Anomali Pangkal Arteri Koroner: Peran CT Angiografi

Introduction: The anomalous origin of the right coronary artery (RCA) from the left coronary sinus coursing between the aorta and the pulmonary trunk is rare, but may cause myocardial ischemia and sudden death. Multislice CT coronaryangiography offers the possibility to visualize anomalous coronary artery origin non-invasively in details.Case Illustration: A 54-year-old man with a history of arterial hypertension, and hypercholesterolemia began to present with typical chest pain. After some non-invasive examination, he had coronary angiographythat revealed 70% stenosis at mid intermediate artery, normalLMCA, LAD and LCX. Ostium of RCA was found near the left valsava sinus afterrepeated cannulation attempts, no stenosis was found at RCA. After successful revascularization at intermediate artery, patient still had typical chest pain with positive ischemic response in treadmill test. Multislice CT coronary angiography was performedto evaluate the etiology of chest pain. The scan showed patent stent at intermediate artery and anomalous RCA origin from the left coronary sinus withacute angle take-off, luminal narrowing of the osteal-proximal part, as well as luminal compression between the ascending aorta and the pulmonary trunk (an interarterial course) while RCA appeared as dominant vessel. These features were considered as malignant coronary anomaly that could lead to the recommendation of surgical correction.Discussion: Accurate recognition and documentation of coronary artery anomalies are essential to determine the significance of such findings and to avoid furtherclinical complications. Multislice CT coronary angiography is a non-invasive imaging modality that can easily and precisely depict the origin and course of coronary artery anomalies as well as its relationship with adjacent structures.Pendahuluan Kasus anomali dimana arteri koroner kanan berasal dari sinus koronarius kiri yang melintas diantara aorta dan arteri pulmonalis adalah jarang, namun dapat menyebabkan iskemia miokardium dan kematian jantung mendadak. Pencitraan dengan multislice CT angiografi koroner dapat mendeteksi anomali arteri koroner secara detail dan non invasif.Ilustrasi Kasus Laki laki berusia 54 tahun dengan riwayat hipertensi dan hiperkolesterolemia datang dengan keluhan nyeri dada tipikal. Setelah dilakukan beberapa pemeriksaan non invasif, pasien menjalani angiografi koroner dan didapatkan stenosis 70% pada arteri mid intermediate, normal arteri koroner cabang utama, arteri koroner anterior desendens, dan arteri koroner sirkumfleksa. Ostium arteri koroner kanan ditemukan setelah beberapa usaha kanulasi dan terletak dekat sinus valsava kiri. Tidak didapatkan stenosis pada arteri koroner kanan. Setelah dilakukan revaskularisasi pada arteri intermediate dengan sukses, pasen masih mengeluh nyeri dada tipikal dengan respon iskemik positif pada uji latih jantung. MSCT angiografi koroner dilakukan untuk evaluasi etiologi nyeri dada. Hasil MSCT angiografi koroner menunjukkan bahwa stent pada arteri intermediate paten dan anomali arteri koroner kanan dimana berasal dari sinus koronarius kiri dengan sudut yang berbelok tajam, penyempitan lumen pada bagian osteal-proksimal, serta adanya kompresi lumen antara aorta asendens dengan arteri pulmonalis (interarterial course) dimana arteri koroner kanan merupakan pembuluh darah dominan. Anomali ini dianggap sebagai anomali koroner yang malignan dan memerlukan rekomendasi koreksi pembedahan.Diskusi Deteksi akurat dan dokumentasi anomali arteri koroner penting untuk menentukan apakah anomali tersebut menngakibatkan dampak yang signifikan atau tidak dan untuk menghindari komplikasi klinis lebih lanjut. MSCT angiografi koroner adalah modalitas pencitraan non invasif yang dapat dengan mudah dan teliti untuk mendapatkan asal maupun jalur anomali arteri koroner dan hubungannya dengan anatomi struktur lainnya

Effect of Myocardial Fibrosis on Left Ventricular Function in Rheumatic Mitral Stenosis: A Preliminary Study with Cardiac Magnetic Resonance

