Management and Outcome of Prosthetic Patch Infection after Carotid Endarterectomy: A Single-centre Series and Systematic Review of the Literature

AbstractObjectivesOutcomes following prosthetic patch infection after carotid endarterectomy (CEA).MethodsRetrospective audit and systematic review.Results22 patients were treated between January 1992 and April 2012, 5 having undergone their original CEA at another institution. The commonest infecting organism was Staphylococcus. One patient was treated by antibiotic irrigation, one was stented, while 20 underwent debridement and patch excision plus; carotid ligation (n = 3), vein patching (n = 3) or vein bypass (n = 14). There was one peri-operative stroke, but no peri-operative deaths. There were no reinfections at a median follow-up of 54 months.A systematic review identified 123 patients with prosthetic patch infection in the world literature. Thirty-six (29%) presented <2 months, 78 (63%) presented >6 months after the original CEA. Seventy-nine of/87 patients (91%) with a positive culture yielded Staphylococci or Streptococci. Seventy-four patients were treated by patch excision and autologous reconstruction. Four (5%) developed reinfection <30 days, but later reinfections have been reported. Seven of nine patients (78%) undergoing prosthetic reconstruction either died or suffered reinfection. Five patients were treated with a covered stent, none developing reinfection (median followup 12 months).ConclusionPatch infection following CEA is rare. Few have undergone stenting and long term data are awaited. For now, patch excision and autologous reconstruction remains the ‘gold standard’

Galaxy Cluster Scaling Relations between Bolocam Sunyaev-Zel'dovich Effect and Chandra X-ray Measurements

We present scaling relations between the integrated Sunyaev-Zel'dovich Effect (SZE) signal, $Y_{\rm SZ}$, its X-ray analogue, $Y_{\rm X}\equiv M_{\rm gas}T_{\rm X}$, and total mass, $M_{\rm tot}$, for the 45 galaxy clusters in the Bolocam X-ray-SZ (BOXSZ) sample. All parameters are integrated within $r_{2500}$. $Y_{2500}$ values are measured using SZE data collected with Bolocam, operating at 140 GHz at the Caltech Submillimeter Observatory (CSO). The temperature, $T_{\rm X}$, and mass, $M_{\rm gas,2500}$, of the intracluster medium are determined using X-ray data collected with Chandra, and $M_{\rm tot}$ is derived from $M_{\rm gas}$ assuming a constant gas mass fraction. Our analysis accounts for several potential sources of bias, including: selection effects, contamination from radio point sources, and the loss of SZE signal due to noise filtering and beam-smoothing effects. We measure the $Y_{2500}$--$Y_{\rm X}$ scaling to have a power-law index of $0.84\pm0.07$, and a fractional intrinsic scatter in $Y_{2500}$ of $(21\pm7)\%$ at fixed $Y_{\rm X}$, both of which are consistent with previous analyses. We also measure the scaling between $Y_{2500}$ and $M_{2500}$, finding a power-law index of $1.06\pm0.12$ and a fractional intrinsic scatter in $Y_{2500}$ at fixed mass of $(25\pm9)\%$. While recent SZE scaling relations using X-ray mass proxies have found power-law indices consistent with the self-similar prediction of 5/3, our measurement stands apart by differing from the self-similar prediction by approximately 5$\sigma$. Given the good agreement between the measured $Y_{2500}$--$Y_{\rm X}$ scalings, much of this discrepancy appears to be caused by differences in the calibration of the X-ray mass proxies adopted for each particular analysis.Comment: 31 pages, 15 figures, accepted by ApJ 04/11/2015. This version is appreciably different from the original submission: it includes an entirely new appendix, extended discussion, and much of the material has been reorganize

Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery for Popliteal Artery Aneurysm

OBJECTIVES: To report outcomes following ligation and bypass (LGB) surgery for popliteal artery aneurysm (PAA) and study factors influencing patient and graft survival. MATERIALS AND METHODS: A retrospective review of patients undergoing LGB surgery for PAA between September 1999 and August 2012 at a tertiary referral vascular unit was performed. Primary graft patency (PGP), primary-assisted graft patency (PAGP), and secondary graft patency (SGP) rates were calculated using survival analyses. Patient, graft aneurysm-free survival (GAFS), aneurysm reperfusion-free survival (ARFS), and amputation-free survival (AFS) rates were also calculated. Log-rank testing and Cox proportional hazards modeling were used to perform univariate and multivariate analysis of influencing factors, respectively. RESULTS: Eighty-four LGB repairs in 69 patients (mean age 71.3 years, 68 males) were available for study. The 5-year PGP, PAGP, SGP, and patient survival rates were 58.1%, 84.4%, 85.2%, and 81.1%, respectively. On multivariate analysis, the principal determinants of PGP were urgency of operation ( P = .009) and smoking status ( P = .019). The principal determinants of PAGP were hyperlipidemia status ( P = .048) and of SGP were hyperlipidemia ( P = .042) and cerebrovascular disease (CVD) status ( P = .045). The principal determinants of patient survival were previous myocardial infarction ( P = .004) and CVD ( P = .001). The 5-year GAFS, ARFS, and AFS rates were 87.9%, 91.6%, and 96.1%, respectively. CONCLUSION: This study has shown that traditional cardiovascular risk factors, such as a smoking and ischemic heart disease, are the most important predictors of early graft failure and patient death following LGB surgery for PAA

