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Sample records for high arterial compliance

  1. Obesity and arterial compliance alterations.

    Science.gov (United States)

    Seifalian, Alexander M; Filippatos, Theodosios D; Joshi, Jatin; Mikhailidis, Dimitri P

    2010-03-01

    Obesity is associated with increased cardiovascular disease (CVD) risk, especially when excess body fat is distributed preferentially within the abdominal region. Obese subjects usually have increased arterial stiffness compared with non-obese subjects of similar age. The factors associated with increased arterial stiffness in obesity include endothelial dysfunction (decreased nitric oxide bioavailability), impaired smooth muscle cell function, insulin resistance, as well as elevated cholesterol and C-peptide levels. Furthermore, visceral fat, the adipose tissue-related renin-angiotensin-aldosterone system and hyperleptinaemia contribute to the obesity-associated impaired arterial compliance. Weight loss improves CVD risk factors and arterial compliance. Because increased arterial stiffness is a marker of CVD risk these findings support the concept that the presence of obesity has vascular implications.

  2. THE IMPORTANCE OF THE COMPLIANCE TO A MEDICAL TREATMENT OF A PATIENT WITH A VERY HIGH CARDIOVASCULAR RISK AND COMORBIDITY: ARTERIAL HYPERTENSION, ATRIAL FIBRILLATION AND DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    T. V. Zolotarova

    2016-12-01

    Full Text Available The ultimate goal of any prescribed medical therapy is to achieve certain desired results in the patients concerned. Compliance to medical recommendations not only includes patient compliance with medication but also with diet, exercise, or lifestyle changes. Considered a clinical example of the patient of a very high cardiovascular risk with comorbid pathology: arterial hypertension, atrial fibrillation and diabetes mellitus. We have shown with this case as in comorbid patients with high cardiovascular risk could be organized medical treatment without polypharmacy.

  3. Irbesartan improves arterial compliance more than lisinopril

    Science.gov (United States)

    Ali, Khalid; Rajkumar, Chakravarthi; Fantin, Francesco; Schiff, Rebekah; Bulpitt, Christopher J

    2009-01-01

    Background Antihypertensive agents can reduce arterial stiffness. We hypothesized that an angiotensin receptor blocker (ARB) irbesartan and an angiotensin converting enzyme inhibitor (ACEI) lisinopril improved arterial compliance. Methods A randomized, double-blind, double-dummy, controlled crossover trial. Fifteen hypertensive patients, mean age 65.5 ± 8.9 years (mean ± SD) were given irbesartan (150 to 300 mg/day) or lisinopril (10 to 20 mg/day) for 12 weeks and then crossed over for 12 weeks. Pulse wave velocity (PWV) in the carotid-femoral (CF), carotid-radial (CR), and femoral dorsalis-pedis (FD) were measured using a Complior® PWV system. Results After 12 weeks, systolic blood pressure (SBP) decreased from 162.4 ± 12.9 to 134.5 ± 14.8 with irbesartan and to 145.2 ± 25 mmHg with lisinopril. Irbesartan and lisinopril reduced PWV (CF) in the elastic arterial system from 15.1 ± 5 to 13.3 ± 2.6 (p < 0.005) and to 14 ± 4.7 (p < 0.05) m/s respectively (p = 0.345). Irbesartan reduced PWV (CR) and PWV (FD), whereas lisinopril did not. The difference between treatments was significant after SBP adjustment (p = 0.037 for PWV (CR) and p < 0.001 for PWV (FD)). Conclusions Irbesartan improved arterial compliance in elastic and muscular arteries, whereas lisinopril improved it only in elastic arteries. PMID:19649309

  4. Irbesartan improves arterial compliance more than lisinopril

    Directory of Open Access Journals (Sweden)

    Khalid Ali

    2009-07-01

    Full Text Available Khalid Ali,1 Chakravarthi Rajkumar,1 Francesco Fantin,2 Rebekah Schiff,3 Christopher J Bulpitt31Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK; 2Department of Geriatrics, University of Verona, Italy; 3Section of Geriatric Medicine, Imperial College School of Medicine, London, UKBackground: Antihypertensive agents can reduce arterial stiffness. We hypothesized that an angiotensin receptor blocker (ARB irbesartan and an angiotensin converting enzyme inhibitor (ACEI lisinopril improved arterial compliance.Methods: A randomized, double-blind, double-dummy, controlled crossover trial. Fifteen hypertensive patients, mean age 65.5 ± 8.9 years (mean ± SD were given irbesartan (150 to 300 mg/day or lisinopril (10 to 20 mg/day for 12 weeks and then crossed over for 12 weeks. Pulse wave velocity (PWV in the carotid-femoral (CF, carotid-radial (CR, and femoral dorsalis-pedis (FD were measured using a Complior® PWV system.Results: After 12 weeks, systolic blood pressure (SBP decreased from 162.4 ± 12.9 to 134.5 ± 14.8 with irbesartan and to 145.2 ± 25 mmHg with lisinopril. Irbesartan and lisinopril reduced PWV (CF in the elastic arterial system from 15.1 ± 5 to 13.3 ± 2.6 (p < 0.005 and to 14 ± 4.7 (p < 0.05 m/s respectively (p = 0.345. Irbesartan reduced PWV (CR and PWV (FD, whereas lisinopril did not. The difference between treatments was significant after SBP adjustment (p = 0.037 for PWV (CR and p < 0.001 for PWV (FD.Conclusions: Irbesartan improved arterial compliance in elastic and muscular arteries, whereas lisinopril improved it only in elastic arteries.Keywords: arterial compliance, angiotensin receptor blockers, ACE inhibitors, hypertension

  5. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren; Schifter, S

    2001-01-01

    catecholamines, renin activity, endothelin-1, and calcitonin gene related peptide (CGRP) at baseline and during oxygen inhalation. RESULTS: COMP(art) was significantly increased in cirrhotic patients compared with controls (1.32 v 1.06 ml/mm Hg; padrenaline levels (r=-0.......001) and central circulation time (r=-0.49; padrenaline (-16%; p... to COMP(art) disappeared. The relation of COMP(art) to CGRP and circulatory variables remained unchanged. CONCLUSION: Elevated arterial compliance in cirrhosis is related to low adrenaline, high CGRP, and systemic hyperdynamics but not to indicators of the activated vasoconstrictor systems (noradrenaline...

  6. Radial arterial compliance measurement by fiber Bragg grating pulse recorder.

    Science.gov (United States)

    Sharath, U; Shwetha, C; Anand, K; Asokan, S

    2014-12-01

    In the present work, we report a novel, in vivo, noninvasive technique to determine radial arterial compliance using the radial arterial pressure pulse waveform (RAPPW) acquired by fiber Bragg grating pulse recorder (FBGPR). The radial arterial compliance of the subject can be measured during sphygmomanometric examination by the unique signatures of arterial diametrical variations and the beat-to-beat pulse pressure acquired simultaneously from the RAPPW recorded using FBGPR. This proposed technique has been validated against the radial arterial diametrical measurements obtained from the color Doppler ultrasound. Two distinct trials have been illustrated in this work and the results from both techniques have been found to be in good agreement with each other.

  7. Elevated arterial compliance in patients with cirrhosis is not related to arterial endothelin-1

    DEFF Research Database (Denmark)

    Møller, Søren; Gülberg, V; Becker, Povl Ulrik

    2002-01-01

    study was to investigate a potential relation between altered arterial compliance and arterial ET-1 in patients with cirrhosis. As ET-1 may be manipulated by somastostatin, the study includes infusion of octreotide in a subset of patients. METHODS: A total of 67 patients with cirrhosis and 27 controls...... (P relationships could be established between arterial compliance and arterial ET-1 (r = -0.15 to 0.23, ns). Intravenous bolus injection and infusion of octreotide (100 pg + 100 microg/h, n = 9) did...

  8. Arterial compliance measurement using a noninvasive laser Doppler measurement system

    Science.gov (United States)

    Hast, Jukka T.; Myllylae, Risto A.; Sorvoja, Hannu; Nissilae, Seppo M.

    2000-11-01

    The aim of this study was to study the elasticity of the arterial wall using a non-invasive laser Doppler measurement system. The elasticity of the arterial wall is described by its compliance factor, which can be determined when both blood pressure and the radial velocity of the arterial wall are known. To measure radical velocity we used a self- mixing interferometer. The compliance factors were measured from six healthy volunteers, whose ages were varied from 21 to 32. Although a single volunteer's compliance factor is presented as an example, this paper treated the volunteers as a group. First, the elastic modulus, which is inversely proportional to the compliance factor, was determined. Then, an exponential curve was fitted into the measured data and a characteristic equation for the elastic modulus of the arterial wall was determined. The elastic modulus was calculated at different pressures and the results were compared to the static incremental modulus of a dog's femoral artery. The results indicate that there is a correlation between human elastic and canine static incremental modulus for blood pressures varying from 60 to 110 mmHg.

  9. [Alterations in arterial compliance of dyslipidemic patients].

    Science.gov (United States)

    Clara, Fernando Mario; Corral, Pablo; Blanco, Gustavo Hector; Scandurra, Adriana Graciela; Meschino, Gustavo Javier

    2015-01-01

    We studied the alteration on the distensibility of the arterial walls caused by dyslipidemia LDLc dependent, along the decades of life, by means of a study of the radial artery pulse wave. We made an analysis of the radial artery pulse wave records acquired by means a movement displacement sensor, placed on radial palpation area. We recruited 100 dyslipidemic men without other cardiovascular risk factors, between the 3rd and the 6th decade. We identified the reflected wave in the records and we computed the augmentation index in order to quantify its amplitude and position. This index is useful to assess the endothelial dysfunction. Besides, we defined a velocity coefficient as the ratio between the size of the individuals and the delay time between the peak of the systolic wave and the arrival of the reflected wave. Results were compared against those obtained in a group of 161 healthy volunteers. We found that dyslipidemic patients presented augmentation index values similar to controls until the fourth decade, increasing thereafter with significant differences only in the 6th decade. No significant differences were found in the velocity index in any of the ages studied. We conclude that alterations produced by dyslipidemia take decades to manifest, and they begin affecting the mechanism of vasodilation of distal arteries with highest proportion of smooth muscle, without altering the proximal conduit arteries with more elastin content. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  10. Irbesartan improves arterial compliance more than lisinopril

    OpenAIRE

    2009-01-01

    Khalid Ali,1 Chakravarthi Rajkumar,1 Francesco Fantin,2 Rebekah Schiff,3 Christopher J Bulpitt31Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK; 2Department of Geriatrics, University of Verona, Italy; 3Section of Geriatric Medicine, Imperial College School of Medicine, London, UKBackground: Antihypertensive agents can reduce arterial stiffness. We hypothesized that an angiotensin receptor blocker (ARB) irbesartan and an angiotensin converting enzyme inhibit...

  11. Effects of Long Duration Spaceflight on Venous and Arterial Compliance

    Science.gov (United States)

    Ribeiro, L. C.; Lee, S. M. C.; Martin, D. S.; Ploutz-Snyder, R.; Stenger, M. B.; Westby, C. M.; Platts, S. H.

    2014-01-01

    The visual impairment and intracranial pressure syndrome (VIIP) is a newly described space flight-associated medical condition made up of a constellation of symptoms affecting at least 34% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures, and is thought to be related to elevated intracranial pressure secondary to space flightinduced cephalad fluid shifts. Loss of visual acuity could be a significant threat to crew health and performance and may be suggestive of other adaptations with implications for years post-flight. Our primary objective is to determine whether vascular compliance is altered by space flight and whether such adaptations are related to the incidence of VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no space flight experience, in astronauts before, during, and after space flight, and in bed rest subjects with conditions similar to space flight. Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archive to determine which factors might be predictive of the development of VIIP. The project will be conducted in four separate but related parts. To understand the baseline condition of astronauts without any prior space flight experience, we will study 10 astronauts who have never flown in space by performing a comprehensive evaluation of the vasculature of the head, neck and eyes. Hemodynamic data (stroke volume and blood pressure), ocular (tonometry and ocular ultrasound), venous and arterial parameters will be acquired across a range of tilt angles (20, 10, 0, -10, -20 degrees). Vessels to be studied include the temporal, jugular, and vertebral veins and the cerebral, carotid and vertebral arteries. Ophthalmic data from the annual physical will be obtained through data sharing. To examine

  12. Clinical Significance of Evaluating Antihypertensive Effect with Arterial Compliance

    Institute of Scientific and Technical Information of China (English)

    李新立; 倪春辉; 王震震

    2002-01-01

    Objective To evaluate the clinical significance of antihypertensive effect witharterial compliance. Methods In males, 72 cases were control group, 35 cases were EH-controlled,and 35 cases were EH-uncontrolled groups. Blood pressure and arterial compliance (C1 and C2) weredetected by HDI DO-2020. Results In the EH-uncontrolled group,the values of systolic blood pres-sure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP), and pulse pressure(PP) were significantly higher than those of the control and the EH-controlled groups (P<0.01),however ,there was no difference between the control and the EH-controlled groups. In the EH-uncon-trolled group,the values of C1 and C2 were lower tlan those of both the control and the EH-controlledgroups (P<0.01) ,again,with no difference between the control and the EH-controlled groups. Con-clttsion Arterial compliance (C1 and C2) measurements may serve as a sensitive indicator of evalu-ating antihypertensive effect.

  13. Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters.

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    Konala, Bhaskar Chandra; Das, Ashish; Banerjee, Rupak K

    2011-03-15

    Functional diagnostic parameters such as Fractional Flow Reserve (FFR), which is calculated from pressure measurements across stenosed arteries, are often used to determine the functional severity of coronary artery stenosis. This study evaluated the effect of arterial wall-stenosis compliance, with limiting scenarios of stenosis severity, on the diagnostic parameters. The diagnostic parameters considered in this study include an established index, FFR and two recently developed parameters: Pressure Drop Coefficient (CDP) and Lesion Flow Coefficient (LFC). The parameters were assessed for rigid artery (RR; signifying high plaque elasticity), compliant artery with calcified plaque (CC; intermediate plaque elasticity) and compliant artery with smooth muscle cell proliferation (CS; low plaque elasticity), with varying degrees of epicardial stenosis. A hyperelastic Mooney-Rivlin model was used to model the arterial wall and plaque materials. Blood was modeled as a shear thinning, non-Newtonian fluid using the Carreau model. The arterial wall compliance was evaluated using the finite element method. The present study found that, with an increase in stenosis severity, FFR decreased whereas CDP and LFC increased. The cutoff value of 0.75 for FFR was observed at 78.7% area stenosis for RR, whereas for CC and CS the cutoff values were obtained at higher stenosis severities of 81.3% and 82.7%, respectively. For a fixed stenosis, CDP value decreased and LFC value increased with a decrease in plaque elasticity (RR to CS). We conclude that the differences in diagnostic parameters with compliance at intermediate stenosis (78.7-82.7% area blockage) could lead to misinterpretation of the stenosis severity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Fuglsang, S; Bendtsen, F; Christensen, E

    2001-01-01

    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40...... predictors of SV/PP (P compliance is elevated in cirrhosis. A simplified SV/PP index seems to reflect abnormalities in the arterial compliance of these patients....

  15. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Henriksen, J H; Fuglsang, Stefan; Bendtsen, Flemming;

    2001-01-01

    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40...... predictors of SV/PP (P index seems to reflect abnormalities in the arterial compliance of these patients....

  16. An inverse approach to determining spatially varying arterial compliance using ultrasound imaging

    Science.gov (United States)

    Mcgarry, Matthew; Li, Ronny; Apostolakis, Iason; Nauleau, Pierre; Konofagou, Elisa E.

    2016-08-01

    The mechanical properties of arteries are implicated in a wide variety of cardiovascular diseases, many of which are expected to involve a strong spatial variation in properties that can be depicted by diagnostic imaging. A pulse wave inverse problem (PWIP) is presented, which can produce spatially resolved estimates of vessel compliance from ultrasound measurements of the vessel wall displacements. The 1D equations governing pulse wave propagation in a flexible tube are parameterized by the spatially varying properties, discrete cosine transform components of the inlet pressure boundary conditions, viscous loss constant and a resistance outlet boundary condition. Gradient descent optimization is used to fit displacements from the model to the measured data by updating the model parameters. Inversion of simulated data showed that the PWIP can accurately recover the correct compliance distribution and inlet pressure under realistic conditions, even under high simulated measurement noise conditions. Silicone phantoms with known compliance contrast were imaged with a clinical ultrasound system. The PWIP produced spatially and quantitatively accurate maps of the phantom compliance compared to independent static property estimates, and the known locations of stiff inclusions (which were as small as 7 mm). The PWIP is necessary for these phantom experiments as the spatiotemporal resolution, measurement noise and compliance contrast does not allow accurate tracking of the pulse wave velocity using traditional approaches (e.g. 50% upstroke markers). Results from simulations indicate reflections generated from material interfaces may negatively affect wave velocity estimates, whereas these reflections are accounted for in the PWIP and do not cause problems.

  17. Associations of blood pressure and arterial compliance with occupational noise exposure in female workers of textile mill

    Institute of Scientific and Technical Information of China (English)

    NI Chun-hui; ZHANG Yu-jun; CHEN Zhi-yong; ZHOU Yin; ZHOU Jian-wei; Pan Jing-jing; LIU Nian; WANG Jun; LIANG Chen-ke; ZHANG Zhi-zhong

    2007-01-01

    Background There are few studies on the arterial compliance of noise exposure. The purpose of this study was to understand the relationship between hearing loss, blood pressure and arterial compliance of female workers who exposed to occupational noise in a textile mill.Methods The noise levels in the workplace were measured with a HS6288 sound level meter. Cumulated noise exposure (CNE) was calculated according to the noise intensity and the exposure period. Hearing ability and arterial compliance were measured in 618 noise exposed workers. The database was set up with EpiData and the statistical analysis was performed with SAS software 9.1.3.Results The noise levels were 80.1dB(A) to 113.5dB(A), of which the levels at 92.5% of the noise monitoring sites were over the national standard. The incidence of high frequency hearing loss (HFHL) was 24.43% and language frequency hearing impairment (LFHI) was 0.81%. The incidence of hypertension was 7.93%. Both systolic blood pressure (SBP)and diastolic blood pressure (DBP) in the high frequency hearing loss group were significantly higher than those in the normal hearing group (P<0.05), while C1 (large artery compliance) and C2 (small artery compliance) were significantly lower (P<0.05). The high frequency hearing threshold (HFHT) of the hypertension group was significantly higher than in the normal blood pressure group (P<0.05), while C1 and C2 were significantly lower (P<0.05). C1 and C2 had a negative correlation with HFHT, SBP, DBP, mean of arterial pressure (MAP), pulse pressure (PP) and pulse rate (PR) (P<0.05).The multiple regression analyses showed that blood pressure and PR were the main influencing factors on C1 and C2.LFHT was an influence on C2 and HFHT on C1.Conclusions Textile mill noise pollution is very serious and has an obvious influence on worker's auditory function. The female workers with Iow artery compliance or with high blood pressure might be suffering from hearing loss; those with noise

  18. Relation of epicardial adipose tissue with arterial compliance and stiffness in patients with hypertension.

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    Korkmaz, Levent; Cirakoglu, Omer Faruk; Ağaç, Mustafa Tarik; Erkan, Hakan; Korkmaz, Ayca Ata; Acar, Zeydin; Kul, Selim; Hatem, Engin; Çelik, Şükrü

    2014-09-01

    The main aim of the present study was to investigate the association between epicardial adipose tissue (EAT) and arterial function in patients with asymptomatic hypertension. Patients with hypertension (n = 155) were enrolled consecutively. Patients with decreased arterial compliance (AC) and increased cardioankle vascular index (CAVI) had higher EAT values compared with those with normal AC and CAVI (6.23 ± 1.67 vs 4.91 ± 1.40, P arterial function in patients with asymptomatic hypertension. The link between EAT and arterial stiffness deserves further investigation.

  19. Microalbuminuria associated with systolic blood pressure and arterial compliance in Chinese metabolic syndrome patients

    Institute of Scientific and Technical Information of China (English)

    LI Xin-li; XU Qiong; TONG Min; LU Xin-zheng; ZHANG Hai-feng; ZHOU Yan-li; CAO Ke-jiang; HUANG Jun

    2007-01-01

    Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome (MS) patients remains unknown.Methods According to the definition of MS proposed by ATPⅢ in 2001, USA, subjects (n=362) were divided into three groups according to the number of risk factors: group 1 (control), group 2 (medium, < 3 risk factors) and group 3 (MS, ≥ 3 risk factors). Both large artery compliance (C1) and small artery compliance (C2) were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine.Results (1) As C1 and C2 levels elasticity decreased, albumin creatinine ratio (ACR) and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors (all P<0.05). (2) Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. (3) Multivariate regression analysis showed that increased systolic blood pressure (SBP) and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group.Conclusions The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities.Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.

  20. Electrical stimulation alters FMD and arterial compliance in extremely inactive legs

    NARCIS (Netherlands)

    Groot, P.C.E. de; Crozier, J.; Rakobowchuk, M.; Hopman, M.T.E.; MacDonald, M.

    2005-01-01

    PURPOSE: The main aim of the study was to assess the effect and time course of 4 wk of electrically induced leg training on arterial compliance and endothelial function. METHODS: Six spinal cord-injured (SCI) individuals participated in 4 wk of daily one-leg functional electrical stimulation (FES) t

  1. Clinical characteristic of pulse wave velocity and arterial compliance in elderly patients with diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    张红

    2013-01-01

    Objective To explore the clinical characteristics of pulse wave velocity,arterial compliance and cardiovascular risk factors in elderly patients with type 2 diabetes mellitus.Methods A total of 363 patients were selected and divided into 4 groups:diabetic group,diabetic

  2. Association of metabolic syndrome with arterial compliance in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li; MI Jie; LI Ming; JIANG Benyu

    2007-01-01

    The association of metabolic syndrome (MS)with arterial compliance in children and adolescents was explored.337 subjects (188 men and 149 women) aged 6-18 (10.95±3.01) years,out of "Beijing Child Metabolic Syndrome Study",were divided into three ease groups (one component,two components,three & more components of MS) and one control group based on the Cook's MS definition in children and adolescents.Measurements including anthropometry,blood pressure,fasting plasma glucose and insulin,serum lipid profile were done.Homeostasis model assessment for insulin resistance (HOMA-IR) index was calculated for estimating individual insulin resistance.Arterial compliance was measured using digital pulse wave analyzing method from the pulse trace machine (Micro medical,London),and then the stiffness index (SI) was determined.The mean value of SI in MS group was significant higher than that in control group [(7.69±1.63) vs (6.25 + 0.86) m/s,P < 0.01 ].With the increase of the clustering of MS components,SI and HOMA-IR were gradually increased.After taking account of gender,age and pubertal development,the partial correlation analysis showed that the amount of components of MS and HOMA-IR were positively correlated with SI (both P values were less than 0.05).The arterial compliance of MS group was significantly lowered in children and adolescents,and with the increase of the clustering of MS components,arterial compliance was gradually decreased.It was suggested that arterial compliance assessment in children and adolescents was important for early prevention of cardiovascular diseases.

  3. Assessment of arterial stiffness among schizophrenia-spectrum disorders using aortic pulse wave velocity and arterial compliance: a pilot study.

    Science.gov (United States)

    Phillips, Aaron A; Warburton, Darren E R; Flynn, Sean W; Fredrikson, Diane; Lang, Donna J

    2014-01-30

    Cardiovascular disease (CVD) is the leading cause of death in individuals with chronic schizophrenia. Arterial stiffness provides a non-invasive indication of cardiovascular disease risk. To date, arterial stiffness, which has been shown to have independent predictive value for CVD morbidity and mortality, has not been evaluated in this population. We aimed to examine aortic pulse wave velocity (aPWV) as well as large and small artery compliance (Comp1 and Comp2) in patients being treated for schizophrenia, compared to healthy volunteers. Ten patients and 10 age and gendermatched volunteers underwent a comprehensive evaluation of arterial stiffness including: aPWV, Comp1, Comp2, stroke volume, cardiac output, and systemic vascular resistance. Patient aPWV was significantly elevated compared to healthy volunteers (9.1 ± 4.11 vs. 5.7 ± 1.4, P=0.03). Increased age, blood pressure, heart rate, and cigarettes/day were associated with reduced arterial health in patients. This is the first time aPWV has been described in those treated for schizophrenia. Arterial stiffness is increased in this population. Measuring arterial stiffness is a non-invasive, sensitive and effective tool for evaluating CVD risk in this population. © 2013 Published by Elsevier Ireland Ltd.

  4. Arterial hypertension in cirrhosis: arterial compliance, volume distribution, and central haemodynamics

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Fuglsang, S; Bendtsen, F;

    2006-01-01

    were 130 normotensive cirrhotic patients, 19 controls with normal arterial blood pressure and without liver disease, and 16 patients with essential arterial hypertension. All groups underwent haemodynamic investigation with determination of cardiac output (CO), plasma volume (PV), central blood volume...

  5. Screening aortic drug treatments through arterial compliance measurements.

    Science.gov (United States)

    Rentschler, Mark E; Baxter, B Timothy

    2008-10-01

    Abdominal aortic aneurysm (AAA) is a common and deadly problem. The aortic diameter increases in association with a complex remodeling process that includes changes in the structure and content of key proteins, elastin and collagen. As these changes occur, the tissue mechanical properties also change. The natural history of AAA is progressive enlargement to a point of mechanical tissue failure typically followed by death. Currently, the marker used to predict the risk of impending rupture is the largest transverse diameter. After reaching a diameter threshold of 5.5 cm the AAA needs to be surgically repaired. This criterion does not consider any patient-specific information or heterogeneity of the AAA that may, in some cases, lead to rupture before the AAA reaches the standard intervention threshold. Conversely, in many patients, continued observation beyond this threshold is safe. While no medical treatment is yet approved, doxycycline (Doxy) has been shown to greatly reduce AAA growth in animal models and has been shown to slow growth in 1 small clinical trial. While larger prospective randomized trials are needed, one unknown is what effect Doxy has on the structural integrity of the aortic wall. That is, does slowed AAA growth, by Doxy treatment, prevent rupture, or does the wall continue to weaken and the AAA instead ruptures at a smaller diameter? Using an established animal model of AAA, we begun to determine the changes in tissue mechanics compliance of the aorta as the AAA develops. Our current research is focused on verifying that these changes mimic the observed changes seen in the human population as reported by other researchers, so that we can confidently study how potential drug therapies may affect wall strength and compliance in the human population. The long-term objectives are to understand better factors related to progression of AAA and help verify that drug therapy with Doxy will decrease the chance of rupture by preventing wall weakening and

  6. Supervised exercise therapy in the management of peripheral arterial disease - an assessment of compliance.

    Science.gov (United States)

    Aherne, Thomas M; Kheirelseid, Elrasheid A H; Boland, Michael; Carr, Shane; Al-Zabi, Thekra; Bashar, Khalid; Moneley, Daragh; Leahy, Austin; McCaffrey, Noel; Naughton, Peter

    2017-05-01

    Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation. Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews. Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0-31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET. Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.

  7. Acute effects of supramaximal exercise on carotid artery compliance and pulse pressure in young men and women.

    Science.gov (United States)

    Rossow, Lindy; Fahs, Christopher A; Guerra, Myriam; Jae, Sae Young; Heffernan, Kevin S; Fernhall, Bo

    2010-11-01

    The purpose of this study was to determine the cumulative effects of repeated cycling sprints (Wingate tests) on carotid compliance and blood pressure (BP). Fourteen young, healthy men and women completed this study. Vascular and hemodynamic measurements were taken at rest, 5 min following a first Wingate test, 25 min following the first Wingate test, 5 min following a second Wingate test, and 25 min following the second Wingate test. At each time point, the measurements taken included brachial and carotid pulse pressure (PP), heart rate, carotid artery maximum and minimum diameters, and carotid compliance. Carotid BP was obtained with applanation tonometry. Carotid diameters were obtained using ultrasonography and compliance was calculated from carotid diameters and BP. Carotid and brachial PP increased significantly (P sprint, carotid arterial compliance decreased significantly more than 5 min following the first sprint (P sprint reduces carotid artery compliance immediately after exercise. Performance of a second identical cycling sprint further compounds this vascular change, reducing carotid artery compliance beyond levels seen following a single cycling sprint.

  8. Effect of beta-adrenergic blockade on elevated arterial compliance and low systemic vascular resistance in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Henriksen, Jens Henrik Sahl

    2001-01-01

    with beta-blockers, but the effect of this treatment on arterial compliance has not been investigated. The aim of the present study was therefore to assess the effects of propranolol on the arterial compliance of patients with cirrhosis. METHODS: Twenty patients with cirrhosis underwent a haemodynamic......) of 17.8 mmHg, and responded to beta-blocker treatment with a significant reduction in the HVPG (-16%; P beta-adrenergic blockade (1.27 versus 1.29 ml/mmHg, +2%, ns), whereas...... with beta-blockers increases small vessel (arteriolar) vascular tone towards the normal level, but does not affect the elevated compliance of the larger arteries in patients with cirrhosis....

  9. Effects of pressure-dependent segmental arterial compliance and postural changes on pulse wave transmission in an arterial model of the human upper limb.

    Science.gov (United States)

    Xu, Ke; Butlin, Mark; Avolio, Alberto P

    2011-01-01

    With increasing interest in the effect of postural changes on arterial blood pressure and vascular properties, it is important to understand effects of pressure-dependent arterial compliance. This study investigates effects of pressure-dependent compliance on pulse wave velocity (PWVar), pressure wave shape, and transmission characteristics in an arterial model of the human arm from heart to radial artery from supine to standing. Estimated central pressure waveform was used as the input for the model, calculated using a validated transfer function (SphygmoCor, AtCor Medical) from recorded radial pulses in 10 healthy male subjects (53.8 ± 7.9 years) during 0, 30, 60 and 90 degree head-up tilt. A 5-segment linear model was optimized using estimated central and recorded radial arterial pulse; each segment represented by an equivalent inductance, resistance and capacitance (compliance (C)) Pressure-dependent compliance (C(P)=a · e(b · P) was added to develop a nonlinear model, and the radial pulse calculated. Comparison of the radial pulse calculated by the linear and nonlinear models showed no statistical difference in systolic, diastolic, mean, and pulse pressure in any position of tilt. However, waveform shape was increasingly divergent at higher angles of tilt (RMS error 2.3 ± 1.2 mmHg supine, 6.5 ± 3.0 mmHg standing) as was PWVar (0% increase from supine to standing in the linear model, 16.7% increase in nonlinear model). Fourier analysis demonstrated peak amplitude of transmission being at higher frequencies and phase delay being lower in the nonlinear model relative to the linear model. Pressure-dependent arterial compliance, whilst having no effect on peak values of pressure, has significant effects on waveform shape and transmission speed, especially with a more upright position.

  10. Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease

    DEFF Research Database (Denmark)

    Brinch, Kim; Bendtsen, Flemming; Becker, Povl Ulrik;

    2003-01-01

    BACKGROUND/AIMS: The aim of the study was to investigate the effect of a standard albumin load on blood volume distribution, arterial compliance, and the renin-angiotensin-aldosterone system in patients with different degrees of cirrhosis. METHODS: 31 patients with cirrhosis (Child classes A/B/C=...... effective arterial blood volume of such patients, which may be important in the prevention of circulatory dysfunction....

  11. Effects of Long Duration Spaceflight on Venous and Arterial Compliance in Astronants

    Science.gov (United States)

    Platts, Steven; Ribeiro, L. Christine

    2014-01-01

    1. Project Overview Visual impairment and intracranial pressure (VIIP) is a spaceflight-associated medical condition affecting at least a third of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures. In some astronauts, eye-related changes do not revert back to the preflight state upon return to Earth. Our team will study some of the possible causes for this syndrome. This will be achieved by reviewing previous astronaut data for factors that may predispose astronauts to higher rates of developing this syndrome or greater severity of symptoms. Additionally, we will conduct 3 separate experiments that will characterize vessels in the head and neck and measure the effects of the experimental conditions on ocular structures and function. 2. Technical Summary The primary objective of this study is to determine whether vascular compliance is altered by spaceflight and whether such adaptations are related to the incidence of the VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no spaceflight experience (Ground), in astronauts before, during, and after spaceflight (Flight), and in bed rest subjects with conditions similar to spaceflight (Bed Rest). Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archives to determine which factors might be predictive of the development of VIIP (Data Mining). The project will be conducted in four separate, but related parts. Hypothesis The central hypothesis of this proposal is that exposure to the spaceflight environment aboard the ISS may lead to development of the VIIP syndrome (increased intracranial pressure and impaired visual acuity) and that this may be related to alterations in venous and/or arterial compliance in the head and neck. Specific Aims 1. To determine whether

  12. Effects of Long Duration Spaceflight on Venous and Arterial Compliance: Bed Rest

    Science.gov (United States)

    Ribeiro, L. Christine; Platts, Steven H.; Laurie, Steven S.; Lee, Stuart M. C.; Martin, David S.; Ploutz-Snyder, Robert J.; Stenger, Michael B.

    2017-01-01

    The primary objective was to determine whether a high sodium diet during bed rest induced alterations in vascular compliance and was related to the incidence of VIIP. Ocular structural and functional measures and vascular ultrasound of the head and neck were acquired in bed rest subjects completing 10-14 days in 6deg head-down tilt.

  13. High resolution ultrasound and arterial wall changes in early atherosclerosis

    Science.gov (United States)

    Renton, Sophie Caroline

    Non-invasive vascular testing evolved initially to meet the needs of the surgeon to identify haemodynamically significant lesions. However, with refinement of techniques and the development of high resolution ultrasound, it has become possible to detect early lesions and to measure the thickness of die arterial wall with an accuracy of 0.2mm. Such measurements have epidemiological and prognostic potential. They may allow the study of progression (or regression) of atherosclerotic disease before symptoms develop. The aim of this thesis was to assess the value of arterial wall measurements of intima-media thickness and compliance of the common carotid artery in the prediction of early atherosclerotic disease. Four different anatomical patterns of carotid bulb morphology have been identified, according to the position of the bulb origin in relation to the flow divider. It has been demonstrated that bulb morphology influences the site of early plaque formation. The presence of plaque at the carotid and femoral bifurcations was found to be associated with increased intima-media thickening of the common carotid artery. Histological analysis of common carotid arteries taken at post-mortem showed that this diffuse intima-media thickening is the result of deposition of cholesterol crystals, medial atrophy, fatty and fibrous change, and accumulation of necrotic debris, the features characteristic of plaques, even though discrete plaques rarely occur at this site. Subsequently, a number of clinical studies were undertaken which demonstrated that the intima-media thickness is increased in diabetics, hypopituitary patients and claudicants as compared to controls. It was found that the intima-media thickness of the common carotid artery could be used to predict the presence of bifurcation plaques and macrovascular disease. The work of this thesis has demonstrated that high resolution ultrasound is a powerful technique for die study of the arterial wall and should be tested in

  14. Evacuee Compliance Behavior Analysis using High Resolution Demographic Information

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Wei [ORNL; Han, Lee [University of Tennessee, Knoxville (UTK); Liu, Cheng [ORNL; Tuttle, Mark A [ORNL; Bhaduri, Budhendra L [ORNL

    2014-01-01

    The purpose of this study is to examine whether evacuee compliance behavior with route assignments from different resolutions of demographic data would impact the evacuation performance. Most existing evacuation strategies assume that travelers will follow evacuation instructions, while in reality a certain percent of evacuees do not comply with prescribed instructions. In this paper, a comparison study of evacuation assignment based on Traffic Analysis Zones (TAZ) and high resolution LandScan USA Population Cells (LPC) were conducted for the detailed road network representing Alexandria, Virginia. A revised platform for evacuation modeling built on high resolution demographic data and activity-based microscopic traffic simulation is proposed. The results indicate that evacuee compliance behavior affects evacuation efficiency with traditional TAZ assignment, but it does not significantly compromise the efficiency with high resolution LPC assignment. The TAZ assignment also underestimates the real travel time during evacuation, especially for high compliance simulations. This suggests that conventional evacuation studies based on TAZ assignment might not be effective at providing efficient guidance to evacuees. From the high resolution data perspective, traveler compliance behavior is an important factor but it does not impact the system performance significantly. The highlight of evacuee compliance behavior analysis should be emphasized on individual evacuee level route/shelter assignments, rather than the whole system performance.

  15. Atherosclerosis measured by whole body magnetic resonance angiography and carotid artery ultrasound is related to arterial compliance, but not to endothelium-dependent vasodilation - the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study.

    Science.gov (United States)

    Lind, Lars; Andersson, Jessika; Hansen, Tomas; Johansson, Lars; Ahlström, Håkan

    2009-09-01

    Arterial compliance and endothelium-dependent vasodilation are two characteristics of the vessel wall. In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, we studied the relationships between arterial compliance and endothelium-dependent vasodilation versus atherosclerosis as measured with two imaging modalities. In the population-based PIVUS study (1016 subjects aged 70), arterial compliance was determined by ultrasound in the carotid artery and the stroke volume to pulse pressure ratio by echocardiography, while endothelium-dependent vasodilation was assessed by the invasive forearm technique with acetylcholine and brachial artery ultrasound. Intima-media thickness was evaluated by ultrasound in the carotid artery (n = 954). Stenosis in the carotid, aorta, renal, upper and lower leg arteries were determined by magnetic resonance angiography in a random subsample of 306 subjects. After adjustments for gender, Framingham risk score, obesity, myocardial infarction and stroke, distensibility in the carotid artery and the stroke volume to pulse pressure ratio were both significantly related to a weighted index of stenosis in the five arterial territories evaluated by magnetic resonance angiography (p<0.02 for both). Distensibility in the carotid artery (P = 0.021), but not the stroke volume to pulse pressure ratio (P = 0.08), was also significantly related to intima-media thickness. In the elderly population, atherosclerosis is mainly related to arterial compliance, but not to endothelium-dependent vasodilation in peripheral conduit or resistance vessels.

