Scaling Evolution of Universal Dark-Matter Halo Density Profiles

Dark-matter halos show a universal density profile with a scaling such that less massive systems are typically denser. This mass-density relation is well described by a proportionality between the characteristic density of halos and the mean cosmic density at halo formation time. It has recently been shown that this proportionality could be the result of the following simple evolutionary picture. Halos form in major mergers with essentially the same, cosmogony-dependent, dimensionless profile, and then grow inside-outside, as a consequence of accretion. Here we verify the consistency of this picture and show that it predicts the correct zero point of the mass-density relation.Comment: 9 pages, 1 Table and 1 postscript figure, latex uses aaspp4.sty, accepted for publication in The Astrophysical Journal Letter

Theoretical dark matter halo kinematics and triaxial shape

In a recent paper, Salvador-Solé et al. have derived the typical inner structure of dark matter haloes from that of peaks in the initial random Gaussian density field, determined by the power spectrum of density perturbations characterizing the hierarchical cosmology under consideration. In this paper, we extend this formalism to the typical kinematics and triaxial shape of haloes. Specifically, we establish the link between such halo properties and the power spectrum of density perturbations through the typical shape of peaks. The trends of the predicted typical halo shape, pseudo-phase-space density and anisotropy profiles are in good agreement with the results of numerical simulations. Our model sheds light on the origin of the power-law-like pseudo-phase-space density profile for virialized haloes

Theoretical dark matter halo kinematics and triaxial shape

In a recent paper, Salvador-Sol\'e et al. (2012) have derived the typical inner structure of dark matter haloes from that of peaks in the initial random Gaussian density field, determined by the power-spectrum of density perturbations characterising the hierarchical cosmology under consideration. In the present paper, we extend this formalism to the typical kinematics and triaxial shape of haloes. Specifically, we establish the link between such halo properties and the power-spectrum of density perturbations through the typical shape of peaks. The trends of the predicted typical halo shape, pseudo phase-space density and anisotropy profiles are in good agreement with the results of numerical simulations. Our model sheds light on the origin of the power-law-like pseudo phase-space density profile for virialised haloes.Comment: 18 pages, 6 figures. Published in MNRA

Incremental prognostic value of lung ultrasound on contemporary heart failure risk scores

Introduction: Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up. Methods: We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention. Results: The AUC of the GWTG score increased from 0.682 to 0.789 (p = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 (p < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 (p < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 (p < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance (p = 0.08 and p = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, p < 0.05; 0.056 and 0.111 in the 1-year score, p < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 (p = 0.06) and an IDI of 0.092 (p < 0.05). Conclusion: Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients

New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block

Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory

Background: functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: a total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation

Mecanismos y consecuencias clínicas de los patrones electrocardiográficos de infarto agudo de miocardio con bloqueo de rama izquierda del haz de His.

El diagnòstic d'infart de miocardi en presència de bloqueig de branca esquerra del feix de His (BBEFH) és un repte per al clínic, donat que els canvis electrocardiogràfics intrínsecs al propi trastorno de la conducció basal poden emmascarar els patrons electrocardiogràfics d'isquèmia. L'estratègia actual, recomanada per les guies clíniques europees és realitzar una coronariografia emergent a tots els pacients amb sospita de síndrome coronària aguda i bloqueig de branca esquerra no conegut però, aquesta estratègia presenta un nombre de falsos positius molt elevat. A pesar de que s'han creat diversos algoritmes electrocardiogràfics pel diagnòstic d'infart en presència de BBEFH, no es recomana el seu us generalitzat degut a la falta de sensibilitat. La present tesi doctoral es composa d'un estudi experimental publicat al 2019 i un estudi clínic encara no publicat, que analitza els patrons electrocardiogràfics associats a la localització i duració de la isquèmia miocàrdica amb l'objectiu, per una banda, de demostrar que existeixen canvis electrocardiogràfics específics a pesar del trastorn de la conducció i, per altra banda, objectivar l'impacte que té la localització i duració de la isquèmia sobre la capacitat diagnòstica dels algoritmes actualment publicats. Els resultats del nostre treball aporten una millor caracterització electrocardiográfica dels pacients amb infart i BBEFH. El patró electrocardiogràfic d'aquests pacients difereix significativament en base a la localització, transmuralitat i duració de la isquèmia miocàrdica. L'anàlisi electrocardiogràfic minuciós d'aquests patrons permetrà millorar l'eficàcia dels algoritmes diagnòstics actuals.El diagnóstico de infarto de miocardio en presencia de bloqueo de rama izquierda del haz de His (BRIHH) es un reto para el clínico, dado que los cambios electrocardiográficos intrínsecos al trastorno de conducción basal pueden enmascarar los patrones electrocardiográficos de isquemia. La estrategia actual, recomendada por las guías clínicas europeas es realizar una coronariografía emergente a todos los pacientes con sospecha de síndrome coronario agudo y bloqueo de rama izquierda no conocido, sin embargo, esta estrategia cuenta con un número de falsos positivos muy elevado. A pesar de que se han creado diversos algoritmos electrocardiográficos para el diagnóstico de infarto en presencia de BRIHH, no se recomienda su uso generalizado por falta de sensibilidad. La presente tesis doctoral se compone de un estudio experimental publicado en 2019 y un estudio clínico todavía no publicado, que analizan los patrones electrocardiográficos asociados a la localización y duración de la isquemia miocárdica con el objetivo, por un lado, de demostrar que existen cambios electrocardiográficos específicos a pesar del trastorno de la conducción y, por otro lado, objetivar el impacto que tiene la localización y duración de la isquemia en la capacidad diagnóstica de los algoritmos actualmente publicados. Los resultados de nuestro trabajo aportan una mejor caracterización electrocardiográfica de los pacientes con infarto y BRIHH. El patrón electrocardiográfico de estos pacientes difiere significativamente en base a la localización, transmuralidad y duración de la isquemia miocárdica. El análisis electrocardiográfico minucioso de estos patrones permitirá mejorar la eficacia de los algoritmos diagnósticos actuales.The electrocardiographic recognition of acute myocardial infarction in patients with concurrent left bundle branch block (LBBB) is hampered by background changes in ST-segment directly caused by the basal LBBB. Nowadays, the European clinical guidelines, recommend to perform an emergent coronary angiography in all patients with suspected acute coronary syndrome and unknown left bundle branch block, but this strategy has a very high number of false positives. Although various electrocardiographic algorithms have been created for the diagnosis of acute myocardial infarction in the presence of LBBB, their use is not recommended due to lack of sensitivity. This thesis consists of an experimental and a clinical studies which analyze the electrocardiographic patterns associated with the location and duration of myocardial ischemia with the aim, on the one hand, to demonstrate that there are specific electrocardiographic changes despite the conduction disorder and, on the other hand, to objectify how the location and duration of the ischemia impact on the diagnostic accuracy of the currently published algorithms. The results of our work provide a better electrocardiographic characterization of patients with infarction and LBBB. The electrocardiographic patterns of these patients differs significantly based on the location, extension, and duration of the myocardial ischemia. A detailed analysis of these patterns will improve the efficacy of current diagnostic algorithms.Universitat Autònoma de Barcelona. Programa de Doctorat en Medicin