of 730 [31.5%], P = .001). There was no statistical difference between the 1-year rates of MACE in reclassified (9.7%) and nonreclassified patients (12.0%) (P = .37). Among patients with diabetes, FFR-based deferral identified patients with a lower risk of MACE at 12 months (25 of 296 [8.4%]) compared with those undergoing revascularization (47 of 257 [13.1%]) (P = .04), and the rate was of the same magnitude of the observed rate among deferred patients without diabetes (7.9%, P = .87). Status of insulin treatment had no association with outcomes. Patients (6.6% of the population) in whom FFR was disregarded had the highest MACE rates regardless of diabetes status. Conclusions and relevance: Routine integration of FFR for the management of coronary artery disease in patients with diabetes may be associated with a high rate of treatment reclassification. Management strategies guided by FFR, including revascularization deferral, may be useful for patients with diabetes.info:eu-repo/semantics/publishedVersio

Percutaneous coronary intervention in asians- are there differences in clinical outcome?

<p>Abstract</p> <p>Background</p> <p>Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI) have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD).</p> <p>Methods</p> <p>A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE) of myocardial infarction (MI), repeat revascularization and all-cause death at six months.</p> <p>Results</p> <p>7889 patients underwent PCI; 7544 (96%) patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11). There were 5130 (68%) Chinese, 1056 (14%) Malays and 1001 (13.3%) Indian patients. The remaining 357 (4.7%) patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1%) patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p < 0.001). This was contributed by increased rates of MI (Indians 1.9% vs. Chinese 0.9% vs. Malays 1.3%; OR 4.49 95%CI 1.91-10.56 p = 0.001), repeat revascularization (Indians 6.5% vs. Chinese 4.1% vs. Malays 5.1%; OR 1.64 95%CI 1.22-2.21 p = 0.0012) and death (Indians 11.4% vs. Chinese 7.6% vs. Malays 9.9%; OR 1.65 95%CI 1.23-2.20 p = 0.001) amongst Indian patients.</p> <p>Conclusion</p> <p>These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.</p

What do we know about the α/β for prostate cancer?

Since last decade, the debate on the parameter which reflects prostate cancer sensitivity to fractionation in a radiotherapy treatment, the α/β, has become extensive. Unlike most tumors, the low labeling indices (LI) and large potential doubling time that characterize the prostate tumor led some authors to consider that it may behave as a late responding tissue. So far, the existing studies with regard to this subject point to a low value of α/β, around 2.7 Gy, which may be considered as a therapeutic gain in relation to surrounding normal tissues by using fewer and larger fractions. The aim of this paper is to review several estimates that have been made in the last few years regarding the prostate cancer α/β both from clinical and experimental data, as well as the set of factors that have potentially influenced these evaluations

Precision photometric redshift calibration for galaxy-galaxy weak lensing

Accurate photometric redshifts are among the key requirements for precision weak lensing measurements. Both the large size of the Sloan Digital Sky Survey (SDSS) and the existence of large spectroscopic redshift samples that are flux-limited beyond its depth have made it the optimal data source for developing methods to properly calibrate photometric redshifts for lensing. Here, we focus on galaxy-galaxy lensing in a survey with spectroscopic lens redshifts, as in the SDSS. We develop statistics that quantify the effect of source redshift errors on the lensing calibration and on the weighting scheme, and show how they can be used in the presence of redshift failure and sampling variance. We then demonstrate their use with 2838 source galaxies with spectroscopy from DEEP2 and zCOSMOS, evaluating several public photometric redshift algorithms, in two cases including a full p(z) for each object, and find lensing calibration biases as low as <1 per cent (due to fortuitous cancellation of two types of bias) or as high as 20 per cent for methods in active use (despite the small mean photoz bias of these algorithms). Our work demonstrates that lensing-specific statistics must be used to reliably calibrate the lensing signal, due to asymmetric effects of (frequently non-Gaussian) photoz errors. We also demonstrate that large-scale structure (LSS) can strongly impact the photoz calibration and its error estimation, due to a correlation between the LSS and the photoz errors, and argue that at least two independent degree-scale spectroscopic samples are needed to suppress its effects. Given the size of our spectroscopic sample, we can reduce the galaxy-galaxy lensing calibration error well below current SDSS statistical error

Precision photometric redshift calibration for galaxy–galaxy weak lensing

Accurate photometric redshifts are among the key requirements for precision weak lensing measurements. Both the large size of the Sloan Digital Sky Survey (SDSS) and the existence of large spectroscopic redshift samples that are flux-limited beyond its depth have made it the optimal data source for developing methods to properly calibrate photometric redshifts for lensing. Here, we focus on galaxy–galaxy lensing in a survey with spectroscopic lens redshifts, as in the SDSS. We develop statistics that quantify the effect of source redshift errors on the lensing calibration and on the weighting scheme, and show how they can be used in the presence of redshift failure and sampling variance. We then demonstrate their use with 2838 source galaxies with spectroscopy from DEEP2 and zCOSMOS, evaluating several public photometric redshift algorithms, in two cases including a full p(z) for each object, and find lensing calibration biases as low as <1 per cent (due to fortuitous cancellation of two types of bias) or as high as 20 per cent for methods in active use (despite the small mean photoz bias of these algorithms). Our work demonstrates that lensing-specific statistics must be used to reliably calibrate the lensing signal, due to asymmetric effects of (frequently non-Gaussian) photoz errors. We also demonstrate that large-scale structure (LSS) can strongly impact the photoz calibration and its error estimation, due to a correlation between the LSS and the photoz errors, and argue that at least two independent degree-scale spectroscopic samples are needed to suppress its effects. Given the size of our spectroscopic sample, we can reduce the galaxy–galaxy lensing calibration error well below current SDSS statistical errors