  16. Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography

    Science.gov (United States)

    Haluska, B A; Matthys, K; Fathi, R; Rozis, E; Carlier, S G; Marwick, T H

    2006-01-01

    Objective To seek an association between total arterial compliance (TAC) and the extent of ischaemia at stress echocardiography. Design Cohort study. Setting Regional cardiac centre. Methods 255 consecutive patients (147 men; mean (SD) age 58 (8)) presenting for stress echocardiography for clinical indications were studied. Wall motion score index (WMSI) was calculated and ischaemia was defined by an inducible or worsening wall motion abnormality. Peak WMSI was used to reflect the extent of dysfunction (ischaemia or scar), and ΔWMSI was indicative of extent of ischaemia. TAC was assessed at rest by simultaneous radial applanation tonometry and pulsed wave Doppler in all patients. Results Ischaemia was identified by stress echocardiography in 65 patients (25%). TAC was similar in the groups with negative and positive echocardiograms (1.08 (0.41) v 1.17 (0.51) ml/mm Hg, not significant). However, the extent of dysfunction was associated with TAC independently of age, blood pressure, risk factors, and use of a β blocker. Moreover, the extent of ischaemia was determined by TAC, risk factors, and use of a β blocker. Conclusion While traditional cardiovascular risk factors are strong predictors of ischaemia on stress echocardiography, TAC is an independent predictor of the extent of ischaemia. PMID:16365349

  17. Rationale and methodology of monitoring ambulatory blood pressure and arterial compliance in the Hypertension in the Very Elderly Trial

    OpenAIRE

    2006-01-01

    OBJECTIVE: This article describes the rationale and methodology for the monitoring of ambulatory blood pressure and arterial compliance in hypertensive patients aged 80 years and above. This is a side project of the Hypertension in the Very Elderly Trial. METHODS: The hypertension in the Very Elderly Trial is a multicentre, double-blind, randomized, placebo-controlled trial aiming to investigate the effect of active treatment on cardiovascular and other outcomes in hypertensive patients aged ...

  18. Difficulties in high blood pressure treatment compliance: considerations based on a qualitative study in a primary health care unit Dificuldades de adesão ao tratamento na hipertensão arterial sistêmica: considerações a partir de um estudo qualitativo em uma unidade de Atenção Primária à Saúde

    Directory of Open Access Journals (Sweden)

    Angélica Manfroi

    2010-11-01

    Full Text Available

    Introduction: High blood pressure (HBP is a chronic disease whose control is essential for preventing long-term complications related to cardiovascular mortality and morbidity. The treatment for HBP is based on non-pharmacological and pharmacological measures. Treatment compliance is characterized by the degree of coincidence between medical orientation and patient behavior. On Primary Health Care level there are often difficulties in maintaining a systematic control over the blood pressure of hypertensive patients, probably due to the lack of treatment compliance of these patients. Objective: Assess the factors involved in the difficulty of compliance with anti-hypertensive treatment from the patients’ point of view. Methodology: Qualitative research, with open and semi structured individual interviews with 13 hypertensive adults, enrolled in the Program for Hypertensive Patients of a Primary Health Care Unit in Porto Alegre, Brazil. Results: Factors hampering treatment compliance were: a initial asymptomatic phase; b use of medication only when patients think their blood pressure is high (the increase is associated with symptoms patients believe to be a consequence of HBP such as headache, nausea, or when they “get nervous”; c the idea of cure and abandonment of treatment while, in fact, their blood pressure is but under control; d resistance in taking the medication in a systematic way, making them “dependent”; e side effects of the drugs, such as erectile dysfunction and coughing ; f difficulty in following a hyposodic diet, besides the fact that the relatives have to get used to it as well; g the need for monthly appointments in order to obtain a refill of the medication at the health care unit: h lack of free medication at the health care unit; i some patients feel they are “slaves” of the schedule they have to follow because it is interfering with their daily routine. Conclusion: It is important that the health care

  19. 7 CFR 760.821 - Compliance with highly erodible land and wetland conservation.

    Science.gov (United States)

    2010-01-01

    ... Disaster Program § 760.821 Compliance with highly erodible land and wetland conservation. (a) The highly erodible land and wetland conservation provisions of part 12 of this title apply to the receipt of disaster... participants must be in compliance with the highly erodible land and wetland conservation compliance...

  20. Effect of beta-adrenergic blockade on elevated arterial compliance and low systemic vascular resistance in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Henriksen, Jens Henrik

    2001-01-01

    ) of 17.8 mmHg, and responded to beta-blocker treatment with a significant reduction in the HVPG (-16%; P controls 1.01 ml/mmHg; P ... systemic vascular resistance increased substantially (1083 versus 1378 dyn x s x cm-5, +27%; P blood pressure (-6%; P blood flow (-22%; P ... with beta-blockers increases small vessel (arteriolar) vascular tone towards the normal level, but does not affect the elevated compliance of the larger arteries in patients with cirrhosis....

  1. Porcine radial artery decellularization by high hydrostatic pressure.

    Science.gov (United States)

    Negishi, Jun; Funamoto, Seiichi; Kimura, Tsuyoshi; Nam, Kwangoo; Higami, Tetsuya; Kishida, Akio

    2015-11-01

    Many types of decellularized tissues have been studied and some have been commercially used in clinics. In this study, small-diameter vascular grafts were made using HHP to decellularize porcine radial arteries. One decellularization method, high hydrostatic pressure (HHP), has been used to prepare the decellularized porcine tissues. Low-temperature treatment was effective in preserving collagen and collagen structures in decellularized porcine carotid arteries. The collagen and elastin structures and mechanical properties of HHP-decellularized radial arteries were similar to those of untreated radial arteries. Xenogeneic transplantation (into rats) was performed using HHP-decellularized radial arteries and an untreated porcine radial artery. Two weeks after transplantation into rat carotid arteries, the HHP-decellularized radial arteries were patent and without thrombosis. In addition, the luminal surface of each decellularized artery was covered by recipient endothelial cells and the arterial medium was fully infiltrated with recipient cells.

  2. The relationship of pulmonary vascular resistance and compliance to pulmonary artery wedge pressure during submaximal exercise in healthy older adults

    Science.gov (United States)

    Wright, Stephen P.; Granton, John T.; Esfandiari, Sam; Goodman, Jack M.

    2016-01-01

    Key points A consistent inverse hyperbolic relationship has been observed between pulmonary vascular resistance and compliance, although changes in pulmonary artery wedge pressure (PAWP) may modify this relationship.This relationship predicts that pulmonary artery systolic, diastolic and mean pressure maintain a consistent relationship relative to the PAWP.We show that, in healthy exercising human adults, both pulmonary vascular resistance and compliance decrease in relation to exercise‐associated increases in PAWP.Pulmonary artery systolic, diastolic and mean pressures maintain a consistent relationship with one another, increasing linearly with increasing PAWP.Increases in PAWP in the setting of exercise are directly related to a decrease in pulmonary vascular compliance, despite small decreases in pulmonary vascular resistance, thereby increasing the pulsatile afterload to the right ventricle. Abstract The resistive and pulsatile components of right ventricular afterload (pulmonary vascular resistance, Rp; compliance, Cp) are related by an inverse hyperbolic function, expressed as their product known as RpCp‐time. The RpCp‐time exhibits a narrow range, although it may be altered by the pulmonary artery wedge pressure (PAWP). Identifying the determinants of RpCp‐time should improve our understanding of the physiological behaviour of pulmonary arterial systolic (PASP), diastolic (PADP) and mean (mPAP) pressures in response to perturbations. We examined the effect of exercise in 28 healthy non‐athletic adults (55 ± 6 years) who underwent right heart catheterization to assess haemodynamics and calculate Rp and Cp. Measurements were made at rest and during two consecutive 8–10 min stages of cycle ergometry, at targeted heart‐rates of 100 beats min–1 (Light) and 120 beats min–1 (Moderate). Cardiac output increased progressively during exercise. PASP, PADP, mPAP and PAWP increased for Light exercise, without any further rise for Moderate

  3. Localization of relaxin receptors in arteries and veins, and region-specific increases in compliance and bradykinin-mediated relaxation after in vivo serelaxin treatment.

    Science.gov (United States)

    Jelinic, Maria; Leo, Chen-Huei; Post Uiterweer, Emiel D; Sandow, Shaun L; Gooi, Jonathan H; Wlodek, Mary E; Conrad, Kirk P; Parkington, Helena; Tare, Marianne; Parry, Laura J

    2014-01-01

    Relaxin is a potent vasodilator of small resistance arteries and modifies arterial compliance in some systemic vascular beds, yet receptors for relaxin, such as RXFP1, have only been localized to vascular smooth muscle. This study first aimed to localize RXFP1 in rat arteries and veins from different organ beds and determine whether receptors are present in endothelial cells. We then tested the hypothesis that region-specific vascular effects of relaxin may be influenced by the cellular localization of RXFP1 within different blood vessels. The aorta, vena cava, mesenteric artery, and vein had significantly higher (Pdifferential distribution of RXFP1 on endothelial and smooth muscle across the vasculature. In rats, mesenteric arteries exhibit the greatest functional response to chronic serelaxin treatment.

  4. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of...

  5. Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices.

    Science.gov (United States)

    Sickbert-Bennett, Emily E; DiBiase, Lauren M; Willis, Tina M Schade; Wolak, Eric S; Weber, David J; Rutala, William A

    2016-09-01

    Improving hand hygiene from high to very high compliance has not been documented to decrease healthcare-associated infections. We conducted longitudinal analyses during 2013-2015 in an 853-bed hospital and observed a significantly increased hand hygiene compliance rate (p<0.001) and a significantly decreased healthcare-associated infection rate (p = 0.0066).

  6. 75 FR 417 - Certificate of Alternative Compliance for the High Speed Ferry SUSITNA

    Science.gov (United States)

    2010-01-05

    ... of Alternative Compliance for the High Speed Ferry SUSITNA AGENCY: Coast Guard, DHS. ACTION: Notice... speed ferry SUSITNA as required by 33 U.S.C. 1605(c) and 33 CFR 81.18. DATES: The Certificate of... and 89, has been issued for the high speed ferry SUSITNA, O.N. 1189367. Full compliance with 72...

  7. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

    Energy Technology Data Exchange (ETDEWEB)

    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

    2017-06-15

    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  8. An Evaluation of the High-Probability Instruction Sequence with and without Programmed Reinforcement for Compliance with High-Probability Instructions

    Science.gov (United States)

    Zuluaga, Carlos A.; Normand, Matthew P.

    2008-01-01

    We assessed the effects of reinforcement and no reinforcement for compliance to high-probability (high-p) instructions on compliance to low-probability (low-p) instructions using a reversal design. For both participants, compliance with the low-p instruction increased only when compliance with high-p instructions was followed by reinforcement.…

  9. Environmental permit tracking and compliance: Central Artery/Tunnel Project, Boston, MA

    Energy Technology Data Exchange (ETDEWEB)

    Forbush, L. (BSC Group, Boston, MA (United States))

    1993-01-01

    The Central Artery/Tunnel (CA/T) Project in Boston, Massachusetts involves the replacement of the existing I-93 interstate highway (Central Artery) and the extension of I-90 (Massachusetts Turnpike) to Logan International Airport. To date, approximately 95 environmental and related permits have been obtained for the CA/T Project. At least 200 permits from federal, state and local regulatory agencies will be acquired for the entire Project. The proposed action includes construction activities and permanent structures related to the crossing of three bodies of water: Charles River, Fort Point Channel, and Boston Inner Harbor. The Project also includes work in Massachusetts filled tidelands, relocation or construction of outfalls, disposition of construction dewatering and tunnel drainage fluids, and capping of an abandoned landfill. The number of permits, interrelationships between permits and interfaces with design and construction schedules have necessitated the development and implementation of a permit tracking system. The system tracks permit applications from preparation through public and agency review to permit issuance. The issues are discussed in detail: Phased development of the tracking system; Utilization of Project standard scheduling system software, Primavera Project Planner; How the information generated by the tracking system is used at the Project; Report format and production; Construction phase services and the multidiscipline, integrated Project schedule.

  10. Compliance with adjuvant treatment guidelines in endometrial cancer: room for improvement in high risk patients.

    Science.gov (United States)

    Eggink, F A; Mom, C H; Boll, D; Ezendam, N P M; Kruitwagen, R F P M; Pijnenborg, J M A; van der Aa, M A; Nijman, H W

    2017-08-01

    Compliance of physicians with guidelines has emerged as an important indicator for quality of care. We evaluated compliance of physicians with adjuvant therapy guidelines for endometrial cancer patients in the Netherlands in a population-based cohort over a period of 10years. Data from all patients diagnosed with endometrial cancer between 2005 and 2014, without residual tumor after surgical treatment, were extracted from the Netherlands Cancer Registry (N=14,564). FIGO stage, grade, tumor type and age were used to stratify patients into risk groups. Possible changes in compliance over time and impact of compliance on survival were assessed. Patients were stratified into low/low-intermediate (52%), high-intermediate (21%) and high (20%) risk groups. Overall compliance with adjuvant therapy guidelines was 85%. Compliance was highest in patients with low/low-intermediate risk (98%, no adjuvant therapy indicated). The lowest compliance was determined in patients with high risk (61%, external beam radiotherapy with/without chemotherapy indicated). Within this group compliance decreased from 64% in 2005-2009 to 57% in 2010-2014. In high risk patients with FIGO stage III serous disease compliance was 55% (chemotherapy with/without radiotherapy indicated) and increased from 41% in 2005-2009 to 66% in 2010-2014. While compliance of physicians with adjuvant therapy guidelines is excellent in patients with low and low-intermediate risk, there is room for improvement in high risk endometrial cancer patients. Eagerly awaited results of ongoing randomized clinical trials may provide more definitive guidance regarding adjuvant therapy for high risk endometrial cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. High success rate after arterial renal embolisation

    DEFF Research Database (Denmark)

    Thorlund, Mie Gaedt; Egge Wennevik, Gjertrud; Andersen, Margrethe

    2015-01-01

    INTRODUCTION: The objective of this study was to present patients who underwent either elective or acute renal embolisation in a single centre where embolisation was available at all hours. METHODS: The records of all patients who underwent transcatheter arterial embolisation (TAE) at Odense Univ...

  12. High success rate after arterial renal embolisation

    DEFF Research Database (Denmark)

    Thorlund, Mie Gaedt; Wennevik, Gjertrud Egge; Andersen, Margrethe;

    2015-01-01

    INTRODUCTION: The objective of this study was to present patients who underwent either elective or acute renal embolisation in a single centre where embolisation was available at all hours. METHODS: The records of all patients who underwent transcatheter arterial embolisation (TAE) at Odense...... University Hospital from October 2010 to July 2013 were extracted retrospectively and examined to determine the indication for treatment, procedural details and complications. Patients were divided into four groups: renal cancer, trauma, angiomyolipoma (AML) and others. When there was indication...... for embolisation, a renal angiography was performed and followed by embolisation, if possible. The procedure was performed in local analgesia via the common femoral artery and as a super-selective procedure to save as many viable nephrons as possible. The most commonly used embolisation materials were coils...

  13. Study effective factors on customer compliance in high contact services based on Bandura social - Cognitive theory

    OpenAIRE

    zahra asadi; bahman hajipour

    2014-01-01

    In today's competitive world, all market participants ranging from individuals, organizations should be looking for ways to success in the market. The secret to success high contact service providers as important part of market participants is, compliance and follow customers of high contact service providers the instructions and guidance. In this paper, a model based on Bandura social - Cognitive theory has Provided to customer compliance . According Bandura social - Cognitive theory and t...

  14. A CASE REPORT ON HIGH ORIGIN OF RADIAL ARTERY

    Directory of Open Access Journals (Sweden)

    Vaishali Bondage

    2014-09-01

    Full Text Available Background: The use of radial artery (RA as an access to heart and for other procedures and surgeries make it significant. The context and purpose: The RA is a common access port for coronary angiography (CAG, percutaneous coronary intervention (PCI, and coronary artery bypass graft Surgery (CABG, RA cannulation, along with others. Results: In this case report, we want to present a case of unilateral high origin of RA arising as branch of brachial artery in the proximal 1/3rd of arm. Conclusions, brief summary and potential implications: Misdiagnosis, complications during medical procedures and increased possibility of injury are the most common dangers of having a superficial RA.

  15. Relations between a novel, reliable, and rapid index of arterial compliance (PP-HDI) and well-established inidices of arterial blood pressure (ABP) in a sample of hypertensive elderly subjects.

    Science.gov (United States)

    Bergamini, L; Finelli, M E; Bendini, C; Ferrari, E; Veschi, M; Neviani, F; Manni, B; Pelosi, A; Rioli, G; Neri, M

    2009-01-01

    Hypertension is a risk factor for a long-lasting arterial wall-remodelling leading to stiffness. The rapid method measuring the pulse pressure (PP) by means of the tool of Hypertension Diagnostic Instruments (HDI) called PP-HDI, overcomes some of the problems arising with more-time consuming methods, like ambulatory blood pressure monitoring (ABPM), and give information about the elasticity of the arterial walls. We studied the relationship between the PP-HDI, the large artery compliance (LA-C) and small artery compliance (SA-C) and few well-established indices of arterial blood pressure (ABP) in a sample of 75 hypertensive subjects, aged 65 years and over. Significant correlations between LA-C and heart rate (HR), PP-ABPM and PP-HDI were found. SA-C relates with HR and systolic blood pressure (SBP) measured in lying and standing positions. Applying a stepwise regression analysis, we found that LA-C variance stems from PP-HDI and HR, while SA-C variance stems from SBP in lying position. Receiver operator characteristic (ROC) curves for thresholds of PP showed that PP-HDI reached levels of sensitivity/specificity similar to PP-ABPM. In conclusion, surveillance of ABP through hemo-dynamic indices, in particular of SBP, is essential, nevertheless the advantage of this control is not known in an elderly population where the organ damage is already evident. PP needs necessarily an instrumental measurement. The PP-HDI result is similar in reliability with respect to PPABPM, but is more rapid and well applicable in an elderly population.

  16. Heart and Artery Damage and High Blood Pressure

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More How High Blood Pressure Can Lead to a Heart Attack Updated:Dec ... sheet This content was last reviewed October 2016. High Blood Pressure • Home • Get the Facts About HBP • Know Your ...

  17. Low Compliance to Handwashing Program and High Nosocomial Infection in a Brazilian Hospital

    Directory of Open Access Journals (Sweden)

    Lizandra Ferreira de Almeida e Borges

    2012-01-01

    Full Text Available Background. It is a fact that hand hygiene prevents nosocomial infection, but compliance with recommended instructions is commonly poor. The purpose of this study was to implement a hand hygiene program for increase compliance with hand hygiene and its relationship with nosocomial infection (NI and MRSA infection/colonization rates. Methods. Compliance to hand hygiene was evaluated in a hospital by direct observation and measured of health care-associated infections, including methicillin resistant Staphylococcus aureus, before and after an educational intervention, using visual poster, colorful stamps, and feedback of the results. Results. Overall compliance did not increase during intervention, only handwashing before and after patient contact has improved from 40% to 76% (=0.01 for HCWs, but NI and MRSA rates remained high and stable. Conclusion. In a combination of high prevalence of NI and low compliance to hand hygiene, the programme of measure does not motivate the HCW hand hygiene. Future interventions should employ incremental evaluation to develop effective hand hygiene initiatives.

  18. Anxiety and compliance among women at high risk for breast cancer.

    Science.gov (United States)

    Lindberg, N M; Wellisch, D

    2001-01-01

    The aim of this study was to investigate the association between symptoms of depression and general anxiety, patient's feelings of vulnerability to cancer, the anxiety experienced specifically in relation to various cancer-screeningprocedures, and compliance with these procedures among women atfamilial risk for breast cancer The data were obtained from 430 patients from the High Risk Clinic at the UCLA Revlon Breast Center who completed the State-Trait Anxiety Inventory and answered questions about their perceived vulnerability to breast cancer; the anxiety they experienced regarding undergoing pap smear tests, mammograms, and breast self-examinations (BSEs); and their compliance with these cancer-screening procedures. Correlations were used to estimate the association between feelings of anxiety and compliance. We found that women attending programs targeting those at familial risk for breast cancer suffer from significant symptoms of general anxiety. General anxiety was found to be related to anxiety regarding specific screening practices but not to women's perceived vulnerability to cancer In general, neither general nor screening-specific anxiety were found to be related to patients 'compliance with screening practices; however, significant associations were found between patient's feelings of anxiety regarding BSEs and their actual performing them. BSE appears to be the only procedure for which compliance is negatively associated with procedure-specific anxiety. We offer possible explanations for this relation and discuss the possible psychological impact that recommendations regarding BSEs may have on highly anxious at-risk women.

  19. 7 CFR 1412.68 - Compliance with highly erodible land and wetland conservation provisions.

    Science.gov (United States)

    2010-01-01

    ... and wetland conservation provisions. The provisions of part 12 of this title apply to this part. ... 7 Agriculture 10 2010-01-01 2010-01-01 false Compliance with highly erodible land and wetland conservation provisions. 1412.68 Section 1412.68 Agriculture Regulations of the Department of...

  20. Antecedents of Compliance in 2-Year-Olds From a High-Risk Sample.

    Science.gov (United States)

    Erickson, Martha Farrell; Crichton, Leslie

    In order to identify antecedents of infant's compliance with mothers' directions on how to solve four tasks (graded in terms of stressfulness to the infant), 194 high-risk mothers and their 2-year-old children were observed on videotape and assessed with a six-point rating scale. Data collected prenatally and postnatally at 3, 6, 12 and 18 months…

  1. Level of arterial ligation in rectal cancer surgery: Low tie preferred over high tie. A review

    NARCIS (Netherlands)

    M.M. Lange (Marilyne); M. Buunen (Mark); C.J.H. van de Velde (Cornelis)

    2008-01-01

    textabstractConsensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just cau

  2. Compliance Framing - Framing Compliance

    OpenAIRE

    Lutz-Ulrich Haack; Martin C. Reimann

    2012-01-01

    Corporations have to install various organizational measures to comply with legal as well as internal guidelines systematically. Compliance management systems have the challenging task to make use of an internal compliance-marketing approach in order to ensure not only an adequate but also effective compliance-culture. Compliance-literature and findings of persuasive goal-framing-theory give opposite implications for establishing a rather values- versus rule-based compliance-culture respectiv...

  3. Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

    Directory of Open Access Journals (Sweden)

    Michael Kelly

    2008-11-01

    Full Text Available A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA and Magnetic resonance angiogram (MRA demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was treated with heparin prior to starting warfarin. He made a partial recovery and was discharged to a rehabilitation facility. This case is a reminder of carotid dissection as an uncommon but serious complication of high speed motor vehicle accident, which may be silent initially. Literature Review suggests risk stratification before relevant radiological screening at risk patients. Significant advances in CTA have made it the diagnostic tool of choice, but ultrasound is an important screening tool.

  4. Compliance with High-Intensity Radiated Fields Regulations - Emitter's Perspective

    Science.gov (United States)

    Statman, Joseph; Jamnejad, Vahraz; Nguyen, Lee

    2012-01-01

    NASA's Deep Space Network (DSN) uses high-power transmitters on its large antennas to communicate with spacecraft of NASA and its partner agencies. The prime reflectors of the DSN antennas are parabolic, at 34m and 70m in diameter. The DSN transmitters radiate Continuous Wave (CW) signals at 20 kW - 500 kW at X-band and S-band frequencies. The combination of antenna reflector size and high frequency results in a very narrow beam with extensive oscillating near-field pattern. Another unique feature of the DSN antennas is that they (and the radiated beam) move mostly at very slow sidereal rate, essentially identical in magnitude and at the opposite direction of Earth rotation.The DSN is in the process of revamping its documentation to provide analysis of the High Intensity Radiation Fields (HIRF) environment resulting from radio frequency radiation from DSN antennas for comparison to FAA regulations regarding certification of HIRF protection as outlined in the FAA regulations on HIRF protection for aircraft electrical and electronic systems (Title 14, Code of Federal Regulations (14 CFR) [section sign][section sign] 23.1308, 25.1317, 27.1317, and 29.1317).This paper presents work done at JPL, in consultation with the FAA. The work includes analysis of the radiated field structure created by the unique DSN emitters (combination of transmitters and antennas) and comparing it to the fields defined in the environments in the FAA regulations. The paper identifies areas that required special attention, including the implications of the very narrow beam of the DSN emitters and the sidereal rate motion. The paper derives the maximum emitter power allowed without mitigation and the mitigation zones, where required.Finally, the paper presents summary of the results of the analyses of the DSN emitters and the resulting DSN process documentation.

  5. Giant, Dissecting, High-Pressure Pulmonary Artery Aneurysm

    Science.gov (United States)

    Smalcelj, Anton; Brida, Vojtjeh; Samarzija, Miroslav; Matana, Ante; Margetic, Eduard; Drinkovic, Niksa

    2005-01-01

    We report the rare subchronic clinical course of a giant, dissecting pulmonary artery aneurysm in an oligosymptomatic middle-aged woman who had idiopathic pulmonary hypertension. Diagnosis was simple with the use of echocardiography and multislice computed tomography. Conversely, deciding on the treatment was difficult, because prominent surgeons declined to perform surgical repair of the aneurysm and recommended heart–lung transplantation. Therefore, we were forced to treat our patient medically. She survived for 1 year, including 8 months of treatment with sildenafil, and then died suddenly while awaiting transplantation. Our patient, who had a dissecting, high-pressure pulmonary artery aneurysm, had an unexpectedly stable and uneventful clinical course for 1 year, which, under more favorable circumstances, might have provided enough time for heart–lung transplantation to be performed. PMID:16429912

  6. Long-term use of first-line highly active antiretroviral therapy is not associated with carotid artery stiffness in human immunodeficiency virus-positive patients

    Directory of Open Access Journals (Sweden)

    Haohui Zhu

    2014-09-01

    Full Text Available Objective: To evaluate whether or not highly active antiretroviral therapy is associated with carotid artery stiffness in human immunodeficiency virus-positive patients in Henan Province, China. Method: Fifty human immunodeficiency virus-positive patients with at least a 5-year history of highly active antiretroviral therapy use and 50 human immunodeficiency virus-positive patients without a history of highly active antiretroviral therapy use were enrolled in this study. Carotid artery intima-media thickness and stiffness were determined by quantitative inter-media thickness and quantitative artery stiffness, respectively. Results: No statistically significant difference in carotid artery intima-media thickness and stiffness was observed between groups. A significant association between human immunodeficiency virus infection time and carotid artery stiffness was observed, but no significant association between human immunodeficiency virus infection time and intima-media thickness was found. No significant association between intima-media thickness, stiffness, and CD4+ and CD8+ T-cell counts were observed. Conclusion: The first-line highly active antiretroviral therapy currently used in China is not associated with carotid artery stiffness in human immunodeficiency virus-positive patients with good highly active antiretroviral therapy compliance. Human immunodeficiency virus may play a role in the development of atherosclerosis.

  7. Accessory brachialis muscle associated with high division of brachial artery

    Directory of Open Access Journals (Sweden)

    Krishnamurthy A

    2010-10-01

    Full Text Available During routine dissection for the undergraduate students in the Department of Anatomy, Kasturba Medical College, Mangalore, of a male cadaver aged 73 years, we encountered an additional slip of brachialis muscle taking origin in the flexor compartment of left arm and inserting into the forearm. The origin of the additional muscle belly was from the anteromedial surface of shaft and medial supracondylar ridge of lower end of humerus. The additional muscle slip merged with the tendon of pronator teres before inserting on the lateral surface of the shaft of radius. The median nerve pierced the muscle at a distance of 6 cm from the medial epicondyle of humerus, supplied it and had a routine course later. Associated with the muscular abnormality was the high division of brachial artery into radial and ulnar arteries 17.5 cm from the medial epicondyle. The ulnar artery passed beneath the accessory brachialis muscle along with the median nerve. The role of additional muscles in compression syndrome is a well known phenomenon. The altered anatomy of the blood vessels may make them more vulnerable to trauma and to hemorrhage but at the same time more accessible for cannulation. Medical fraternity including orthopedicians and neurologists need to be aware of such variations when dealing with upper limb injuries or operations around the elbow joint.

  8. Apoyo familiar en el apego al tratamiento de la hipertensión arterial esencial Family support and drug therapy compliance in essential hypertension

    Directory of Open Access Journals (Sweden)

    Florentina Marín-Reyes

    2001-08-01

    Full Text Available Objetivo. Determinar la asociación entre apoyo familiar (AF y apego al tratamiento de la hipertensión arterial esencial (HAS. Material y métodos. Estudio de casos y controles al que se integraron 80 sujetos con diagnóstico establecido de HAS, con 40 pacientes en cada grupo. Se consideró como casos a los pacientes con apego y como controles a los pacientes sin apego al tratamiento. El estudio se realizó de mayo a diciembre de 1999, en el Hospital Regional del IMSS, en la ciudad de Durango, Durango, México. La edad, género, duración de la HAS, escolaridad y estado civil fueron criterios de pareamiento. Las diferencias se establecieron con las pruebas ji cuadrada y t de student. Se calculó la razón de momios para estimar la fuerza de asociación. El diagnóstico de hipertensión arterial secundaria, o de otras enfermedades crónicas fueron criterios de exclusión. Resultados. No hubo diferencias entre los grupos respecto a las variables sociodemográficas, modalidad de tratamiento ni conocimiento que el enfermo tenía sobre su enfermedad. Tenían control de la presión arterial 31 (77.5% pacientes con apego y 11 (27.5% sin apego, p= 0.003. El AF se asoció de manera independiente con apego al tratamiento, RM 6.9, IC 95% 2.3-21.1. Conclusiones. El apego se vincula de forma significativa con el apoyo que los familiares otorgan al enfermo. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.htmlObjective. To assess the relationship between family support and drug therapy compliance in essential hypertension. Material and methods. A case-control study was conducted between May and December 1999, at Mexican Institute of Social Security Regional Hospital in Durango, among 80 hypertensive subjects; 40 were cases and 40 controls. Cases were subjects who complied with drug therapy and controls were those who did not, matched by age, gender, schooling, hypertensive disease duration, and marital status

  9. High speed intravascular photoacoustic imaging of atherosclerotic arteries (Conference Presentation)

    Science.gov (United States)

    Piao, Zhonglie; Ma, Teng; Qu, Yueqiao; Li, Jiawen; Yu, Mingyue; He, Youmin; Shung, K. Kirk; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2016-02-01

    Cardiovascular disease is the leading cause of death in the industrialized nations. Accurate quantification of both the morphology and composition of lipid-rich vulnerable atherosclerotic plaque are essential for early detection and optimal treatment in clinics. In previous works, intravascular photoacoustic (IVPA) imaging for detection of lipid-rich plaque within coronary artery walls has been demonstrated in ex vivo, but the imaging speed is still limited. In order to increase the imaging speed, a high repetition rate laser is needed. In this work, we present a high speed integrated IVPA/US imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A miniature catheter with 1.0 mm outer diameter was designed with a 200 μm multimode fiber and an ultrasound transducer with 45 MHz center frequency. The fiber was polished at 38 degree and enclosed in a glass capillary for total internal reflection. An optical/electrical rotary junction and pull-back mechanism was applied for rotating and linearly scanning the catheter to obtain three-dimensional imaging. Atherosclerotic rabbit abdominal aorta was imaged as two frame/second at 1725 nm. Furthermore, by wide tuning range of the laser wavelength from 1680 nm to 1770 nm, spectroscopic photoacoustic analysis of lipid-mimicking phantom and an human atherosclerotic artery was performed ex vivo. The results demonstrated that the developed IVPA/US imaging system is capable for high speed intravascular imaging for plaque detection.

  10. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most......Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release...

  11. Insulin resistance and associated dysfunction of resistance vessels and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2005-01-01

    vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counterregulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of vasopressin), and resistance to vasopressors. The vasodilatory state is mediated through adrenomedullin...

  12. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...... likely includes the combination of vasodilatation and vasoconstriction in parallel. Arterial compliance; Central vascular filling; Chyperdynamic circulation; Kidney function, Nitric oxide; Blood pressure regulation; Renin–angiotensin–aldosterone system; Sympathetic nervous system; Vasodilatation...

  13. Symptomatic isolated middle cerebral artery dissection: High resolution MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Byon, Jung Hee; Kwak, Hyo Sung; Chung, Gyung Ho; Hwang, Seung Bae [Dept. of Radiology, Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2015-11-15

    To perform high-resolution magnetic resonance imaging (HRMRI) and determine clinical features of patients with acute symptomatic middle cerebral artery (MCA) dissection. Thirteen patients with acute symptomatic MCA dissection underwent HRMRI within 3 days after initial clinical onset. They also underwent routine brain MR imaging. HRMRI examinations included time-of-flight MR angiography (MRA), T2-weighted, T1-weighted, proton-density-weighted, and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences. Conventional angiography and MRA were used as reference standard to establish the diagnosis of MCA dissection. The angiographic findings and HRMRI findings such as intimal flap, double lumen, and intramural hematoma were analyzed in this study. All patients presented cerebral ischemia (median National Institutes of Health Stroke Scale score = 4, range = 0-18). String sign was seen on MRA in seven patients. However, double lumen was seen in all patients on HRMRI by intimal flap. High signal lesion on MPRAGE sequences around the dissection lumen due to intramural hematoma was seen in three patients. HRMRI can be used to easily detect the wall structure of MCA such as the intimal flap and double lumen in patients with acute symptomatic MCA dissection. MPRAGE can detect hemorrhage in false lumen of MCA dissection.

  14. High origin of a testicular artery: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Spyridakis Ioannis

    2011-02-01

    Full Text Available Abstract Introduction Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance. Case presentation We report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery. Conclusions A knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

  15. A adesão ao tratamento na hipertensão arterial: análise da produção científica Compliance in antihypertensive therapy: analyses in scientific articles

    Directory of Open Access Journals (Sweden)

    Leila Maria Mansano Sarquis

    1998-12-01

    Full Text Available O estudo teve como objetivo avaliar a produção científica publicada entre 1991 e 1995, para identificar como o assunto adesão ao tratamento anti-hipertensivo vem sendo abordado. Foram analisados 107 artigos científicos. Os resultados mostraram que a adesão foi abordada da seguinte maneira: 68% relacionaram ao paciente, 63% ao tratamento farmacológico, 62% a aspectos gerais, 39% ao tratamento não farmacológico, 34% a fatores institucionais, e 8% relativos à, doença. A adesão ao tratamento anti-hipertensivo tem sido um desafio no controle da hipertensão arterial e conhecer como este assunto está sendo enfocado na literatura pode contribuir para aumentar adesão ao tratamento na hipertensão arterial.The aim of this study was to evaluate scientific articles published between 1991-1995, in order to identify the compliance in antihypertensive therapy. One hundred seven scientific articles were evaluated. The results showed that 68% were related to patient, 63% to pharmacological treatment, 62% general, 39% non pharmacological treatment, 34% organizational factors, and 8% related to desease. Compliance with antihypertensive therapy was the major challenge of hypertension management and to know how this aspect was focalized in scientific articles possible reduce non compliance in hypertension.

  16. Small arteries can be accurately studied in vivo, using high frequency ultrasound

    DEFF Research Database (Denmark)

    Nielsen, T H; Iversen, Helle Klingenberg; Tfelt-Hansen, P

    1993-01-01

    We have validated measurements of diameters of the superficial temporal artery and other small arteries in man with a newly developed 20 MHz ultrasound scanner with A, B and M-mode imaging. The diameter of a reference object was 1.202 mm vs. 1.205 mm as measured by stereomicroscopy (nonsignifican......-gauge plethysmography (nonsignificant). Pulsations were 4.6% in the radial artery. We conclude that high frequency ultrasound provides an accurate and reproducible measure of the diameter of small and medium sized human arteries in vivo....

  17. Effect of frailty syndrome on treatment compliance in older hypertensive patients

    Directory of Open Access Journals (Sweden)

    Chudiak A

    2017-05-01

    Full Text Available Anna Chudiak, Beata Jankowska-Polańska, Izabella Uchmanowicz Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Background: Frailty syndrome (FS is an important problem in older persons. It may develop concomitantly to many aging-related diseases, including arterial hypertension, and exerts detrimental effects on both their outcomes and treatment compliance.Objective: To analyze the effect of FS on treatment compliance in older hypertensive patients.Materials and methods: This study of 300 hypertensive patients (167 women and 133 men aged between 65 and 91 years (mean 71.75±7.79 years was based on the analysis of medical documentation and survey with the Tilburg Frailty Indicator (TFI and Hill-Bone High Blood Pressure Compliance Scale.Results: Mean systolic and diastolic blood pressure values of the study subjects were 141.97 and 85.16 mm Hg, respectively. Mean time elapsed since the diagnosis of arterial hypertension was 13.74 years. FS was diagnosed in 65.67% of the study subjects. Mean global score of the Hill-Bone High Blood Pressure Compliance Scale was 20.75 points. TFI scores correlated significantly with the global score of the Hill-Bone High Blood Pressure Compliance Scale (R=0.509, P<0.001 and the values of its 2 subscales: Appointment Keeping (R=0.34, P<0.001 and Medication Taking (R=0.537, P<0.001.Conclusion: FS exerts a significant effect on treatment compliance of older hypertensive patients. Treatment compliance is modulated by patients’ sex (worse compliance in men, education (better compliance in subjects with higher education, and TFI scores (worse compliance in patients with FS. Keywords: frailty syndrome, compliance, adherence, arterial hypertension, older age

  18. Effect of treatment temperature on collagen structures of the decellularized carotid artery using high hydrostatic pressure.

    Science.gov (United States)

    Negishi, Jun; Funamoto, Seiichi; Kimura, Tsuyoshi; Nam, Kwangoo; Higami, Tetsuya; Kishida, Akio

    2011-09-01

    Decellularized tissues have attracted a great deal of attention as regenerating transplantation materials. A decellularizing method based on high hydrostatic pressure (HHP) has been developed, and the preparation of many types of decellularized tissues has been investigated, including aorta, cornea, and dermis. The preparation of a small-diameter vascular graft was studied using a carotid artery from the viewpoint of collagen denaturation and leakage. After HHP, the carotid artery was washed at two washing temperatures (37 and 4°C). Histological evaluation, collagen content measurement and circular dichroism (CD) measurement indicated that the washing temperatures clearly affected the collagen structure of the decellularized carotid artery. The amount of collagen decreased in the carotid artery decellularized by HHP washed at 37°C (HHP/37°C). On the other hand, the amount and structure of collagen were preserved in the carotid artery washed at 4°C after HHP (HHP/4°C). In rat carotid artery syngeneic transplantation, the HHP/37°C decellularized carotid artery occluded after 2 weeks, but the HHP/4°C decellularized one did not. These results indicate that collagen denaturation and leakage of the decellularized carotid artery affect the in vivo performance of the carotid artery.

