Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction.

AbstractOBJECTIVESThe aim of the study was to verify the prognostic implications of viability detection using baseline-nitrate sestamibi imaging in patients with left ventricular (LV) dysfunction due to chronic coronary artery disease (CAD) submitted to different therapeutic strategies.BACKGROUNDThe prognostic meaning of preserved viability in these patients is still debated. Sestamibi is increasingly used for myocardial perfusion scintigraphy and is being accepted also as viability tracer, but no data are available about the relationship between viability in sestamibi imaging, subsequent treatment, and patient’s outcome.METHODSFollow-up data were collected in 105 CAD patients with LV dysfunction who had undergone baseline-nitrate sestamibi perfusion imaging for viability assessment and had been later treated medically (group 1), or submitted to revascularization, which was either complete (group 2A) or incomplete (group 2B).RESULTSEighteen hard events (cardiac death or nonfatal myocardial infarction) were registered during the follow-up. A significantly worse event-free survival curve was observed in the patients of group 1 (p < 0.0002) and group 2B (p < 0.03) compared to those of group 2A. Using a Cox proportional hazard model, the most powerful prognostic predictors of events were the number of nonrevascularized asynergic segments with viability in sestamibi imaging (p < 0.003, risk ratio [RR] = 1.4), and the severity of CAD (p < 0.02, RR = 1.28).CONCLUSIONSViability detection in sestamibi imaging has important prognostic implications in CAD patients with LV dysfunction. Patients with preserved viability kept on medical therapy or submitted to incomplete revascularization represent high-risk groups

The species identification problem in mirids (Hemiptera: Heteroptera) highlighted by DNA barcoding and species delimitation studies

Due to the difficulties associated with detecting and correctly identifying mirids, developing an accurate species identification approach is crucial, especially for potential harmful species. Accurate identification is often hampered by inadequate morphological key characters, invalid and/or outdated systematics, and biases in the molecular data available in public databases. This study aimed to verify whether molecular characterization (i.e. DNA barcoding) is able to identify mirid species of economic relevance and if species delimitation approaches are reliable tools for species discrimination. Cytochrome c oxydase 1 (cox1) data from public genetic databases were compared with new data obtained from mirids sampled in different Italian localities, including an old specimen from private collection, showing contrasting results. Based on the DNA barcoding approach, for the genus Orthops, all sequences were unambiguously assigned to the same species, while in Adelphocoris, Lygus and Trigonotylus there were over-descriptions and/or misidentifications of species. On the other hand, in Polymerus and Deraeocoris there was an underestimation of the taxonomic diversity. The present study highlighted an important methodological problem: DNA barcoding can be a good tool for pest identification and discrimination, but the taxonomic unreliability of public DNA databases can make this method useless or even misleading

Second T = 3/2 state in 9^9B and the isobaric multiplet mass equation

Recent high-precision mass measurements and shell model calculations~[Phys. Rev. Lett. {\bf 108}, 212501 (2012)] have challenged a longstanding explanation for the requirement of a cubic isobaric multiplet mass equation for the lowest $A = 9$ isospin quartet. The conclusions relied upon the choice of the excitation energy for the second $T = 3/2$ state in $^9$B, which had two conflicting measurements prior to this work. We remeasured the energy of the state using the $^9{\rm Be}(^3{\rm He},t)$ reaction and significantly disagree with the most recent measurement. Our result supports the contention that continuum coupling in the most proton-rich member of the quartet is not the predominant reason for the large cubic term required for $A = 9$ nuclei