High Spectral Resolution Measurement of the Sunyaev–Zel'dovich Effect Null with Z-Spec

The Sunyaev-Zel'dovich (SZ) effect spectrum crosses through a null where ΔT_CMB = 0 near ν_0 = 217 GHz. In a cluster of galaxies, ν0 can be shifted from the canonical thermal SZ effect value by corrections to the SZ effect scattering due to the properties of the inter-cluster medium. We have measured the SZ effect in the hot galaxy cluster RX J 1347.5 – 1145 with Z-Spec, an R ~ 300 grating spectrometer sensitive between 185 and 305 GHz. These data comprise a high spectral resolution measurement around the null of the SZ effect and clearly exhibit the transition from negative to positive ΔT_CMB over the Z-Spec band. The SZ null position is measured to be ν_0 = 225.8 ± 2.5(stat.) ± 1.2(sys.) GHz, which differs from the canonical null frequency by 3.0σ and is evidence for modifications to the canonical thermal SZ effect shape. Assuming the measured shift in ν0 is due only to relativistic corrections to the SZ spectrum, we place the limit kT_e = 17.1 ± 5.3 keV from the zero-point measurement alone. By simulating the response of the instrument to the sky, we are able to generate likelihood functions in {y_0, T_e, v_pec} space. For v_pec = 0 km s^(–1), we measure the best-fitting SZ model to be y_0 = 4.6^(+0.6)_(–0.9) × 10^(–4), T_e, 0 = 15.2^(+12)_(–7.4) keV. When v pec is allowed to vary, a most probable value of v_pec = + 450 ± 810 km s^(–1) is found

The design-by-adaptation approach to universal access: learning from videogame technology

This paper proposes an alternative approach to the design of universally accessible interfaces to that provided by formal design frameworks applied ab initio to the development of new software. This approach, design-byadaptation, involves the transfer of interface technology and/or design principles from one application domain to another, in situations where the recipient domain is similar to the host domain in terms of modelled systems, tasks and users. Using the example of interaction in 3D virtual environments, the paper explores how principles underlying the design of videogame interfaces may be applied to a broad family of visualization and analysis software which handles geographical data (virtual geographic environments, or VGEs). One of the motivations behind the current study is that VGE technology lags some way behind videogame technology in the modelling of 3D environments, and has a less-developed track record in providing the variety of interaction methods needed to undertake varied tasks in 3D virtual worlds by users with varied levels of experience. The current analysis extracted a set of interaction principles from videogames which were used to devise a set of 3D task interfaces that have been implemented in a prototype VGE for formal evaluation

Mendelian randomisation of eosinophils and other cell types in relation to lung function and disease

RATIONALE: Eosinophils are associated with airway inflammation in respiratory disease. Eosinophil production and survival is controlled partly by interleukin-5: anti-interleukin-5 agents reduce asthma and response correlates with baseline eosinophil counts. However, whether raised eosinophils are causally related to chronic obstructive pulmonary disease (COPD) and other respiratory phenotypes is not well understood. OBJECTIVES: We investigated causality between eosinophils and: lung function, acute exacerbations of COPD, asthma-COPD overlap (ACO), moderate-to-severe asthma and respiratory infections. METHODS: We performed Mendelian randomisation (MR) using 151 variants from genome-wide association studies of blood eosinophils in UK Biobank/INTERVAL, and respiratory traits in UK Biobank/SpiroMeta, using methods relying on different assumptions for validity. We performed multivariable analyses using eight cell types where there was possible evidence of causation by eosinophils. MEASUREMENTS AND MAIN RESULTS: Causal estimates derived from individual variants were highly heterogeneous, which may arise from pleiotropy. The average effect of raising eosinophils was to increase risk of ACO (weighted median OR per SD eosinophils, 1.44 (95%CI 1.19 to 1.74)), and moderate-severe asthma (weighted median OR 1.50 (95%CI 1.23 to 1.83)), and to reduce forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) and FEV(1) (weighted median estimator, SD FEV(1)/FVC: -0.054 (95% CI -0.078 to -0.029), effect only prominent in individuals with asthma). CONCLUSIONS: Broad consistency across MR methods may suggest causation by eosinophils (although of uncertain magnitude), yet heterogeneity necessitates caution: other important mechanisms may be responsible for the impairment of respiratory health by these eosinophil-raising variants. These results could suggest that anti-IL5 agents (designed to lower eosinophils) may be valuable in treating other respiratory conditions, including people with overlapping features of asthma and COPD

Microwave Kinetic Inductance Detector (MKID) Camera Testing for Submillimeter Astronomy