  19. Niflumic Acid Attenuated Pulmonary Artery Tone and Vascular Structural Remodeling of Pulmonary Arterial Hypertension Induced by High Pulmonary Blood Flow In Vivo.

    Science.gov (United States)

    Wang, Kai; Ma, Jianfa; Pang, Yusheng; Lao, Jinquan; Pan, Xuanren; Tang, Qiaoyun; Zhang, Feng; Su, Danyan; Qin, Suyuan; Shrestha, Arnav Prasad

    2015-10-01

    Calcium-activated chloride channels (CaCCs) play a vital role in regulating pulmonary artery tone during pulmonary arterial hypertension (PAH) induced by high blood flow. The role of CaCCs inhibitor niflumic acid (NFA) in vivo during this process requires further investigation. We established the PAH model by abdominal shunt surgery and treated with NFA in vivo. Fifty rats were randomly divided into normal, sham, shunt, NFA group 1 (0.2 mg/kg), and NFA group 2 (0.4 mg/kg). Pathological changes, right ventricle hypertrophy index, arterial wall area/vessel area, and arterial wall thickness/vessel external diameter were analyzed. Then contraction reactions of pulmonary arteries were measured. Finally, the electrophysiological characteristics of pulmonary arterial smooth muscle cells were investigated using patch-clamp technology. After 11 weeks of shunting, PAH developed, accompanied with increased right ventricle hypertrophy index, arterial wall area/vessel area, and arterial wall thickness/vessel external diameter. In the NFA treatment groups, the pressure and pathological changes were alleviated. The pulmonary artery tone in the shunt group increased, whereas it decreased after NFA treatment. The current density of CaCC was higher in the shunt group, and it was decreased in the NFA treatment groups. In conclusion, NFA attenuated pulmonary artery tone and structural remodeling in PAH induced by high pulmonary blood flow in vivo. CaCCs were involved and the augmented current density was alleviated by NFA treatment.

  20. 75 FR 76019 - Compliance Policy Guide Sec. 390.500 Definition of “High-Voltage Vacuum Switch”-21 CFR 1002.61(a...

    Science.gov (United States)

    2010-12-07

    ... HUMAN SERVICES Food and Drug Administration Compliance Policy Guide Sec. 390.500 Definition of ``High... Administration, HHS. ACTION: Notice; withdrawal. SUMMARY: The Food and Drug Administration (FDA) is announcing the withdrawal of Compliance Policy Guide Sec. 390.500 Definition of ``High-Voltage Vacuum...

  1. Temperature dependence of creep compliance of highly cross-linked epoxy: A molecular simulation study

    Energy Technology Data Exchange (ETDEWEB)

    Khabaz, Fardin, E-mail: rajesh.khare@ttu.edu; Khare, Ketan S., E-mail: rajesh.khare@ttu.edu; Khare, Rajesh, E-mail: rajesh.khare@ttu.edu [Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409 (United States)

    2014-05-15

    We have used molecular dynamics (MD) simulations to study the effect of temperature on the creep compliance of neat cross-linked epoxy. Experimental studies of mechanical behavior of cross-linked epoxy in literature commonly report creep compliance values, whereas molecular simulations of these systems have primarily focused on the Young’s modulus. In this work, in order to obtain a more direct comparison between experiments and simulations, atomistically detailed models of the cross-linked epoxy are used to study their creep compliance as a function of temperature using MD simulations. The creep tests are performed by applying a constant tensile stress and monitoring the resulting strain in the system. Our results show that simulated values of creep compliance increase with an increase in both time and temperature. We believe that such calculations of the creep compliance, along with the use of time temperature superposition, hold great promise in connecting the molecular insight obtained from molecular simulation at small length- and time-scales with the experimental behavior of such materials. To the best of our knowledge, this work is the first reported effort that investigates the creep compliance behavior of cross-linked epoxy using MD simulations.

  2. In vivo adaptive response of the peripheral conduit artery in patients with borderline systolic hypertension

    Institute of Scientific and Technical Information of China (English)

    陶军; 靳亚非; 王礼春; 唐安丽; 廖新学; 杨震; 马虹

    2003-01-01

    Objective To investigate elastic changes of the radial artery, a medium-sized muscular peripheral conduit artery, in patients with borderline systolic hypertension. Methods Using a non-invasive high-resolution echo-tracking device coupled to a photoplethysmography (Finapres system) allowing simultaneous arterial diameter and finger blood pressure monitoring, we measured radial artery elastic parameters of 20 patients with borderline systolic hypertension and 20 normal subjects according to Langewouters model.Results The diameter of the radial artery of control subjects and those with borderline systolic hypertension at the isobaric level of 100 mmHg and mean arterial pressure was similar, but the compliance and distensibility at similar conditions in patients with borderline systolic hypertension did not further reduced and even increased. Conclusion In patients with borderline systolic hypertension, the adaptive responses of the radial artery compliance and distensibility to increased pressure were directed to maintain its elasticity, contributing to the homeostasis of the cardiovascular system.

  3. Effect of fixed-dose ACE-inhibitor/calcium channel blocker combination therapy vs. ACE-inhibitor monotherapy on arterial compliance in hypertensive patients with type 2 diabetes.

    Science.gov (United States)

    Winer, Nathaniel; Folker, Amy; Murphy, Julie A; Hung, Elena; Bard, Mara; Perkelvald, Alexander; Sowers, James R; Bakris, George L

    2005-01-01

    Assessment of vascular compliance may be a useful measurement of the clinical effects of antihypertensive treatment. Both angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are known to improve vascular elasticity. A study was performed to test the hypothesis that combined therapy with an ACE inhibitor and a calcium channel blocker would have additive benefits on vascular compliance at similar levels of blood pressure (BP), as compared with monotherapy with an ACE inhibitor. This 12-week, double-blind study was a substudy of a larger clinical hypertension study conducted in patients with hypertension and type 2 diabetes. Subjects (N = 20) were randomized to either a fixed-dose combination of amlodipine besylate/benazepril HCl or to enalapril monotherapy. BP, heart rate, large- and small-vessel compliance, systemic vascular resistance, and urinary microalbumin excretion were assessed at baseline and after treatment. Both treatments were similarly effective in lowering BP, reducing systemic vascular resistance, and decreasing urinary microalbumin excretion. Improvement in large-vessel compliance was significantly greater among subjects who received ACE-inhibitor/calcium channel blocker combination therapy (52%) as compared with those who received ACE-inhibitor monotherapy (32%; p < 0.05). No significant change in small-vessel compliance was observed with either treatment. Greater improvement in large-vessel compliance with combination therapy was independent of BP lowering.

  4. Sodium hydrosulfide alleviates pulmonary artery collagen remodeling in rats with high pulmonary blood flow.

    Science.gov (United States)

    Li, Xiaohui; Du, Junbao; Jin, Hongfang; Geng, Bin; Tang, Chaoshu

    2008-11-01

    This study aimed to explore the effect of sodium hydrosulfide (NaHS) on pulmonary artery collagen remodeling in rats with high pulmonary blood flow. Thirty-two Sprague-Dawley rats were randomly divided into a sham group, shunt group, sham + NaHS (an H2S donor) group, and shunt + NaHS group. After 11 weeks of shunting, mean pulmonary artery pressure (MPAP), relative median area (RMA) of pulmonary arteries, H2S concentration in lung tissues, plasma endothelin-1 (ET-1) levels, and ET-1 mRNA in lung tissues were investigated. Collagen I and collagen III were evaluated by immunohistochemistry. Hydroxyproline assay and Sirius-red staining were performed. Matrix metalloproteinase-13 (MMP-13), tissue inhibitor of metalloproteinase-1 (TIMP-1), and connective tissue growth factor (CTGF) were evaluated by immunohistochemistry. After 11 weeks of shunting, rats showed a significant pulmonary hypertension and pulmonary artery collagen remodeling in association with a decrease in lung tissue H2S content. After NaHS treatment for 11 weeks, lung tissue H(2)S content was increased, whereas MPAP was attenuated and RMA was reduced. Meanwhile, pulmonary artery collagen I and collagen III protein expressions of intra-acinar pulmonary arteries were inhibited, but MMP-13/TIMP-1 ratio was augmented with a decreased plasma ET-1 content and lung tissue ET-1mRNA and CTGF expressions. The downregulation of H(2)S is involved in the development of pulmonary artery collagen remodeling induced by high pulmonary blood flow.

  5. To assess the intimal thickness, flow velocities, and luminal diameter of carotid arteries using high-resolution B-mode ultrasound doppler imaging

    Science.gov (United States)

    Vemuru, Madhuri; Jabbar, Afzal; Chandra, Suman

    2004-04-01

    Carotid imaging is a Gold Standard test that provides useful information about the structure and functions of carotid arteries. Spectral imaging helps to evaluate the vessel and hemodynamic changes. High resolution B-mode imaging has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and its progression and for assessing cardiovascular risks. The measurements made with Doppler correlate well with pathologic measurements. Recent prospective studies have clearly demonstrated that these measurements of carotid intimal thickness are potent predictors of Myocardial Infarction and Stroke. This method appears very attractive as it is non-invasive, extremely safe, well accepted by the patient and relatively inexpensive. It can be performed serially and has the advantage of visualizing the arterial wall in contrast to angiographic techniques which provide only an outline of the arterial lumen. Recently, there has been an interest in the clinical use of this technique in making difficult clinical decisions like deciding on preventive therapies. 30 subjects aged 21-60 years and 30 subjects aged 61-85 years of both sexes are selected after doing a baseline study to exclude Hypertension, Diabetes, Obesity and Hyperlipidemia. The carotid arteries were examined for intimal thickening, blood flow velocities and luminal diameter. With aging there is a narrowing of the carotid vessels and significant increase in intimal thickening with a consequent increase in the blood flow velocities. Inter-observer, intra-observer and instrument variations are seen and there is no significant change in the values when the distal flow pattern is considered for measurements. Aging produces major cardiovascular changes including decreased elasticity and compliance of great arteries leading to structural and functional alterations in heart and vessels. With aging there is increased intimal thickness and increased pulse wave velocity which is clearly

  6. Arterial function of carotid and brachial arteries in postmenopausal vegetarians.

    Science.gov (United States)

    Su, Ta-Chen; Torng, Pao-Ling; Jeng, Jiann-Shing; Chen, Ming-Fong; Liau, Chiau-Suong

    2011-01-01

    Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited. This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR). Fasting blood levels of glucose, lipids, lipoprotein (a), high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured. Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a) and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity. Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians.

  7. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S

    2017-01-01

    in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population.......%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of "no or medical treatment", "referral to percutaneous coronary intervention...

  8. Liver cirrhosis and arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    Jens H Henriksen; Soren Moller

    2006-01-01

    Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system,sympathetic nervous system, release of vasopressin),and resistance to vasopressors. The vasodilatory state is mediated through adrenomedullin, calcitonin generelated peptide, nitric oxide, and other vasodilators,and is most pronounced in the splanchnic area.This constitutes an effective (although relative)counterbalance to increased arterial blood pressure.This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most likely includes the combination of vasodilatation and vasoconstriction in parallel.

  9. Investigation of arterial gas occlusions. [effect of noncondensable gases on high performance heat pipes

    Science.gov (United States)

    Saaski, E. W.

    1974-01-01

    The effect of noncondensable gases on high-performance arterial heat pipes was investigated both analytically and experimentally. Models have been generated which characterize the dissolution of gases in condensate, and the diffusional loss of dissolved gases from condensate in arterial flow. These processes, and others, were used to postulate stability criteria for arterial heat pipes under isothermal and non-isothermal condensate flow conditions. A rigorous second-order gas-loaded heat pipe model, incorporating axial conduction and one-dimensional vapor transport, was produced and used for thermal and gas studies. A Freon-22 (CHCIF2) heat pipe was used with helium and xenon to validate modeling. With helium, experimental data compared well with theory. Unusual gas-control effects with xenon were attributed to high solubility.

  10. Selective Arterial Embolization in the Treatment of High Flow Priapism: Report of 5 Cases

    Directory of Open Access Journals (Sweden)

    H. Rokni Yazdi

    2005-06-01

    Full Text Available High flow priapism is a rare entity caused by a pathologic influx from lacerated arteries to the cavernous bodies. Transcatheter embolization of feeding arteries is the treatment of choice. We reviewed a series of 5 patients who un derwent transcatheter embolization in our hospital from 2000 to 2004. The mean age of patients was 32 years; dur ation of priapism was between one week and a year. All underwent bilateral pudendal artery ca theterization with No.5 French Cobra-II catheters. We did not microcatheters in our patien ts. Embolized materials were gel-foam, coils and polyvinyl alcohol microspheres. We could follow four of them for 6 to 40 months; one of the patients dropped out from our follow-up study. All the four patients had completed detumescence after a maximum of two days from embolization;none of them experienced signific ant complications and all returned to normal sexual function and remained symptom free thereafter (6-40 months. We noted no difference in complications and duration to restore erectile function and less recurrence rate with embolization of main br anch of pudendal artery instead of superselective embolization of arteriocavernous fistul a feeder artery with a microcatheter that is the method of choice for the treatment of high flow priapism, but due to small number of cases it needs further studies to be confirmed.

  11. High compliance with newborn community-to-facility referral in eastern Uganda:.an opportunity to improve newborn survival.

    Directory of Open Access Journals (Sweden)

    Christine Kayemba Nalwadda

    Full Text Available BACKGROUND: Seventy-five percent of newborn deaths happen in the first-week of life, with the highest risk of death in the first 24-hours after birth.WHO and UNICEF recommend home-visits for babies in the first-week of life to assess for danger-signs and counsel caretakers for immediate referral of sick newborns. We assessed timely compliance with newborn referrals made by community-health workers (CHWs, and its determinants in Iganga and Mayuge Districts in rural eastern Uganda. METHODS: A historical cohort study design was used to retrospectively follow up newborns referred to health facilities between September 2009 and August 2011. Timely compliance was defined as caretakers of newborns complying with CHWs' referral advice within 24-hours. RESULTS: A total of 724 newborns were referred by CHWs of whom 700 were successfully traced. Of the 700 newborns, 373 (53% were referred for immunization and postnatal-care, and 327 (47% because of a danger-sign. Overall, 439 (63% complied, and of the 327 sick newborns, 243 (74% caretakers complied with the referrals. Predictors of referral compliance were; the newborn being sick at the time of referral- Adjusted Odds Ratio (AOR = 2.3, and 95% Confidence-Interval (CI of [1.6 - 3.5], the CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: [1.2 -2.7]; and age of mother (25-29 and (30-34 years, (AOR =0.4; 95% CI: [0.2 - 0.8] and (AOR = 0.4; 95% CI: [0.2 - 0.8] respectively. CONCLUSION: Caretakers' newborn referral compliance was high in this setting. The newborn being sick, being born to a younger mother and a reminder visit by the CHW to a referred newborn were predictors of newborn referral compliance. Integration of CHWs into maternal and newborn care programs has the potential to increase care seeking for newborns, which may contribute to reduction of newborn mortality.

  12. Compliance status

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.

  13. Unilateral high origin of facial artery associated with a variant origin of the glandular branch to the submandibular gland

    Directory of Open Access Journals (Sweden)

    Mohandas Rao KG

    2009-11-01

    Full Text Available The variations in the carotid arteries and their branches are common in the anterior triangle of the neck. However, variations in the origin of facial artery and its branches given in the digastric triangle are not very common. A case of high origin of facial artery and abnormal origin of the glandular branch to submandibular gland encountered during routine dissection of anterior triangle of the neck is reported. The facial artery was arising from the external carotid artery deep in the digastric triangle and the glandular branch to submandibular gland was also arising from the external carotid artery about 1 cm below the origin of facial artery in the digastric triangle. Further, the surgical, importance of the case was discussed.

  14. Preliminary Waste Form Compliance Plan for the Idaho National Engineering and Environmental Laboratory High-Level Waste

    Energy Technology Data Exchange (ETDEWEB)

    B. A. Staples; T. P. O' Holleran

    1999-05-01

    The Department of Energy (DOE) has specific technical and documentation requirements for high-level waste (HLW) that is to be placed in a federal repository. This document describes in general terms the strategy to be used at the Idaho National Engineering and Environmental Laboratory (INEEL) to demonstrate that vitrified HLW, if produced at the INEEL, meets these requirements. Waste form, canister, quality assurance, and documentation specifications are discussed. Compliance strategy is given, followed by an overview of how this strategy would be implemented for each specification.

  15. High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence.

    Science.gov (United States)

    Wolf, J S; Lue, T F

    1992-01-01

    Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is 'high-flow'; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.

  16. A Clinical model to identify patients with high-risk coronary artery disease

    NARCIS (Netherlands)

    Y. Yang (Yelin); L. Chen (Li); Y. Yam (Yeung); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D.S. Berman (Daniel); M.J. Budoff (Matthew); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor); K. Chinnaiyan (Kavitha); R.C. Cury (Ricardo); A. Delago (Augustin); A. Dunning (Allison); G.M. Feuchtner (Gudrun); M. Hadamitzky (Martin); J. Hausleiter (Jörg); R.P. Karlsberg (Ronald); P.A. Kaufmann (Philipp); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); T.M. LaBounty (Troy); F.Y. Lin (Fay); E. Maffei (Erica); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James K.); B.J.W. Chow (Benjamin)

    2015-01-01

    textabstractObjectives This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Background Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify th

  17. High-density lipoproteins and coronary artery disease: a single-center cohort study

    NARCIS (Netherlands)

    Schaffer, A.; Verdoia, M.; Barbieri, L.; Aprami, T.M.; Suryapranata, H.; Marino, P.; Luca, G.D.

    2014-01-01

    Our goal was to estimate the role of high-density lipoprotein cholesterol (HDL-C) in predicting the prevalence and extent of coronary artery disease (CAD) in 3280 patients undergoing coronary angiography. Predictors of lower HDL levels (<32 mg/dL) were male gender (P < .001), diabetes mellitus

  18. A Clinical model to identify patients with high-risk coronary artery disease

    NARCIS (Netherlands)

    Y. Yang (Yelin); L. Chen (Li); Y. Yam (Yeung); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D.S. Berman (Daniel); M.J. Budoff (Matthew); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor); K. Chinnaiyan (Kavitha); R.C. Cury (Ricardo); A. Delago (Augustin); A. Dunning (Allison); G.M. Feuchtner (Gudrun); M. Hadamitzky (Martin); J. Hausleiter (Jörg); R.P. Karlsberg (Ronald); P.A. Kaufmann (Philipp); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); T.M. LaBounty (Troy); F.Y. Lin (Fay); E. Maffei (Erica); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James K.); B.J.W. Chow (Benjamin)

    2015-01-01

    textabstractObjectives This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Background Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify th

  19. UTERINE ARTERY DOPPLER STUDY FOR PREDICTION OF ADVERSE OUTCOME IN HIGH RISK PREGNANCY

    Directory of Open Access Journals (Sweden)

    Gunjan

    2015-07-01

    Full Text Available AIM : To detect abnormal waveforms in uterine artery in pregnancies at risk between 20 to 24 weeks of gestation and to measure Resistance index (RI and systolic/diastolic ratio(S/D of these waveforms in study population and to study correlation of Doppler dat a with adverse pregnancy outcome. METHODS : This is a prospective study included Doppler analysis of uterine artery waveforms in 107 normotensive women with singleton pregnancy between 20 to24 weeks of period of gestation who were considered to be at increa sed risk of developing pregnancy complications. Women with Multiple gestation, with congenital anomaly of fetus, chronic hypertension, renal disease, cardiac disease, Diabetes Mellitus were excluded from the study. Bilateral uterine artery Doppler was done and Parameters studied were S/D ratio and RI in uterine artery. Early diastolic notch in uterine artery was watched for. The flow velocity waveforms considered abnormal if there was an early diastolic notch in uterine artery in either right or left uterin e artery was watched for abnormal pregnancy outcomes considered are Gestational hypertension, Pre - eclampsia IUGR, Abruptio placentae, IUD and preterm deliveries. RESULTS : minimum women were aged 21 – 25 year with minimum of 18 years and maximum of 36 years, 28% were primigravidae while 72% were multigravidae mean gestational age of which scan was done was 22 wks 1 day (20 - 24 minimum gestational age at time of delivery was 28 wks of gestation 70% women were delivered vaginally and 30% LSCS. 7% women developed Gestational Hypertension, 5% developed Preeclampsia, 8% neonates with IUGR, 3% developed Placental Abruption while 4% had IUD and 8% had Preterm deliveries. CONCLUSION : Abnormal uterine artery Doppler studies in second trimester have been associated with subsequent adverse pregnancy out comes including Preeclampsia IUGR and perinatal mortality. Doppler velocimetry is a primary tool for fetomaternal surveillance in high

  20. Serial measurements of high-sensitivity cardiac troponin T after exercise stress test in stable coronary artery disease

    DEFF Research Database (Denmark)

    Axelsson, Anna; Ruwald, Martin Huth; Dalsgaard, Morten;

    2013-01-01

    The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD).......The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD)....

  1. Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Greil, Gerald F.; Hofbeck, Michael; Sieverding, Ludger [University of Tuebingen, Department of Pediatric Cardiology, Children' s Hospital, Tuebingen (Germany); Schoebinger, Max; Meinzer, Hans-Peter [German Cancer Research Center, Division of Medical and Biological Informatics, Heidelberg (Germany); Kuettner, Axel; Schaefer, Juergen F.; Dammann, Florian; Claussen, Claus D. [University of Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany)

    2006-06-15

    Precise visualization of the pulmonary vasculature is mandatory for adequate treatment of patients with pulmonary atresia and ventricular septal defect (PA-VSD). Aortopulmonary collateral arteries (APCs) can be visualized by selective injections of contrast agent in the catheterization laboratory. To evaluate multidetector CT (MDCT) and different image postprocessing methods for analysis of complex pulmonary blood supply in patients with PA-VSD. Eight patients (6 weeks to 27.8 years of age) with PA-VSD and APCs underwent MDCT and cardiac catheterization. Using multiplanar reformatting, volume rendering and semiautomatic segmentation algorithms, the aorta, pulmonary arteries and APCs were displayed. MDCT and cardiac catheterization were analyzed by two independent observers. MDCT accurately imaged central pulmonary arteries (n=8), aortopulmonary shunts (n=2), right ventricular to pulmonary artery conduits (n=2) and origin, course and intrapulmonary connections of APCs (n=25), compared to X-ray angiography. A high correlation was found between the MDCT vessel diameter measurements by two independent observers (n=70, r=0.96, P<0.01) and between MDCT and angiographic vessel diameter measurements (n=68, r=0.96, P<0.01). Using three-dimensional imaging software, a complex pulmonary blood supply can be non-invasively and accurately imaged with high-resolution MDCT. This technique may help to reduce the number of cardiac catheterizations or guide interventional or surgical therapy. (orig.)

  2. Personalized diet management can optimize compliance to a high-fiber, high-water diet in children with refractory functional constipation.

    Science.gov (United States)

    Karagiozoglou-Lampoudi, Thomais; Daskalou, Efstratia; Agakidis, Charalambos; Savvidou, Afroditi; Apostolou, Aggeliki; Vlahavas, Georges

    2012-05-01

    Diet modification to increase water and fiber consumption is considered an important component in the management of constipation. This prospective randomized study aimed to evaluate the compliance of 86 children with refractory functional constipation (mean age 4.4 years, range 1 to 11 years)-to a high-fiber, high-water diet following either physician's dietary advice (PI group) (n=42) or physician's dietary advice plus personalized diet management by a registered dietitian (DM group) (n=44). Dietary intake was assessed by a 24-hour dietary recall at baseline and 1 month later. The changes in water and fiber consumption were used as compliance criteria. DM group had comparable anthropometric measurements; sex distribution; and baseline intakes of energy, macronutrient, water, and dietary fiber compared with the PI group. Comparison of nutrient intakes between the two visits within each group showed a significant increase in fiber consumption in both groups that was more pronounced in the DM group. Water, energy, and carbohydrate consumption increased significantly only in the DM group. Multivariate regression analysis revealed that the intervention group was the only significant independent predictor for the change in fiber and water consumption after controlling for age, sex, and weight-for-age z score. Children receiving personalized diet management for refractory functional constipation achieved better compliance in increasing fiber and water consumption. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  3. HIGH ARTERIAL BLOOD LACTATE AS SIRS PREDICTOR IN PATIENTS WITH SEVERE HEAD INJURY

    Directory of Open Access Journals (Sweden)

    L Lengkong

    2013-05-01

    Full Text Available Objectives: Lactate is one of the prognostic factor for evaluation of clinical severe head injury patients outcome. Lactate is also known as a factor to support diagnostic and prognosis of SIRS cases. Severe head injury is a head traumatic case frequently found in Emergency Units, where some cases result in mortality. Based on Glasgow Coma Scale (GCS, severe head injury is define as a head injury with GCSscore between 3 and 8. This study aims to determine whether high arterial blood lactate can be used as predictor that causes the occurrence of SIRS.Method: A Cohort prospective study applied in thisresearch to determine arterial blood lactate as a predictor that causes the occurrence of SIRS. This study was conducted at Sanglah General Hospital Bali-Indonesia from May 2013 to July 2013 with 40 patients who fulfilled the inclusive criteria. Data were presented in tables and analyzed by applying Chi Square Test with CI 95% and p <0.05 was considered significant.Results: From 40 samples, 27 were male (62.5% and 17 female (37.5% at the age of 0-10, 2 people (5%, 10-20 years 7 people (17.5%, 20-40 years 14 people (35%, 40-60 years 12 people (30% and over 60 years 5 people (12.5%. On the first day, patients with normal level blood arterial lactate 2 (5%, and high 38 (95% causing SIRS (+ 39 (97.5% and SIRS (- 1 (2.5% samples to occur. Using bivariate analysis between arterial blood lactate level and the amount occurrence of SIRS, we obtain p < 0.05 and variable control using multivariate analysis we obtained variable of liver dysfunction that give significant value with level arterial blood lactate with p < 0.05.Conclusion: From 40 samples of Severe head injury, there were 38 (95% whose blood arterial lactate level increased on the first day, 2 (5% in normal limit and 39 (97.5% with SIRS on the third day when p < 0.05 so that high level arterial blood lactate can be used as predictor that causes SIRS to occur.

  4. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    Directory of Open Access Journals (Sweden)

    Su T

    2011-08-01

    Full Text Available Ta-Chen Su1, Pao-Ling Torng2, Jiann-Shing Jeng3, Ming-Fong Chen1, Chiau-Suong Liau1,41Division of Cardiology, Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, 4Cardiovascular Center, Taipei Buddist Tzu-Chi Hospital, Hsin-Dian, Taipei, TaiwanBackground: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited.Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD, compliance (BAC, and resistance (BAR. Fasting blood levels of glucose, lipids, lipoprotein (a, high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured.Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity.Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than

  5. Artery wall layer dimensions during normal pregnancy: a longitudinal study using noninvasive high-frequency ultrasound.

    Science.gov (United States)

    Akhter, Tansim; Larsson, Anders; Larsson, Marita; Wikström, Anna-Karin; Naessen, Tord

    2013-01-15

    The vascular effects of normal pregnancy were investigated by estimating the intima and media thicknesses of the common carotid artery separately using 22-MHz ultrasound (Collagenoson, Meudt, Germany) in 57 healthy women with normal pregnancies and pregnancy outcomes, in all three trimesters and at 1 yr postpartum. A thick intima, thin media, and high intima-to-media (I/M) ratio are signs of a less healthy artery wall. Mean artery wall layer dimensions remained fairly constant during pregnancy, but the intima thickness and I/M thickness ratio appeared to improve (decrease) postpartum (P blood pressure in the first trimester were associated with higher I/M ratios, especially in the second trimester, whereas higher serum estradiol levels were significantly associated with a lower I/M ratio. Changes from the first to second trimesters in I/M ratio, taking into account differential changes in intima and media thickness, were significantly (P pregnancy appeared to improve postpartum. However, higher age, body mass index, or blood pressure and lower serum estradiol levels in the first trimester appeared to negatively affect the artery wall, strongly suggesting that pregnancy has negative vascular effects in some women. A less likely explanation involves possible adaptation to physiological changes during and after pregnancy.

  6. Low WSS and High OSI Measured by 3D Cine PC MRI Reflect High Pulmonary Artery Pressures in Suspected Secondary Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Terada, Masaki; Takehara, Yasuo; Isoda, Haruo; Uto, Tomohiro; Matsunaga, Masaki; Alley, Marcus

    2016-01-01

    Institutional Review Board (IRB)-approved prospective study was conducted to test whether objective and quantitative hemodynamic markers wall shear stress (WSS) and oscillatory shear index (OSI) measured by three-dimensional (3D) cine phase-contrast (PC) can reflect pulmonary arterial hypertension (PAH). Seventeen consecutive patients of suspected secondary PAH were examined for pulmonary artery pressures (PAPs) with right heart catheterization (RHC) and three-dimensional (3D) cine PC MR. Based on the RHC data, patients were subdivided into two groups of 12 non-PAH (median age of 74.5 years) and 5 PAH (median age of 77 years) patients. Based on 3D cine PC magnetic resonance (MR), hemodynamic parameters including spatially averaged systolic WSS (sWSS), diastolic WSS (dWSS), mean WSS (mWSS), OSI and blood vessel section area (BVSA) at the pulmonary arterial trunk were calculated. Streamline images in the pulmonary arteries were also assessed. All the parameters were compared between non-PAH and PAH groups. sWSS (N/m(2)) and mWSS (N/m(2)) of PAH group was lower than that of non-PAH group (0.594 ± 0.067 vs. 0.961 ± 0.590, P = 0.001), (0.365 ± 0.035 vs. 0.489 ± 0.132, P = 0.027). OSI of PAH group was higher than that of non-PAH (0.214 ± 0.026 vs. 0.130 ± 0.046, P = 0.001). sWSS, mWSS, and dWSS were inversely correlated and OSI was positively correlated to mean PAP or systolic PAP with r values of -0.638 (P = 0.005), -0.643 (P = 0.005), -0.485 (P = 0.049), and 0.625 (P = 0.007); or -0.622 (P = 0.008), -0.629 (P = 0.007), -0.484 (P = 0.049), and 0.594 (P = 0.012), respectively. sWSS was also inversely correlated to BVSA with r value of -0.488 (P = 0.049), and OSI was correlated to BVSA with r value of 0.574 (P = 0.016). Vortex or helical flows were observed more frequently in PAH patients. The low sWSS and mWSS as well as high OSI measured with 3D cine PC MR could be potential hemodynamic markers for the increased PAP in suspected secondary PAH patients.

  7. Comparison of thermal damage of the internal thoracic artery using ultra high radiofrequency and monopolar diathermy.

    Science.gov (United States)

    Bulat, Cristijan; Pešutić-Pisac, Valdi; Capkun, Vesna; Marović, Zlatko; Pogorelić, Zenon; Družijanić, Nikica

    2014-10-01

    The internal thoracic artery (ITA) has been accepted worldwide as a first choice conduit for myocardial revascularisation. It still remains questionable what is the best method for ITA harvesting in a skeletonized fashion according to structural integrity of artery, as a risk factor of early and late graft failure. The purpose of this study was to determine the impact of the ultra-high radiofrequency energy used for ITA harvesting on arterial structural integrity, in particular on the endothelial layer. Seventy-four ITA specimens were divided into two groups depending on device used for harvesting (radiofrequency-knife (RF) or electrocauter (EC)). Thermal damage on arterial structural integrity was measured using light microscope, morphometric imaging analysis and immunohistochemical methods. Thermal damage of endothelium was 2.8 times higher in EC than in RF group (p = 0.041) and 5 times higher in patients older than 66 years of age (p = 0.002). Extent of endothelial damage (graded from 0 to 3) was significantly higher in EC group (p = 0.03). Also, in EC group, in patients older than 66 years of age higher proportion of extent of endothelial damage was found (p = 0.027). The endothelial damage was more often in EC than in RF group as in the patients older than 66 years of age. Demonstrated results suggest that the radiosurgery in comparison to conventional electrocautery is safe and effective method, and significantly reduces thermal damage to endothelial layer of artery. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  8. High resolution wavenumber analysis for investigation of arterial pulse wave propagation

    Science.gov (United States)

    Hasegawa, Hideyuki; Sato, Masakazu; Irie, Takasuke

    2016-07-01

    The propagation of the pulse wave along the artery is relatively fast (several m/s), and a high-temporal resolution is required to measure pulse wave velocity (PWV) in a regional segment of the artery. High-frame-rate ultrasound enables the measurement of the regional PWV. In analyses of wave propagation phenomena, the direction and propagation speed are generally identified in the frequency-wavenumber space using the two-dimensional Fourier transform. However, the wavelength of the pulse wave is very long (1 m at a propagation velocity of 10 m/s and a temporal frequency of 10 Hz) compared with a typical lateral field of view of 40 mm in ultrasound imaging. Therefore, PWV cannot be identified in the frequency-wavenumber space owing to the low resolution of the two-dimensional Fourier transform. In the present study, PWV was visualized in the wavenumber domain using phases of arterial wall acceleration waveforms measured by high-frame-rate ultrasound.

  9. High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wu Wang; Zun-Jing Liu

    2016-01-01

    Objective:To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis.Date Sources:We retrieved information from PubMed database up to December 2015,using various search terms including vessel wall imaging (VWI),high-resolution magnetic resonance imaging,intracranial arterial stenosis,black blood,and intracranial atherosclerosis.Study Selection:We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI.We organized this data to explain the value of VWI in clinical application.Results:VWI with black blood technique could provide high-quality images with submillimeter voxel size,and display both the vessel wall and lumen of intracranial artery simultaneously.Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening,enhancement,and vessel remodeling on VWI.This technique could be used for determining causes of stenosis,identification of stroke mechanism,risk-stratifying patients,and directing therapeutic management in clinical practice.In addition,a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy.Conclusions:This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.

  10. Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy

    Directory of Open Access Journals (Sweden)

    Mattar Rejane

    2008-05-01

    Full Text Available Abstract Background The Brazilian consensus recommends a short-term treatment course with clarithromycin, amoxicillin and proton-pump inhibitor for the eradication of Helicobacter pylori (H. pylori. This treatment course has good efficacy, but cannot be afforded by a large part of the population. Azithromycin, amoxicillin and omeprazole are subsidized, for several aims, by the Brazilian federal government. Therefore, a short-term treatment course that uses these drugs is a low-cost one, but its efficacy regarding the bacterium eradication is yet to be demonstrated. The study's purpose was to verify the efficacy of H. pylori eradication in infected patients who presented peptic ulcer disease, using the association of azithromycin, amoxicillin and omeprazole. Methods Sixty patients with peptic ulcer diagnosed by upper digestive endoscopy and H. pylori infection documented by rapid urease test, histological analysis and urea breath test were treated for six days with a combination of azithromycin 500 mg and omeprazole 20 mg, in a single daily dose, associated with amoxicillin 500 mg 3 times a day. The eradication control was carried out 12 weeks after the treatment by means of the same diagnostic tests. The eradication rates were calculated with 95% confidence interval. Results The eradication rate was 38% per intention to treat and 41% per protocol. Few adverse effects were observed and treatment compliance was high. Conclusion Despite its low cost and high compliance, the low eradication rate does not allow the recommendation of the triple therapy with azithromycin as an adequate treatment for H. pylori infection.

  11. Performing compliance

    DEFF Research Database (Denmark)

    Wimmelmann, Camilla Lawaetz

    2017-01-01

    the local policy workers front-staged some practices in the implementation process and back-staged others. The local policy workers deliberately performed ‘guideline compliance’ by using information control and impression management techniques. The findings suggest that local guideline compliance should......Guidelines are increasingly used to regulate how local authorities engage in practices. Focusing on the Danish national health promotion guidelines, this article reveals that the local policy workers did not implement the guidelines as proposed. Using a dramaturgical framework, it illustrates how...... be regarded as a staged performance in which deliberate techniques are used to produce and manage certain impressions of compliance....

  12. Handwashing compliance.

    Science.gov (United States)

    Antoniak, Jeannie

    2004-09-01

    Undeniably, handwashing remains the single most effective and cost-efficient method for preventing and reducing the transmission of nosocomial infections. Yet the rates and outbreaks of nosocomial infections in Canadian and international healthcare institutions continue to increase. Shaikh Khalifa Medical Center developed and implemented a multidisciplinary approach to address the challenges of handwashing compliance among nurses and healthcare workers in its workplace setting. Supported by evidence-based research, the approach consisted of three components: collaboration, implementation and evaluation. The use of the alcohol-based hand rub sanitizer or "solution" was integral to the multidisciplinary approach. Ongoing education, communication and a committed leadership were essential to promote and sustain handwashing compliance.

  13. Increased wall tension in response to vasoconstrictors in isolated mesenteric arterial rings from patients with high blood pressure.

    Science.gov (United States)

    Tahvanainen, Anna; Taurio, Jyrki; Mäki-Jouppi, Jenni; Kööbi, Peeter; Mustonen, Jukka; Kähönen, Mika; Sand, Juhani; Nordback, Isto; Pörsti, Ilkka

    2006-12-01

    Essential hypertension is associated with several alterations in arterial function. A wealth of information from animal models is available concerning hypertensive changes in the mesenteric circulation, while only few studies have examined human mesenteric arterial function. The tone of isolated mesenteric arterial segments (outer diameter 0.7-0.9 mm) was examined from individuals with high (n=17) or normal (n=22) blood pressure, grouped using the current definition of elevated blood pressure (140/90 mmHg). Since the majority of them were operated because of malignancies, we evaluated whether functional vascular properties provided information about patient prognosis. Wall tension development (mN/mm) in response to vasoconstrictors (noradrenaline, 5-hydroxy tryptamine, potassium chloride) was higher in mesenteric arterial rings from patients with high than normal blood pressure. There was no difference in vasoconstrictor sensitivity, or endothelium-dependent and endothelium-independent vasorelaxation. Arterial segment weight was higher in hypertensive subjects, suggesting vascular wall hypertrophy. The 10-year follow-up showed no differences in the control of arterial tone between the surviving (n=14) or deceased (n=25) patients. In conclusion, isolated mesenteric arterial segments from hypertensive patients showed increased wall tension in response to vasoconstrictors. Since the mesenteric circulation is an important regulator of peripheral arterial resistance, possible functional alterations in this vascular bed should be further investigated in hypertensive patients.