Characterization of Large Volume 3.5 x 8 inches LaBr3:Ce Detectors

The properties of large volume cylindrical 3.5 x 8 inches (89 mm x 203 mm) LaBr3:Ce scintillation detectors coupled to the Hamamatsu R10233-100SEL photo-multiplier tube were investigated. These crystals are among the largest ones ever produced and still need to be fully characterized to determine how these detectors can be utilized and in which applications. We tested the detectors using monochromatic gamma-ray sources and in-beam reactions producing gamma rays up to 22.6 MeV; we acquired PMT signal pulses and calculated detector energy resolution and response linearity as a function of gamma-ray energy. Two different voltage dividers were coupled to the Hamamatsu R10233-100SEL PMT: the Hamamatsu E1198-26, based on straightforward resistive network design, and the LABRVD, specifically designed for our large volume LaBr3:Ce scintillation detectors, which also includes active semiconductor devices. Because of the extremely high light yield of LaBr3:Ce crystals we observed that, depending on the choice of PMT, voltage divider and applied voltage, some significant deviation from the ideally proportional response of the detector and some pulse shape deformation appear. In addition, crystal non-homogeneities and PMT gain drifts affect the (measured) energy resolution especially in case of high-energy gamma rays. We also measured the time resolution of detectors with different sizes (from 1x1 inches up to 3.5x8 inches), correlating the results with both the intrinsic properties of PMTs and GEANT simulations of the scintillation light collection process. The detector absolute full energy efficiency was measured and simulated up to gamma-rays of 30 Me

Identification and rejection of scattered neutrons in AGATA

Gamma rays and neutrons, emitted following spontaneous fission of 252Cf, were measured in an AGATA experiment performed at INFN Laboratori Nazionali di Legnaro in Italy. The setup consisted of four AGATA triple cluster detectors (12 36-fold segmented high-purity germanium crystals), placed at a distance of 50 cm from the source, and 16 HELENA BaF2 detectors. The aim of the experiment was to study the interaction of neutrons in the segmented high-purity germanium detectors of AGATA and to investigate the possibility to discriminate neutrons and gamma rays with the gamma-ray tracking technique. The BaF2 detectors were used for a time-of-flight measurement, which gave an independent discrimination of neutrons and gamma rays and which was used to optimise the gamma-ray tracking-based neutron rejection methods. It was found that standard gamma-ray tracking, without any additional neutron rejection features, eliminates effectively most of the interaction points due to recoiling Ge nuclei after elastic scattering of neutrons. Standard tracking rejects also a significant amount of the events due to inelastic scattering of neutrons in the germanium crystals. Further enhancements of the neutron rejection was obtained by setting conditions on the following quantities, which were evaluated for each event by the tracking algorithm: energy of the first and second interaction point, difference in the calculated incoming direction of the gamma ray, figure-of-merit value. The experimental results of tracking with neutron rejection agree rather well with Geant4 simulations

Prevalence and factors associated with chronic use of levothyroxine: A cohort study

Importance Levothyroxine prescriptions are rising worldwide. However, there are few data on factors associated with chronic use. Objective To assess the prevalence of chronic levothyroxine use, its rank among other chronic drugs and factors associated with chronic use. To assess the proportion of users outside the therapeutic range of thyroid-stimulating hormone (TSH). Design Cohort study (CoLaus|PsyCoLaus) with recruitment from 2003 to 2006. Follow-ups occurred 5 and 10 years after baseline. Participants A random sample of Lausanne (Switzerland) inhabitants aged 35-75 years. Main outcomes We evaluated the prevalence of chronic levothyroxine use and we then ranked it among the other most used chronic drugs. The ranking was compared to data from health insurance across the country. We assessed the association between each factor and chronic levothyroxine use in multivariable logistic regression models. The proportion of chronic levothyroxine users outside the usual TSH therapeutic range was assessed. Results 4,334 participants were included in the analysis (mean±SD age 62.8±10.4 years, 54.9% women). 166 (3.8%) participants were chronic levothyroxine users. Levothyroxine was the second most prescribed chronic drug after aspirin in the cohort (8.2%) and the third most prescribed when using Swiss-wide insurance data. In multivariable analysis, chronic levothyroxine use was associated with increasing age [odds ratio 1.03, 95% confidence interval 1.01-1.05 per 1-year increase]; female sex [11.87 (5.24-26.89)]; BMI [1.06 (1.02- 1.09) per 1-kg/m2 increase]; number of concomitant drugs [1.22 (1.16-1.29) per 1-drug increase]; and family history of thyroid pathologies [2.18 (1.37-3.48)]. Among chronic levothyroxine users with thyroid hormones assessment (n = 157), 42 (27%) were outside the TSH therapeutic range (17% overtreated and 10% undertreated). Conclusions In this population-based study, levothyroxine ranked second among chronic drugs. Age, female sex, BMI, number of drugs and family history of thyroid pathologies were associated with chronic levothyroxine use. More than one in four chronic users were over- or undertreated