Background: Left ventricular (LV) dysfunction was frequently found in rheumatic mitral stenosis. Myocardial fibrosis had been revealed in rheumatic heart disease and could be associated with LV dysfunction. We evaluate myocardial fibrosis profile related to LV function in rheumatic mitral stenosis with cardiac magnetic resonance (CMR). Methods: Eighteen patients with severe rheumatic mitral stenosis without history of coronary artery disease or its risk factors underwent 1.5T CMR examination. LV ejection fraction (LVEF), right ventricular ejection fraction (RVEF), myocardial fibrotic tissue were evaluated with CMR. Other hemodynamic data was derived from echocar­diography results. Results: These patients (40.4±10.5 years old, 72.2% female, 66.7% atrial fibrillation) had LVEF of 50.9±15.9% and RVEF of 37.7±13.9%. Volume of fibrotic tissue in these patients were 16.6 (5.5-55.8)%. In multivariate analysis, volume of fibrotic tissue was a significant predictor of LVEF that myocardial fibrotic tissue of 1% was associated with LVEF reduction of 0.87% (95% CI 0.51%-1.24%). Conclusion: LV function was determined by the extent of myocardial fibrosis in rheu­matic mitral stenosis.   Abstrak Latar Belakang: Disfungsi ventrikel kiri (LV) sering ditemukan pada mitral stenosis rematik. Fibrosis miokardium ditemukan pada penyakit jantung rematik. Fibrosis miokardium pada penyakit jantung rematik juga dihubungkan dengan disfungsi LV. Kami mengevaluasi profil fibrosis miokardium yang berhubungan dengan fungsi LV pada mitral stenosis rematik dengan cardiac magnetic resonance (CMR). Metode: Dilakukan pemeriksaan 1.5T CMR pada delapanbelas pasien dengan mitral stenosis rematik berat tanpa riwayat penyakit jantung koroner atau faktor resikonya. Fraksi ejeksi LV (LVEF), fraksi ejeksi RV (RVEF), dan jaringan fibrotik miokardium dievaluasi menggunakan CMR. Data hemodinamik lainnya didapatkan dari pemeriksaan ekokardiografi. Hasil: Pasien tersebut (40.4±10.5 tahun, 72.2% perempuan, 66.7% fibrilasi atrium) memiliki LVEF 50.9±15.9% dan RVEF 37.7±13.9%. Vol­ume jaringan fibrotic pada pasien tersebut adalah 16.6 (5.5-55.8)%. Dalam analisis multivariat, volume jaringan fibrotic adalah prediktor LVEF yang signifikan yaitu 1% jaringan fibrotic miokardium dihubungkan dengan menurunan LVEF sebesar 0.87% (95% CI 0.51%-1.24%). Kesimpulan: Fungsi LV dipengaruhi seberapa besar fibrosis miokardium pada mitral stenosis remati

Durabilitas Beton Bubuk Kulit Kerang di Lingkungan Air Laut

In this study,blood clam used as cement replacement material. The specimens were cured in distilled water until 28 days. Then specimens were immersed in sodium chloride solution until 91 days. The parameters studied include compressive strength, workability, and density. These properties were compared with those of a control concrete that was made of Ordinary Portland Cement (OPC). The main parameter of this study was the proportion of waste blood clam (4% by cement weight)

Perancangan Promosi Varian Roti Resep Tempo Dulu Toko Roti Ganep's Surakarta

Perancangan ini bertujuan untuk memperkenalkan macam-macam roti resep tempo duluproduk Ganep's. Sekarang ini, sebagian masyarakat menggemari hal-hal yang berhubungandengan tempo dulu, termasuk jenis-jenis makanan dan camilan. Salah satu varian Ganep's adalahroti resep tempo dulu. Promosi ini menyesuaikan kebiasaan sasaran perancangan, dimanakarakteristiknya adalah terhubung melalui jaringan sosial media, salah satunya adalah instagram.Oleh karenanya promosi roti resep tempo dulu produk Ganep's dilakukan dengan menyesuaikankebiasaan media pada sasaran perancangan. Selain juga menggunakan pendekatan desain sesuaidengan selera anak muda jaman sekarang. Promosi didukung melalui beberapa media penunjangseperti kalender, notes dan voucher diskon untuk bonus event