  14. ARTERIAL STIFFNESS PARAMETERS IN PATIENTS WITH MODERATE/HIGH CARDIOVASCULAR RISK DURING LISINOPRIL AND SIMVASTATIN TREATMENT

    Directory of Open Access Journals (Sweden)

    V. N. Isakova

    2016-01-01

    Full Text Available Aim. To evaluate parameters of arterial stiffness by non-invasive arteriography in patients with moderate/high cardiovascular risk receiving lisinopril and simvastatin.Material and methods. 20 patients (aged 50-55 y.o. with arterial hypertension of the 1st degree and dislipidemia are included in the study. All patients had pulse wave velocity (PWV ≥ 10 m/s and/or the corrected index of pulse wave augmentation (AI × 80 ≥ -10% according to non-invasive arteriography data; and moderate-high cardiovascular risk (≥ 3%. Patients received therapy with lisinopril and simvastatin. Blood pressure (BP levels and lipid profiles were assessed before therapy and in 1, 2, 6 and 12 month of the observation. Non-invasive arteriography was performed before therapy and in 2, 6 and 12 months later.Results. BP target levels were reached within 1 month of treatment as well as improvement of lipid profile was reached within 2 months in majority of the patients. Reference PWV and AI were reached in 85,7% of patients within one year of treatment.Conclusion. Arterial stiffness parameters help to evaluate cardiovascular risk changes accurately as the results of treatment.

  15. Oxidative modification of high density lipoprotein induced by cultured human arterial smooth muscle cells

    Institute of Scientific and Technical Information of China (English)

    江渝; 刘红; 彭家和; 叶治家; 何凤田; 董燕麟; 刘秉文

    2003-01-01

    Objective: To observe the oxidative modification of high density lipoprotein (HDL) induced by cultured human arterial smooth muscle cells (SMCs). Methods: HDL cocultured with SMCs at 37℃ in 48 h was subjected, and native HDL (N-HDL) served as control. Oxidative modification of HDL was identified by using agarose gel electrophoresis. Absorbances of conjugated diene (CD) and lipid hydroperoxide (LOOH) were measured with ultraviolet spectrophotometry at 234 and 560 nm respectively, and fluorescence intensity of thiobarbuturic acid reaction substance (TBARS) with fluorescence spectrophotometry at 550 nm emission wavelength with excitation at 515 nm. Results: In comparison with N-HDL, the electrophoretic mobility of SMCs-cocultured HDL was increased, and the contents of CD, LOOH and TBARS HDL were very significantly higher than those of the control HDL (P<0.01). Conclusion: Oxidative modification of HDL can be induced by human arterial SMCs.

  16. Giant, dissecting, high-pressure pulmonary artery aneurysm: case report of a 1-year natural course.

    Science.gov (United States)

    Smalcelj, Anton; Brida, Vojtjeh; Samarzija, Miroslav; Matana, Ante; Margetic, Eduard; Drinkovic, Niksa

    2005-01-01

    We report the rare subchronic clinical course of a giant, dissecting pulmonary artery aneurysm in an oligosymptomatic middle-aged woman who had idiopathic pulmonary hypertension. Diagnosis was simple with the use of echocardiography and multislice computed tomography. Conversely, deciding on the treatment was difficult, because prominent surgeons declined to perform surgical repair of the aneurysm and recommended heart-lung transplantation. Therefore, we were forced to treat our patient medically. She survived for 1 year, including 8 months of treatment with sildenafil, and then died suddenly while awaiting transplantation. Our patient, who had a dissecting, high-pressure pulmonary artery aneurysm, had an unexpectedly stable and uneventful clinical course for 1 year, which, under more favorable circumstances, might have provided enough time for heart-lung transplantation to be performed.

  17. Capsaicin, arterial hypertensive crisis and acute myocardial infarction associated with high levels of thyroid stimulating hormone.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca; Cerrito, Marco; Coglitore, Sebastiano

    2009-05-01

    Chili peppers are rich in capsaicin. The potent vasodilator calcitonin gene-related peptide (CGRP) is stored in a population of C-fiber afferents that are sensitive to capsaicin. CGRP and peptides released from cardiac C fibers have a beneficial effect in myocardial ischemia and reperfusion. It has been reported that capsaicin pretreatment deplete cardiac C-fiber peptide stores. Furthermore, it has also been reported that capsaicin-treated pigs significantly increase mean arterial blood pressure compared with controls and that the decrease in CGRP synthesis and release contributes to the elevated blood pressure. It has also been reported that sub-clinical hypothyroidism is associated with a significant risk of coronary heart disease (CHD). We present a case of arterial hypertensive crisis and acute myocardial infarction in a 59-year-old Italian man with high levels of thyroid stimulating hormone and with an abundant ingestion of peppers and of chili peppers which occurred the day before.

  18. Formalizing and applying compliance patterns for business process compliance

    NARCIS (Netherlands)

    Elgammal, A.F.S.A.; Türetken, O.; van den Heuvel, W.J.A.M.; Papazoglou, M.

    2016-01-01

    Today’s enterprises demand a high degree of compliance of business processes to meet diverse regulations and legislations. Several industrial studies have shown that compliance management is a daunting task, and organizations are still struggling and spending billions of dollars annually to ensure a

  19. Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2016-01-01

    Full Text Available We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

  20. 31 CFR 30.3 - Q-3: How are the SEOs and most highly compensated employees identified for purposes of compliance...

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Q-3: How are the SEOs and most highly compensated employees identified for purposes of compliance with this part? 30.3 Section 30.3 Money and Finance: Treasury Office of the Secretary of the Treasury TARP STANDARDS FOR COMPENSATION AND CORPORATE...

  1. The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate

    DEFF Research Database (Denmark)

    Damkjær, Mads; Wang, T; Brøndum, E

    2015-01-01

    BACKGROUND: The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary...... on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP....... renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological...

  2. Modeling of the wave transmission properties of large arteries using nonlinear elastic tubes.

    Science.gov (United States)

    Pythoud, F; Stergiopulos, N; Meister, J J

    1994-11-01

    We propose a new, simple way of constructing elastic tubes which can be used to model the nonlinear elastic properties of large arteries. The tube models are constructed from a silicon elastomer (Sylgard 184, Dow Corning), which exhibits a nonlinear behavior with increased stiffness at high strains. Tests conducted on different tube models showed that, with the proper choice of geometric parameters, the elastic properties, in terms of area-pressure relation and compliance, can be similar to that of real arteries.

  3. Study effective factors on customer compliance in high contact services based on Bandura social - Cognitive theory

    National Research Council Canada - National Science Library

    zahra asadi; bahman hajipour

    2014-01-01

    ... . According Bandura social - Cognitive theory and the nature of high contact service characteristics contain of communication skills, customer orientation, expertise and reputation of service providers...

  4. Arterial distensibility as a possible compensatory mechanism in chronic aortic regurgitation

    Directory of Open Access Journals (Sweden)

    Kopel Liliane

    2001-01-01

    Full Text Available OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30±1 years (control group and 14 asymptomatic patients with severe aortic regurgitation aged 29±2 years and left ventricular ejection fraction of 0.61±0.02 (radioisotope ventriculography were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78±3 versus 48±1mmHg, P<0.01. Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0±0.8 versus 8.1±0.7 10-10 N-1 m4, P=0.01 e and 39.3±2.6 versus 31.1±2.0 10-6 N-1 m², P=0.02, respectively. CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.

  5. Low-intensity resistance training after high-intensity resistance training can prevent the increase of central arterial stiffness.

    Science.gov (United States)

    Okamoto, T; Masuhara, M; Ikuta, K

    2013-05-01

    Although high-intensity resistance training increases arterial stiffness, low-intensity resistance training reduces arterial stiffness. The present study investigates the effect of low-intensity resistance training before and after high-intensity resistance training on arterial stiffness. 30 young healthy subjects were randomly assigned to a group that performed low-intensity resistance training before high-intensity resistance training (BLRT, n=10), a group that performed low-intensity resistance training after high-intensity resistance training (ALRT, n=10) and a sedentary control group (n=10). The BLRT and ALRT groups performed resistance training at 80% and 50% of one repetition maximum twice each week for 10 wk. Arterial stiffness was measured using carotid-femoral and femoral-ankle pulse wave velocity (PWV). One-repetition maximum strength in the both ALRT and BLRT significantly increased after the intervention (Ptraining in the ALRT group did not change from before training. In contrast, carotid-femoral PWV after combined training in the BLRT group increased from before training (P training in the both BLRT and ALRT groups did not change from before training. These results suggest that although arterial stiffness is increased by low-intensity resistance training before high-intensity resistance training, performing low-intensity resistance training thereafter can prevent the increase of arterial stiffness. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Arterial Catheterization

    Science.gov (United States)

    ... way of keeping the blood pressure up. The arterial catheter allows accurate, second-to-second measurement of the blood pressure; repeated meas- urement is called monitoring. ■ High blood pressure (hypertension)— In some sit- uations, ...

  7. Thermodynamic Predictions of Thermal Expansivity and Elastic Compliances at High Temperatures and Pressures Applied to Perovskite Crystals

    Science.gov (United States)

    Burns, S. J.

    2016-12-01

    The possibility of near zero thermal expansion coefficients at very high pressures is explored for application to the Earth's core materials and mantle dynamics. The pressures in the Earth are large enough to effectively reduce thermal expansion coefficients to values which will decouple heat from mechanical work. It is shown that at pressures below the bulk modulus the thermal expansion coefficient will approach zero in all simple linear-elastic crystalline models. Advanced models of crystalline elastic solids based on interatomic potentials and density functional theory are shown to violate Gibb's potential for a solid, crystalline material described by three elastic matrix compliance entries; it is established that the temperature dependence of S 11 and S 12 are thermodynamically identical; it is also established that the pressure dependence of S 11 and S 12 are thermodynamically identical. The basis for thermal energy in materials is the phonon energy in solids. However, it is noted that heat capacity measurements which are obtained from constant pressure heat capacity conditions converted to constant volume values on isobars are not in the correct state when compared to theoretical models; at atmospheric pressure there may be very little difference between these states but at very high pressures the effect may be major. Very large pressures always reduce thermal expansion coefficients; the importance of very small thermal expansion coefficients is discussed in relation to physical processes deep in the core and mantle of the Earth.

  8. An Integrated Wireless Power Management and Data Telemetry IC for High-Compliance-Voltage Electrical Stimulation Applications.

    Science.gov (United States)

    Zhao, Jianming; Yao, Lei; Xue, Rui-Feng; Li, Peng; Je, Minkyu; Xu, Yong Ping

    2016-02-01

    This paper describes a 13.56-MHz wireless power recovery system with bidirectional data link for high-compliance-voltage neural/muscle stimulator. The power recovery circuit includes a 2-stage rectifier, 2 LDOs and a high voltage charge pump to provide 3 DC outputs: 1.8 V, 3.3 V and 20 V for the stimulator. A 2-stage time division based rectifier is proposed to provide 3 DC outputs simultaneously. It improves the power efficiency without introducing any impact on the forward data recovery. The 20 V output is generated by a modified low ripple charge pump that reduces the ripple voltage by 40%. The power management system shows 49% peak power efficiency. The data link includes a clock and data recovery (CDR) circuit and a load shift keying (LSK) modulator for bidirectional data telemetry. The forward and backward data rates of the data telemetry are 61.5 kbps and 33.3 kbps, respectively. In addition, a power monitor circuit for closed-loop power control is implemented. The whole system has been fabricated in a 24 V HV LDMOS option 1.8 μ m CMOS process, occupying a core area of around 3.5 mm (2).

  9. Effect of Bearing Compliance on Thermo-hydrodynamic Lubrication of High Speed Misaligned Journal Bearing Lubricated with Bubbly Oil

    Directory of Open Access Journals (Sweden)

    Basim Ajeel Abass

    2015-03-01

    Full Text Available In the present work the effect of bearing compliance on the performance of high speed misaligned journal bearing lined with a compliant PTFE liner lubricated with bubbly oil at high speeds has been studied. The effect of induced oil film temperature due to shearing effect has been implemented. Hydrodynamic effect of the complaint bearing and the influence of aerated oil have been examined by the classical thermohydrodynamic lubrication theory modified to include the effect of oil film turbulence and oil film temperature with suitable models for bubbly oil viscosity and density. The effect of liner elastic deformation has been implemented by using Winkler model. The effects of variable density and specific heat on the most importantbearing parameters such as maximum pressure, maximum temperature, bearing load carrying capacity and power losses have been investigated.The results obtained show that the oil film pressure and load carrying capacity increased for the bearing lubricated with bubbly oil of higher aeration level and smaller size of air bubbles. Including the effect of elastic deformation of the bearing liner reduces the oil film pressure, load carrying capacity and frictional power loss for the misaligned bearing working at the same circumstances

  10. Peripheral arterial disease in a female using high-dose combined oral contraceptive pills

    Directory of Open Access Journals (Sweden)

    P Pallavee

    2013-01-01

    Full Text Available The association between oral contraceptive (OC pills and vascular diseases is well-known, although, the present generation of pills is considered to be relatively safer in this regard. Hormonal treatment for severe abnormal uterine bleeding is usually considered after ruling out malignancy, when such bleeding is resistant to all other forms of treatment. We report a case of severe peripheral arterial disease in a female, who had been on high-dose OC pills for an extended period of time for severe uterine bleeding.

  11. Peripheral arterial disease: A high risk – but neglected – disease population

    Directory of Open Access Journals (Sweden)

    Lip Gregory YH

    2005-06-01

    Full Text Available Abstract Peripheral arterial disease (PAD is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.

  12. Acute arterial thrombosis associated with inadvertent high dose of tranexamic acid

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2013-01-01

    Full Text Available Tranexamic acid (TA act as anti-fibrinolytic agent and is widely used to limit bleeding in clinical practice. Tranexemic acid bind with plasminogen and prevent its conversion to plasmin, which limits the fibrinolytic pathway, so there is a theoretical risk of increasing thrombosis with high or prolonged therapy with TA. We encountered a case of acute arterial thrombosis following inadvertent administration of high dose of TA. A 27-years-old male with no other co-morbidity was ordered intravenous 1 gm TA to control excessive bleeding from previous bladder injury, but by mistake, he received 10 gm of TA. The patient developed signs and symptoms of acute ischemia in the right lower limb, which was diagnosed as acute iliac arterial thrombosis by computed tomography (CT angiography. The patient was managed with systemic heparinization, fasciotomy for impending gangrene and other supportive care following which he recovered fully within a few days. Caution should be exercised for all prophylactic use, especially with high dosage or prolonged therapy with TA.

  13. High Resolution Contrast-enhanced MRA in the Evaluation of Rabbit Carotid Artery

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Introduction:Accurate lumen definition of carotid artery is crucial for determining patient treatment, because a 70% or greater stenosis of a carotid artery will benefit from carotid endarterectomy to reduce the incidence of stroke[1].

  14. Effect of High-Calcium Diet on Coronary Artery Disease in Ossabaw Miniature Swine With Metabolic Syndrome.

    Science.gov (United States)

    Phillips-Eakley, Alyssa K; McKenney-Drake, Mikaela L; Bahls, Martin; Newcomer, Sean C; Radcliffe, John S; Wastney, Meryl E; Van Alstine, William G; Jackson, George; Alloosh, Mouhamad; Martin, Berdine R; Sturek, Michael; Weaver, Connie M

    2015-08-13

    Calcium is a shortfall essential nutrient that has been a mainstay of osteoporosis management. Recent and limited findings have prompted concern about the contribution of calcium supplementation to cardiovascular risk. A proposed mechanism is through the acceleration of coronary artery calcification. Determining causality between calcium intake and coronary artery calcification has been hindered by a lack of sensitive methodology to monitor early vascular calcium accumulation. The primary study aim was to assess the impact of high calcium intake on coronary artery calcification using innovative calcium tracer kinetic modeling in Ossabaw swine with diet-induced metabolic syndrome. Secondary end points (in vitro wire myography, histopathology, intravascular ultrasound) assessed coronary disease. Pigs (n=24; aged ≈15 months) were fed an atherogenic diet with adequate calcium (0.33% by weight) or high calcium (1.90% from calcium carbonate or dairy) for 6 months. Following 5 months of feeding, all pigs were dosed intravenously with (41)Ca, a rare isotope that can be measured in serum and tissues at a sensitivity of 10(-18) mol/L by accelerator mass spectrometry. Kinetic modeling evaluated early coronary artery calcification using (41)Ca values measured in serial blood samples (collected over 27 days) and coronary artery samples obtained at sacrifice. Serum disappearance of (41)Ca and total coronary artery (41)Ca accumulation did not differ among groups. Secondary end points demonstrated no treatment differences in coronary artery disease or function. There was no detectable effect of high calcium diets (from dairy or calcium carbonate) on coronary artery calcium deposition in metabolic syndrome swine. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. Algunas consideraciones sobre la hipertensión arterial en la diabetes mellitus tipo 2 Some considerations related to arterial high blood pressure in Type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Yanes Quesada

    2009-09-01

    Full Text Available Se realizó una revisión del tema relacionado con la hipertensión arterial en el paciente diabético tipo 2, con el objetivo de actualizar algunos elementos particulares en este grupo de pacientes. Se plantea que su prevalencia es considerablemente más alta que en la población no diabética, donde la hiperinsulinemia y la disfunción endotelial cobran un papel protagónico en su etiopatogenia. La hipertensión arterial en estos pacientes clínicamente se manifiesta como un patrón non dipper, lo que incrementa la morbimortalidad por esta entidad. El tratamiento medicamentoso es habitualmente necesario, y se usan como drogas de primera línea los inhibidores de la enzima convertidora, los antagonistas de los receptores de angiotensina ll y los calcioantagonistas, aunque se pueden utilizar también los diuréticos tiacídicos a dosis bajas.Authors made a review of the topic related to arterial high blood pressure in the patient presenting with Type 2 diabetes mellitus to update some particular elements in this group of patients. We propose that its prevalence is higher than that present in non-diabetic population, where the hyperinsulinism and the endothelial dysfunction have a leading role in its ethiopathogenesis. The arterial high blood pressure in these patients clinically is manifested as a non-dipper pattern increasing the morbidity and mortality. Drug therapy is commonly necessary and as first line-drugs are used the converting-enzyme inhibitors, the agiotensin-II receptors antagonists, and the antagonists-calcium, although the low-dose thiacidic diuretics.

  16. Coronary angiography of pregnancy-associated coronary artery dissection: a high-risk procedure.

    Science.gov (United States)

    Martins, Raphaël Pedro; Leurent, Guillaume; Corbineau, Hervé; Fouquet, Olivier; Seconda, Sébastien; Baruteau, Alban E; Moreau, Olivier; Le Breton, Hervé; Bedossa, Marc

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome occurring predominantly in young women without any cardiovascular risk factors, especially during the peripartum and early postpartum period. Here, we report a case of a 28-year-old pregnant woman who was found to have an isolated distal SCAD of the left anterior descending artery (LAD). Coronary angiography was complicated by extensive LAD and circumflex arteries dissection, requiring an emergency coronary artery bypass grafting associated with ventricular assist device implantation and underlying the extreme fragility of coronary arteries in pregnant women.

  17. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yuoness, Salem A.; Goha, Ahmed M.; Romsa, Jonathan G.; Akincioglu, Cigdem; Warrington, James C.; Datta, Sudip; Gambhir, Sanjay; Urbain, Jean-Luc C.; Vezina, William C. [London Health Sciences Centre, Department of Nuclear Medicine, London, ON (Canada); Massel, David R. [London Health Sciences Centre, Division of Cardiology, London, ON (Canada); Martell, Rafael [Private Practice, London, ON (Canada)

    2015-09-15

    Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

  18. Risk of High Dietary Calcium for Arterial Calcification in Older Adults

    Directory of Open Access Journals (Sweden)

    Philip J. Klemmer

    2013-09-01

    Full Text Available Concern has recently arisen about the potential adverse effects of excessive calcium intakes, i.e., calcium loading from supplements, on arterial calcification and risks of cardiovascular diseases (CVD in older adults. Published reports that high calcium intakes in free-living adults have relatively little or no beneficial impact on bone mineral density (BMD and fracture rates suggest that current recommendations of calcium for adults may be set too high. Because even healthy kidneys have limited capability of eliminating excessive calcium in the diet, the likelihood of soft-tissue calcification may increase in older adults who take calcium supplements, particularly in those with age or disease-related reduction in renal function. The maintenance of BMD and bone health continues to be an important goal of adequate dietary calcium consumption, but eliminating potential risks of CVDs from excessive calcium intakes needs to be factored into policy recommendations for calcium by adults.

  19. Association between high-sensitive troponin I and coronary artery calcification in a Danish general population

    DEFF Research Database (Denmark)

    Olson, Fredrik; Engborg, Jonathan; Grønhøj, Mette H.;

    2016-01-01

    BACKGROUND: High-sensitive troponin I (hs-TnI) is an individual predictor of future cardiovascular disease (CVD). However, the relationship between hs-TnI and coronary artery calcification (CAC) as determined by computed tomography (CT) has not previously been investigated in a general population....... METHODS: 1173 randomized, middle-aged subjects without known CVD underwent a non-contrast cardiac-CT scan for CAC determination. Hs-TnI was detected using ARCHITECT STAT High Sensitive Troponin-I immunoassay. Total 10-year cardiovascular mortality risk was estimated using HeartScore. The relationship...... between hs-TnI and CAC was assessed using logistic regression analyses and receiver operating characteristic curves (ROC). RESULTS: Concentrations of hs-TnI above the limit of detection were measured in 89.3% of all subjects. Presence of CAC (Agatston score >0) was detected in 29% in the lowest hs...

  20. A New High-Resolution Spectral Approach to Noninvasively Evaluate Wall Deformations in Arteries

    Directory of Open Access Journals (Sweden)

    Ivonne Bazan

    2014-01-01

    Full Text Available By locally measuring changes on arterial wall thickness as a function of pressure, the related Young modulus can be evaluated. This physical magnitude has shown to be an important predictive factor for cardiovascular diseases. For evaluating those changes, imaging segmentation or time correlations of ultrasonic echoes, coming from wall interfaces, are usually employed. In this paper, an alternative low-cost technique is proposed to locally evaluate variations on arterial walls, which are dynamically measured with an improved high-resolution calculation of power spectral densities in echo-traces of the wall interfaces, by using a parametric autoregressive processing. Certain wall deformations are finely detected by evaluating the echoes overtones peaks with power spectral estimations that implement Burg and Yule Walker algorithms. Results of this spectral approach are compared with a classical cross-correlation operator, in a tube phantom and “in vitro” carotid tissue. A circulating loop, mimicking heart periods and blood pressure changes, is employed to dynamically inspect each sample with a broadband ultrasonic probe, acquiring multiple A-Scans which are windowed to isolate echo-traces packets coming from distinct walls. Then the new technique and cross-correlation operator are applied to evaluate changing parietal deformations from the detection of displacements registered on the wall faces under periodic regime.

  1. A New High-Resolution Spectral Approach to Noninvasively Evaluate Wall Deformations in Arteries

    Science.gov (United States)

    Bazan, Ivonne; Negreira, Carlos; Ramos, Antonio; Brum, Javier; Ramirez, Alfredo

    2014-01-01

    By locally measuring changes on arterial wall thickness as a function of pressure, the related Young modulus can be evaluated. This physical magnitude has shown to be an important predictive factor for cardiovascular diseases. For evaluating those changes, imaging segmentation or time correlations of ultrasonic echoes, coming from wall interfaces, are usually employed. In this paper, an alternative low-cost technique is proposed to locally evaluate variations on arterial walls, which are dynamically measured with an improved high-resolution calculation of power spectral densities in echo-traces of the wall interfaces, by using a parametric autoregressive processing. Certain wall deformations are finely detected by evaluating the echoes overtones peaks with power spectral estimations that implement Burg and Yule Walker algorithms. Results of this spectral approach are compared with a classical cross-correlation operator, in a tube phantom and “in vitro” carotid tissue. A circulating loop, mimicking heart periods and blood pressure changes, is employed to dynamically inspect each sample with a broadband ultrasonic probe, acquiring multiple A-Scans which are windowed to isolate echo-traces packets coming from distinct walls. Then the new technique and cross-correlation operator are applied to evaluate changing parietal deformations from the detection of displacements registered on the wall faces under periodic regime. PMID:24688596

  2. Habitual rowing exercise is associated with high physical fitness without affecting arterial stiffness in older men.

    Science.gov (United States)

    Kawano, Hiroshi; Iemitsu, Motoyuki; Gando, Yuko; Ishijima, Toshimichi; Asaka, Meiko; Aoyama, Tomoko; Ando, Takafumi; Tokizawa, Ken; Miyachi, Motohiko; Sakamoto, Shizuo; Higuchi, Mitsuru

    2012-01-01

    The present study elucidated the effects of habitual rowing exercise on arterial stiffness and plasma levels of the vasoconstrictor endothelin-1 and the vasodilator nitric oxide (NO) in older men. Eleven rowers (68.0 ± 1.6 years) and 11 sedentary control older men (64.9 ± 1.1 years) were studied. Peak oxygen uptake (36.0 ± 1.7 vs. 27.7 ±1.9 ml · kg(-1) · min(-1)), leg press power (1346 ± 99 vs. 1077 ± 68 W), and HDL-cholesterol (75 ± 5 vs. 58 ±3 mg · ml(-1)) were higher and triglyceride (78 ± 9 vs. 120 ± 14 mg · ml(-1)) was lower in rowers than in control participants (all P cardio-ankle vascular index) and plasma endothelin-1 and NOx (nitrite + nitrate) levels did not differ between the two groups. These results suggest that habitual rowing exercise in older men is associated with high muscle power and aerobic capacity, and favourable blood lipid profile without affecting arterial stiffness or plasma levels of endotheline-1 and NO.

  3. High volume practice proved the safety of off-pump coronary artery bypass surgery in left main coronary artery lesions:a two-year single center experience

    Institute of Scientific and Technical Information of China (English)

    LIU Tong; LU Chun-shan; LU Jia-kai; GAN Hui-li; ZHANG Jian-qun; HUANG Fang-jong; GU Cheng-xiong; KONG Qing-yu; CAO Xiang-rong; BO Ping

    2012-01-01

    Background Left main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG).This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG),compared with non-left main coronary artery stenosis (non-mainstem disease).Methods From January 1,2009 to December 31,2010,4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital.According to the pathology of LMCA lesions,they were retrospectively classified as a non-mainstem disease group (n=3933) or a LMCA group (n=936).Propensity scores were used to match the two groups,patients from the non-mainstem disease group (n=831) were also randomly selected to match patients from the LMCA group (n=831).Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.Results The difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P=0.429,P=0.127 respectively).With a mean follow-up of (12.8±7.5) months and a cumulative follow-up of 1769.6 patient-years,the difference in the freedom from MACCEs between the two groups,calculated through Kaplan-Meier method,did not reach statistical significance (P=0.831).Conclusion Analysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG.Therefore,a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

  4. Checking Security Policy Compliance

    CERN Document Server

    Gowadia, Vaibhav; Kudo, Michiharu

    2008-01-01

    Ensuring compliance of organizations to federal regulations is a growing concern. This paper presents a framework and methods to verify whether an implemented low-level security policy is compliant to a high-level security policy. Our compliance checking framework is based on organizational and security metadata to support refinement of high-level concepts to implementation specific instances. Our work uses the results of refinement calculus to express valid refinement patterns and their properties. Intuitively, a low-level security policy is compliant to a high-level security policy if there is a valid refinement path from the high-level security policy to the low-level security policy. Our model is capable of detecting violations of security policies, failures to meet obligations, and capability and modal conflicts.

  5. Associations between high factor VIII and low free protein S levels with traditional arterial thrombotic risk factors and their risk on arterial thrombosis : Results from a retrospective family cohort study

    NARCIS (Netherlands)

    Mulder, Rene; van Schouwenburg, Inge M.; Mahmoodi, Bakhtawar K.; Veeger, Nic J. G. M.; Mulder, Andre B.; Middeldorp, Saskia; Kluin-Nelemans, Hanneke C.; Lijfering, Willem M.

    2010-01-01

    Introduction: Whether high factor (F)VIII and low free protein S levels are risk factors for arterial thrombosis is unclarified. Material and Methods: In a post-hoc analysis of a single-centre retrospective family cohort, we determined if these two proteins could increase the risk of arterial

  6. COMPARISON OF HIGH-DEFINITION OSCILLOMETRIC AND DIRECT ARTERIAL BLOOD PRESSURE MEASUREMENT IN ANESTHETIZED CHEETAHS (ACINONYX JUBATUS).

    Science.gov (United States)

    Sant Cassia, Emma V; Boswood, Adrian; Tordiffe, Adrian S W

    2015-09-01

    Blood pressure measurement reveals important insights into the health of conscious and anesthetized individuals. This is of particular interest in cheetahs (Acinonyx jubatus), which in captivity are known to suffer from chronic diseases that may be associated with hypertension and which often require immobilization for transport or veterinary treatment. Invasive testing methods are considered the gold standard but are not practical in many settings. Consequently, it is important to evaluate the use of noninvasive methods in this species. Measurements for systolic, diastolic, and mean arterial pressure obtained using high-definition oscillometry (HDO) at the coccygeal artery were compared to simultaneous direct measurements obtained via catheterization of the femoral or dorsal pedal artery in eight anesthetized captive cheetahs during nine anesthetic events. Overall, HDO and direct measurements agreed most closely for mean arterial pressure, and the poorest agreement was observed for systolic pressure. There was a tendency for low diastolic pressures to be underestimated and for high diastolic pressures to be overestimated. Across all three parameters, HDO measurements from the tail overestimated directly measured pressures in the femoral artery and underestimated those in the dorsal pedal artery. HDO agreed most closely with directly measured dorsal pedal pressures. Mean arterial pressure showed the greatest precision (standard deviation of 10.2 mm Hg) and lowest bias (-1.2 mm Hg), with 75.9% of readings within 10 mm Hg of the direct dorsal pedal pressure. Agreement with systolic pressure was hindered by a high bias (-10.4 mm Hg), but if a correction factor of +10 mm Hg was applied to all systolic measurements, agreement was improved and 65.7% of readings were within 10 mm Hg of the direct pressure. When compared to criteria defined by the American College of Veterinary Internal Medicine for validation of blood pressure devices, results were favorable, but a

  7. A fully-integrated high-compliance voltage SoC for epi-retinal and neural prostheses.

    Science.gov (United States)

    Lo, Yi-Kai; Chen, Kuanfu; Gad, Parag; Liu, Wentai

    2013-12-01

    This paper presents a fully functionally integrated 1024-channel mixed-mode and mixed-voltage system-on-a-chip (SoC) for epi-retinal and neural prostheses. Taking an AC input, an integrated power telemetry circuits is capable of generating multiple DC voltages with a voltage conversion efficiency of 83% at a load of 100 mW without external diodes or separate power integrated circuits, reducing the form factor of the prosthetic device. A wireless DPSK receiver with a novel noise reduction scheme supports a data rate of 2 Mb/s at a bit-error-rate of 2 ×10⁻⁷. The 1024-channel stimulator array meets an output compliance voltage of ±10 V and provides flexible stimulation waveforms. Through chip-clustering, the stimulator array can be further expanded to 4096 channels. This SoC is designed and fabricated in TSMC 0.18 μm high-voltage 32 V CMOS process and occupies a chip area of 5.7 mm × 6.6 mm. Using this SoC, a retinal implant bench-top test system is set up with real-time visual verification. In-vitro experiment conducted in artificial vitreous humor is designed and set-up to investigate stimulation waveforms for better visual resolution. In our in-vivo experiment, a hind-limb paralyzed rat with spinal cord transection and implanted chronic epidural electrodes has been shown to regain stepping and standing abilities using stimulus provided by the SoC.

  8. Relationship of arterial compliance and blood pressure with microalbuminuria and mildly decreased glomerular filtration rate: a Chinese community-based analysis.

    Directory of Open Access Journals (Sweden)

    Shihui Fu

    Full Text Available This analysis is designed to determine the prevalence of microalbuminuria (MAU and mildly decreased glomerular filtration rate (GFR; to investigate the association of augmentation index (AIx, central blood pressure (cBP and peripheral blood pressure (pBP with MAU and mildly decreased GFR; and to compare the association strength of cBP and pBP with MAU and mildly decreased GFR.This community-based analysis included 2071 Chinese residents. Urine albumin-to-creatinine ratio (UACR, GFR, and pulse wave measurements were performed. UACR of 30-299 mg/g and GFR of 60-89 ml/min/1.73 m2 were identified as MAU and mildly decreased GFR.The prevalence of MAU and mildly decreased GFR was 21.3% and 33.2%. The AIx, cBP and pBP were significantly higher in participants with MAU compared with those without MAU, and in participants with mildly decreased GFR compared with those without mildly decreased GFR (all P<0.001. After participants were categorized into four subgroups based on the presence or absence of MAU and mildly decreased GFR, Aix, cBP and pBP progressively increased from the subgroup without both of MAU and mildly decreased GFR to the subgroups with either one of them, and arrived at top in the subgroup with both of them (all P<0.001. Compared with the reference category without MAU and mildly decreased GFR, the odd ratio values significantly increased from the category with either one of MAU and mildly decreased GFR to the category with both of them (all P<0.001. The AIx, cBP and pBP were all independently associated with MAU and mildly decreased GFR after full adjustment (all P<0.05, and the association strength of MAU and mildly decreased GFR with cBP was similar to those with pBP.In Chinese community-dwelling population, there was a high prevalence of MAU and mildly decreased GFR. The AIx, cBP and pBP were all independently associated with MAU and mildly decreased GFR; meanwhile, cBP did not exhibit stronger association with MAU and mildly

  9. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V;

    1993-01-01

    patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...

  10. The dynamic of aterosclerosis affection on brachio-cefalic arterys of the high risk patients under the hypolipidemic treatment

    Directory of Open Access Journals (Sweden)

    V.V. Simerzin

    2010-06-01

    Full Text Available Purpose. To study the statin influence on lipid exchange and the degree of the brachiocefalic arterys alteration. Methods. The research included 33 high risk patients. The patients inverstigation included lipid spectrum, blood coagulation indexes, by the means of triplex scanning of the brachiochefalic arterys the thickness of the intima - media complex and the expression of stenosis of carotid, vertebral and subclavian arterys were measured. Results. All the patients were divided into the groups according to the total cholesterol and low density lipoprotein cholesterol levels. Patients were divided into subgroups according to the expression of stenosis. The 1 group of patients received rosuvastating 10 mg, the 2 group - atorvastain 20 mg, 3the 3 group - simvastatin 40 mg. This inverstigation shows that the high risk patients with high levels of total cholesterol and low density lipoproteins have the highest expressiveness of brachiocefalic arterys atherosclerosis affection. Conclusion. The assignment of the statins to these patients is accompanied by the lowering of the levels of total cholesterol and low density lipoproteins and the quantity of arteries affected by the atherosclerosis and also by decreasing of the stenosis expression

  11. Oxidized LDL and Fructosamine Associated with Severity of Coronary Artery Atherosclerosis in Insulin Resistant Pigs Fed a High Fat/High NaCl Diet.

    Directory of Open Access Journals (Sweden)

    Timothy C Nichols

    Full Text Available Insulin-resistant subjects develop more severe and diffuse coronary artery atherosclerosis than insulin-sensitive controls but the mechanisms that mediate this atherosclerosis phenotype are unknown.To determine the metabolic parameters that associate with the severity of coronary atherosclerosis in insulin resistant pigs fed a high fat/high NaCl diet.The primary endpoint was severity of coronary atherosclerosis in adult pigs (Sus scrofa, n = 37 fed a high fat diet that also contained high NaCl (56% above recommended levels for 1 year.Twenty pigs developed severe and diffuse distal coronary artery atherosclerosis (i.e., severe = intimal area as a percent medial area > 200% in at least 2 coronary artery cross sections and diffuse distal = intimal area as a percent medial area ≥ 150% over 3 sections separated by 2 cm in the distal half of the coronary artery. The other 17 pigs had substantially less coronary artery atherosclerosis. All 37 pigs had blood pressure in a range that would be considered hypertensive in humans and developed elevations in total and LDL and HDL cholesterol, weight gain, increased backfat, and increased insulin resistance (Bergman Si without overt diabetes. Insulin resistance was not associated with atherosclerosis severity. Five additional pigs fed regular pig chow also developed increased insulin resistance but essentially no change in the other variables and little to no detectible coronary atherosclerosis. Most importantly, the 20 high fat/high NaCl diet-fed pigs with severe and diffuse distal coronary artery atherosclerosis had substantially greater increases (p< 0.05 in oxidized LDL (oxLDL and fructosamine consistent with increased protein glycation.In pigs fed a high fat/high NaCl diet, glycated proteins are induced in the absence of overt diabetes and this degree of increase is associated with the development of severe and diffuse distal coronary artery atherosclerosis.

  12. Oxidized LDL and Fructosamine Associated with Severity of Coronary Artery Atherosclerosis in Insulin Resistant Pigs Fed a High Fat/High NaCl Diet.

