Aneurysmal disease is associated with lower carotid intima-media thickness than occlusive arterial disease

Objective: Patients with aneurysmal and occlusive arterial disease have overlapping cardiovascular risk profiles. The question remains how atherosclerosis is related to the formation of aortic aneurysms. Common carotid artery intima-media thickness (CIMT) is an easily accessible and objective marker of early atherosclerosis. The aim of the current study was to investigate whether there is a difference in atherosclerotic burden as measured by CIMT between patients with aneurysmal and those with occlusive arterial disease. Methods: From 2004 to 2011, the CIMT was measured using B-mode ultrasound scanning in patients undergoing vascular surgery for aortic aneurysmal or occlusive arterial disease at the Erasmus University Medical Center. Cardiovascular risk factors, comorbidities, and medication were recorded. Patients treated for combined aneurysmal and occlusive arterial disease and patients diagnosed with a genetic aneurysm syndrome were excluded. Univariable and multivariable analyses wer

Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography

<p>Abstract</p> <p>Background</p> <p>Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE), systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE) as compared to transesophageal echocardiography (TEE) in patients with an intermediate likelihood of native valve IE.</p> <p>Methods</p> <p>Between 2004 and 2005, 36 consecutive inpatients with an intermediate likelihood of disease were prospectively evaluated by hTTE and TEE.</p> <p>Results</p> <p>Of 36 patients (21 males with a mean age of 57 ± 15 years, range 32 to 86 years), 19 patients had definite IE by TEE. The sensitivity for the detection of vegetations by hTTE was 84%, specificity of 88%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 82%. The association between hTTE and TTE interpretation for the presence and absence of vegetations were high (kappa = 0.90 and 0.85 respectively).</p> <p>Conclusion</p> <p>In patients with an intermediate likelihood of native valve IE, TTE with harmonic imaging provides diagnostic quality images in the majority of cases, has excellent concordance with TEE and should be recommended as the first line test.</p

Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

Background: Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function is not known

Optimizing Three-Dimensional Trade-Off Problem of Time–Cost–Quality over Multi-Mode Projects with Generalized Logic

Clients typically tend to aim for reasonable prices, minimum possible makespans, and the best quality for the construction projects that they engage in. Evidently, weighing the available offers and coming up with an optimal decision can pose challenges for the decision makers. In this regard, the generation of a tool that helps decision makers strike a proper balance among the conflicting project objectives (i.e., time, cost, and quality) is imperative. To this end, this study proposes a method which assists in the selection of the best compromise choices among the options available for each of the project activities. In addition to the time and cost, the proposed method is designed to bring the quality aspect into the equation as well. To quantify the quality, a value referring to the weighted importance and performance of each activity is used. The proposed method is based on a modified multi-objective genetic algorithm (GA) that incorporates the domination concept for the selection of the best solutions out of the potential candidates. The GA-based method is capable of handling an unlimited number of precedence relationships for each activity, and above all, it is able to capture and unravel any type of logical relationship. This very feature significantly improves the practical relevance of this research, as the parallelization of activities is a common practice in real-life projects. Planners benefit from the various types of relationships (i.e., Start to Start, Start to Finish, Finish to Start, and Finish to Finish), and the concept of lag time frequently introduces parallelization into the network. Overlapped activities, in turn, help reduce the unwanted idle times and speed up the project significantly. Accordingly, in order to demonstrate the application and effectiveness of the proposed model, it has been used in the solution of four time–cost–quality (TCQ) trade-off problems, three of which are generated within the context of this paper. The practiced instances include a small benchmark TCQT problem with 18 activities taken from the literature in addition to more complex 29- and 63-activity TCQTPs produced herein based on benchmark time–cost trade-off problems. The performance of the presented approach is ultimately examined over a large-scale, real-case construction project with over four hundred activities and generalized logic in an unprecedented attempt to validate a model in the realm of TCQTPs. The successful results of the experiments reveal the effectiveness of the proposed model and corroborate the feasibility of its application by the planners amidst arduous decision-making processes