Pleistocene Niche Stability And Lineage Diversification In The Subtropical Spider Araneus Omnicolor (araneidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The influence of Quaternary climate oscillations on the diversification of the South American fauna is being increasingly explored. However, most of these studies have focused on taxa that are endemic to tropical environments, and relatively few have treated organisms restricted to subtropical biomes. Here we used an integrative phylogeographical framework to investigate the effects of these climate events on the ecological niche and genetic patterns of the subtropical orb-weaver spider Araneus omnicolor (Araneidae). We analyzed the mitochondrial (Cytochrome Oxidase I, COI) and nuclear (Internal Transcribed Subunit II, ITS2) DNA of 130 individuals throughout the species' range, and generated distribution models in three different climate scenarios [present, Last Glacial Maximum (LGM), and Last Interglacial Maximum (LIG)]. Additionally, we used an Approximate Bayesian Computation (ABC) approach to compare possible demographic scenarios and select the hypothesis that better explains the genetic patterns of A. omnicolor. We obtained high haplotype diversity but low nucleotide variation among sequences. The population structure and demographic analyses showed discrepancies between markers, suggesting male-biased dispersal in the species. The time-calibrated COI phylogenetic inference showed a recent diversification of lineages (Middle/Late Pleistocene), while the paleoclimate modeling indicated niche stability since similar to 120 Kya. The ABC results agreed with the niche models, supporting a panmictic population as the most likely historical scenario for the species. These results indicate that A. omnicolor experienced no niche or population reductions during the Late Pleistocene, despite the intense landscape modifications that occurred in the subtropical region, and that other factors beside LGM and LIG climate oscillations might have contributed to the demographic history of this species. This pattern may be related to the high dispersal ability and wide environmental tolerance of A. omnicolor, highlighting the need for more phylogeographical studies with invertebrates and other generalist taxa, in order to understand the effects of Quaternary climate changes on Neotropical biodiversity.104Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP [2012/02526-7

Detailed Precision of Computed Tomography Angiography Compared to Invasive Angiography in Different Coronary Vessels: Overestimate, Underestimate, or Concordance?

Background: Quantitative analysis of stenosis lesions by Computed Tomography angiography (CTA) show good correlation with Invasive Coronary Angiography (ICA) examination. However, detailed precision whether CTA overestimate or underestimate have not been explored thoroughly. Objectives: This research is performed to analyze the precision of CTA compared to ICA. Materials & Methods: There are 195 patients examined by both CTA and ICA from October 2014 until December 2015 in our hospital. CTA was analyzed by a team of cardiovascular imaging cardiologists. Quantitative grading of stenosis was determined visually using 2014 Society of Cardiovascular Computed Tomography (SCCT) guidelines classification. Quantitative measurement of stenosis during ICA was classified with the same criteria so that it can be comparable. The final comparison of both tests was clas­sified as concordance, overestimate and underestimate. Results: Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are significantly associated with detailed precision of quantitative analysis comparison in CTA and ICA. LM coronary stenosis quantification from CTA is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9% vessels), while stenosis analysis by CTA in other major coronary vessels is spread without conspicuous domination (p<0.001). Sensitivity, specificity, PPV, and NPV of CTA to detect obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, respectively (780 vessels). Conclusions: Degree of stenosis in LM is predominantly overestimate by CTA. The precision of stenosis grading in CTA in different coronary vessels is not the same.   Abstrak Latar Belakang: Analisis kuantitatif lesi stenosis pada pembuluh koroner menggunakan modalitas Computed Tomography Angiography (CTA) memiliki korelasi yang baik dengan pemeriksaan Invasive Coronary Angiography (ICA). Namun, presisi CTA terhadap ICA masih belum ter­eksplorasi dengan baik. Terutama dari sisi apakah CTA menunjukkan presisi yang overestimate atau underestimate. Tujuan: Penelitian ini dilakukan untuk menganalisis presisi CTA terhadap ICA dalam mendeteksi lesi stenosis pada pembuluh koroner. Metode Penelitian: Terdapat 195 pasien yang diperiksa menggunakan CTA dan ICA sejak Oktober 2014 hingga Desember 2015 di RS Jan­tung dan Pembuluh Darah Harapan Kita, Jakarta. Analisis kuantitatif CTA dilakukan oleh tim kardiolog pencitraan kardiovaskular. Klasifikasi derajat stenosis ditentukan secara visual menggunakan pedoman dari Society of Cardiovascular Computed Tomography (SCCT) 2014. Analisis kuantitatif lesi stenosis dari pemeriksaan ICA diklasifikasikan menggunakan pedoman yang sama sehingga keduanya dapat diperbandingkan. Data hasil perbandingan kedua modalitas diklasifikasikan sebagai concordance, overestimate dan underestimate. Hasil Penelitian: Lesi stenosis ditemukan pada 573 pembuluh koroner. Pembuluh koroner yang berbeda secara signifikan berhubungan dengan perbandingan klasifikasi analisis semi-kuantitatif CTA dan ICA. Pembuluh koroner LM terutama menunjukkan lesi dengan kategori overestimate (75.9%). Sementara analisis stenosis pada pembuluh koroner lainnya tidak menunjukkan perbedaan yang mencolok (p < 0,001). Sensitivitas, spesifisitas, PPV, dan NPV CTA dalam mendeteksi lesi koroner obstruktif (stenosis ≥50%) terhadap ICA adalah sebesar 81.4%, 80.4%, 73.9%, dan 86.3% (780 pembuluh kroner). Kesimpulan: Analisis stenosis semi-kuantitatif pada LM terutama adalah overestimate berdasarkan pemeriksaan CTA. Presisi analisis perband­ingan derajat stenosis CT angiografi pada setiap pembuluh koroner tidak sama