    Science.gov (United States)

    Nichols, Timothy C; Merricks, Elizabeth P; Bellinger, Dwight A; Raymer, Robin A; Yu, Jing; Lam, Diana; Koch, Gary G; Busby, Walker H; Clemmons, David R

    2015-01-01

    Insulin-resistant subjects develop more severe and diffuse coronary artery atherosclerosis than insulin-sensitive controls but the mechanisms that mediate this atherosclerosis phenotype are unknown. To determine the metabolic parameters that associate with the severity of coronary atherosclerosis in insulin resistant pigs fed a high fat/high NaCl diet. The primary endpoint was severity of coronary atherosclerosis in adult pigs (Sus scrofa, n = 37) fed a high fat diet that also contained high NaCl (56% above recommended levels) for 1 year. Twenty pigs developed severe and diffuse distal coronary artery atherosclerosis (i.e., severe = intimal area as a percent medial area > 200% in at least 2 coronary artery cross sections and diffuse distal = intimal area as a percent medial area ≥ 150% over 3 sections separated by 2 cm in the distal half of the coronary artery). The other 17 pigs had substantially less coronary artery atherosclerosis. All 37 pigs had blood pressure in a range that would be considered hypertensive in humans and developed elevations in total and LDL and HDL cholesterol, weight gain, increased backfat, and increased insulin resistance (Bergman Si) without overt diabetes. Insulin resistance was not associated with atherosclerosis severity. Five additional pigs fed regular pig chow also developed increased insulin resistance but essentially no change in the other variables and little to no detectible coronary atherosclerosis. Most importantly, the 20 high fat/high NaCl diet-fed pigs with severe and diffuse distal coronary artery atherosclerosis had substantially greater increases (p< 0.05) in oxidized LDL (oxLDL) and fructosamine consistent with increased protein glycation. In pigs fed a high fat/high NaCl diet, glycated proteins are induced in the absence of overt diabetes and this degree of increase is associated with the development of severe and diffuse distal coronary artery atherosclerosis.

  13. Effect of high laser output on the central bronchi and pulmonary artery.

    Science.gov (United States)

    Kirschbaum, A; Rexin, P; Bartsch, D K; Quint, K

    2017-05-01

    A diode-pump Nd:YAG high-power laser (wavelength 1320 nm, power 100 W) is routinely used to surgically remove lung metastases. Even pulmonary lesions in central locations are resectable via this method, yet it also carries a potential risk of damaging the larger bronchi and vessels in the vicinity. Studies investigating the safety of using high-power lasers are lacking. We therefore aimed to examine the direct effects of a 100-watt laser on the bronchi and pulmonary artery at a standard working velocity. From freshly slaughtered pigs, we isolated cylindrical specimens of the trachea, the main and lobar bronchi, and the central pulmonary artery from the both lungs. These specimens were fixed consecutively in rows behind each other on a Styrofoam surface in the laboratory. The laser's handle was clamped into a hydraulic feed unit so that the laser was focused at constant distance perpendicular to the tissue and would move at 10 mm/s over the specimens. The Nd:YAG Laser LIMAX® 120 functioned at a consistent power of 100 W during all the experiments. The lasered specimens were examined macroscopically and histologically for tissue damage. None of the trachea or bronchial walls were perforated. Compared to the pulmonary parenchyma, we observed no vaporization effects-only minor superficial coagulation (with a mean depth of 2.1 ± 0.8 mm). This finding was histologically confirmed in each specimen, which revealed mild superficial coagulation and no damage to the cartilage. In the presence of a residual peribronchial fatty tissue, the laser effect was even attenuated. The pulmonary arteries presented no lumen openings whatsoever, merely a discrete trace of coagulation. The vessel wall revealed increased vacuolization without alteration of the remaining vessel wall. In conclusion, laser resection at 100 W of the central lung areas is safe with respect to airways and blood vessels and the laser output does not need to be reduced when treating these areas.

  14. High resolution MR angiography with rephasing and dephasing sequences for selective vascular imaging of arteries

    Energy Technology Data Exchange (ETDEWEB)

    Seiderer, M.; Laub, G.; Staebler, A.; Yousry, P.; Lauterjung, L.

    1988-03-01

    With rephasing and dephasing sequences the vascular system is imaged with high or low signal intensity whereas stationary tissue is imaged with identical signal intensity. With images recorded in systole and diastole followed by image subtraction separate imaging of arteries or veins without background superposition is possible. 13 patients with vascular lesions of the lower extremities and 7 volunteers were examined. Vascular stenosis, aneurysm, dilatation, occlusion and collateral vessels could be imaged similar to digital subtraction angiography. Vessels with a diameter down to 1 mm could be imaged. The large slice thickness up to 80 mm results in projection type images where the vascular tree is imaged over the whole field of view and without partial volume effects.

  15. Local motion-compensated method for high-quality 3D coronary artery reconstruction.

    Science.gov (United States)

    Liu, Bo; Bai, Xiangzhi; Zhou, Fugen

    2016-12-01

    The 3D reconstruction of coronary artery from X-ray angiograms rotationally acquired on C-arm has great clinical value. While cardiac-gated reconstruction has shown promising results, it suffers from the problem of residual motion. This work proposed a new local motion-compensated reconstruction method to handle this issue. An initial image was firstly reconstructed using a regularized iterative reconstruction method. Then a 3D/2D registration method was proposed to estimate the residual vessel motion. Finally, the residual motion was compensated in the final reconstruction using the extended iterative reconstruction method. Through quantitative evaluation, it was found that high-quality 3D reconstruction could be obtained and the result was comparable to state-of-the-art method.

  16. Study of the stenosis-inhibiting effects of high-dose rate endovascular irradiation in balloon injured rabbit iliac artery

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Masao; Sekine, Hiroshi; Suzuki, Akihiko; Ohyama, Noriaki; Hataba, Yoshiaki [Jikei Univ., Tokyo (Japan). School of Medicine

    2002-12-01

    With scanning electron microscopy, we investigated the effectiveness of inhibition by endovascular irradiation (Ir-192 high dose rate) of intimal hyperplasia after angioplasty. We also examined changes in the irradiated arterial vessel wall after balloon injury and the mechanism of the inhibition of intimal hyperplasia. Japanese white rabbits (male, 3.0-3.5 kg) were used. Under anesthesia, a percutaneous transluminal angioplasty balloon catheter was inserted into the iliac arteries and inflated to 6 atm for 1 minute 3 times at 1-minute intervals. One artery was irradiated (12 Gy) with an iridium-192 high-dose rate endovascular irradiation device (the reference point was set at 2 mm to center; dose rate 18-48 Gy/min). From 2 days to 12 weeks after the procedure, fixation was performed at a perfusion pressure of 120 to 150 cm H{sub 2}O, and the arteries were systematically examined. Endothelial cells after balloon injury with or without irradiation were examined with light microscopy or scanning electron microscopy. Endovascular irradiation inhibited intimal hyperplasia for at least 12 weeks. Irradiated arteries were not constricted, so we assumed that this phenomenon was caused by inhibition of negative remodeling. From 1 to 2 weeks after the procedure, we recognized mild intimal hyperplasia at nonirradiated arteries, but no hyperplasia recognized at irradiated arteries. This hyperplasia was mainly constituted by endothelial cells, and this change happened at least 2 days with scanning electron scopy. At the injury site, platelet aggregation, thrombus, and endothelial cells were observed. After irradiation, endothelial cells and nuclei were injured. Hypertrophic nuclei, the deformity of cell alignment, and stratified endothelial cells were recognized. It means that irradiation may affect the metabolism of the endothelial cells against normal formation with light microscopy. (author)

  17. Arterial Stiffness.

    Science.gov (United States)

    Avolio, Alberto

    2013-04-01

    Stiffness of large arteries has been long recognized as a significant determinant of pulse pressure. However, it is only in recent decades, with the accumulation of longitudinal data from large and varied epidemiological studies of morbidity and mortality associated with cardiovascular disease, that it has emerged as an independent predictor of cardiovascular risk. This has generated substantial interest in investigations related to intrinsic causative and associated factors responsible for the alteration of mechanical properties of the arterial wall, with the aim to uncover specific pathways that could be interrogated to prevent or reverse arterial stiffening. Much has been written on the haemodynamic relevance of arterial stiffness in terms of the quantification of pulsatile relationships of blood pressure and flow in conduit arteries. Indeed, much of this early work regarded blood vessels as passive elastic conduits, with the endothelial layer considered as an inactive lining of the lumen and as an interface to flowing blood. However, recent advances in molecular biology and increased technological sophistication for the detection of low concentrations of biochemical compounds have elucidated the highly important regulatory role of the endothelial cell affecting vascular function. These techniques have enabled research into the interaction of the underlying passive mechanical properties of the arterial wall with the active cellular and molecular processes that regulate the local environment of the load-bearing components. This review addresses these emerging concepts.

  18. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    DEFF Research Database (Denmark)

    Krähenbühl, B; Nielsen, S L; Lassen, N A

    1977-01-01

    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  19. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    DEFF Research Database (Denmark)

    Krähenbühl, B; Nielsen, S L; Lassen, N A

    1977-01-01

    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  20. Effect of cholesterol lowering on stiffness of aortic and femoral arterial walls in rabbits on a high fat diet

    Institute of Scientific and Technical Information of China (English)

    XUE Li; XU Wan-hai; XU Jin-zhi; ZHANG Tong; BI Hong-yuan; SHEN Bao-zhong

    2009-01-01

    Background Researches in arterial elasticity have increased over the past few years. We investigated the effects of simvastatin on vascular stiffness in fat fed rabbits by ultrasonography.Methods Thirty rabbits were assigned randomly to 3 groups: normal control group (A), the cholesterol group (B), simvastatin group (C: high fat diet for 4 weeks and high fat diet + simvastatin for further 4 weeks). Stiffness coefficient, pressure strain elastic modulus and velocity of pulse waves in abdominal aorta and femoral artery were measured by ultrasonographic echo tracking at the end of the 4th and the 8th weeks.Results At the end of the 4th week, stiffness coefficient, pressure strain elastic modulus and pulse wave velocity of femoral artery were significantly increased in group B compared with those in group A. Similarly, at the end of the 8th week, the same parameters of abdominal aorta were significantly increased in group B compared with those in group A. In contrast, stiffness coefficient, pressure strain elastic modulus and pulse wave velocity of femoral artery were significantly decreased in group C compared with those in group B, however, there was no significant difference in parameters of abdominal aorta between groups B and C.Conclusion Short term administration of simvastatin can improve the elasticity of femoral artery but not abdominal aorta.

  1. High dose of green tea infusion normalized spiral artery density in rats treated with the depot-medroxyprogesterone acetate.

    Science.gov (United States)

    Emilda, A S; Veri, Nora; Alchalidi, Alchalidi

    2017-01-01

    The purpose of this study was to investigate the effects of green tea (GT) on the spiral artery density and endometrial thickness in female rats treated with the depot-medroxyprogesterone acetate (DMPA). A total of 24 female rats were randomly divided into four groups (n = 6 each): The control group (no treatment), the DMPA-treated group, treated with DMPA and GT doses of 165 mg/kg of body weight/day, and treated with DMPA and GT doses of 330 mg/kg of body weight/day. Spiral artery density and endometrial thickness were subjected to histopathological analysis. Spiral artery density decreased in the DMPA-treated group, despite the insignificant difference (P > 0.05). With regard to the administration of GT at doses of 165 and 330 mg/g of body weight/day, only GT at the high dose was capable of significantly preventing a decrease in spiral artery density (P 0.05). Meanwhile, the administration of DMPA and/or DMPA with GT did not cause significant changes in endometrial thickness relative to the control group (P > 0.05). DMPA induced a decrease in spiral artery density, despite the insignificant differences, and these changes could be normalized by the administration of high doses of GT. Therefore, GT could be a candidate herb to prevent the adverse effects of the contraceptive DMPA.

  2. Increased arterial compliance in decompensated cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, Søren; Schifter, S

    1999-01-01

    in patients with biopsy-verified cirrhosis (Child-Turcotte classes A/B/C=10/15/6). RESULTS: COMPart was significantly higher in cirrhotic patients (n=31) than in controls (n=10) (1.44 vs 1.00 x 10(-3) l/mmHg, pTurcotte classes A, B, and C (1.02, 1.47, and 2...

  3. A clinical model to identify patients with high-risk coronary artery disease.

    Science.gov (United States)

    Yang, Yelin; Chen, Li; Yam, Yeung; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S; Budoff, Matthew J; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Cheng, Victor Y; Chinnaiyan, Kavitha; Cury, Ricardo; Delago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jörg; Karlsberg, Ronald P; Kaufmann, Philipp A; Kim, Yong-Jin; Leipsic, Jonathon; LaBounty, Troy; Lin, Fay; Maffei, Erica; Raff, Gilbert L; Shaw, Leslee J; Villines, Todd C; Min, James K; Chow, Benjamin J W

    2015-04-01

    This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify those patients with and without high-risk coronary anatomy. Retrospective analysis of a prospectively collected multinational coronary computed tomographic angiography (CTA) cohort was conducted. High-risk anatomy was defined as left main diameter stenosis ≥50%, 3-vessel disease with diameter stenosis ≥70%, or 2-vessel disease involving the proximal left anterior descending artery. Using a cohort of 27,125, patients with a history of CAD, cardiac transplantation, and congenital heart disease were excluded. The model was derived from 24,251 consecutive patients in the derivation cohort and an additional 7,333 nonoverlapping patients in the validation cohort. The risk score consisted of 9 variables: age, sex, diabetes, hypertension, current smoking, hyperlipidemia, family history of CAD, history of peripheral vascular disease, and chest pain symptoms. Patients were divided into 3 risk categories: low (≤7 points), intermediate (8 to 17 points) and high (≥18 points). The model was statistically robust with area under the curve of 0.76 (95% confidence interval [CI]: 0.75 to 0.78) in the derivation cohort and 0.71 (95% CI: 0.69 to 0.74) in the validation cohort. Patients who scored ≤7 points had a low negative likelihood ratio (risk CAD was 1% in patients with ≤7 points and 16.7% in those with ≥18 points. We propose a scoring system, based on clinical variables, that can be used to identify patients at high and low pre-test probability of having high-risk CAD. Identification of these populations may detect those who may benefit from a trial of medical therapy and those who may benefit most from an invasive strategy. Copyright © 2015 American College of Cardiology Foundation. Published by

  4. Two- and three-dimensional quantitative image analysis of coronary arteries from high-resolution histological sections

    Science.gov (United States)

    Holmes, David R., III; Robb, Richard A.

    2000-05-01

    The study of coronary arteries has evolved from examining gross anatomy and morphology to scrutinizing micro-anatomy and cellular composition. Technological advances such as high-powered digital microscopes and high precision cutting devices have allowed clinicians to examine coronary artery morphology and pathology at micron resolution. Our work explores the composition of normal coronary arteries in order to provide the foundation for further study of remodeled tissue. The first of two coronary arteries was sliced into 442 sections with 4 micron inter-slice spacing. Each slice was stained for elastin and collagen. The second coronary artery was sectioned into 283 slices, also with 4 micron resolution. These slices were stained for cellular nuclei and smooth muscle. High sectioned into 283 slices, also with 4 micron resolution. These slices were stained for cellular nuclei and smooth muscle. High resolution light microscopy was used to image the sections. The data was analyzed for collagen/elastin content and nuclei density, respectively. Processing of this type of data is challenging in the areas of segmentation, visualization and quantification. Segmentation was confounded by variation in image quality as well as complexity of the coronary tissue. These problems were overcome by the development of 'smart' thresholding algorithms for segmentation. In addition, morphology and image statistics were used to further refine the result of the segmentation. Specificity/sensitivity analysis suggests that automatic segmentation can be very effective. 3D visualization of coronary arteries is challenging due to multiple tissue layers. Method such as summed voxel projection and maximum intensity projection appear to be effective. Shading methods also provide adequate visualization, however it is important to incorporate combined 2D and 3D displays. Surface rendering techniques are useful tools for visualizing parametric data. Quantification in 3D is simple in practice but

  5. The arterial load in pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    A. Vonk-Noordegraaf

    2010-09-01

    Full Text Available The anatomical differences between the pulmonary and systemic arterial system are the main cause of the difference in distribution of compliance. In the pulmonary arterial system compliance is distributed over the entire arterial system, and stands at the basis of the constancy of the RC-time. This distribution depends on the number of peripheral vessels, which is ∼8–10 times more in the pulmonary system than the systemic tree. In the systemic arterial tree the compliance is mainly located in the aorta (80% of total compliance in thoracic-abdominal aorta. The constant RC-time in the pulmonary bed results in proportionality of systolic and diastolic pressure with mean pressure and, in turn, in the constant ratio of oscillatory and mean power.

  6. The blood pressure variability, arterial elasticity and humoral factors in subjects with family history of hypertension.

    Science.gov (United States)

    Rafidah, H M; Azizi, A; Suhaimi, H; Noriah, M N

    2008-03-01

    Normotensive subjects with family history of hypertension (FHT) have been reported to have increased left ventricular mass index and reduced ventricular compliance. Of interest is whether blood pressure variability (BPV), which has been associated with target organ damage, is then part of this complex inherited syndrome? The objectives of this study are to determine whether there are any significant differences in BPV, arterial compliance and humoral factors in subjects with FHT as compared to controls. Thirty-five subjects with self reported FHT and 35 matched controls underwent 24 hour BP monitoring (BR-102, Schiller Inc. Germany). Arterial compliance was measured using systolic pulse wave tonometry (HDI/Pulsewave Cardiovascular Profiling Instrument, Hypertension Diagnostic Inc. USA). None of the subjects were hypertensive or diabetic. Out of these numbers, 25 subjects with FHT and 26 controls had measurements of plasma catecholamines, plasma renin and serum aldosterone. Catecholamines were assayed with high performance liquid chromatography, while both renin and aldosterone measurements were by radioimmunoassay. Subjects with FHT have higher night time BPV. There was no significant difference in arterial compliances between both groups. There were increased level of norepinephrine (NE) in subjects with FHT but epinephrine (E), renin and aldosterone levels were similar in both groups. There were no correlations between NE and BPV but E was negatively associated with daytime and mean arterial systolic BPV. In conclusion subjects with FHT demonstrated a higher night time BPV and NE level as compared to controls.

  7. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    Directory of Open Access Journals (Sweden)

    Abbas Afrasiabirad

    2015-01-01

    Full Text Available Background: There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG in coronary high-risk patients in comparison with the conventional methods. Methods: In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results: Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001. Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion: Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.

  8. Electrocardiographically triggered CT angiography of the whole aorta and coronary arteries with high-pitch dual-source CT

    Institute of Scientific and Technical Information of China (English)

    张楠

    2013-01-01

    Objective To investigate the feasibility of comprehensive assessment of the whole aorta and coronary arteries(CA)simultaneously with high-pitch128-slice dualsource CT ECG-gated FLASH protocol.Methods A totalof 48 consecutive patients with suspected aortic diseases

  9. High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and normal left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Madsen, Claus Juul; Andersen, Kim F; Zerahn, Bo

    2013-01-01

    Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS...

  10. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery : Six months' angiographic and clinical follow-up of a prospective randomized study

    NARCIS (Netherlands)

    Drenth, DJ; Winter, JB; Veeger, NJGM; Monnink, SHJ; van Boven, AJ; Grandjean, JG; Mariani, MA; Boonstra, PW

    Objective: We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart

  11. The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate.

    Science.gov (United States)

    Damkjaer, M; Wang, T; Brøndum, E; Østergaard, K H; Baandrup, U; Hørlyck, A; Hasenkam, J M; Smerup, M; Funder, J; Marcussen, N; Danielsen, C C; Bertelsen, M F; Grøndahl, C; Pedersen, M; Agger, P; Candy, G; Aalkjaer, C; Bie, P

    2015-08-01

    The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary adaption in the giraffe kidney allows normal for size renal haemodynamics and glomerular filtration rate (GFR) despite a MAP double that of other mammals. Fourteen anaesthetized giraffes were instrumented with vascular and bladder catheters to measure glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological characteristics of vascular and renal tissues were determined. GFR averaged 342 ± 99 mL min(-1) and ERPF 1252 ± 305 mL min(-1) . RIHP varied between 45 and 140 mmHg. Renal pelvic pressure was 39 ± 2 mmHg and renal venous pressure 32 ± 4 mmHg. A valve-like structure at the junction of the renal and vena cava generated a pressure drop of 12 ± 2 mmHg. RI was 0.27. The renal capsule was durable with a calculated burst pressure of 600 mmHg. Plasma renin and AngII were 2.6 ± 0.5 mIU L(-1) and 9.1 ± 1.5 pg mL(-1) respectively. In giraffes, GFR, ERPF and RI appear much lower than expected based on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP. © 2015 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  12. Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

    Science.gov (United States)

    Ko, Heung Kyu; Ko, Gi Young; Gwon, Dong Il; Kim, Jin Hyung; Han, Kichang; Lee, Shin-Wha

    2017-01-01

    Objective To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. Materials and Methods A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. Results All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Conclusion Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility. PMID:28246515

  13. Transcatheter arterial chemo-lipiodol infusion for unresectable hepatocellular carcinoma in 96 high-risk patients

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, H.-J. [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, J.H., E-mail: m1fenew@daum.ne [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, K.-A.; Lee, I.-S.; Ko, G.-Y.; Song, H.-Y.; Gwon, D.I. [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    Aim: To evaluate the safety and efficacy of transcatheter arterial chemo-lipiodol infusion (TACL) in high-risk patients with unresectable hepatocellular carcinoma (HCC). Materials and methods: From January 2005 to April 2009, 96 patients underwent TACL. All patients had diffuse, infiltrative or multifocal tumours. Twenty-nine (30%) patients had an increased serum bilirubin level (>=2 mg/dl), and 75 patients (78%) had a low serum albumin level (<3.5 mg/dl). The Child-Pugh (CP) score was 9 or more in 13 (14%) patients. Sixty-five patients (68%) had major portal vein occlusion. Sixteen patients (17%) had biliary dilatation. Results: TACL was technically successful in all patients. After TACL, 18 (19%) of the 96 patients showed tumour response using computed tomography (CT) criteria. The 30 day mortality and morbidity rates were 1 and 2%, respectively. The median survival period was 8.6 months, and the overall 6 month, 1, 2, and 3 year survival rates were 59, 44, 26, and 15%, respectively. Portal vein occlusion (p < 0.001) was the only significant risk factor associated with the length of the survival period after TACL, whereas the CP score (p = 0.498), serum bilirubin level (p = 0.153), serum albumin level (p = 0.399), and biliary obstruction (p = 0.636) had no significant effect. Conclusions: TACL can be performed safely in high risk HCC patients resulting in a median survival rate of 8.6 months in the present series.

  14. [High-sensitivity troponin in patients with stable coronary artery disease].

    Science.gov (United States)

    van 't Hof, Arnoud W J

    2015-01-01

    With the introduction of more sensitive markers of myocardial necrosis, it was shown that the diagnosis of (acute) myocardial infarction could be improved. However, many patients without myocardial infarction have elevated troponin levels (low sensitivity), resulting in additional diagnostic testing and longer admission times to find the cause of the troponin rise. Elevated troponin levels in these patients were found to have limited diagnostic but strong prognostic value. This led to studies assessing the value of high-sensitivity troponin in patients with stable disease, e.g. coronary artery disease, or even in patients without apparent (clinical) disease. These studies consistently showed a strong association with long-term (cardiac) mortality. What is the value for the general physician in daily practice? Although troponin levels may help in finding (healthy?) patients at higher risk, it remains unclear whether interventions (medication, lifestyle) are more (cost-)effective in this high-risk subgroup. The role of troponin levels as a prognostic marker in stable patients therefore remains to be determined.

  15. Efficacy of prophylactic uterine artery embolization before obstetrical procedures with high risk for massive bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Heung Kyu; Shin, Ji Hoon; Ko, Gi Young; Gwon, Dong Il; Kim, Jin Hyung; Han, Ki Chang; Lee, Shin Wha [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D and C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D and C for retained placenta with vascularity (n = 5), and D and C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. All women received successful bilateral prophylactic UAE followed by D and C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

  16. High-quality 3-D coronary artery imaging on an interventional C-arm x-ray system

    Energy Technology Data Exchange (ETDEWEB)

    Hansis, Eberhard; Carroll, John D.; Schaefer, Dirk; Doessel, Olaf; Grass, Michael [Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany); Department of Medicine, Division of Cardiology, Health Sciences Center, University of Colorado, Denver, Colorado 80262 (United States); Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany); Institute of Biomedical Engineering, University of Karlsruhe, Kaiserstr. 12, 76131 Karlsruhe (Germany); Philips Technologie GmbH Forschungslaboratorien, Roentgenstrasse 24-26, 22335 Hamburg (Germany)

    2010-04-15

    Purpose: Three-dimensional (3-D) reconstruction of the coronary arteries during a cardiac catheter-based intervention can be performed from a C-arm based rotational x-ray angiography sequence. It can support the diagnosis of coronary artery disease, treatment planning, and intervention guidance. 3-D reconstruction also enables quantitative vessel analysis, including vessel dynamics from a time-series of reconstructions. Methods: The strong angular undersampling and motion effects present in gated cardiac reconstruction necessitate the development of special reconstruction methods. This contribution presents a fully automatic method for creating high-quality coronary artery reconstructions. It employs a sparseness-prior based iterative reconstruction technique in combination with projection-based motion compensation. Results: The method is tested on a dynamic software phantom, assessing reconstruction accuracy with respect to vessel radii and attenuation coefficients. Reconstructions from clinical cases are presented, displaying high contrast, sharpness, and level of detail. Conclusions: The presented method enables high-quality 3-D coronary artery imaging on an interventional C-arm system.

  17. Intracranial arterial calcification is highly prevalent in hemodialysis patients but does not associate with acute ischemic stroke.

    Science.gov (United States)

    Power, Albert; Chan, Kakit; Haydar, Ali; Hamady, Mohamed; Cairns, Tom; Taube, David; Duncan, Neill

    2011-04-01

    Intracranial arterial calcification (IAC) is associated with ischemic stroke in the general population but this relationship has not been examined in hemodialysis patients. We examined the factors associated with IAC and its relationship with acute ischemic stroke in this population. We retrospectively studied 490 head computed tomographic scans from 2225 hemodialysis patients presenting with neurological symptoms at our center (October 2005-May 2009). Intracranial arterial calcification was graded using a validated scoring system. Multivariate regression was used to examine the factors associated with the presence of IAC, its severity, and its ability to predict acute ischemic stroke. Weibull's survival models analyzed the relationship between IAC severity and survival. Ninety-five percent of patients with ischemic stroke had IAC vs. 83% in the nonstroke group (P=0.02). Intracranial arterial calcification severity increased with age (Pacute ischemic stroke (P=0.05) on logistic regression analysis. High-grade and not low-grade IAC was associated with worse survival (P=0.008). Intracranial arterial calcification is highly prevalent in hemodialysis patients, especially in those with acute ischemic stroke. Its severity is prognostically significant and associated with risk factors for vascular calcification and may confer a greater risk of acute ischemic stroke. The mechanisms underlying the high incidence of ischemic stroke in this patient group require further comprehensive study. © 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.

  18. "Medical high risk" designation is not associated with survival after carotid artery stenting.

    Science.gov (United States)

    Yuo, Theodore H; Goodney, Philip P; Powell, Richard J; Cronenwett, Jack L

    2008-02-01

    While medical high risk (MHR) has been proposed as an indication for carotid artery stenting (CAS), the impact of MHR on long-term survival and stroke after CAS has not been described. A retrospective chart review of CAS procedures at our institution was performed. One hundred seventy-nine consecutive patients who underwent 196 CAS procedures were classified by MHR status based on cardiac, pulmonary, and renal criteria routinely used in high-risk clinical trials. Survival and stroke rates were compared after 90 CAS procedures in MHR patients vs 106 CAS procedures in normal risk patients. Survival results were also compared with 365 contemporaneous carotid endarterectomy (CEA) procedures in 346 patients. The mean age of CAS patients was 72 years, with 87% having a smoking history, 85% hypertension, 38% diabetes, 39% symptomatic, and 74% documented coronary artery disease. Mean follow-up was 23 months. Recurrent stenosis after CEA comprised 21% of all CAS procedures. During the 30-day post-procedure period, there were five minor strokes, one major stroke, and one death, for a combined stroke/death rate of 3.6%. Kaplan-Meier analysis demonstrated mortality of 5% at 1 year and 21% at 3 years for the entire cohort. Cox regression analysis found that MHR designation was not associated with increased mortality or an increase in a composite end point of death or stroke. MHR patients had mortality of 4% at 1 year and 22% at 3 years. Normal risk patients had mortality of 6% at 1 year and 20% at 3 years. Preoperative age over 80 years old, low density lipoprotein (LDL) > or =160 mg/dL, and serum creatinine > or =1.5 mg/dL conferred statistically significant risk for death (Hazard ratios: 2.9, 4.3, and 2.4, respectively). As a point of comparison, a contemporaneous group of CEA patients were analyzed similarly. After adjusting for age over 80 years old and serum creatinine > or =1.5 mg/dL, there was no survival difference between MHR patients undergoing CAS or CEA. The

  19. Simultaneous transfer of cholesterol, triglycerides, and phospholipids to high-density lipoprotein in aging subjects with or without coronary artery disease

    OpenAIRE

    AZEVEDO, Carolina H. M; Maurício Wajngarten; Ana C. Lo Prete; Jayme Diament; Raul C. Maranhão

    2011-01-01

    OBJECTIVE: To verify whether the capacity of high-density lipoprotein (HDL) to simultaneously receive non-esterified cholesterol, triglycerides, cholesteryl esters, and phospholipids changes with aging and the presence of coronary artery disease. DESIGN: Cross-sectional study with biochemical analyses. SUBJECTS: Eleven elderly patients with coronary artery disease (74±5 years) were compared with the following groups of non-coronary artery disease subjects (referred to as “healthy”): 25 young ...

  20. Arterial elasticity imaging: comparison of finite-element analysis models with high-resolution ultrasound speckle tracking

    Directory of Open Access Journals (Sweden)

    Park Dae

    2010-06-01

    Full Text Available Abstract Background The nonlinear mechanical properties of internal organs and tissues may be measured with unparalleled precision using ultrasound imaging with phase-sensitive speckle tracking. The many potential applications of this important noninvasive diagnostic approach include measurement of arterial stiffness, which is associated with numerous major disease processes. The accuracy of previous ultrasound measurements of arterial stiffness and vascular elasticity has been limited by the relatively low strain of nonlinear structures under normal physiologic pressure and the measurement assumption that the effect of the surrounding tissue modulus might be ignored in both physiologic and pressure equalized conditions. Methods This study performed high-resolution ultrasound imaging of the brachial artery in a healthy adult subject under normal physiologic pressure and the use of external pressure (pressure equalization to increase strain. These ultrasound results were compared to measurements of arterial strain as determined by finite-element analysis models with and without a surrounding tissue, which was represented by homogenous material with fixed elastic modulus. Results Use of the pressure equalization technique during imaging resulted in average strain values of 26% and 18% at the top and sides, respectively, compared to 5% and 2%, at the top and sides, respectively, under physiologic pressure. In the artery model that included surrounding tissue, strain was 19% and 16% under pressure equalization versus 9% and 13% at the top and sides, respectively, under physiologic pressure. The model without surrounding tissue had slightly higher levels of strain under physiologic pressure compared to the other model, but the resulting strain values under pressure equalization were > 60% and did not correspond to experimental values. Conclusions Since pressure equalization may increase the dynamic range of strain imaging, the effect of the

  1. Arterial and fat tissue inflammation are highly correlated: a prospective {sup 18}F-FDG PET/CT study

    Energy Technology Data Exchange (ETDEWEB)

    Bucerius, Jan [Mount Sinai School of Medicine, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, P. O. Box 1234, New York, NY (United States); Mount Sinai School of Medicine, Department of Radiology, New York, NY (United States); Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht (Netherlands); Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht (Netherlands); University Hospital RWTH Aachen, Department of Nuclear Medicine, Aachen (Germany); Mani, Venkatesh; Fayad, Zahi A. [Mount Sinai School of Medicine, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, P. O. Box 1234, New York, NY (United States); Mount Sinai School of Medicine, Department of Radiology, New York, NY (United States); Mount Sinai School of Medicine, Department of Cardiology, Zena and Michael A. Weiner Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, New York, NY (United States); Wong, Stephanie; Moncrieff, Colin; Izquierdo-Garcia, David [Mount Sinai School of Medicine, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, P. O. Box 1234, New York, NY (United States); Mount Sinai School of Medicine, Department of Radiology, New York, NY (United States); Machac, Josef [Mount Sinai School of Medicine, Division of Nuclear Medicine, Department of Radiology, New York, NY (United States); Fuster, Valentin [Mount Sinai School of Medicine, Department of Cardiology, Zena and Michael A. Weiner Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, New York, NY (United States); The Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid (Spain); Farkouh, Michael E. [Mount Sinai School of Medicine, Department of Cardiology, Zena and Michael A. Weiner Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, New York, NY (United States); Mount Sinai School of Medicine, Cardiovascular Imaging Clinical Trials Unit, New York, NY (United States); Rudd, James H.F. [University of Cambridge, Division of Cardiovascular Medicine, Cambridge (United Kingdom)

    2014-05-15

    There is evidence that the link between obesity and cardiovascular disease might relate to inflammation in both fat tissue and the arterial wall. {sup 18}F-FDG uptake on PET is a surrogate marker of vessel wall inflammation. The aim of the study was to measure FDG uptake in both regions using PET and identify links between adipose and arterial inflammation. Included in the study were 173 cardiovascular patients who were prospectively imaged with FDG PET/CT. Arterial FDG uptake was measured in the carotid arteries and ascending aorta. The same was done in fat tissue in the neck, the presternal region (both subcutaneous) and the pericardium. FDG uptake was quantified as average maximal target-to-background ratio ({sub mean}TBR{sub max}). Multivariate regression analyses were performed to identify significant associations between arterial and adipose tissue FDG uptake and clinical variables as given by the standardized correlation coefficient (β). FDG uptake values in all fat tissue regions were highly predictive of vascular FDG uptake in both the carotids (β 0.262, p < 0.0001, in the neck subcutaneous region) and aorta (β 0.22, p = 0.008, in the chest pericardial region; β 0.193, p = 0.019, in the chest subcutaneous region). Obesity was significantly associated with elevated FDG uptake in adipose tissue (β 0.470, p < 0.0001, in the neck subcutaneous region; β 0.619, p = 0.028, in the chest subcutaneous region; β 0.978, p = 0.035, in the chest pericardial region). FDG uptake in diverse fat tissue regions was significantly associated with arterial FDG uptake, a reasonable surrogate of inflammation. Increasing body weight significantly predicted the level of fatty inflammation. FDG PET therefore provides imaging evidence of an inflammatory link between fat tissue and the vasculature in patients with cardiovascular disease. (orig.)

  2. Motivation and barriers for compliance to high-intensity physical exercise at the workplace: When intervention meets organisation

    DEFF Research Database (Denmark)

    Bredahl, Thomas Viskum Gjelstrup

    The second of three presentations in the symposium “High‐Intensity Physical Training in the Treatment of work‐related Musculoskeletal Disorders” will provide a comprehensive qualitative understanding of motivational factors and barriers important for compliance to high‐intensity workplace physical...... exercise aiming at reducing musculoskeletal disorders. The data are based upon semi‐deductive, thematic, and structured in‐depth interviews with informants with diverse fields of sedentary office work, participating in strength training at the workplace three times 20 minutes per week. Results show...

  3. Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease.

    Science.gov (United States)

    Zhang, J W; Liu, W W; McCaffrey, Timothy A; He, X Q; Liang, W Y; Chen, X H; Feng, X R; Fu, Sidney W; Liu, M L

    2017-01-01

    Previous studies have illustrated the link between high on-aspirin platelet reactivity (HAPR) with increasing thrombotic risks. The aim of our study was to investigate relative risk factors of HAPR in elderly patients with coronary artery disease. Elderly, hospitalized coronary artery disease patients on regular aspirin treatment were enrolled from January 2014 to September 2016. Medical records of each patient were collected, including demographic information, cardiovascular risk factors, concomitant drugs and routine biological parameters. Arachidonic acid (AA, 0.5 mg/mL) and adenosine diphosphate (ADP, 5 µmol/L) induced platelet aggregation were measured via light transmission assay (LTA) to evaluate antiplatelet responses, referred as LTA-AA and LTA-ADP. A total of 275 elderly patients were included, with mean age of 77.2±8.1 years, and males accounted for 81.8%. HAPR was defined as LTA-AA in the upper quartile of the enrolled population. HAPR patients tended to have lower renal function (P=0.052). Higher serum uric acid (SUA) level, as well as lower platelet count, hemoglobin and hematocrit were observed in HAPR patients, with a higher proportion of diuretics use (P<0.05). Multivariate analysis revealed that SUA (OR: 1.004, 95% CI: 1.000-1.007, P=0.048), platelet count (OR: 0.994, 95% CI: 0.989-1.000, P=0.045), hematocrit (OR: 0.921, 95% CI: 0.864-0.981, P=0.011) and concomitant P2Y12 receptor inhibitors use (OR: 1.965, 95% CI: 1.075-3.592, P=0.028) were correlated with HAPR. Spearman's correlation analysis demonstrated an inverse association of LTA-AA with hematocrit (r=-0.234, P<0.001), hemoglobin (r=-0.209, P<0.001) and estimated glomerular filtration rate (r=-0.132, P=0.031). SUA, platelet count, hematocrit and P2Y12 receptor inhibitors use were independently correlated with HAPR. These parameters might provide novel therapeutic targets for optimizing antiplatelet therapy.

  4. Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection

    Energy Technology Data Exchange (ETDEWEB)

    Han, Miran; Rim, Nae-Jung; Kim, Sun Yong; Choi, Jin Wook [Ajou University School of Medicine, Ajou University Medical Center, Department of Radiology, Suwon (Korea, Republic of); Lee, Jin Soo [Ajou University School of Medicine, Ajou University Medical Center, Department of Neurology, Suwon (Korea, Republic of)

    2014-12-15

    To evaluate the feasibility of high-resolution MRI (HR-MRI) for diagnosing intracranial vertebrobasilar artery dissection (VBD) and to identify the most useful imaging findings suggesting dissection. We retrospectively reviewed 50 patients with suspected intracranial VBDs who underwent HR-MRI. Two neuroradiologists independently reviewed the HR-MR images. The diagnosis based on HR-MRI was compared with the final diagnosis by consensus among the neuroradiologists, neurointerventionist, and neurologist. Two neuroradiologists also sought signs of dissection (mural hematoma, dissection flap, outer-diameter enlargement on T2WI of steno-occlusive lesions). Inter- and intraobserver agreements were analysed. HR-MRI corroborated the final diagnosis in 47 (94 %; 31 VBD and 16 non-VBD) patients. A mural haematoma was best detected on T1WI and contrast-enhanced (CE)-T1WI (54.3 %). Dissection flaps were observed in almost all cases on CE-T1WI (91.4 %), and then were detected on T2WI (68.6 %). Outer-diameter enlargement of the steno-occlusive lesions on angiography was detected in more than half of the cases (62.9 %). The two reviewers showed almost perfect agreement for the diagnosis of VBD and detecting dissection signs on every sequence. HR-MRI can be a useful and non-invasive diagnostic tool for intracranial VBD, and dissection flaps on CE-T1WI are the signs with the greatest diagnostic value. (orig.)