Developing kilopixel focal planes for incoherent submm- and mm-wave detectors remains challenging due to either the large hardware overhead or the complexity of multiplexing standard detectors. Microwave kinetic inductance detectors (MKIDs) provide a efficient means to produce fully lithographic background-limited kilopixel focal planes. We are constructing an MKID-based camera for the Caltech Submillimeter Observatory with 576 spatial pixels each simultaneously sensitive in 4 bands at 230, 300, 350, and 400 GHz. The novelty of MKIDs has required us to develop new techniques for detector characterization. We have measured quasiparticle lifetimes and resonator Qs for detector bath temperatures between 200 mK and 400 mK. Equivalent lifetime measurements were made by coupling energy into the resonators either optically or by driving the third harmonic of the resonator. To determine optical loading, we use both lifetime and internal Q measurements, which range between 15,000 and 30,000 for our resonators. Spectral bandpass measurements confirm the placement of the 230 and 350 GHz bands. Additionally, beam maps measurements conform to expectations. The same device design has been characterized on both sapphire and silicon substrates, and for different detector geometries. We also report on the incorporation of new shielding to reduce detector sensitivity to local magnetic fields

PCAT-DE: Reconstructing point-like and diffuse signals in astronomical images using spatial and spectral information

Observational data from astronomical imaging surveys contain information about a variety of source populations and environments, and its complexity will increase substantially as telescopes become more sensitive. Even for existing observations, measuring the correlations between point-like and diffuse emission can be crucial to correctly inferring the properties of any individual component. For this task information is typically lost, either because of conservative data cuts, aggressive filtering or incomplete treatment of contaminated data. We present the code PCAT-DE, an extension of probabilistic cataloging designed to simultaneously model point-like and diffuse signals. This work incorporates both explicit spatial templates and a set of non-parametric Fourier component templates into a forward model of astronomical images, reducing the number of processing steps applied to the observed data. Using synthetic Herschel-SPIRE multiband observations, we demonstrate that point source and diffuse emission can be reliably separated and measured. We present two applications of this model. For the first, we perform point source detection/photometry in the presence of galactic cirrus and demonstrate that cosmic infrared background (CIB) galaxy counts can be recovered in cases of significant contamination. In the second we show that the spatially extended thermal Sunyaev-Zel'dovich (tSZ) effect signal can be reliably measured even when it is subdominant to the point-like emission from individual galaxies.Comment: 23 pages, 13 figures, Accepted for publication in The Astronomical Journa

The MUSIC of CLASH: predictions on the concentration-mass relation

We present the results of a numerical study based on the analysis of the MUSIC-2 simulations, aimed at estimating the expected concentration-mass relation for the CLASH cluster sample. We study nearly 1400 halos simulated at high spatial and mass resolution, which were projected along many lines-of-sight each. We study the shape of both their density and surface-density profiles and fit them with a variety of radial functions, including the Navarro-Frenk-White, the generalised Navarro-Frenk-White, and the Einasto density profiles. We derive concentrations and masses from these fits and investigate their distributions as a function of redshift and halo relaxation. We use the X-ray image simulator X-MAS to produce simulated Chandra observations of the halos and we use them to identify objects resembling the X-ray morphologies and masses of the clusters in the CLASH X-ray selected sample. We also derive a concentration-mass relation for strong-lensing clusters. We find that the sample of simulated halos which resemble the X-ray morphology of the CLASH clusters is composed mainly by relaxed halos, but it also contains a significant fraction of un-relaxed systems. For such a sample we measure an average 2D concentration which is ~11% higher than found for the full sample of simulated halos. After accounting for projection and selection effects, the average NFW concentrations of CLASH clusters are expected to be intermediate between those predicted in 3D for relaxed and super-relaxed halos. Matching the simulations to the individual CLASH clusters on the basis of the X-ray morphology, we expect that the NFW concentrations recovered from the lensing analysis of the CLASH clusters are in the range [3-6], with an average value of 3.87 and a standard deviation of 0.61. Simulated halos with X-ray morphologies similar to those of the CLASH clusters are affected by a modest orientation bias.Comment: 21 pages, 16 figures, 3 tables, submitted to Ap

Frontier fields clusters: deep Chandra observations of the complex merger MACS~J1149.6+2223

The Hubble Space Telescope Frontier Fields cluster MACS J1149.6+2223 is one of the most complex merging clusters, believed to consist of four dark matter halos. We present results from deep (365 ks) Chandra observations of the cluster, which reveal the most distant cold front (z = 0.544) discovered to date. In the cluster outskirts, we also detect hints of a surface brightness edge that could be the bow shock preceding the cold front. The substructure analysis of the cluster identified several components with large relative radial velocities, thus indicating that at least some collisions occur almost along the line of sight. The inclination of the mergers with respect to the plane of the sky poses significant observational challenges at X-ray wavelengths. MACS J1149.6+2223 possibly hosts a steep-spectrum radio halo. If the steepness of the radio halo is confirmed, then the radio spectrum, combined with the relatively regular ICM morphology, could indicate that MACS J1149.6+2223 is an old merging cluster