Processing and Properties of Plastic Lumber

Plastic residue can be processed into composites using wood flour, mineral fillers, plant or synthetic fibers to obtain plastic lumber, a substitute material for natural wood. The composition and processing conditions are largely responsible for the final characteristics of the plastic lumber. Factors such as density, particle size and moisture content in the material to be processed require extruders with specific technical characteristics, in order to reduce the residence time of the plastic inside the equipment, maintain a constant feed rate and ensure good degassing and homogenization of the components. The composites can be manufactured using single-screw, co- or counter-rotating conical or parallel twin-screw extruders. Plastic lumber exhibits different physical and mechanical properties from natural wood, including lower stiffness (elastic modulus) and superior weathering resistance

Quantitative multiplex detection of plant pathogens using a novel ligation probe-based system coupled with universal, high-throughput real-time PCR on OpenArrays™

<p>Abstract</p> <p>Background</p> <p>Diagnostics and disease-management strategies require technologies to enable the simultaneous detection and quantification of a wide range of pathogenic microorganisms. Most multiplex, quantitative detection methods available suffer from compromises between the level of multiplexing, throughput and accuracy of quantification. Here, we demonstrate the efficacy of a novel, high-throughput, ligation-based assay for simultaneous quantitative detection of multiple plant pathogens. The ligation probes, designated Plant Research International-lock probes (PRI-lock probes), are long oligonucleotides with target complementary regions at their 5' and 3' ends. Upon perfect target hybridization, the PRI-lock probes are circularized via enzymatic ligation, subsequently serving as template for individual, standardized amplification via unique probe-specific primers. Adaptation to OpenArrays™, which can accommodate up to 3072 33 nl PCR amplifications, allowed high-throughput real-time quantification. The assay combines the multiplex capabilities and specificity of ligation reactions with high-throughput real-time PCR in the OpenArray™, resulting in a flexible, quantitative multiplex diagnostic system.</p> <p>Results</p> <p>The performance of the PRI-lock detection system was demonstrated using 13 probes targeting several significant plant pathogens at different taxonomic levels. All probes specifically detected their corresponding targets and provided perfect discrimination against non-target organisms with very similar ligation target sites. The nucleic acid targets could be reliably quantified over 5 orders of magnitude with a dynamic detection range of more than 10⁴. Pathogen quantification was equally robust in single target versus mixed target assays.</p> <p>Conclusion</p> <p>This novel assay enables very specific, high-throughput, quantitative detection of multiple pathogens over a wide range of target concentrations and should be easily adaptable for versatile diagnostic purposes.</p