  5. Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients

    Directory of Open Access Journals (Sweden)

    Maher Thomas D

    2010-02-01

    Full Text Available Abstract Background Statins are widely prescribed to patients with atherosclerosis. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG. Methods The study population comprised 2377 patients who had isolated CABG at Allegheny General Hospital between 2000 and 2004. Mean age of the patients was 65 ± 11 years (range 27 to 92 years. 1594 (67% were male, 5% had previous open heart procedures, and 4% had emergency surgery. 1004 patients (42% were being treated with a statin at the time of admission. Univariate, bivariate (Chi2, Fisher's Exact and Student's t-tests and multivariate (stepwise linear regression analyses were used to evaluate the association of statin use with mortality following CABG. Results Annual prevalence of preoperative statin use was similar over the study period and averaged 40%. Preoperative clinical risk assessment demonstrated a 2% risk of mortality in both the statin and non-statin groups. Operative mortality was 2.4% for all patients, 1.7% for statin users and 2.8% for non-statin users (p Conclusions Between 2000 and 2004 less than 50% of patients at this institution were receiving statins before admission for isolated CABG. A retrospective analysis of this cohort provides evidence that preoperative statin use is associated with lower operative mortality in high-risk patients.

  6. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Tonga Nfor

    2015-08-01

    Full Text Available Purpose: Previous studies comparing percutaneous coronary intervention (PCI with coronary artery bypass graft surgery (CABG in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83 vs. 13.6 ± 7.1% for CABG (n=187 (P=0.31. After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8. There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001. Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23. Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.

  7. Does PGA external stenting reduce compliance mismatch in venous grafts?

    Directory of Open Access Journals (Sweden)

    Zou Liang-jian

    2007-04-01

    Full Text Available Abstract Background Autogenous vein grafting is widely used in regular bypassing procedures. Due to its mismatch with the host artery in both mechanical property and geometry, the graft often over expands under high arterial blood pressure and forms a step-depth where eddy flow develops, thus causing restenosis, fibrous graft wall, etc. External stents, such as sheaths being used to cuff the graft, have been introduced to eliminate these mismatches and increase the patency. Although histological and immunochemical studies have shown some positive effects of the external stent, the mechanical mismatch under the protection of an external stent remains poorly analyzed. Methods In this study, the jugular veins taken from hypercholesterolemic rabbits were transplanted into the carotid arteries, and non-woven polyglycolic acid (PGA fabric was used to fabricate the external stents to study the effect of the biodegradable external stent. Eight weeks after the operation, the grafts were harvested to perform mechanical tests and histological examinations. An arc tangent function was suggested to describe the relationship between pressure and cross-sectional area to analyse the compliance of the graft. Results The results from the mechanical tests indicated that grafts either with or without external stents displayed large compliance in the low-pressure range and were almost inextensible in the high-pressure range. This was very different from the behavior of the arteries or veins in vivo. The data from histological tests showed that, with external stents, collagen fibers were more compact, whilst those in the graft without protection were looser and thicker. No elastic fiber was found in either kind of grafts. Furthermore, grafts without protection were over-expanded which resulted in much bigger cross-sectional areas. Conclusion The PGA external extent contributes little to the reduction of the mechanical mismatch between the graft and its host artery

  8. High oxygen modifies vasodilator effect of cysteine via enhanced oxidative stress and thromboxane production in the rat mesenteric artery.

    Science.gov (United States)

    Yasuda, Yoshitaka; Feng, Guo-Gang; Li, Jiazheng; Nakamura, Emi; Hayashi, Hisaki; Sato, Motohiko; Fujiwara, Yoshihiro; Kinoshita, Hiroyuki

    2016-09-01

    Whether high oxygen is harmful to the vascular function is unclear. The present study examined if high oxygen modifies vasodilator effect of cysteine via enhanced oxidative stress and thromboxane production. Rat mesenteric arteries with endothelium at 95 or 50 % oxygen were subjected to isometric force recordings, measurement of thromboxane B2 levels, determination of superoxide and peroxynitrite levels and evaluation of NADPH oxidase subunit protein expression, respectively. L-cysteine (0.01-3 mM) constricted or dilated arteries at 95 and 50 % oxygen, respectively. Thromboxane receptor antagonist SQ-29,548 (1 μM) abolished the constriction at 95 % oxygen. L-cysteine (3 mM) increased levels of thromboxane B2 in arteries upon 95 % oxygen application. L-cysteine relaxed arteries treated with superoxide inhibitor tiron (2 mM) or NADPH oxidase inhibitor gp91ds-tat (1 μM) irrespective of the oxygen concentration while ATP-sensitive K(+) channel inhibitor glibenclamide (1 μM) and cystathionine-γ-lyase (CSE) inhibitor DL-propargylglycine (10 mM) similarly abolished the relaxation. L-cysteine (3 mM) with 95 % oxygen augmented levels of superoxide as well as nitrotyrosine within the artery, concomitantly with enhanced membrane protein expression of NADPH oxidase subunit p47phox. The higher concentration of oxygen attenuates L-cysteine-induced vasodilation via superoxide production mediated by NADPH oxidase along with thromboxane A2 production, resulting in vasoconstriction. The increased levels of superoxide, as well as peroxynitrite, coexist with the impaired vasodilation related to ATP-sensitive K(+) channels and CSE. Higher oxygen with plasma cysteine may cause oxidative stress and vasoconstrictor prostanoid production in blood vessels.

  9. [Upper extremity arterial diseases].

    Science.gov (United States)

    Becker, F

    2007-02-01

    Compared to lower limb arterial diseases, upper limb arterial diseases look rare, heterogeneous with various etiologies and a rather vague clinical picture, but with a negligible risk of amputation. Almost all types of arterial diseases can be present in the upper limb, but the anatomical and hemodynamic conditions particular to the upper limb often confuse the issue. Thus, atherosclerosis affects mainly the subclavian artery in its proximal segment where the potential of collateral pathway is high making the symptomatic forms not very frequent whereas the prevalence of subclavian artery stenosis or occlusion is relatively high. The clinical examination and the etiologies are discussed according to the clinical, anatomical and hemodynamic context.

  10. High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Korn, A.; Fenchel, M.; Bender, B.; Danz, S.; Ernemann, U. [Department of Diagnostic und Interventional Neuroradiology, Tuebingen (Germany); Thomas, C.; Ketelsen, D.; Claussen, C.D.; Heuschmid, M. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Moonis, G. [Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Krauss, B. [Siemens AG, Imaging and Therapy Division, Forchheim (Germany); Brodoefel, H. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (United States)

    2013-04-15

    High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 {+-} 16.5 versus 57.3 {+-} 14.8; p = 0.50) and venous segments (15.8 {+-} 6.7 versus 18.9 {+-} 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35 % (218.2 {+-} 30 versus 141.8 {+-} 20 mGy x cm). Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis. (orig.)

  11. Pool boiling with high heat flux enabled by a porous artery structure

    Science.gov (United States)

    Bai, Lizhan; Zhang, Lianpei; Lin, Guiping; Peterson, G. P.

    2016-06-01

    A porous artery structure utilizing the concept of "phase separation and modulation" is proposed to enhance the critical heat flux of pool boiling. A series of experiments were conducted on a range of test articles in which multiple rectangular arteries were machined directly into the top surface of a 10.0 mm diameter copper rod. The arteries were then covered by a 2.0 mm thickness microporous copper plate through silver brazing. The pool wall was fabricated from transparent Pyrex glass to allow a visualization study, and water was used as the working fluid. Experimental results confirmed that the porous artery structure provided individual flow paths for the liquid supply and vapor venting, and avoided the detrimental effects of the liquid/vapor counter flow. As a result, a maximum heat flux of 610 W/cm2 over a heating area of 0.78 cm2 was achieved with no indication of dryout, prior to reaching the heater design temperature limit. Following the experimental tests, the mechanisms responsible for the boiling critical heat flux and performance enhancement of the porous artery structure were analyzed.

  12. Nonalcoholic Hepatic Steatosis Is a Strong Predictor of High-Risk Coronary-Artery Plaques as Determined by Multidetector CT.

    Directory of Open Access Journals (Sweden)

    Kazuhiro Osawa

    Full Text Available Nonalcoholic fatty liver disease is associated with a risk of coronary artery disease (e.g., diabetes mellitus, dyslipidemia, metabolic syndrome. We evaluated whether nonalcoholic hepatic steatosis is associated with high-risk plaques as assessed by multidetector computed tomography (CT.This retrospective study involved 414 participants suspected of having coronary artery disease. Nonalcoholic hepatic steatosis was defined as a liver-to-spleen fat ratio of <1.0 and the presence and appropriate characteristics of coronary-artery plaques as assessed by coronary CT angiography. High-risk plaques were identified, as were low-density plaques, positive remodeling, and spotty calcification.Compared with patients who did not have nonalcoholic hepatic steatosis, patients with nonalcoholic hepatic steatosis had more low-density plaques (21% vs. 44%, p<0.01, positive remodeling (41% vs. 58%, p = 0.01, and spotty calcification (12% vs. 36%, p<0.01. The number of high-risk plaques in patients with nonalcoholic hepatic steatosis was greater than in those without nonalcoholic hepatic steatosis (p<0.01. Patients with nonalcoholic hepatic steatosis were more likely to have high-risk plaques than were those with only an elevated level of visceral adipose tissue (≥86 cm2; 35% vs. 16%, p<0.01. Multivariate analyses that included nonalcoholic hepatic steatosis, amount of visceral adipose tissue, and the presence/absence of traditional risk factors demonstrated that nonalcoholic hepatic steatosis was an independent predictor of high-risk plaques (odds ratio: 4.60; 95% confidence interval: 1.94-9.07, p<0.01.Diagnosis of nonalcoholic hepatic steatosis may be of value when assessing the risk of coronary artery disease.

  13. Monitoring compliance with high-level commitments in health: the case of the CARICOM Summit on Chronic Non-Communicable Diseases.

    Science.gov (United States)

    Samuels, T Alafia; Kirton, John; Guebert, Jenilee

    2014-04-01

    The CARICOM Summit on Chronic Non-Communicable Diseases - the first government summit ever devoted to noncommunicable diseases (NCDs) - was convened by the Caribbean Community (CARICOM) in Trinidad and Tobago in September 2007. Leaders in attendance issued the declaration of Port of Spain, a call for the prevention and control of four major NCDs and their risk factors. An accountability instrument for monitoring compliance with summit commitments was developed for CARICOM by the University of the West Indies in 2008 and revised in 2010. The instrument - a one-page colour-coded grid with 26 progress indicators - is updated annually by focal points in Caribbean health ministries, verified by each country's chief medical officer and presented to the annual Caucus of Caribbean Community Ministers of Health. In this study, the G8 Research Group's methods for assessing compliance were applied to the 2009 reporting grid to assess each country's performance. Given the success of the CARICOM Summit, a United Nations high-level meeting of the General Assembly on the prevention and control of NCDs was held in September 2011. In May 2013 the World Health Assembly adopted nine global targets and 25 indicators to measure progress in NCD control. This study shows that the CARICOM monitoring grid can be used to document progress on such indicators quickly and comprehensibly. An annual reporting mechanism is essential to encourage steady progress and highlight areas needing correction. This paper underscores the importance of accountability mechanisms for encouraging and monitoring compliance with the collective political commitments acquired at the highest level.

  14. Deadline Compliance Status Reports

    Data.gov (United States)

    Department of Housing and Urban Development — These monthly Deadline Compliance Status Reports assist Participating Jurisdictions and HUD Field Offices in monitoring compliance with the 2-year commitment and...

  15. Going High with Heart Disease: The Effect of High Altitude Exposure in Older Individuals and Patients with Coronary Artery Disease.

    Science.gov (United States)

    Levine, Benjamin D

    2015-06-01

    Levine, Benjamin D. Going high with heart disease: The effect of high altitude exposure in older individuals and patients with coronary artery disease. High Alt Med Biol 16:89-96, 2015.--Ischemic heart disease is the largest cause of death in older men and women in the western world (Lozano et al., 2012 ; Roth et al., 2015). Atherosclerosis progresses with age, and thus age is the dominant risk factor for coronary heart disease in any algorithm used to assess risk for cardiovascular events. Subclinical atherosclerosis also increases with age, providing the substrate for precipitation of acute coronary syndromes. Thus the risk of high altitude exposure in older individuals is linked closely with both subclinical and manifest coronary heart disease (CHD). There are several considerations associated with taking patients with CHD to high altitude: a) The reduced oxygen availability may cause or exacerbate symptoms; b) The hypoxia and other associated environmental conditions (exercise, dehydration, change in diet, thermal stress, emotional stress from personal danger or conflict) may precipitate acute coronary events; c) If an event occurs and the patient is far from advanced medical care, then the outcome of an acute coronary event may be poor; and d) Sudden death may occur. Physicians caring for older patients who want to sojourn to high altitude should keep in mind the following four key points: 1). Altitude may exacerbate ischemic heart disease because of both reduced O2 delivery and paradoxical vasoconstriction; 2). Adverse events, including acute coronary syndromes and sudden cardiac death, are most common in older unfit men, within the first few days of altitude exposure; 3). Ensuring optimal fitness, allowing for sufficient acclimatization (at least 5 days), and optimizing medical therapy (especially statins and aspirin) are prudent recommendations that may reduce the risk of adverse events; 4). A graded exercise test at sea level is probably sufficient for

  16. Matrix metalloproteinase-2 and -9 are associated with high stresses predicted using a nonlinear heterogeneous model of arteries.

    Science.gov (United States)

    Kim, Yu Shin; Galis, Zorina S; Rachev, Alexander; Han, Hai-Chao; Vito, Raymond P

    2009-01-01

    Arteries adapt to their mechanical environment by undergoing remodeling of the structural scaffold via the action of matrix metalloproteinases (MMPs). Cell culture studies have shown that stretching vascular smooth muscle cells (VSMCs) positively correlates to the production of MMP-2 and -9. In tissue level studies, the expressions and activations of MMP-2 and -9 are generally higher in the outer media. However, homogeneous mechanical models of arteries predict lower stress and strain in the outer media, which appear inconsistent with experimental findings. The effects of heterogeneity may be important to our understanding of VSMC function since arteries exhibit structural heterogeneity across the wall. We hypothesized that local stresses, computed using a heterogeneous mechanical model of arteries, positively correlate to the levels of MMP-2 and -9 in situ. We developed a model of the arterial wall accounting for nonlinearity, residual strain, anisotropy, and structural heterogeneity. The distributions of elastin and collagen fibers in situ, measured in the media of porcine carotid arteries, showed significant nonuniformities. Anisotropy was represented by the direction of collagen fibers measured by the helical angle of VSMC nuclei. The points at which the collagen fibers became load bearing were computed, assuming a uniform fiber strain and orientation under physiological loading conditions, an assumption motivated by morphological measurements. The distributions of circumferential stresses, computed using both heterogeneous and homogeneous models, were correlated to the distributions of expressions and activations of MMP-2 and -9 in porcine common carotid arteries incubated in an ex vivo perfusion organ culture system under physiological conditions for 48 h. While strains computed using incompressibility were identical in both models, the heterogeneous model, unlike the homogeneous model, predicted higher circumferential stresses in the outer layer correlated

  17. High accuracy of arterial spin labeling perfusion imaging in differentiation of pilomyxoid from pilocytic astrocytoma

    Energy Technology Data Exchange (ETDEWEB)

    Nabavizadeh, S.A.; Assadsangabi, R.; Hajmomenian, M.; Vossough, A. [Perelman School of Medicine of the University of Pennsylvania, Department of Radiology, Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Santi, M. [Perelman School of Medicine of the University of Pennsylvania, Department of Pathology, Children' s Hospital of Philadelphia, Philadelphia, PA (United States)

    2015-05-01

    Pilomyxoid astrocytoma (PMA) is a relatively new tumor entity which has been added to the 2007 WHO Classification of tumors of the central nervous system. The goal of this study is to utilize arterial spin labeling (ASL) perfusion imaging to differentiate PMA from pilocytic astrocytoma (PA). Pulsed ASL and conventional MRI sequences of patients with PMA and PA in the past 5 years were retrospectively evaluated. Patients with history of radiation or treatment with anti-angiogenic drugs were excluded. A total of 24 patients (9 PMA, 15 PA) were included. There were statistically significant differences between PMA and PA in mean tumor/gray matter (GM) cerebral blood flow (CBF) ratios (1.3 vs 0.4, p < 0.001) and maximum tumor/GM CBF ratio (2.3 vs 1, p < 0.001). Area under the receiver operating characteristic (ROC) curves for differentiation of PMA from PA was 0.91 using mean tumor CBF, 0.95 using mean tumor/GM CBF ratios, and 0.89 using maximum tumor/GM CBF. Using a threshold value of 0.91, the mean tumor/GM CBF ratio was able to diagnose PMA with 77 % sensitivity, 100 % specificity, and a threshold value of 0.7, provided 88 % sensitivity and 86 % specificity. There was no statistically significant difference between the two tumors in enhancement pattern (p = 0.33), internal architecture (p = 0.15), or apparent diffusion coefficient (ADC) values (p = 0.07). ASL imaging has high accuracy in differentiating PMA from PA. The result of this study may have important applications in prognostication and treatment planning especially in patients with less accessible tumors such as hypothalamic-chiasmatic gliomas. (orig.)

  18. High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Wiinberg, Niels; Joergensen, Bjarne S

    2010-01-01

    The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiov......The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention...

  19. The Impact of Moderate-Altitude Staging on Pulmonary Arterial Hemodynamics after Ascent to High Altitude

    Science.gov (United States)

    2010-01-01

    pressure ( Pao2 ) and arterial oxygenation saturation (Sao2) were measured at each time point. Compared to mean PAP at SL (mean SD, 14 3 mmHg), mean PAP...increased after DA to 37 8 mmHg (D¼ 24 10 mmHg, p< 0.001) and was negatively correlated with both Pao2 (r 2¼ 0.57, p¼ 0.011) and Sao2 (r2¼ 0.64, p...subcostal view. Assessment of oxygenation The primary indexes of oxygenation in this study were alveolar oxygen pressure ( Pao2 ) and arterial oxygen

  20. An unusual case of left aberrant innominate artery with right aortic arch: evaluation with high-resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Calcagni, Giulio [University Rene Descartes-Paris 5, Department of Pediatric Cardiology, Hopital Necker Enfants Malades, Paris (France); Gesualdo, Francesco; Brunelle, Francis; Ou, Phalla [University Rene Descartes-Paris 5, Department of Pediatric Radiology, Hopital Necker Enfants Malades, Paris Cedex 15 (France)

    2008-01-15

    A left aberrant innominate (brachiocephalic) artery is an angiographically well-known entity that may cause tracheal compression. We report a male newborn who was admitted for further investigation of a prenatally suspected major vessel anomaly. High-resolution CT was used to completely assess the abnormal anatomy and the relationship with the airway, as well as to guide the surgical approach for its correction. (orig.)

  1. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  2. 36. The relationship between compliance and quality of life among ...

    African Journals Online (AJOL)

    Esem

    that diabetic retinopathy is responsible for 4.8% of all blindness (Kaseba, 2012). ... Compliance also help patients to take control of their situations with focus on ..... knowledge on compliance is not sufficient for adolescents high levels of ...

  3. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; ten Kate, Min Ki; Waanders, Femke; Veeger, Nic J. G. M.; Brouwer, Jan-Leendert P.; Vogt, Liffert; Navis, Gerjan; van der Meer, Jan

    2008-01-01

    Background-No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of V

  4. Retraction Statement: Unrecognized High Brachial Artery Bifurcation is Associated with Higher Rate of Dialysis Access by Dr. Lee Kirksey.

    Science.gov (United States)

    2017-03-01

    The above article from Seminars in Dialysis, published online on 4 September 2011 in Wiley Online Library (http://wileyonlinelibrary.com) has been retracted by agreement among the journal's Editor-in-Chief, Richard A. Sherman MD, the journal's North American editor of ASDIN content at the time, Arif Asif MD, and Wiley Periodicals, Inc. The decision to retract was agreed upon following notification by Dr. HeeJun Yang, the author of an article published in 2008, "Variations of the Superficial Brachial Artery in Korean Cadavers." Figure 1 (A & B) and Figure 2 (A-C) in the Kirksey article (1), which originally appeared in the 2008 article by Dr. Yang, were used without authorization or permission from Dr. Yang or the article's publisher. Reference Kirksey L: Unrecognized high brachial artery bifurcation is associated with higher rate of dialysis access. Semin Dial 24(6):698-702, 2011. doi: 10.1111/j.1525-139X.2011.00923.x.

  5. Quality beyond compliance.

    Science.gov (United States)

    Centanni, N; Monroe, M; White, L; Larson, R

    1999-01-01

    The service sector within the biopharmaceutical industry has experienced phenomenal growth over the past decade. In the highly regulated Good Laboratory Practices environment, the need for timely, high-quality service, accurate results, and on-time deliverables becomes paramount for the success and profitability of biopharmaceutical companies. The quality assurance process is a vital component of this drug product-development cycle and ensures compliance to the highest domestic and international regulatory standards. Quality-assurance professionals historically have held the role of independent auditors of the processes, who certify that results meet current standards of practice. Covance, a contract research organization that includes Good Laboratory Practices laboratories, reorganized and expanded the functional responsibilities of its quality assurance team in 1997. Auditors and quality assurance professionals have assumed roles beyond traditional compliance auditing and are forging new leadership and mentoring roles as process-improvement specialists. The results have been tangible, measurable benefits for clients and the Covance organization. This article provides an overview of this cultural change and the processes put in place to improve efficiency, productivity, and customer and employee satisfaction.

  6. The "T-MIDCAB" procedure. Use of extension grafts from the undisturbed internal mammary artery in high-risk patients.

    Science.gov (United States)

    Coulson, A S; Bakhshay, S A

    1998-01-01

    Minimally invasive direct coronary artery bypass grafting (MIDCAB) is an attractive new alternative for revascularizing patients with high perioperative risk for standard coronary surgery. However, limited surgical exposure through a small thoracotomy makes harvesting the full length of the internal mammary artery (IMA) very difficult and time consuming. We are now employing a new alternative with a "T" shaped bridge graft constructed from the undisturbed IMA using a 4 centimeter interposition segment of donor vessel. We prefer this approach in high risk cases in order to reduce the trauma of the thoracotomy, minimize pain and narcotic use, promote early extubation, and achieve immediate post-operative mobilization and recovery in patients who would otherwise be at risk for a poor outcome with conventional grafting techniques. From September 10, 1997 to December 19, 1997 eight high-risk patients underwent at least one "T-MIDCAB" graft from the undisturbed IMA to the coronary artery using a short segment of either radial artery or saphenous vein. All cases were performed using a limited access anterior thoracotomy through the bed of the resected costal cartilage and without intercostal retraction. Five males and three females ranging from 58 to 83 years (average 73 years) were operated using this new concept. Pre-operative ejection fractions ranged from 25% to 80% (mean 43%). Parsonnet scores ranged from 21 to 43 (average 34) with predicted mortalities ranging from 30 to 40%. Eleven "T" grafts were placed (1.38 distals/patient). All 8 patients survived. Postoperative complications were minimal. The average length of stay was only 8 days (range 3 to 9 days). Intensive care unit stay averaged 3 days (range 1 to 4 days). One patient underwent postoperative angiography which demonstrated full patency of the conduit and all anastomoses. "T-MIDCAB" using a bridge graft of free radial artery or saphenous vein appears to be successful in high risk patients. The authors

  7. Compliance with physical exercise

    DEFF Research Database (Denmark)

    Gram, Anne Sofie; Bønnelycke, Julie; Rosenkilde Larsen, Mads

    2014-01-01

    , a moderate (MOD; 300 kcal/day) or a high-dose (HIGH; 600 kcal/day) endurance exercise group for 12 weeks. A sub-set of the subjects were interviewed using pre-determined, qualitative questions to elucidate physical activity and health behaviour. In combination with the Theory of Planned Behaviour (TPB......Aims: Sixty-one healthy, sedentary, moderately overweight young men participated in a randomised controlled trial to examine the effects of two different doses of endurance exercise on health behaviour and exercise compliance. Methods: Participants were randomised to a sedentary control group...... improved various metabolic health parameters. The MOD group was untroubled by the exercise load and had a positive attitude towards exercise. The HIGH group expressed increased fatigue, less positivity and perceived exercise as time-consuming. The MOD group described themselves as more energetic...

  8. Does high altitude increase risks of the elderly patients with coronary artery disease?

    Institute of Scientific and Technical Information of China (English)

    Tian-Yi Wu; Zhong-Yan Zhan; Qin-Li Wu; Suo-Lung Baomu; Yu-Ling Jie; Min Sun

    2009-01-01

    Objective To assess the effect of altitude hypoxia on the elderly patients with coronary artery disease (CAD). Methods Three subject groups were surveyed during their train trip on the highest railroad--the Qinghai-Tibet Railway: 22 elderly individuals with documented CAD, 20 healthy elderly controls, and 20 healthy young controls, all of whom from Beijing near the sea level (76 m). Survey questions addressed clinical features of their healthy conditions and aspects of their coronary disease. The baseline study was performed at Xining at an altitude of 2261 m, and then during acute exposure to altitudes of 2808 m, 4768m, 5072 m and 4257 m by train for 24 hours. Resting pulse rate, blood pressure, oxygen saturation, electrocardiograph (ECG), and cardiac work estimated by the heart rate-blood pressure double product were obtained five times in each subject at different altitudes. Results On arrival to altitudes between 4768 m and 5072 m, the older passengers, especially those with preexisting coronary disease, had higher HR, higher BP, and lower SaO2, as well as more frequent abnormalities on ECG, as compared to the younger healthy subjects. As compared with the healthy elderly controls, incomplete right bundle branch block, left ventricular hypertrophy, and ST segment depression were more frequently seen in the elderly coronary patients (P<0.01). Cardiac work in group 1 was increased by 13% 12 hours after arrival to altitudes between 2808 m and 5072 m. Oxygen saturation decreased significantly with the altitude increasing by train ascent but improved after inhalation of oxygen. Most of the older subjects tolerated their sojourn at high altitude well except one who developed angina repeatedly with a significant ST segment depression. Conclusions Coronary events and ECG signs of myocardial ischemia are rare in elderly individuals with CAD who travel from sea level to moderate altitudes of 1500m to 2800 m. Patients with CAD who are well compensated at sea level

  9. Effect of long-term treatment with antioxidants (vitamin C, vitamin E, coenzyme Q10 and selenium on arterial compliance, humoral factors and inflammatory markers in patients with multiple cardiovascular risk factors

    Directory of Open Access Journals (Sweden)

    Debby Ortal

    2010-07-01

    Full Text Available Abstract Background Antioxidant supplementations have the potential to alleviate the atherosclerotic damage caused by excessive production of reactive oxygen species (ROS. The present study evaluated the effects of prolonged antioxidant treatment on arterial elasticity, inflammatory and metabolic measures in patients with multiple cardiovascular risk factors. Methods Study participants were randomly assigned to two groups. Group 1 received oral supplementation with 2 capsules per day of Mid Life Guard, SupHerb, Israel. In each capsule vitamin C (500 mg vitamin E (200 iu, co-enzyme Q10 (60 mg and selenium (100 mcg, Group 2 received matching placebo(SupHerb for 6 months. Patients were evaluated for lipid profile, HbA1C, insulin, C-peptide, hs-CRP, endothelin, aldosterone, plasma renin activity and Homeostasis model assessment-insulin resistance (HOMA-IR. Arterial elasticity was evaluated using pulse wave contour analysis (HDI CR 2000, Eagan, Minnesota. Results Antioxidant-treated patients exhibited significant increases in large arterial elasticity index (LAEI as well as small arterial elasticity index (SAEI. A significant decline HbA1C and a significant increase in HDL-cholesterol were also observed. In the placebo group, significant changes in LAEI, SAEI or metabolic measures were not observed. Conclusions Antioxidant supplementation significantly increased large and small artery elasticity in patients with multiple cardiovascular risk factors. This beneficial vascular effect was associated with an improvement in glucose and lipid metabolism as well as decrease in blood pressure.

  10. Analysis of the population at high risk of stroke detected with carotid artery ultrasonography in Tianjin urban communities

    Directory of Open Access Journals (Sweden)

    Wei YUE

    2015-04-01

    Full Text Available Objective To investigate the features of carotid atherosclerosis in a population at high risk of stroke in urban communities of Tianjin, so as to provide inspiration for carotid ultrasonography to play a greater role in the prevention and control of stroke.  Methods A total of 956 residents at high risk of stroke were selected from 4 urban communities in Tianjin using cluster random sampling method. Doppler ultrasound screening was performed in bilateral common carotid artery (CCA, internal carotid artery (ICA, external carotid artery (ECA, vertebral artery (VA, subclavian artery (SCA and innominate artery of the population. The intima-media thickness (IMT, atherosclerotic plaque formation and its location and size, vascular stenosis or occlusion, and flow spectrum were detected. The results and features of carotid ultrasound screening were analyzed and compared among different gender and age groups.  Results 1 The detection rate of carotid atherosclerosis was 71.55% (684/956, and the detection rate in males was significantly higher than that in females (79.08% vs 65.87%; χ2 = 20.067, P = 0.000. 2 Among the population with carotid atherosclerosis, the most common manifestation was the formation of atherosclerotic plaques (81.58%, 558/684, secondly intima-media thickening (13.01%, 89/684, followed by moderate to severe stenosis or occlusion (5.41%, 37/684. The proportion of intima-media thickening in males was lower than that in females (7.08% vs 18.38%; χ2 = 19.269, P = 0.000. The proportion of carotid atherosclerotic plaque formation in males was higher than that in females (86.46% vs 77.16%; χ2 = 9.824, P = 0.002. The median rating of carotid atherosclerosis was 1.79, with males higher than females [1.98 (0.70, 3.26 vs 1.52 (0.20, 2.84; Z = 2.304, P = 0.042]. The site of plaque formation was most commonly located in carotid bulb (36.61%, secondly SCA (22.18%. Of the type of carotid stenosis, ICA stenosis was detected in 30 cases, VA

  11. High dose folic acid supplementation improves arterial endothelial function of coronary patients independent of homocysteine level

    Institute of Scientific and Technical Information of China (English)

    KS Woo; P Chook; M Qiao; AKY Chan; LLT Chan; WWM Chan; DS Celermajer

    2003-01-01

    @@ Background Hyperhomocysteinemia (prevalent in rural northern China)is an emerging risk factor for arterial endothelial dysfunction in CAD, which can be improved with folic acid supplementation. Such homocysteine-lowerying dosage of folio acid ( < 1 mg/d ) can reduce restenosis after PTCA, but not the cardiovascular events.Folic acid has additional vascular protection in antixidation, NO synthase protection, angiogenesis-promotion and cytokines reduction.

  12. High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Wiinberg, Niels; Joergensen, Bjarne S

    2010-01-01

    The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiov...... of cardiovascular events should be addressed aggressively. The present study was aimed at providing a valid estimate on the prevalence of PAD in patients attending their general practitioner and having previously suffered a cardio- or cerebrovascular event....

  13. Vital Signs – Presión arterial alta (High Blood Pressure)

    Centers for Disease Control (CDC) Podcasts

    2012-10-02

    En los EE. UU. casi un tercio de la población adulta tiene presión arterial alta, el principal factor de riesgo de enfermedades cardiacas y accidentes cerebrovasculares, dos de las principales causas de muerte en el país.  Created: 10/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/17/2012.

  14. Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

    2004-04-01

    Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

  15. Renal Arteries: Isotropic, High-Spatial-Resolution, Unenhanced MR Angiography with Three-dimensional Radial Phase Contrast1

    Science.gov (United States)

    Lum, Darren P.; Johnson, Kevin M.; Landgraf, Benjamin R.; Bley, Thorsten A.; Reeder, Scott B.; Schiebler, Mark L.; Grist, Thomas M.; Wieben, Oliver

    2011-01-01

    Purpose: To prospectively compare a new three-dimensional (3D) radial phase-contrast magnetic resonance (MR) angiographic method with contrast material–enhanced MR angiography for anatomic assessment of the renal arteries. Materials and Methods: An institutional review board approved this prospective HIPAA-compliant study. Informed consent was obtained. Twenty-seven subjects (mean age, 52.6 years ± 20.5 [standard deviation]) were imaged with respiratory-gated phase-contrast vastly undersampled isotropic projection reconstruction (VIPR) prior to contrast-enhanced MR angiographic acquisition with a 3.0-T clinical system. The imaging duration for phase-contrast VIPR was 10 minutes and provided magnitude and complex difference (“angiographic”) images with 3D volumetric (320 mm) coverage and isotropic high spatial resolution (1.25 mm3). Quantitative analysis consisted of comparing vessel diameters between the two techniques. Qualitative assessment included evaluation of the phase-contrast VIPR and contrast-enhanced MR angiographic techniques for artifacts, noise, and image quality. Bland-Altman analysis was used for comparison of quantitative measurements, and the Wilcoxon signed rank test was used for comparison of qualitative scores. Results: Phase-contrast VIPR images were successfully acquired in all subjects. The vessel diameters measured with phase-contrast VIPR were slightly greater than those measured with contrast-enhanced MR angiography (mean bias = 0.09 mm). Differences in mean artifact, quality scores for the proximal renal arteries, and overall image quality scores between phase-contrast VIPR and contrast-enhanced MR angiographic techniques were not statistically significant (P = .31 and .29, .27 and .39, and .43 and .69 for readers 1 and 2, respectively). The quality scores for the segmental renal arteries were higher for phase-contrast VIPR than for contrast-enhanced MR angiography (P contrast-enhanced MR angiography and were statistically

  16. Cerebral artery alpha-1 AR subtypes: high altitude long-term acclimatization responses.

    Directory of Open Access Journals (Sweden)

    Ravi Goyal

    Full Text Available In response to hypoxia and other stress, the sympathetic (adrenergic nervous system regulates arterial contractility and blood flow, partly through differential activities of the alpha1 (α1 - adrenergic receptor (AR subtypes (α1A-, α1B-, and α1D-AR. Thus, we tested the hypothesis that with acclimatization to long-term hypoxia (LTH, contractility of middle cerebral arteries (MCA is regulated by changes in expression and activation of the specific α1-AR subtypes. We conducted experiments in MCA from adult normoxic sheep maintained near sea level (300 m and those exposed to LTH (110 days at 3801 m. Following acclimatization to LTH, ovine MCA showed a 20% reduction (n = 5; P<0.05 in the maximum tension achieved by 10-5 M phenylephrine (PHE. LTH-acclimatized cerebral arteries also demonstrated a statistically significant (P<0.05 inhibition of PHE-induced contractility in the presence of specific α1-AR subtype antagonists. Importantly, compared to normoxic vessels, there was significantly greater (P<0.05 α1B-AR subtype mRNA and protein levels in LTH acclimatized MCA. Also, our results demonstrate that extracellular regulated kinase 1 and 2 (ERK1/2-mediated negative feedback regulation of PHE-induced contractility is modulated by α1B-AR subtype. Overall, in ovine MCA, LTH produces profound effects on α1-AR subtype expression and function.

