Adjunctive strategies in the management of resistant, 'undilatable' coronary lesions after successfully crossing a CTO with a guidewire.

Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various 'offlabel' settings

Geometric discord and Measurement-induced nonlocality for well known bound entangled states

We employ geometric discord and measurement induced nonlocality to quantify non classical correlations of some well-known bipartite bound entangled states, namely the two families of Horodecki's ($2\otimes 4$, $3\otimes 3$ and $4\otimes 4$ dimensional) bound entangled states and that of Bennett etal's in $3\otimes 3$ dimension. In most of the cases our results are analytic and both the measures attain relatively small value. The amount of quantumness in the $4\otimes 4$ bound entangled state of Benatti etal and the $2\otimes 8$ state having the same matrix representation (in computational basis) is same. Coincidently, the $2m\otimes 2m$ Werner and isotropic states also exhibit the same property, when seen as $2\otimes 2m^2$ dimensional states.Comment: V2: Title changed, one more state added; 11 pages (single column), 2 figures, accepted in Quantum Information Processin

Fluctuation relations for heat engines in time-periodic steady states

A fluctuation relation for heat engines (FRHE) has been derived recently. In the beginning, the system is in contact with the cooler bath. The system is then coupled to the hotter bath and external parameters are changed cyclically, eventually bringing the system back to its initial state, once the coupling with the hot bath is switched off. In this work, we lift the condition of initial thermal equilibrium and derive a new fluctuation relation for the central system (heat engine) being in a time-periodic steady state (TPSS). Carnot's inequality for classical thermodynamics follows as a direct consequence of this fluctuation theorem even in TPSS. For the special cases of the absence of hot bath and no extraction of work, we obtain the integral fluctuation theorem for total entropy and the generalized exchange fluctuation theorem, respectively. Recently microsized heat engines have been realized experimentally in the TPSS. We numerically simulate the same model and verify our proposed theorems.Comment: 9 page

Improvement in Renal Function and Reduction in Serum Uric Acid with Intensive Statin Therapy in Older Patients: A Post Hoc Analysis of the SAGE Trial.

BackgroundImprovement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, and laboratory parameters, including SUA, in elderly coronary artery disease (CAD) patients (65-85 years) with or without chronic kidney disease (CKD).MethodsPatients were randomized to atorvastatin 80 mg/day or pravastatin 40 mg/day and treated for 12 months. Patients were stratified using Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rates (eGFRs) in CKD (eGFR <60 mL/min/1.73 m(2)) and non-CKD populations.ResultsOf the 893 patients randomized, 858 had complete renal data and 418 of 858 (49%) had CKD (99% Stage 3). Over 12 months, eGFR increased with atorvastatin and remained stable with pravastatin (+2.38 vs. +0.18 mL/min/1.73 m(2), respectively; p < 0.0001). MDRD eGFR improved significantly in both CKD treatment arms; however, the increased eGFR in patients without CKD was significantly greater with atorvastatin (+2.08 mL/min/1.73 m(2)) than with pravastatin (-1.04 mL/min/1.73 m(2)). Modest reductions in SUA were observed in both treatment arms, but a greater fall occurred with atorvastatin than with pravastatin (-0.52 vs. -0.09 mg/dL, p < 0.0001). Change in SUA correlated negatively with changes in eGFR and positively with changes in low-density lipoprotein cholesterol. Reports of myalgia were rare (3.6% CKD; 5.7% non-CKD), and there were no episodes of rhabdomyolysis. Elevated serum alanine and aspartate transaminase to >3 times the upper limit of normal occurred in 4.4% of atorvastatin- and 0.2% of pravastatin-treated patients.ConclusionIntensive management of dyslipidemia in older patients with stable coronary heart disease may have beneficial effects on renal function and SUA