Study of proton-unbound states in 24Al^{24}{\rm Al} relevant for the 23Mg(p,γ)^{23}{\rm Mg}(p,\gamma) reaction in novae

Background: The nucleosynthesis of several proton-rich nuclei is determined by radiative proton-capture reactions on unstable nuclei in nova explosions. One such reaction is $^{23}{\rm Mg}(p,\gamma)^{24}{\rm Al}$, which links the NeNa and MgAl cycles in oxygen-neon (ONe) novae. Purpose: To extract $^{23}{\rm Mg}(p,\gamma)^{24}{\rm Al}$ resonance strengths from a study of proton-unbound states in $^{24}{\rm Al}$, produced via the $^{24}$Mg($^{3}$He,$t$) reaction. Methods: A beam of $^3 {\rm He}^{2+}$ ions at 50.7 MeV was used to produce the states of interest in $^{24}$Al. Proton-triton angular correlations were measured with a $K=600$ QDD magnetic spectrometer and a silicon detector array, located at iThemba LABS, South Africa. Results: We measured the excitation energies of the four lowest proton-unbound states in $^{24}$Al and place lower-limits on $\Gamma_p/\Gamma$ values for these four states. Together with USD-C shell-model calculations of partial gamma widths, the experimental data are also used to determine resonance strengths for the three lowest $^{23}{\rm Mg}(p,\gamma)^{24}{\rm Al}$ resonances. Conclusions: The energy of the dominant first $^{23}{\rm Mg}(p,\gamma)$ resonance is determined to be $E_{r} = 481.4 \pm 1.1$ keV, with a resonance strength $\omega \gamma = 18 \pm 6$ meV

Characterization of the proposed 4-α cluster state candidate in O 16

The O16(α,α′) reaction was studied at θlab=0 at an incident energy of Elab=200 MeV using the K600 magnetic spectrometer at iThemba LABS. Proton decay and α decay from the natural parity states were observed in a large-acceptance silicon strip detector array at backward angles. The coincident charged-particle measurements were used to characterize the decay channels of the 06+ state in O16 located at Ex=15.097(5) MeV. This state is identified by several theoretical cluster calculations to be a good candidate for the 4-α cluster state. The results of this work suggest the presence of a previously unidentified resonance at Ex≈15 MeV that does not exhibit a 0+ character. This unresolved resonance may have contaminated previous observations of the 06+ state

Characterization of Large Volume 3.5″ x 8″ LaBr3:Ce Detectors for the HECTOR+ array

A selection of the properties of large volume, cylindrical 3.5" x 8" LaBr 3 :Ce scintillation detectors coupled to a 3.5" PMT (model R10233-1000SEL from HAMAMATSU) and a special designed Voltage Divider (LABRVD) will be discussed. A number of 10 of such detectors constitute the HECTOR + array which, in fall 2012, measured at GSI coupled to the AGATA DEMOSTRATOR at the PRESPEC experimental setup. These crystals are among the largest ever produced and needed to be characterized. We have performed several tests and here we discuss, in particular, the energy resolution measured using monochromatic γ −ray sources and in-beam reactions producing γ −rays up to 22.6 MeV. As already measured in two previous works a saturation in the energy resolution was observed in case of high energy gamma rays. Crystal non-homogeneities and PMT gain drifts can affect the resolution of measurements especially in case of high energy γ −rays