  17. Elastic and Muscular Arteries Differ in Structure, Basal NO Production and Voltage-Gated Ca(2+)-Channels.

    Science.gov (United States)

    Leloup, Arthur J A; Van Hove, Cor E; Heykers, Annick; Schrijvers, Dorien M; De Meyer, Guido R Y; Fransen, Paul

    2015-01-01

    In the last decades, the search for mechanisms underlying progressive arterial stiffening and for interventions to avoid or reverse this process has gained much attention. In general, arterial stiffening displays regional variation and is, for example, during aging more prominent in elastic than in muscular arteries. We hypothesize that besides passive also active regulators of arterial compliance [i.e., endothelial and vascular smooth muscle cell (VSMC) function] differ between these arteries. Hence, it is conceivable that these vessel types will display different time frames of stiffening. To investigate this hypothesis segments of muscular arteries such as femoral and mesenteric arteries and elastic arteries such as the aorta and carotid artery were isolated from female C57Bl6 mice (5-6 months of age, n = 8). Both microscopy and passive stretching of the segments in a myograph confirmed that passive mechanical properties (elastin, collagen) of elastic and muscular arteries were significantly different. Endothelial function, more specifically basal nitric oxide (NO) efficacy, and VSMC function, more specifically L-type voltage-gated Ca(2+) channel (VGCC)-mediated contractions, were determined by α1-adrenoceptor stimulation with phenylephrine (PE) and by gradual depolarization with elevated extracellular K(+) in the absence and presence of eNOS inhibition with L-NAME. PE-mediated isometric contractions significantly increased after inhibition of NO release with L-NAME in elastic, but not in muscular vessel segments. This high basal eNOS activity in elastic vessels was also responsible for shifts of K(+) concentration-contraction curves to higher external K(+). VGCC-mediated contractions were similarly affected by depolarization with elevated K(+) in muscular artery segments or in elastic artery segments in the absence of basal NO. However, K(+)-induced contractions were inhibited by the VGCC blocker diltiazem with significantly higher sensitivity in the muscular

  18. Elastic and muscular arteries differ in structure, basal NO production and voltage-gated Ca2+-channels

    Directory of Open Access Journals (Sweden)

    Arthur J.A. Leloup

    2015-12-01

    Full Text Available In the last decades, the search for mechanisms underlying progressive arterial stiffening and for interventions to avoid or reverse this process has gained much attention. In general, arterial stiffening displays regional variation and is, for example, during aging more prominent in elastic than in muscular arteries. We hypothesize that besides passive also active regulators of arterial compliance (i.e. endothelial and vascular smooth muscle cell (VSMC function differ between these arteries. Hence, it is conceivable that these vessel types will display different time frames of stiffening. To investigate this hypothesis segments of muscular arteries such as femoral and mesenteric arteries and elastic arteries such as the aorta and carotid artery were isolated from female C57Bl6 mice (5-6 months of age, n=8. Both microscopy and passive stretching of the segments in a myograph confirmed that passive mechanical properties (elastin, collagen of elastic and muscular arteries were significantly different. Endothelial function, more specifically basal nitric oxide (NO efficacy, and VSMC function, more specifically L-type voltage-gated Ca2+ channel (VGCC-mediated contractions, were determined by α1-adrenoceptor stimulation with phenylephrine (PE and by gradual depolarization with elevated extracellular K+ in the absence and presence of eNOS inhibition with L-NAME. PE-mediated isometric contractions significantly increased after inhibition of NO release with L-NAME in elastic, but not in muscular vessel segments. This high basal eNOS activity in elastic vessels was also responsible for shifts of K+ concentration-contraction curves to higher external K+. VGCC-mediated contractions were similarly affected by depolarization with elevated K+ in muscular artery segments or in elastic artery segments in the absence of basal NO. However, K+-induced contractions were inhibited by the VGCC blocker diltiazem with significantly higher sensitivity in the muscular

  19. High User Control in Game Design Elements Increases Compliance and In-game Performance in a Memory Training Game.

    Science.gov (United States)

    Nagle, Aniket; Riener, Robert; Wolf, Peter

    2015-01-01

    Computer games are increasingly being used for training cognitive functions like working memory and attention among the growing population of older adults. While cognitive training games often include elements like difficulty adaptation, rewards, and visual themes to make the games more enjoyable and effective, the effect of different degrees of afforded user control in manipulating these elements has not been systematically studied. To address this issue, two distinct implementations of the three aforementioned game elements were tested among healthy older adults (N = 21, 69.9 ± 6.4 years old) playing a game-like version of the n-back task on a tablet at home for 3 weeks. Two modes were considered, differentiated by the afforded degree of user control of the three elements: user control of difficulty vs. automatic difficulty adaptation, difficulty-dependent rewards vs. automatic feedback messages, and user choice of visual theme vs. no choice. The two modes ("USER-CONTROL" and "AUTO") were compared for frequency of play, duration of play, and in-game performance. Participants were free to play the game whenever and for however long they wished. Participants in USER-CONTROL exhibited significantly higher frequency of playing, total play duration, and in-game performance than participants in AUTO. The results of the present study demonstrate the efficacy of providing user control in the three game elements, while validating a home-based study design in which participants were not bound by any training regimen, and could play the game whenever they wished. The results have implications for designing cognitive training games that elicit higher compliance and better in-game performance, with an emphasis on home-based training.

  20. Increased level of glycated hemoglobin portends high risk of coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    ZENG FAN-fang; WANG Li-li; LONG Juan; YI Wen-ya; LUO Ying

    2016-01-01

    Background Increased level of glycated hemoglobin (HbA1c) is associated with higher incidence of coronary artery disease (CAD) in the diabetics.However,the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial.Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year.Clinical and laboratory variables at the initial and the second time of admission were collected.According to the initial median HbA1c level,all participants were divided into two groups named lower and higher groups.The relationship between HbA1c level and the risk of coronary artery stenosis over time was evaluated.Results The initial values of HbA1c in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% (P < 0.05).As compared to the lower group,the percentages of male and smoking participants,and the serum level of CRP were significantly higher in the higher group (P < 0.05).Other traditional risk factors were comparable between the two groups.There were 54.2% and 55.2% participants with single vessel stenosis,and 45.8% and 44.8% with multiple vessel stenoses,respectively in the two groups without significant difference.The second time of admission,were 308.5± 25.4 days (lower group) and 300.7 ± 30.1 days (higher group) from the initial admission.Although no significant changes of HbA1c level were observed when compared to initial,HbA1c level in the higher group was still significantly higher in comparison to the lower group (6.24 ± 0.39% vs.5.80 ± 0.36%,P =0.008).The percentage of new coronary artery stenosis (≥ 50% stenosis) was higher in the higher group than that in the lower group (41.7% vs.32.3%,P < 0.001).Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors.Conclusion In the nondiabetics

  1. Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4)

    DEFF Research Database (Denmark)

    Räber, Lorenz; Taniwaki, Masanori; Zaugg, Serge

    2015-01-01

    AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phen......AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition......, and phenotype in non-infarct-related arteries of STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non......, P = 0.15). CONCLUSION: High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-infarct-related arteries without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients....

  2. Effect of cinnamon on gastric emptying, arterial stiffness, postprandial lipemia, glycemia, and appetite responses to high-fat breakfast

    LENUS (Irish Health Repository)

    Markey, Oonagh

    2011-09-07

    Abstract Background Cinnamon has been shown to delay gastric emptying of a high-carbohydrate meal and reduce postprandial glycemia in healthy adults. However, it is dietary fat which is implicated in the etiology and is associated with obesity, type 2 diabetes and cardiovascular disease. We aimed to determine the effect of 3 g cinnamon (Cinnamomum zeylanicum) on GE, postprandial lipemic and glycemic responses, oxidative stress, arterial stiffness, as well as appetite sensations and subsequent food intake following a high-fat meal. Methods A single-blind randomized crossover study assessed nine healthy, young subjects. GE rate of a high-fat meal supplemented with 3 g cinnamon or placebo was determined using the 13C octanoic acid breath test. Breath, blood samples and subjective appetite ratings were collected in the fasted and during the 360 min postprandial period, followed by an ad libitum buffet meal. Gastric emptying and 1-day fatty acid intake relationships were also examined. Results Cinnamon did not change gastric emptying parameters, postprandial triacylglycerol or glucose concentrations, oxidative stress, arterial function or appetite (p < 0.05). Strong relationships were evident (p < 0.05) between GE Thalf and 1-day palmitoleic acid (r = -0.78), eiconsenoic acid (r = -0.84) and total omega-3 intake (r = -0.72). The ingestion of 3 g cinnamon had no effect on GE, arterial stiffness and oxidative stress following a HF meal. Conclusions 3 g cinnamon did not alter the postprandial response to a high-fat test meal. We find no evidence to support the use of 3 g cinnamon supplementation for the prevention or treatment of metabolic disease. Dietary fatty acid intake requires consideration in future gastrointestinal studies. Trial registration Trial registration number: at http:\\/\\/www.clinicaltrial.gov: NCT01350284

  3. Effect of cinnamon on gastric emptying, arterial stiffness, postprandial lipemia, glycemia, and appetite responses to high-fat breakfast

    Directory of Open Access Journals (Sweden)

    Trinick Tom R

    2011-09-01

    Full Text Available Abstract Background Cinnamon has been shown to delay gastric emptying of a high-carbohydrate meal and reduce postprandial glycemia in healthy adults. However, it is dietary fat which is implicated in the etiology and is associated with obesity, type 2 diabetes and cardiovascular disease. We aimed to determine the effect of 3 g cinnamon (Cinnamomum zeylanicum on GE, postprandial lipemic and glycemic responses, oxidative stress, arterial stiffness, as well as appetite sensations and subsequent food intake following a high-fat meal. Methods A single-blind randomized crossover study assessed nine healthy, young subjects. GE rate of a high-fat meal supplemented with 3 g cinnamon or placebo was determined using the 13C octanoic acid breath test. Breath, blood samples and subjective appetite ratings were collected in the fasted and during the 360 min postprandial period, followed by an ad libitum buffet meal. Gastric emptying and 1-day fatty acid intake relationships were also examined. Results Cinnamon did not change gastric emptying parameters, postprandial triacylglycerol or glucose concentrations, oxidative stress, arterial function or appetite (p half and 1-day palmitoleic acid (r = -0.78, eiconsenoic acid (r = -0.84 and total omega-3 intake (r = -0.72. The ingestion of 3 g cinnamon had no effect on GE, arterial stiffness and oxidative stress following a HF meal. Conclusions 3 g cinnamon did not alter the postprandial response to a high-fat test meal. We find no evidence to support the use of 3 g cinnamon supplementation for the prevention or treatment of metabolic disease. Dietary fatty acid intake requires consideration in future gastrointestinal studies. Trial registration Trial registration number: at http://www.clinicaltrial.gov: NCT01350284

  4. Quantification of coronary artery stenosis with high-resolution CT in comparison with histopathology in an ex vivo study

    Energy Technology Data Exchange (ETDEWEB)

    Dettmer, Matthias, E-mail: dettmerms@upmc.edu [Department of Pathology and Laboratory Medicine, University of Pittsburgh, S-417 BST 200 Lothrop Street, Pittsburgh, PA 15261 (United States); Glaser-Gallion, Nicola, E-mail: nicola.glaser-gallion@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Stolzmann, Paul, E-mail: paul.stolzmann@usz.ch [Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich (Switzerland); Glaser-Gallion, Florian, E-mail: florian.glaser-gallion@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Fornaro, Juergen, E-mail: juergen.fornaro@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Feuchtner, Gudrun, E-mail: Gudrun.Feuchtner@i-med.ac.at [Department of Radiology II, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck (Austria); Jochum, Wolfram, E-mail: wolfram.jochum@kssg.ch [Institute of Pathology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Alkadhi, Hatem, E-mail: hatem.alkadhi@usz.ch [Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich (Switzerland); Wildermuth, Simon, E-mail: simon.wildermuth@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Leschka, Sebastian, E-mail: sebastian.leschka@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland)

    2013-02-15

    Purpose: To investigate the ex vivo performance of high-resolution computed tomography (CT) for quantitative assessment of percentage diameter stenosis in coronary arteries compared to histopathology. Materials and methods: High-resolution CT was performed in 26 human heart specimens after the injection of iodinated contrast media into the coronary arteries. Coronary artery plaques were visually identified on CT images and the grade of stenosis for each plaque was measured with electronic calipers. All coronary plaques were characterized by histopathology according to the Stary classification, and the percentage of stenosis was measured. Results: CT depicted 84% (274/326) of all coronary plaques identified by histology. Missed plaques by CT were of Stary type I (n = 31), type II (n = 16), and type III (n = 5). The stenosis degree significantly correlated between CT and histology (r = 0.81, p < 0.001). CT systematically overestimated the stenosis of calcified plaques (mean difference - 11.0 ± 9.5%, p < 0.01) and systematically underestimated the stenosis of non-calcified plaques (mean difference −6.8 ± 10.4%, p < 0.05), while there was no significant difference for mixed-type plaques (mean difference −0.4 ± 11.7%, p = 0.85). There was a significant underestimation of stenosis degree as measured by CT for Stary II plaques (mean difference −14 ± 9%, p < 0.01) and a significant overestimation for Stary VII plaques (mean difference 9 ± 10%, p < 0.05), but there was no significant difference in stenosis degree between both modalities for other plaque types. Conclusions: High-resolution CT reliably depicts advanced stage coronary plaques with an overall good correlation of stenosis degree compared to histology, however, the degree of stenosis is systematically overestimated in calcified and underestimated in non-calcified plaques.

  5. Mapping Tax Compliance

    DEFF Research Database (Denmark)

    Boll, Karen

    2014-01-01

    Tax compliance denotes the act of reporting and paying taxes in accordance with the tax laws. Current social science scholarship on tax compliance can almost entirely be divided into behavioural psychology analyses and critical tax studies. This article, which presents two cases of how tax...... that studies tax compliance where it takes place as well as what it is made of. Consequently, this article argues that tax compliance is a socio-material assemblage and that complying is a distributed action. The article concludes by highlighting how an ANT approach contributes to the further theoretical...

  6. Determination of the luminal diameter of the radial artery in man by high frequency ultrasound

    DEFF Research Database (Denmark)

    Nielsen, T H; Iversen, Helle Klingenberg; Tfelt-Hansen, P

    1990-01-01

    measurements. By comparing the diameter of the reference object either filled with water or blood at 37 degrees C, the ultrasound velocity in human blood at 37 degrees C was calculated to be 1605 m/s. The intraobserver repeatability coefficients of in-vivo measurements of the radial artery in man were...... in the same range, whether measurements were repeated after 30 min (14%) or from day to day (12%). The interobserver repeatability coefficient was acceptable (15%) when the site of measurements was marked, whereas measurements without a mark resulted in a repeatability coefficient of 24%. The intravenous...

  7. High normal thyroid-stimulating hormone is associated with arterial stiffness in healthy postmenopausal women.

    Science.gov (United States)

    Lambrinoudaki, Irene; Armeni, Eleni; Rizos, Demetrios; Georgiopoulos, Georgios; Kazani, Maria; Alexandrou, Andreas; Deligeoroglou, Efthymios; Livada, Alexandra; Psychas, Charalampos; Creatsa, Maria; Bouboulis, George; Alevizaki, Maria; Stamatelopoulos, Kimon

    2012-03-01

    Apart from the effects of a dysfunctional thyroid gland on the cardiovascular system, thyroid function within the reference range may have an impact on the vasculature. The present study aimed to evaluate the association between thyroid function and markers of arterial structure and function in euthyroid postmenopausal women. The present cross-sectional study recruited 106 healthy postmenopausal women with a mean age of 55.0 years and thyroid-stimulating hormone (TSH) levels within the laboratory reference range (0.4-4.5 μIU/ml). Anthropometric and biochemical measures as well as blood pressure were determined in each individual. Vascular structure and function were assessed by intima-media thickness, pulse wave velocity (PWV), augmentation index and flow-mediated dilation, respectively. We evaluated the associations between arterial markers and serum TSH, free triiodothyronine, free thyroxin, as well as serum thyroid peroxidase and thyroglobulin autoantibodies. Mean levels of PWV increased linearly across increasing TSH quartiles (P value = 0.014). Individuals with serum TSH greater than 2.5 μIU/ml had significantly higher values of PWV when compared with individuals with TSH levels below 2.5 μIU/ml (9.68 ± 1.97 vs. 8.54 ± 1.83 m/s; P = 0.030). In multivariate analysis, age, insulin resistance and TSH above 2.5 μIU/ml were the only significant predictors of PWV (TSH, β-coefficient = 0.222; P = 0.014). No associations were found between the remaining markers and levels of thyroid hormones, whereas thyroid antibodies were not associated with any of the arterial markers. Women with TSH levels in the upper reference range have increased arterial stiffness compared to women with lower TSH. The upper limit of normal TSH in postmenopausal women may need re-evaluation with respect to the effects on the vasculature.

  8. Lp-PLA₂- a novel risk factor for high-risk coronary and carotid artery disease.

    Science.gov (United States)

    Epps, K C; Wilensky, R L

    2011-01-01

    Lipoprotein-associated phospholipase A2 (Lp-PLA₂) is at the crossroads of lipid metabolism and the inflammatory response. It is produced by inflammatory cells, bound to LDL and other lipoproteins, and once in the arterial wall facilitates hydrolysis of phospholipids. Elevated serum levels of Lp-PLA₂ have been associated with increased cardiovascular risk in healthy populations and in patients with known vascular disease. Here, we review the role of Lp-PLA₂ in the development of atherosclerosis and progression to unstable disease, the utility of Lp-PLA₂ as a risk predictor for coronary and carotid events and the potential clinical benefit of pharmacologic inhibition of Lp-PLA₂.

  9. Genetics Home Reference: pulmonary arterial hypertension

    Science.gov (United States)

    ... Home Health Conditions pulmonary arterial hypertension pulmonary arterial hypertension Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Pulmonary arterial hypertension is a progressive disorder characterized by abnormally high ...

  10. Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Kai [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Li, Kuncheng, E-mail: cjr.likuncheng@vip.163.com [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Han, Ruijuan [Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020 (China); Li, Wenhuan; Chen, Nan; Yang, Qi; Du, Xiangying; Wang, Chen [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Liu, Guorong; Li, Yuechun [Department of Neurology Baotou Central Hospital, Inner Mongolia, Baotou 014040 (China); Zhou, Maorong [Department of Radiology, Baotou Central Hospital, Inner Mongolia, Baotou 014040 (China); Li, Ligang; Heidrun, Endt [CT BM Clinic Marketing, Siemens Healthcare, Beijing 100102 (China)

    2015-03-15

    Objectives: To explore the feasibility and diagnostic accuracy of a combined one-step high-pitch dual-source computed tomography angiography (CTA) technique for evaluation of coronary and carotid-cerebrovascular arteries. Materials and methods: 85 symptomatic patients suspected of coronary artery and cerebrovascular disease referred for simultaneous coronary and carotid-cerebrovascular CTA were included. Additional invasive angiography of the coronary and cerebral arteries was performed within 30 days in 23 and 13 patients, respectively. The objective parameters of image quality, the mean CT attenuations, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. The subjective image quality of vessels was also assessed by 2 independent radiologists blinded to the patients’ medical history and scan protocols. The diagnostic performance of CTA including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection or exclusion of significant artery stenosis was calculated using the chi-squared test of contingency and correlated with the results of invasive angiography representing the standard of reference. Results: Image quality was rated excellent (score 1) in 95.3% (1074/1127), good (score 2) in 3.3% (37/1127), adequate (score 3) in 1.0% (11/1127), and non-diagnostic (score 4) in 0.4% (5/1127) of coronary segments. Image quality of carotid and cerebral vessels was rated mostly excellent (score 1, 95.12% [78/82]; score 2, 3.66% [3/82]; score 3, 1.22% [1/82]). The sensitivity, specificity, PPV and NPV for the detection of coronary stenosis were 92.2% (81.1–97.7%), 95.2% (91.7–97.5%), 79.6% (67.1–89.1%) and 98.3% (95.8–99.5%), respectively. For the detection of carotid and cerebral artery stenosis, CTA demonstrated a sensitivity of 92.8% (80.5–98.4%), a specificity of 93.5% (88.3–96.8%), a PPV of 79.6% (65.6–89.7%) and a NPV of 97.9% (94.1–99.5%). The effective

  11. Patterns of compliance with prenatal iron supplementation among Peruvian women.

    Science.gov (United States)

    Zavaleta, Nelly; Caulfield, Laura E; Figueroa, Alberto; Chen, Ping

    2014-04-01

    Prenatal iron supplementation is recommended to control anaemia during pregnancy. Low compliance and side effects have been claimed as the main obstacles for adequate impact of the supplementation. As part of a double-blind supplementation study carried out in a hospital located in a shantytown in Lima, Peru, we monitored compliance throughout pregnancy and evaluated factors associated with variation in compliance over time. Overall, 985 pregnant women were enrolled in a supplementation study that was administered through their prenatal care from 10 to 24 weeks of gestation until 4 weeks postpartum. They received 60 mg iron and 250 µg folate with or without 15 mg zinc. Women had monthly care visits and were also visited weekly to query regarding compliance, overall health status, and potential positive and negative effects of supplement consumption. Median compliance was 79% (inter-quartile range: 65-89%) over pregnancy, and the median number of tablets consumed was 106 (81-133). Primpara had lower average compliance; positive health reports were associated with greater compliance, and negative reports were associated with lower compliance. There was no difference by type of supplement. Women with low initial compliance did achieve high compliance by the end of pregnancy, and women who reported forgetting to take the supplements did have lower compliance. Compliance was positively associated with haemoglobin concentration at the end of pregnancy. In conclusion, women comply highly with prenatal supplementation within a prenatal care model in which supplies are maintained and reinforcing messages are provided. © 2012 John Wiley & Sons Ltd.

  12. A randomized cross over trial of tolerability and compliance of a micronutrient supplement with low iron separated from calcium vs high iron combined with calcium in pregnant women [ISRCTN56071145

    Directory of Open Access Journals (Sweden)

    Couturier Bernard

    2006-04-01

    Full Text Available Abstract Background Prenatal micronutrient combinations with high iron content are associated with high rates of gastrointestinal symptoms. This coupled with nausea and vomiting of pregnancy results in women often discontinuing their multivitamins. A new prescription supplement (PregVit® that separates iron from calcium in two tablets – morning and evening, has lower elemental iron content (35 mg, but results in similar extent of iron absorption when compared to another supplement containing (60 mg of elemental iron (Materna®. The objectives of this study were to compare tolerability and compliance with PregVit® vs. a supplement with high iron content (Materna®, in pregnant women. Methods Randomized, crossover open labeled study in 135 pregnant women attending outpatient clinics in Ontario and Quebec. Results Use of PregVit® was associated with a 30% reduction in constipation rate as compared to Materna®. Both products demonstrated similar compliance rates. Compliance of Materna® was negatively associated with the severity of nausea and vomiting of pregnancy. No such correlation was found for PregVvit®. Conclusion PregVit®, a supplement with lower iron content (35 mg, has significantly decreased constipation rates as compared to 60 mg iron- Materna and has similar compliance rates. High iron content in multivitamin supplements is associated with adverse effects in pregnancy.

  13. Information communication Technology (ICT) compliance among ...

    African Journals Online (AJOL)

    Information communication Technology (ICT) compliance among ... The one with very strong effect is the high cost of hardware and software including fear of virus ... requisite education and upgrade themselves through training programme to ...

  14. Is CT angiography of the pulmonary arteries indicated in patients with high clinical probability of pulmonary embolism?

    Science.gov (United States)

    Martínez Montesinos, L; Plasencia Martínez, J M; García Santos, J M

    2017-06-30

    When a diagnostic test confirms clinical suspicion, the indicated treatment can be administered. A problem arises when the diagnostic test does not confirm the initially suspected diagnosis; when the suspicion is grounded in clinically validated predictive rules and is high, the problem is even worse. This situation arises in up to 40% of patients with high suspicion for acute pulmonary embolism, raising the question of whether CT angiography of the pulmonary arteries should be done systematically. This paper reviews the literature about this issue and lays out the best evidence about the relevant recommendations for patients with high clinical suspicion of acute pulmonary embolism and negative findings on CT angiography. It also explains the probabilistic concepts derived from Bayes' theorem that can be useful for ascertaining the most appropriate approach in these patients. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Predictors and prognostic impact of silent coronary artery disease in asymptomatic high-risk patients with diabetes mellitus.

    Science.gov (United States)

    Zellweger, Michael J; Haaf, Philip; Maraun, Michael; Osterhues, Hans H; Keller, Ulrich; Müller-Brand, Jan; Jeger, Raban; Pfister, Otmar; Brinkert, Miriam; Burkard, Thilo; Pfisterer, Matthias

    2017-10-01

    Evaluation of predictors of silent coronary artery disease (SCAD) in high-risk asymptomatic diabetic patients and to evaluate their two-year outcome. Four hundred diabetic patients without prior CAD but at high CAD risk underwent myocardial perfusion scintigraphy (MPS) in this prospective multicentre outcome trial. MPS were abnormal in 22% of patients. Male sex (OR 2.223, 1.152-4.290; p=0.017), diabetes duration (OR 1.049,1.015-1.085; p=0·005), peripheral artery disease (OR 2.134, 1·150-3.961; p=0.016), smoking (OR 2.064, 1.109-3.839; p=0·022), systolic blood pressure (OR 1.014, 1.00-1.03, p=0·056), brain natriuretic peptide (OR 1.002, 1.001-1.004, p=0·005) independently predicted an abnormal MPS: if 3 predictors were present, 3.2% and 47% patients had an abnormal MPS, respectively (p10%, respectively (each p3 predictors, almost 50% of patients had an abnormal MPS. They may benefit from screening by MPS since the extent of the MPS abnormality discriminated clearly between a favourable compared to a bad 2-year outcome. However, even highest risk patients without objective evidence of CAD had a benign prognosis without need for specific evaluation or therapy. ISRCTN87953632. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Regulatory Enforcement and Compliance

    DEFF Research Database (Denmark)

    May, Peter J.; Winter, Søren

    1999-01-01

    agencies. The latter are shown to be more important in bringing about compliance than are inspectors' enforcement styles. Municipal agencies are shown to increase compliance through the use of third parties, more frequent inspection, and setting priorities for inspection of major items. The findings about...

  17. Metabolic syndrome patient compliance with drug treatment

    Directory of Open Access Journals (Sweden)

    Nilcéia Lopes

    2008-01-01

    Full Text Available OBJECTIVES: 1 To evaluate the compliance with drug treatment in patients with metabolic syndrome. 2 To determine association between access to and use of medicines, as well as the level of knowledge of cardiovascular risk factors and compliance. INTRODUCTION: Low compliance has been one of the greatest challenges for the successful treatment of chronic diseases. Although this issue has been widely studied in patients with isolated hypertension, diabetes and dyslipidemia, compliance studies involving patients with these concomitant diseases or with metabolic syndrome diagnosis are scarce. METHODS: This was a cross-sectional study involving patients who have been diagnosed with metabolic syndrome according to the IDF criteria. Patients were being treated in a Health-Medical School Center bound to the Public Brazilian Healthcare System. This study was conducted in two phases. Phase I was characterized by analyzing medical records and Phase II involved interviewing the patients. A variation of the Morisky-Green Test was used to evaluate compliance. Compliance was the dependent variable and the independent variables included access to medicines, the use of medicines and the level of knowledge concerning cardiovascular risk factors. RESULTS: Two hundred and forty-three patients were identified as being eligible for Phase II, and 75 were included in the study. The average level of compliance was 5.44 points (standard deviation of 0.68, on a scale ranging from 1.00 to 6.00 points. There was no statistically meaningful association between independent variables and compliance. The level of patient knowledge of diet and dyslipidemia was considered to be low. CONCLUSIONS: Patients involved in this study exhibited a high level of compliance with drug treatment. Further research is needed to better elucidate the compliance behavior of patients who have been diagnosed with metabolic syndrome.

  18. Pulmonary Artery Invasion, High-Dose Radiation, and Overall Survival in Patients With Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Han, Cheng-Bo [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Oncology, Shengjing Hospital of China Medical University, Shenyang (China); Wang, Wei-Li [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Fourth Hospital of China Medical University, Shenyang (China); Quint, Leslie [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Xue, Jian-Xin [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu (China); Matuszak, Martha; Ten Haken, Randall [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Kong, Feng-Ming, E-mail: fkong@gru.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2014-06-01

    Purpose: To investigate whether high-dose radiation to the pulmonary artery (PA) affects overall survival (OS) in patients with non-small cell lung cancer (NSCLC). Methods and Materials: Patients with medically inoperable/unresectable NSCLC treated with definitive radiation therapy in prospective studies were eligible for this study. Pulmonary artery involvement was defined on the basis of pretreatment chest CT and positron emission tomography/CT fusion. Pulmonary artery was contoured according to the Radiation Therapy Oncology Group protocol 1106 atlas, and dose-volume histograms were generated. Results: A total of 100 patients with a minimum follow-up of 1 year for surviving patients were enrolled: 82.0% underwent concurrent chemoradiation therapy. Radiation dose ranged from 60 to 85.5 Gy in 30-37 fractions. Patients with PA invasion of grade ≤2, 3, 4, and 5 had 1-year OS and median survival of 67% and 25.4 months (95% confidence interval [CI] 15.7-35.1), 62% and 22.2 months (95% CI 5.8-38.6), 90% and 35.8 months (95% CI 28.4-43.2), and 50% and 7.0 months, respectively (P=.601). Two of the 4 patients with grade 5 PA invasion died suddenly from massive hemorrhage at 3 and 4.5 months after completion of radiation therapy. Maximum and mean doses to PA were not significantly associated with OS. The V45, V50, V55, and V60 of PA were correlated significantly with a worse OS (P<.05). Patients with V45 >70% or V60 >37% had significantly worse OS (13.3 vs 37.9 months, P<.001, and 13.8 vs 37.9 months, P=.04, respectively). Conclusions: Grade 5 PA invasion and PA volume receiving more than 45-60 Gy may be associated with inferior OS in patients with advanced NSCLC treated with concurrent chemoradiation.

  19. Practical issues in medication compliance in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Krzesinski J

    2011-06-01

    Full Text Available Jean-Marie Krzesinski1, Marc Leeman21Nephrology Transplantation Department, Domaine Universitaire, Liège, Belgium; 2Department of Internal Medicine and Hypertension Clinic, Erasme University Hospital, Brussels, BelgiumAbstract: Unsatisfactory compliance in the treatment of high blood pressure is frequently due to sequential barriers, such as insufficient patient education about the illness and low motivation to receive any treatment, existence of a large gap between physicians' perceptions of the problem and clinical reality, complexity of the treatment potentially generating adverse effects, and a health care environment with few public education campaigns and incentives for better coordinated supportive care. In order to improve drug compliance, establishment of personalized plans adapted to each patient is required. First, a good doctor–patient relationship is mandatory, with regular education of the patient about hypertension and its risks, discussion about adverse drug effects, and the complexity and cost of treatment. Second, to have any chance of success, the provider should offer convenient appointments and tailor the treatment regimen to the patient's lifestyle and needs, with written instructions. Third, there is a need to promote active patient collaboration with treatment. An innovative combination of home self-measurement of blood pressure, use of new technology options, eg, texting or telemedicine, and creation of a multidisciplinary working team can offer new, effective opportunities. This approach could reduce cardiovascular complications by improving the control of high blood pressure, and thereby the overall costs of hypertension to the health care system.Keywords: arterial hypertension, therapeutic adherence, drug compliance, persistence

  20. High-definition computed tomography for coronary artery stents imaging: Initial evaluation of the optimal reconstruction algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Xiaoming, E-mail: mmayzy2008@126.com; Li, Tao, E-mail: litaofeivip@163.com; Li, Xin, E-mail: lx0803@sina.com.cn; Zhou, Weihua, E-mail: wangxue0606@gmail.com

    2015-05-15

    Highlights: • High-resolution scan mode is appropriate for imaging coronary stent. • HD-detail reconstruction algorithm is stent-dedicated kernel. • The intrastent lumen visibility also depends on stent diameter and material. - Abstract: Objective: The aim of this study was to evaluate the in vivo performance of four image reconstruction algorithms in a high-definition CT (HDCT) scanner with improved spatial resolution for the evaluation of coronary artery stents and intrastent lumina. Materials and methods: Thirty-nine consecutive patients with a total of 71 implanted coronary stents underwent coronary CT angiography (CCTA) on a HDCT (Discovery CT 750 HD; GE Healthcare) with the high-resolution scanning mode. Four different reconstruction algorithms (HD-stand, HD-detail; HD-stand-plus; HD-detail-plus) were applied to reconstruct the stented coronary arteries. Image quality for stent characterization was assessed. Image noise and intrastent luminal diameter were measured. The relationship between the measurement of inner stent diameter (ISD) and the true stent diameter (TSD) and stent type were analysed. Results: The stent-dedicated kernel (HD-detail) offered the highest percentage (53.5%) of good image quality for stent characterization and the highest ratio (68.0 ± 8.4%) of visible stent lumen/true stent lumen for luminal diameter measurement at the expense of an increased overall image noise. The Pearson correlation coefficient between the ISD and TSD measurement and spearman correlation coefficient between the ISD measurement and stent type were 0.83 and 0.48, respectively. Conclusions: Compared with standard reconstruction algorithms, high-definition CT imaging technique with dedicated high-resolution reconstruction algorithm provides more accurate stent characterization and intrastent luminal diameter measurement.

  1. Coronary Artery Imaging in Children

    Science.gov (United States)

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  2. Compliance and Enforcement Actions (CEA) -

    Data.gov (United States)

    Department of Transportation — Compliance and Enforcement Actions application provides process assistance / improvements for conducting investigation and enforcement activities. The Compliance and...

  3. High compliance randomized controlled field trial of solar disinfection of drinking water and its impact on childhood diarrhea in rural Cambodia

    CSIR Research Space (South Africa)

    McGuigan, KG

    2011-09-01

    Full Text Available Recent solar disinfection (SODIS) studies in Bolivia and South Africa have reported compliance rates below 35% resulting in no overall statistically significant benefit associated with disease rates. In this study, the authors report the results...

  4. Corporate compliance: framework and implementation.

    Science.gov (United States)

    Fowler, N

    1999-01-01

    The federal government has created numerous programs to combat fraud and abuse. The government now encourages healthcare facilities to have a corporate compliance program (CCP), a plan that reduces the chances that the facility will violate laws or regulations. A CCP is an organization-wide program comprised of a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms and other features, all designed to prevent and detect violations of governmental laws, regulations and policies. It is a system or method ensuring that employees understand and will comply with laws that apply to what they do every day. Seven factors, based on federal sentencing guidelines, provide the framework for developing a CCP. First, a facility must establish rules that are reasonably capable of reducing criminal conduct. Second, high-level personnel must oversee the compliance effort. Third, a facility must use due care in delegating authority in the compliance initiative. Fourth, standards must be communicated effectively to employees, and fifth, a facility must take reasonable steps to achieve compliance. Sixth, standards must be enforced consistently across the organization and last, standards must be modified or changed for reported concerns, to ensure they are not repeated. PROMINA Health System, Inc. in Atlanta, Ga., designed a program to meet federal guidelines. It started with a self-assessment to define its areas or risk. Next, it created the internal structure and assigned organizational responsibility for running the CCP. PROMINA then developed standards of business and professional conduct, established vehicles of communication and trained employees on the standards. Finally, it continues to develop evidence of the program's effectiveness by monitoring and documenting its compliance activities.

  5. New therapies for arterial hypertension.

    Science.gov (United States)

    Pagliaro, Beniamino; Santolamazza, Caterina; Rubattu, Speranza; Volpe, Massimo

    2016-03-01

    Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.

  6. An analysis of aircrew procedural compliance

    Science.gov (United States)

    Schofield, J. E.; Giffin, W. C.

    1981-01-01

    This research examines the relationships between aircrew compliance with procedures and operator errors. The data for this analysis were generated by reexamination of a 1976 experiment in full mission simulation conducted by Dr. H. P. Ruffell Smith (1979) for the NASA-Ames Research Center. The character of individual operators, the chemistry of crew composition, and complex aspects of the operational environment affected procedural compliance by crew members. Associations between enumerated operator errors and several objective indicators of crew coordination were investigated. The correspondence among high operator error counts and infrequent compliance with specific crew coordination requirements was most notable when copilots were accountable for control of flight parameters.

  7. Malignant hepatic epithelioid hemangioendothelioma with high-output heart failure: successful management of heart failure with transcatheter arterial chemoembolization.

    Science.gov (United States)

    Hsu, Chien-Yi; Liu, Yao-Chung; Li, Chung-Pin; Huang, Po-Hsun; Lin, Chin-Hsuan; Chao, Yee

    2014-06-01

    A 73-year-old woman was admitted to hospital because of progressive dyspnea on exertion. Computed tomography revealed a large hepatic tumor, which was proved to be a hepatic epithelioid hemangioendothelioma (EHE). Echocardiography demonstrated high cardiac output, for which the tumor was considered to be the leading cause. A transcatheter arterial chemoembolization (TACE) was performed sequentially at 1-month intervals to reduce the size of the hepatic tumor, and this temporarily improved the patient's cardiac condition and quality of life. In this case, we successfully used TACE in the treatment of hepatic EHE with high-output heart failure. TACE is a reasonable choice of treatment both for managing malignant hepatic tumors and resolving low systemic vascular resistance by embolization of the abnormal neoangiogenic vessels. Nevertheless, clinicians should be aware of the potential adverse effect of hepatic decompensation induced by TACE, especially when the tumor involvement is widespread and poorly preserved hepatic function is encountered.

  8. High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of the intramural segment

    Energy Technology Data Exchange (ETDEWEB)

    Biko, David M. [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Chung, Claudia; Chung, Taylor [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Hitt, David M. [Philips Healthcare, Cleveland, OH (United States); Kurio, Gregory [UCSF Benioff Children' s Hospital Oakland, Department of Cardiology, Oakland, CA (United States); Reinhartz, Olaf [UCSF Benioff Children' s Hospital Oakland, Department of Cardiac Surgery, Oakland, CA (United States)

    2015-08-15

    Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients. To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery. All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment. Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01). MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important

  9. Peripheral "oscillatory" compliance is associated with aortic augmentation index

    NARCIS (Netherlands)

    Segers, P; Qasem, A; De Backer, T; Carlier, S; Verdonck, P; Avolio, A

    2001-01-01

    The augmentation index (AIx) and "oscillatory" compliance (C-2) are wave contour analysis parameters for the central aorta (P-ao) and radial artery pressure wave (P-rad)(x) respectively. Both are sensitive to cardiovascular risk factors such as aging, hypertension, and diabetes and have been propose

  10. High-sensitivity C-reactive protein and exercise-induced changes in subjects suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Mouridsen, Mette Rauhe; Nielsen, Olav Wendelboe; Carlsen, Christian Malchau

    2014-01-01

    BACKGROUND: Inflammation plays a major role in the development of atherosclerosis. We wanted to investigate the effects of exercise on high-sensitivity (hs) C-reactive protein (CRP) in subjects who were suspected of having coronary artery disease (CAD). METHODS: Blood samples were obtained before......, 5 minutes after, and 20 hours after an exercise test in 155 subjects who were suspected of CAD. Coronary anatomy was evaluated by computed tomography coronary angiography and/or coronary angiography. RESULTS: Median baseline hs-CRP was higher in subjects with ≥50% coronary artery lumen diameter...... stenosis (n=41), compared with non-CAD-subjects (n=114), 2.93 mg/L (interquartile range 1.03-5.06 mg/L) and 1.30 mg/L (interquartile range 0.76-2.74 mg/L), respectively, P=0.007. In multivariate analyses testing conventional risk factors, hs-CRP proved borderline significant, odds ratio =2.32, P=0...

  11. Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio With Presence and Severity of Isolated Coronary Artery Ectasia.