Study of Dissipative Collisions of 20^{20}Ne (∼\sim7-11 MeV/nucleon) + 27^{27}Al

The inclusive energy distributions of complex fragments (3 $\leq$Z $\leq$ 9) emitted in the reactions $^{20}$Ne (145, 158, 200, 218 MeV) + $^{27}$Al have been measured in the angular range 10$^{o}$ - 50$^{o}$. The fusion-fission and the deep-inelastic components of the fragment yield have been extracted using multiple Gaussian functions from the experimental fragment energy spectra. The elemental yields of the fusion-fission component have been found to be fairly well exlained in the framework of standard statistical model. It is found that there is strong competition between the fusion-fission and the deep-inelastic processes at these energies. The time scale of the deep-inelastic process was estimated to be typically in the range of $\sim$ 10$^{-21}$ - 10$^{-22}$ sec., and it was found to decrease with increasing fragment mass. The angular momentum dissipations in fully energy damped deep-inelastic process have been estimated from the average energies of the deep-inelastic components of the fragment energy spectra. It has been found that, the estimated angular momentum dissipations, for lighter fragments in particular, are more than those predicted by the empirical sticking limit.Comment: 16 pages, 9 figure

Evidence of large nuclear deformation of 32^{32}S∗^{*} formed in 20^{20}Ne + 12^{12}C reaction

Deformations of hot composite $^{32}$S$^{*}$ formed in the reaction $^{20}$Ne ($\sim$ 7 -- 10 MeV/nucleon) + $^{12}$C have been estimated from the respective inclusive $\alpha$-particle evaporation spectra. The estimated deformations for $^{32}$S$^{*}$ have been found to be much larger than the `normal' deformations of hot, rotating composites at similar excitations. This further confirms the formation of highly deformed long-lived configuration of $^{20}$Ne + $^{12}$C at high excitations ($\sim$ 70 -- 100 MeV) -- which was recently indicated from the analysis of the complex fragment emission data for the same system. Exclusive $\alpha$-particle evaporation spectra from the decay of hot composite $^{32}$S$^{*}$ also show similar behaviour.Comment: 9 pages, 6 figure

Angiogenic Factors and Renal Disease in Pregnancy

Background. Preeclampsia is difficult to diagnose in patients with underlying renal disease and proteinuria. Prior studies show that there is an angiogenic factor imbalance with elevated levels of antiangiogenic proteins soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng) and reduced levels of the proangiogenic protein, placental growth factor (PlGF) in women with preeclampsia. These angiogenic biomarkers may be useful in distinguishing preeclampsia from other conditions of pregnancy, which may present with overlapping clinical characteristics. Cases. Case 1: A multiparous woman at 18 weeks gestation with nephrotic syndrome presented with hypertensive emergency and worsening renal insufficiency. She underwent induction of labor for severe preeclampsia. Her sFlt1 and sEng levels were at the 97 percentile while her PlGF level was undetectable (less than the 1st percentile). Case 2: A nulliparous woman with lupus nephritis at 22 weeks gestation presented with fetal demise and heart failure. Three weeks previously, the patient had developed thrombocytopenia and hypertensive urgency. She underwent dilation and evacuation. Her angiogenic profile was consistent with severe preeclampsia. Conclusion. Angiogenic factors may provide evidence to support a diagnosis of preeclampsia in patients with preexisting renal disease and proteinuria, conditions in which the classical definition of hypertension and proteinuria cannot be used

Heavy-chain deposition disease: a morphological, immunofluorescence and ultrastructural assessment

Heavy-chain deposition disease (HCDD) is the least common of the monoclonal immunoglobulin deposition diseases with only 24 reported cases in English literature, including the present case. The rarity of this disease merits its documentation. We present a case of HCDD from our archival material, who presented with rapidly progressive renal failure and nephrotic syndrome and was found to have nodular glomerulosclerosis on renal biopsy which on immunofluorescence and electron microscopy confirmed HCDD of immunoglobulin G1 type without any light-chain deposition. We also present an in-depth literature review on HCDD