Common Β- Thalassaemia Mutations in Northwestern Iran

Introduction: β –Thalassaemia was first explained by Thomas Cooly as Cooly’s anaemia in 1925. The β- thalassaemias are hereditary autosomal disorders with decreased or absent β-globin chain synthesis. The most common genetic defects in β-thalassaemias are caused by point mutations, micro deletions or insertions within the β-globin gene. Material and Methods: In this research , 142 blood samples (64 from childrens hospital of Tabriz , 15 samples from Shahid Gazi hospital of Tabriz , 18 from Urumia and 45 samples from Aliasghar hospital of Ardebil) were taken from thalassaemic patients (who were previously diagnosed ).Then 117 non-familial samples were selected . The DNA of the lymphocytes of blood samples was extracted by boiling and Proteinase K- SDS procedure, and mutations were detected by ARMS-PCR methods. Results: From the results obtained, eleven most common mutations,most of which were Mediterranean mutations were detected as follows; IVS-I-110(G-A), IVS-I-1(G-A) ،IVS-I-5(G-C) ,Frameshift Codon 44 (-C,( codon5(-CT),IVS-1-6(T-C), IVS-I-25(-25bp del) ,Frameshift 8.9 (+G) ,IVS-II-1(G-A) ,Codon 39(C-T), Codon 30(G-C) the mutations of the samples were defined. The results showed that Frameshift 8.9 (+G), IVS-I-110 (G-A) ,IVS-II-I(G-A), IVS-I-5(G-C), IVS-I-1(G-A) , Frameshift Codon 44(-C) , codon5(-CT) , IVS-1-6(T-C) , IVS-I-25(-25bp del) with a frequency of 29.9%, 25.47%,17.83%, 7.00%, 6.36% , 6.63% , 3.8% , 2.5% , 0.63% represented the most common mutations in North - west Iran. No mutations in Codon 39(C-T) and Codon 30(G-C) were detected. Cunclusion: The frequency of the same mutations in patients from North - West of Iran seems to be different as compared to other regions like Turkey, Pakistan, Lebanon and Fars province of Iran. The pattern of mutations in this region is more or less the same as in the Mediterranean region, but different from South west Asia and East Asia

Common Β- Thalassaemia Mutations in

Introduction: β –Thalassaemia was first explained by Thomas Cooly as Cooly’s anaemia in 1925. The β- thalassaemias are hereditary autosomal disorders with decreased or absent β-globin chain synthesis. The most common genetic defects in β-thalassaemias are caused by point mutations, micro deletions or insertions within the β-globin gene. Material and Methods: In this research , 142 blood samples (64 from childrens hospital of Tabriz , 15 samples from Shahid Gazi hospital of Tabriz , 18 from Urumia and 45 samples from Aliasghar hospital of Ardebil) were taken from thalassaemic patients (who were previously diagnosed ).Then 117 non-familial samples were selected . The DNA of the lymphocytes of blood samples was extracted by boiling and Proteinase K- SDS procedure, and mutations were detected by ARMS-PCR methods. Results: From the results obtained, eleven most common mutations,most of which were Mediterranean mutations were detected as follows; IVS-I-110(G-A), IVS-I-1(G-A) ،IVS-I-5(G-C) ,Frameshift Codon 44 (-C,( codon5(-CT),IVS-1-6(T-C), IVS-I-25(-25bp del) ,Frameshift 8.9 (+G) ,IVS-II-1(G-A) ,Codon 39(C-T), Codon 30(G-C) the mutations of the samples were defined. The results showed that Frameshift 8.9 (+G), IVS-I-110 (G-A) ,IVS-II-I(G-A), IVS-I-5(G-C), IVS-I-1(G-A) , Frameshift Codon 44(-C) , codon5(-CT) , IVS-1-6(T-C) , IVS-I-25(-25bp del) with a frequency of 29.9%, 25.47%,17.83%, 7.00%, 6.36% , 6.63% , 3.8% , 2.5% , 0.63% represented the most common mutations in North - west Iran. No mutations in Codon 39(C-T) and Codon 30(G-C) were detected. Cunclusion: The frequency of the same mutations in patients from North - West of Iran seems to be different as compared to other regions like Turkey, Pakistan, Lebanon and Fars province of Iran. The pattern of mutations in this region is more or less the same as in the Mediterranean region, but different from South west Asia and East Asia

Intensity-modulated radiotherapy for early glottic cancer: transition to a new standard of care?

For decades, the standard of care for radiation treatment of early larynx cancers has been conventional treatment using opposed lateral fields encompassing the larynx and overlying neck structures, including the adjacent carotid arteries. While intensity-modulated radiotherapy (IMRT) has replaced conventional radiotherapy for all other head/neck cancer situations, the use of IMRT to treat early glottic cancers remains controversial. The article reviews the published experience with IMRT for this clinical situation and provides a detailed review of the literature on radiation-induced carotid toxicity and how it might apply to the controversy. Finally, we discuss whether the radiation oncology community should transition to IMRT as a new standard of care for the treatment of early glottic cancers