    Science.gov (United States)

    Kundi, Harun; Gok, Murat; Kiziltunc, Emrullah; Cetin, Mustafa; Cicekcioglu, Hulya; Cetin, Zehra Guven; Karayigit, Orhan; Ornek, Ender

    2015-12-01

    The aim of this study was to investigate an easily available inflammatory and oxidative stress marker and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with coronary artery ectasia (CAE). The study population included 405 patients of which 135 patients had isolated CAE, 135 patients had obstructive coronary artery disease (CAD), and 135 patients had normal coronary angiograms (NCAs). The severity of isolated CAE was determined according to the Markis classification. The MHR was significantly greater in patients with isolated CAE than those with obstructive CAD and NCAs: 14.8 (11.6 to 19.8), 11.4 (9.6 to 13.5), 9.8 (7.5 to 11.9), respectively. Linear regression analyses showed that MHR and C-reactive protein were significantly related with the severity of isolated CAE. In conclusion, the MHR is significantly greater in patients with CAE compared to controls with obstructive CAD and NCAs, and MHR is associated with the severity of CAE. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Psychological and Neuropsychological Predictors of Non-Compliance to Mammography Screening Among High-Risk African American Women

    Science.gov (United States)

    2005-04-01

    altering abstract reasoning may be the level of phobic anxiety and paranoid ideation which the individual experiences (marginal significance were...proposed to evaluate the relationship among psychological distress ( anxiety and intrusive thoughts about breast cancer), executive cognitive function...women with a family history of breast cancer experience high levels of anxiety and intrusive thoughts, and that elevated levels of psychological

  13. [Drug compliance of patients on anticoagulant treatment].

    Science.gov (United States)

    Gadó, Klára; Kocsis, Eszter; Zelkó, Romána; Hankó, Balázs; Kovácsné Balogh, Judit; Forczig, Mónika; Domján, Gyula

    2015-08-09

    Despite several therapeutic possibilities the morbidity and mortality of thromboembolic disorders remain high. Improving drug compliance - i. e. keeping up the doctor's prescriptions - may be an effective tool to reach better results. To improve patients' compliance, the risk factors of non-compliance should be recognized. Among these patients' fear of adverse effects of drugs, their lack of knowledge about their illness and medication, forgetfulness, and other social, economic factors may be the most important. Furthermore, adherence may be worsened when the patient feels that the decision has been made over his/her head. Sustained medical adherence is important because anticoagulation may be a life-long treatment. The new oral anticoagulants make the matter of compliance to be current. These new type of drugs do not need regular laboratory monitoring and, therefore, compliance cannot be strictly followed. There are several studies concerning drug compliance to anticoagulant medications. Improvement of adherence is based on regular patient education after reviewing the factors of non-compliance, which needs teamwork with important roles of doctors, pharmacists, dietetics and nurses. Careful and accurate work of the participants of primary care might be complemented by the activity of anticoagulant clinics.

  14. High Central Aortic Rather than Brachial Blood Pressure is Associated with Carotid Wall Remodeling and Increased Arterial Stiffness in Childhood.

    Science.gov (United States)

    Peluso, Gonzalo; García-Espinosa, Victoria; Curcio, Santiago; Marota, Marco; Castro, Juan; Chiesa, Pedro; Giachetto, Gustavo; Bia, Daniel; Zócalo, Yanina

    2017-03-01

    In adults, central blood pressure (cBP) is reported to associate target organ damages (TODs) rather than peripheral blood pressure (pBP). However, data regarding the association of pre-clinical TODs with cBP and pBP in pediatric populations are scarce. To evaluate in children and adolescents the importance of cBP and pBP levels, in terms of their association with hemodynamic and vascular changes. 315 subjects [age (mean/range) 12/8-18 years] were included. pBP (oscillometry, Omron-HEM433INT and Mobil-O-Graph), cBP levels and waveforms (oscillometry, Mobil-O-Graph; applanation tonometry, SphygmoCor), aortic wave reflection-related parameters, carotid intima-media thickness (CIMT) and carotid (elastic modulus, stiffness-index) and aortic stiffness (carotid-femoral pulse wave velocity, PWV). Four groups were defined considering pBP and cBP percentiles (th): cBP ≥90th, cBP blood pressure (cBP or pBP). Subgroups were matched for anthropometric and cardiovascular risk factors (propensity matching-score). Subjects with high cBP showed a worse cardiovascular risk profile in addition to worse peripheral hemodynamic conditions. The CIMT, carotid and aortic stiffness levels were also higher in those subjects. CIMT and carotid stiffness remained statistically higher when subjects were matched for pBP and other cardiovascular risk factors. There were no differences in arterial properties when subjects were analyzed (compared) considering similar pBP levels, during normal and high cBP conditions. Compared with pBP, the cBP levels show a greater association with vascular alterations (high CIMT and arterial stiffness), in children and adolescents.

  15. A novel mouse model of high flow-induced pulmonary hypertension-surgically induced by right pulmonary artery ligation.

    Science.gov (United States)

    Zhang, Anchen; Wang, Hongfei; Wang, Shengwei; Huang, Xiaofan; Ye, Ping; Du, Xinling; Xia, Jiahong

    2017-02-01

    This study sought to establish a new model of high-flow pulmonary hypertension (PH) in mice. This model may be useful for studies seeking to reduce the pulmonary vascular resistance and delay the development of PH caused by congenital heart disease. The right pulmonary artery was ligated via a right posterolateral thoracotomy. Pulmonary hemodynamics was evaluated by right heart catheterization immediately after ligation and at 2, 4, 8, and 12 wk postoperatively. The right ventricle (RV) and the left ventricle (LV) with septum (S) were weighed to calculate the RV/(LV + S) ratio as an index of right ventricular hypertrophy. Morphologic changes in the left lungs were analyzed, and percentages of muscularized pulmonary vessels were assessed by hematoxylin and eosin, elastica van Gieson and alpha-smooth muscle actin staining. All the study data were compared with data from a model of PH generated by hypoxic stimulation. A pulmonary hypertensive state was successfully induced by 2 wk after surgery. However, the morphologic analysis demonstrated that pulmonary vascular muscularization, as evaluated using right ventricular systolic pressure and RV/(LV + S), was not significantly increased until 4 wk postoperatively. When mice from the new model and the hypoxic model were compared, no significant differences were observed in any of the evaluated indices. High-flow PH can be induced within 4 wk after ligation of the right pulmonary artery, which is easily performed in mice. Such mice can be used as a model of high-flow PH. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Circulating Concentrations of Adipocytokines and Their Receptors in the Isolated Corpus Cavernosum and Femoral Artery from Trained Rats on a High-Fat Diet.

    Science.gov (United States)

    Sponton, Amanda C S; Silva, Fábio H; Araujo, Hygor N; Valgas da Silva, Carmem P; de Moraes, Camila; Antunes, Edson; Zanesco, Angelina; Delbin, Maria A

    2017-01-01

    The aim of the present study was to evaluate different signaling pathways by which exercise training would interfere in endothelial function in obesity. Therefore, we examined adipocytokine levels and their receptors in the corpus cavernosum and femoral artery from trained rats on a high-fat diet. Functional experiments were performed in control sedentary and trained rats, and sedentary (h-SD) and trained male Wistar rats on a high-fat diet (h-TR). Nitric oxide (NO) and reactive oxygen species (ROS) were evaluated in vascular tissue. Circulating adipocytokines and their receptors were analyzed. In the h-SD group, the maximal responses to acetylcholine (ACh) were reduced in the femoral artery and corpus cavernosum as well as the electrical field stimulation, accompanied by an increase in circulating insulin, leptin, TNF-α, MCP-1, and PAI-1. Downregulation of ObR protein expression in the femoral artery was observed without alterations in AdipoR1 and TNFR1 in both preparations. A positive effect was observed in the h-TR group regarding the relaxation response to ACh and circulating adipocytokines, resulting in increased NO production and reduced ROS generation. Exercise restored the ObR protein expression only in the femoral artery. Aerobic exercise training ameliorated the inflammatory adipocytokines and restored the relaxation responses in the corpus cavernosum and femoral artery in rats on a high-fat diet. © 2017 S. Karger AG, Basel.

  17. [Compliance of treatment in glaucoma patients].

    Science.gov (United States)

    Banc, Ana; Stan, Cristina

    2013-01-01

    To evaluate the treatment compliance level of glaucoma patients and the correlation between the compliance level and a series of patient's demographic characteristics. We conducted an observational study in which we studied 100 glaucoma patients who answered the questions we included into a questionnaire. We defined and calculated a broad compliance score and a narrow score, and we investigated the connection between the first score and age, gender, demographic location (urban versus rural), education level, current occupation and duration of disease respectively. The mean of the broad compliance score was 9.64 +/- 1.72, which represents 80% of the maximum value of the score, and the mean of the narrow compliance score was 4.73 +/- 1.12, (78% of the maximum value). The correlation coefficient between score and age was z = -0.09 (p value = 0.19), the Z value for the evaluation of the connection between score and gender was -1.16 (p value = 0.24), and for the connection between compliance score and demographic location Z value = -2.42 (p value = 0.01). Chi-square value for the evaluation of the relation between the score and education level was 14.66 (p value = 0.001), and for the current occupation Chi-square value = 3.47 (p value = 0.06). The correlation coefficient between score and disease duration was tau = 0.09 (p value = 0.23). According to the answers the patients gave, we identified the parameters that require more attention in the ophthalmologist - glaucoma patient communication: genetic transmission of glaucoma, treatment's side effects, number of visits to the ophthalmologist, awareness of the life-long gradului period of treatment. In this study, the compliance level of glaucoma patients is relatively high and we observe a correlation between the compliance level and demographic location, and between the compliance level and patient's education level respectively.,

  18. Motivation and compliance with intraoral elastics.

    Science.gov (United States)

    Veeroo, Helen J; Cunningham, Susan J; Newton, Jonathon Timothy; Travess, Helen C

    2014-07-01

    Intraoral elastics are commonly used in orthodontics and require regular changing to be effective. Unfortunately, poor compliance with elastics is often encountered, especially in adolescents. Intention for an action and its implementation can be improved using "if-then" plans that spell out when, where, and how a set goal, such as elastic wear, can be put into action. Our aim was to determine the effect of if-then plans on compliance with elastics. To identify common barriers to compliance with recommendations concerning elastic wear, semistructured interviews were carried out with 14 adolescent orthodontic patients wearing intraoral elastics full time. Emerging themes were used to develop if-then plans to improve compliance with elastic wear. A prospective pilot study assessed the effectiveness of if-then planning aimed at overcoming the identified barriers on compliance with elastic wear. Twelve participants were randomized equally into study and control groups; the study group received information about if-then planning. The participants were asked to collect used elastics, and counts of these were used to assess compliance. A wide range of motivational and volitional factors were described by the interviewed participants, including the perceived benefits of elastics, cues to remember, pain, eating, social situations, sports, loss of elastics, and breakages. Compliance with elastic wear was highly variable among patients. The study group returned more used elastics, suggesting increased compliance, but the difference was not significant. The use of if-then plans might improve compliance with elastic wear when compared with routine clinical instructions. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  19. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S; Schifter, S;

    2001-01-01

    , vasoactivity was manipulated by inhalation of oxygen. STUDY POPULATION AND METHODS: In 20 patients with alcoholic cirrhosis and 12 controls we determined COMP(art) (stroke volume relative to pulse pressure), cardiac output, plasma volume, systemic vascular resistance, central circulation time, plasma...... catecholamines, renin activity, endothelin-1, and calcitonin gene related peptide (CGRP) at baseline and during oxygen inhalation. RESULTS: COMP(art) was significantly increased in cirrhotic patients compared with controls (1.32 v 1.06 ml/mm Hg; p

  20. Is carotid artery evaluation necessary for primary prevention in asymptomatic high-risk patients without atherosclerotic cardiovascular disease?

    Directory of Open Access Journals (Sweden)

    Kim GH

    2015-07-01

    Full Text Available GeeHee Kim,1 Ho-Joong Youn,2 Yun-Seok Choi,2 Hae Ok Jung,2 Wook Sung Chung,2 Chul-Min Kim1 1Department of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, 2Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Objective: Routine measurement of the carotid intima–media thickness is not recommended in recent clinical practice guidelines for risk assessment of the first atherosclerotic cardiovascular disease (ASCVD event (the definition of which includes acute coronary syndromes, a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin. The aim of the present study was to elucidate the role of carotid artery evaluation for primary prevention of ASCVD in asymptomatic high-risk patients visiting a teaching hospital.Methods: Eight hundred seventy-three patients (487 male [55.8%], mean age 59.4±11.5 years who were statin-naive and without ASCVD, which was proven by coronary angiography or coronary CT angiography, were enrolled in this study. The patients underwent carotid scanning in the Medical Department of St Mary’s Hospital from September 2003 to March 2009. ASCVD outcomes were evaluated for median follow-up of 1,402 days.Results: A total of 119 participants experienced ASCVD events. In multivariate Cox regression analysis, age (hazard ratio [HR] =1.026, 95% confidence interval [CI] =1.002–1.050, P=0.033, history of smoking (HR =1.751, 95% CI =1.089–2.815, P=0.021, statin therapy (HR =0.388, 95% CI =0.205–0.734, P=0.004, and carotid plaques (HR =1.556, 95% CI =1.009–2.400, P=0.045 were associated with ASCVD events. In middle-aged group (45≤ age <65, n=473, history of smoking (HR =1.995, 95% CI =1.142–3.485, P=0.015, statin therapy (HR =0.320, 95% CI =0.131

  1. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.

    Science.gov (United States)

    Saskin, Hüseyin; Serhan Ozcan, Kazim; Yilmaz, Seyhan

    2017-03-01

    The monocyte to high-density lipoprotein ratio has recently emerged as an indicator of inflammation and oxidative stress. The aim of this study was to evaluate the association of the monocyte to high-density lipoprotein ratio with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Six hundred and sixty-two patients who were in sinus rhythm preoperatively and who had isolated coronary artery bypass grafting were retrospectively included in the study. Patients who had atrial fibrillation in the early postoperative period were enrolled in group 1 ( n  = 153); patients who remained in sinus rhythm in the early postoperative period were included in group 2 ( n  = 509). The clinical and demographic data of the patients, biochemical and complete blood count parameters, preoperative monocyte count/high-density lipoprotein cholesterol ratio, and operative and postoperative data were recorded. Preoperative monocyte counts ( P  = 0.0001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and C-reactive protein levels ( P  = 0.0001) were significantly increased in group 1. In the first month, 8 patients in group 1 (5.2%) and 5 patients in group 2 (1.0%) died, which was statistically significant ( P  = 0.003). In univariate and multivariate logistic regression analyses, an elevated preoperative monocyte count/high-density lipoprotein cholesterol ratio ( P  = 0.03) and C-reactive protein levels ( P  = 0.0001) were predictors of postoperative atrial fibrillation. Preoperative monocyte counts ( P  = 0.001), monocyte count/high-density lipoprotein cholesterol ratio ( P  = 0.0001) and the use of inotropic support ( P  = 0.0001) were also predictors of mortality in the early postoperative period. We have observed that high preoperative monocyte count/ high-density lipoprotein ratio was associated with postoperative atrial fibrillation and mortality after coronary artery bypass grafting

  2. Compliance for Green IT

    CERN Document Server

    Calder, Alan

    2009-01-01

    The growing range of Green IT regulations are challenging more and more organisations to take specific steps to ensure they are in compliance with sometimes complex regulations, ranging from cap & trade requirements through to regulations concerning IT equipment disposal.

  3. Environmental Compliance Issue Coordination

    Science.gov (United States)

    An order to establish the Department of Energy (DOE) requirements for coordination of significant environmental compliance issues to ensure timely development and consistent application of Departmental environmental policy and guidance

  4. Environmental Compliance Guide

    Energy Technology Data Exchange (ETDEWEB)

    None

    1981-02-01

    The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects.

  5. Prevalência de pressão arterial elevada em crianças e adolescentes: revisão sistemática The prevalence of high arterial blood pressure in children and adolescents: a systematic review

    Directory of Open Access Journals (Sweden)

    Diego Giulliano Destro Christofaro

    2011-12-01

    Full Text Available OBJETIVOS: identificar as prevalências de pressão arterial elevada em crianças e adolescentes em estudos publicados nos últimos 30 anos. MÉTODOS: foi realizada uma busca nas seguintesbases de dados: Medline/PubMed, Lilacs, Web ofScience, Embase e Scielo entre os anos de 1980 e 2009. Foram incluídos estudos originais de prevalência de pressão arterial elevada ou hipertensão com tamanho amostral superior a 500sujeitos. RESULTADOS: a prevalência de pressão arterial elevada em crianças e adolescentes de 4 a 20 anos variou de 0,46% a 20,6%. As menores prevalências de pressão arterial elevada foram detectadas nos estudos em que a maior parte da amostra foi composta por crianças de 4 a 7 anos. Os protocolos mais utilizados na avaliação da pressão arterial foram o da Task Force e o do National High Blood Pressure Education Program. Ao todo 52,4% dos estudos utilizaram o método auscultatório para verificar a medida de pressão arterial e 47,6%, o método oscilométrico. CONCLUSÕES: apesar da grande discrepância dos valores de prevalência encontrados, ressalta-se ocrescimento da prevalência de pressão arterial elevada na população de crianças e adolescentes de diversas partes do mundo.OBJECTIVES: to identify the prevalence of high blood pressure in children and adolescents in studiespublished in the past 30 years. METHODS: a search was carried out in the Medline/PubMed, Lilacs, Web of Science, Embase and Scielo databases for articles published between 1980 and 2009. Articles were included if they were original studies of the prevalence of high arterial blood pressure or hypertension in a sample of more than 500 subjects. RESULTS: the prevalence of high blood pressure (in individuals aged between 4 and 20 years varied from 0.46% to 20.6%. The lower prevalence of high blood pressure was found in studies where the majority ofthe sample was aged between 4 and 7 years. Theprotocols most commonly used for evaluation of blood pressure

  6. Carotid artery atherosclerosis in a Mexico City population with high carbohydrate intake.

    Science.gov (United States)

    González-Villalpando, C; Stern, M P; Rivera Martínez, D; Arredondo Pérez, B; Martínez Diaz, S; Haffner, S

    1995-01-01

    We present the results of a population based survey designed to estimate the prevalence and clinical characteristics of carotid artery atherosclerosis (CAS) diagnosed using vascular ultrasonography (VUS) in a low income area of Mexico City encompassing six neighborhoods that we previously studied. We attempted to locate all the non-diabetic participants of the first two neighborhoods (n = 834) and all diabetics from the six neighborhoods (n = 304). We located 1078 (94.7%) participants and examined 770 (71.4%). All study subjects were men and non-pregnant women between 35-64 years of age and had standardized VUS protocol. In men, the prevalence of CAS was 16.29%, in women the prevalence was 12.3%. CAS was significantly associated in both sexes to age (p < 0.001) and systolic blood pressure (p < 0.001). The ratio of the subscapular to triceps skinfolds was significantly higher in men with CAS (p < 0.04). In women, fasting glucose was higher in subjects with CAS (p < 0.04). The lipid profile was similar in men with and without CAS. However, women with CAS had significantly higher total cholesterol (p < 0.001), LDL cholesterol (p < 0.002), VLDL cholesterol (p < 0.092) and mean TG (p < 0.033). The percent of patients with hypertension, tobacco use, myocardial infarction and diabetic retinopathy of any degree was significantly higher in the subjects with CAS. CAS of any degree was observed in 12.4% of the non-diabetic population and 18.13% of the diabetics.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Stephen M McHugh

    2016-01-01

    Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

  8. Elevated pulmonary artery pressure and brain natriuretic peptide in high altitude pulmonary edema susceptible non-mountaineers

    Science.gov (United States)

    Gupta, Rajinder K.; Himashree, G.; Singh, Krishan; Soree, Poonam; Desiraju, Koundinya; Agrawal, Anurag; Ghosh, Dishari; Dass, Deepak; Reddy, Prassana K.; Panjwani, Usha; Singh, Shashi Bala

    2016-01-01

    Exaggerated pulmonary pressor response to hypoxia is a pathgonomic feature observed in high altitude pulmonary edema (HAPE) susceptible mountaineers. It was investigated whether measurement of basal pulmonary artery pressure (Ppa) and brain natriuretic peptide (BNP) could improve identification of HAPE susceptible subjects in a non-mountaineer population. We studied BNP levels, baseline hemodynamics and the response to hypoxia (FIo2 = 0.12 for 30 min duration at sea level) in 11 HAPE resistant (no past history of HAPE, Control) and 11 HAPE susceptible (past history of HAPE, HAPE-S) subjects. Baseline Ppa (19.31 ± 3.63 vs 15.68 ± 2.79 mm Hg, p < 0.05) and plasma BNP levels (52.39 ± 32.9 vs 15.05 ± 9.6 pg/ml, p < 0.05) were high and stroke volume was less (p < 0.05) in HAPE-S subjects compared to control. Acute hypoxia produced an exaggerated increase in heart rate (p < 0.05), mean arterial pressure (p < 0.05) and Ppa (28.2 ± 5.8 vs 19.33 ± 3.74 mm Hg, p < 0.05) and fall in peripheral oxygen saturation (p < 0.05) in HAPE-S compared to control. Receiver operating characteristic (ROC) curves showed that Ppa response to acute hypoxia was the best variable to identify HAPE susceptibility (AUC 0.92) but BNP levels provided comparable information (AUC 0.85). BNP levels are easy to determine and may represent an important marker for the determination of HAPE susceptibility. PMID:26892302

  9. High levels of activity of bats at gold mining water bodies: implications for compliance with the International Cyanide Management Code.

    Science.gov (United States)

    Griffiths, Stephen R; Donato, David B; Coulson, Graeme; Lumsden, Linda F

    2014-06-01

    Wildlife and livestock are known to visit and interact with tailings dam and other wastewater impoundments at gold mines. When cyanide concentrations within these water bodies exceed a critical toxicity threshold, significant cyanide-related mortality events can occur in wildlife. Highly mobile taxa such as birds are particularly susceptible to cyanide toxicosis. Nocturnally active bats have similar access to uncovered wastewater impoundments as birds; however, cyanide toxicosis risks to bats remain ambiguous. This study investigated activity of bats in the airspace above two water bodies at an Australian gold mine, to assess the extent to which bats use these water bodies and hence are at potential risk of exposure to cyanide. Bat activity was present on most nights sampled during the 16-month survey period, although it was highly variable across nights and months. Therefore, despite the artificial nature of wastewater impoundments at gold mines, these structures present attractive habitats to bats. As tailings slurry and supernatant pooling within the tailings dam were consistently well below the industry protective concentration limit of 50 mg/L weak acid dissociable (WAD) cyanide, wastewater solutions stored within the tailings dam posed a minimal risk of cyanide toxicosis for wildlife, including bats. This study showed that passively recorded bat echolocation call data provides evidence of the presence and relative activity of bats above water bodies at mine sites. Furthermore, echolocation buzz calls recorded in the airspace directly above water provide indirect evidence of foraging and/or drinking. Both echolocation monitoring and systematic sampling of cyanide concentration in open wastewater impoundments can be incorporated into a gold mine risk-assessment model in order to evaluate the risk of bat exposure to cyanide. In relation to risk minimisation management practices, the most effective mechanism for preventing cyanide toxicosis to wildlife

  10. Supraaortic arteries: contrast-enhanced MR angiography at 3.0 T--highly accelerated parallel acquisition for improved spatial resolution over an extended field of view.

    Science.gov (United States)

    Nael, Kambiz; Villablanca, J Pablo; Pope, Whitney B; McNamara, Thomas O; Laub, Gerhard; Finn, J Paul

    2007-02-01

    To prospectively use 3.0-T breath-hold high-spatial-resolution contrast material-enhanced magnetic resonance (MR) angiography with highly accelerated parallel acquisition to image the supraaortic arteries of patients suspected of having arterial occlusive disease. Institutional review board approval and written informed consent were obtained for this HIPAA-compliant study. Eighty patients (44 men, 36 women; age range, 44-90 years) underwent contrast-enhanced MR angiography of the head and neck at 3.0 T with an eight-channel neurovascular array coil. By applying a generalized autocalibrating partially parallel acquisition algorithm with an acceleration factor of four, high-spatial-resolution (0.7 x 0.7 x 0.9 mm = 0.44-mm(3) voxels) three-dimensional contrast-enhanced MR angiography was performed during a 20-second breath hold. Two neuroradiologists evaluated vascular image quality and arterial stenoses. Interobserver variability was tested with the kappa coefficient. Quantitation of stenosis at MR angiography was compared with that at digital subtraction angiography (DSA) (n = 13) and computed tomographic (CT) angiography (n = 12) with Spearman rank correlation coefficient (R(s)). Arterial stenoses were detected with contrast-enhanced MR angiography in 208 (reader 1) and 218 (reader 2) segments, with excellent interobserver agreement (kappa = 0.80). There was a significant correlation between contrast-enhanced MR angiography and CT angiography (R(s) = 0.95, reader 1; R(s) = 0.87, reader 2) and between contrast-enhanced MR angiography and DSA (R(s) = 0.94, reader 1; R(s) = 0.92, reader 2) for the degree of stenosis. Sensitivity and specificity of contrast-enhanced MR angiography for detection of arterial stenoses greater than 50% were 94% and 98% for reader 1 and 100% and 98% for reader 2, with DSA as the standard of reference. Vascular image quality was sufficient for diagnosis or excellent for 97% of arterial segments evaluated. By using highly accelerated parallel

  11. Effect of behavior modification on patient compliance in orthodontics.

    Science.gov (United States)

    Richter, D D; Nanda, R S; Sinha, P K; Smith, D W; Currier, G F

    1998-04-01

    The purpose of this study was to evaluate the effects of a reward system for improving patient compliance in orthodontic treatment. The sample consisted of 144 orthodontic patients (63 male, 81 female, average age 12.8 years), 6 to 12 months into their treatment. The sample was divided into above-average and below-average compliers, based on the orthodontic patient cooperation scale (OPCS). Each group was further divided into three subgroups: (a) a control group, which received only standard instructions; (b) an award group, which received compliance instructions and a written evaluation of compliance; and (c) a reward group, which received compliance instructions, a report card, and eligibility to receive rewards for adherent behavior. Two measurements of patient compliance were used: (1) the OPCS, which divided the sample into high and low compliers and was used to compare compliance before and after the 6-month experimental period; and (2) a clinical evaluation of compliance that was based on oral hygiene, appointment punctuality, appliance wear, and appliance maintenance. Evaluations were completed at each monthly appointment. Average compliance scores of above-average compliers showed no significant improvement with rewards. The average scores of patients with below-average compliance did not improve significantly. Only oral hygiene scores in the low compliance reward group were better than in the low compliance control group. Academic performance in school was found to be correlated (p reward system may help motivate below-average compliers to comply with prescribed instructions.

  12. Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia.

    Science.gov (United States)

    Dockery, Frances; Bulpitt, Christopher J; Agarwal, Sanjiv; Donaldson, Mandy; Rajkumar, Chakravarthi

    2003-02-01

    The role of androgens in cardiovascular disease is uncertain. We aimed to determine the vascular effects of androgen suppression in men with prostate cancer. Arterial stiffness (or 'compliance') was measured in 16 men (71+/-9 years, mean+/-S.D.) prior to, and 3 months after, complete androgen suppression with gonadotrophin-releasing hormone analogues as treatment for prostate cancer. Fifteen control men (70+/-7 years) also had arterial stiffness studies at baseline and 3 months later. Two measures of arterial stiffness were employed: systemic arterial compliance (SAC) was measured by simultaneous recording of aortic flow and carotid artery pressure ('area method'), and pulse wave velocities (PWVs) were recorded with the 'Complior' system. The 16 cases underwent glucose-tolerance and fasting-lipids tests on both visits. After 3 months of testosterone suppression, there was a significant fall in SAC, which was not seen in the controls [mean change+/-S.E.M., -0.26+/-0.09 a.c.u. (arbitrary compliance unit) in the cases versus +0.06+/-0.11 in the controls; P =0.03). Central, but not peripheral, PWVs tended to increase in the cases (mean change+/-S.E.M. for aorto-femoral PWV, +0.5+/-0.4 m/s for cases versus -0.3+/-0.3 m/s for controls; P =0.08). After testosterone suppression, fasting insulin levels increased from 6.89+/-4.84 m-units/l to 11.34+/-8.16 m-units/l (mean+/-S.D.), total cholesterol increased from 5.32+/-0.77 mmol/l to 5.71+/-0.82 mmol/l and high-density lipoprotein cholesterol increased from 1.05+/-0.24 mmol/l to 1.26+/-0.36 mmol/l; P stiffness and serum insulin levels, and may therefore adversely affect cardiovascular risk.

  13. Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: ''High-risk'' anatomy and its clinical relevance

    Energy Technology Data Exchange (ETDEWEB)

    Krupinski, Maciej; Urbanczyk-Zawadzka, Malgorzata; Laskowicz, Bartosz; Irzyk, Malgorzata; Banys, Robert; Klimeczek, Piotr [John Paul II Hospital, Department of Radiology and Diagnostic Imaging, Krakow (Poland); Gruszczynska, Katarzyna; Baron, Jan [Medical University of Silesia, Department of Radiology and Nuclear Medicine, Katowice (Poland)

    2014-10-15

    The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up. A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus. Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p < 0.001), intramural course (15 vs. 3; p < 0.001) and interarterial course (11 vs. 0; p < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3; p = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4; p = NS). High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx. (orig.)

  14. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  15. Increased oxidative stress and severe arterial remodeling induced by permanent high-flow challenge in experimental pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Fadel Elie

    2011-09-01

    Full Text Available Abstract Background Involvement of inflammation in pulmonary hypertension (PH has previously been demonstrated and recently, immune-modulating dendritic cells (DCs infiltrating arterial lesions in patients suffering from idiopathic pulmonary arterial hypertension (IPAH and in experimental monocrotaline-induced PH have been reported. Occurrence of perivascular inflammatory cells could be linked to local increase of oxidative stress (OS, as it has been shown for systemic atherosclerosis. The impact of OS on vascular remodeling in PH is still to be determined. We hypothesized, that augmented blood-flow could increase OS and might thereby contribute to DC/inflammatory cell-recruitment and smooth-muscle-cell-proliferation. Methods We applied a monocrotaline-induced PH-model and combined it with permanent flow-challenge. Thirty Sprague-Dawley rats were assigned to following groups: control, monocrotaline-exposure (MCT, monocrotaline-exposure/pneumonectomy (MCT/PE. Results Hemodynamic exploration demonstrated most severe effects in MCT/PE, corresponding in histology to exuberant medial and adventitial remodeling of pulmonary muscular arteries, and intimal remodeling of smaller arterioles; lung-tissue PCR evidenced increased expression of DCs-specific fascin, CD68, proinflammatory cytokines (IL-6, RANTES, fractalkine in MCT/PE and to a lesser extent in MCT. Major OS enzyme NOX-4 was maximal in MCT/PE. Antioxidative stress enzymes Mn-SOD and glutathion-peroxidase-1 were significantly elevated, while HO-1 showed maximal expression in MCT with significant decrease in MCT/PE. Catalase was decreased in MCT and MCT/PE. Expression of NOX-4, but also of MN-SOD in MCT/PE was mainly attributed to a highly increased number of interstitial and perivascular CXCR4/SDF1 pathway-recruited mast-cells. Stress markers malonedialdehyde and nitrotyrosine were produced in endothelial cells, medial smooth muscle and perivascular leucocytes of hypertensive vasculature

  16. Reproducibility of high-resolution MRI for the middle cerebral artery plaque at 3 T

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Wan-Qun [Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080 (China); Huang, Biao, E-mail: cjr.huangbiao@vip.163.com [Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080 (China); Liu, Xin-Tong [Department of Neurology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080 (China); Liu, Hong-Jun; Li, Pei-Jun [Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080 (China); Zhu, Wen-Zhen, E-mail: zhuwenzhen@hotmail.com [Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 (China)

    2014-01-15

    Purpose: To assess the reproducibility of HR-MRI for the identification of MCA atherosclerotic plaque components and quantification of stenosis. Materials and methods: Seventy-three consecutive subjects who initially had ischemic stroke or asymptomatic MCA stenosis (>50%) were enrolled in the study. All subjects were scanned using 3.0 T MRI. Two independent readers reviewed all images and one reader reevaluated all images four weeks later. The tissue components of plaques were analyzed qualitatively and the vessels were quantitative measured. Results: HR-MRI displayed the artery wall and lumen clearly. The intra-observer reproducibility was excellent for the identification of plaques (kappa [κ] = 0.96; 95% CI: 0.83–1.04) and contrast enhancement (κ = 0.89; 0.78–0.95); it was substantial for intra-plaque hemorrhage (κ = 0.79; 0.57–0.96) and the fibrous cap (κ = 0.65; 0.42–0.86). The inter-observer reproducibility was excellent for plaques (κ = 0.92; 0.73–1.06), substantial for contrast enhancement (κ = 0.80; 0.65–0.93), intra-plaque hemorrhage (κ = 0.68; 0.47–0.92) and moderate for the fibrous cap (κ = 0.58; 0.44–0.79). Both intra-observer and inter-observer reproducibility were excellent for quantitative vessel, lumen and wall measurements with intraclass correlation coefficients ranging from 0.91 to 0.97 and 0.87 to 0.96, respectively. However, vessel and wall areas and the intervals defined by the Bland–Altman plots were wide in comparison to the mean. Conclusions: The identification of MCA atherosclerotic plaque components and the quantification of vessel and lumen measurements are reproducible. The reproducibility is overall acceptable. HR-MRI may provide a useful tool for clinical risk evaluation in MCA atherosclerosis.

  17. Recapitulation of Developing Artery Muscularization in Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Abdul Q. Sheikh

    2014-03-01

    Full Text Available Excess smooth muscle accumulation is a key component of many vascular disorders, including atherosclerosis, restenosis, and pulmonary artery hypertension, but the underlying cell biological processes are not well defined. In pulmonary artery hypertension, reduced pulmonary artery compliance is a strong independent predictor of mortality, and pathological distal arteriole muscularization contributes to this reduced compliance. We recently demonstrated that embryonic pulmonary artery wall morphogenesis consists of discrete developmentally regulated steps. In contrast, poor understanding of distal arteriole muscularization in pulmonary artery hypertension severely limits existing therapies that aim to dilate the pulmonary vasculature but have modest clinical benefit and do not prevent hypermuscularization. Here, we show that most pathological distal arteriole smooth muscle cells, but not alveolar myofibroblasts, derive from pre-existing smooth muscle. Furthermore, the program of distal arteriole muscularization encompasses smooth muscle cell dedifferentiation, distal migration, proliferation, and then redifferentiation, thereby recapitulating many facets of arterial wall development.

  18. Effect of low-grade conductive heating on vascular compliance during in vitro balloon angioplasty.

    Science.gov (United States)

    Mitchel, J F; Fram, D B; Aretz, T A; Gillam, L D; Woronick, C; Waters, D D; McKay, R G

    1994-07-01

    Radiofrequency-powered, thermal balloon angioplasty is a new technique that enhances luminal dilatation with less dissection than conventional angioplasty. The purpose of this study was to assess the effect of radiofrequency heating of balloon fluid on the pressure-volume mechanics of in vitro balloon angioplasty and to determine the histologic basis for thermal-induced compliance changes. In vitro, radiofrequency-powered, thermal balloon angioplasty was performed on 46 paired iliac segments freshly harvested from 23 nonatherosclerotic pigs. Balloon inflations at 60 degrees C were compared to room temperature inflations in paired arterial segments. Intraballoon pressure and volume were recorded during each inflation as volume infusion increased pressure over a 0 to 10 atm range. Pressure-volume compliance curves were plotted for all dilatations. Six segments were stained to assess the histologic abnormalities associated with thermal compliance changes. Radiofrequency heating acutely shifted the pressure-volume curves rightward in 20 of 23 iliac segments compared to nonheated controls. This increase in compliance persisted after heating and exceeded the maximum compliance shift caused by multiple nonheated inflations in a subset of arterial segments. Histologically, heated segments showed increased thinning and compression of the arterial wall, increased medial cell necrosis and altered elastic tissue fibers compared to nonheated specimens. In conclusion, radiofrequency heating of intraballoon fluid to 60 degrees C acutely increases vascular compliance during in vitro balloon angioplasty of nonatherosclerotic iliac arteries. The increased compliance persists after heating and can be greater than the compliance shifts induced by multiple conventional dilatations. Arterial wall thinning and irreversible alteration of elastic tissue fibers probably account for thermal compliance changes.

  19. Regional variation in arterial stiffening and dysfunction in Western diet-induced obesity.

    Science.gov (United States)

    Bender, Shawn B; Castorena-Gonzalez, Jorge A; Garro, Mona; Reyes-Aldasoro, Constantino C; Sowers, James R; DeMarco, Vincent G; Martinez-Lemus, Luis A

    2015-08-15

    Increased central vascular stiffening, assessed in vivo by determination of pulse wave velocity (PWV), is an independent predictor of cardiovascular event risk. Recent evidence demonstrates that accelerated aortic stiffening occurs in obesity; however, little is known regarding stiffening of other disease-relevant arteries or whether regional variation in arterial stiffening occurs in this setting. We addressed this gap in knowledge by assessing femoral PWV in vivo in conjunction with ex vivo analyses of femoral and coronary structure and function in a mouse model of Western diet (WD; high-fat/high-sugar)-induced obesity and insulin resistance. WD feeding resulted in increased femoral PWV in vivo. Ex vivo analysis of femoral arteries revealed a leftward shift in the strain-stress relationship, increased modulus of elasticity, and decreased compliance indicative of increased stiffness following WD feeding. Confocal and multiphoton fluorescence microscopy revealed increased femoral stiffness involving decreased elastin/collagen ratio in conjunction with increased femoral transforming growth factor-β (TGF-β) content in WD-fed mice. Further analysis of the femoral internal elastic lamina (IEL) revealed a significant reduction in the number and size of fenestrae with WD feeding. Coronary artery stiffness and structure was unchanged by WD feeding. Functionally, femoral, but not coronary, arteries exhibited endothelial dysfunction, whereas coronary arteries exhibited increased vasoconstrictor responsiveness not present in femoral arteries. Taken together, our data highlight important regional variations in the development of arterial stiffness and dysfunction associated with WD feeding. Furthermore, our results suggest TGF-β signaling and IEL fenestrae remodeling as potential contributors to femoral artery stiffening in obesity.

  20. Feasibility of low-dose contrast medium high pitch CT angiography for the combined evaluation of coronary, head and neck arteries.

    Directory of Open Access Journals (Sweden)

    Zhiwei Wang

    Full Text Available PURPOSE: To evaluate the image quality and radiation dose of combined heart, head, and neck CT angiography (CTA using prospectively electrocardiography (ECG-triggered high-pitch spiral scan protocol, compared with single coronary CTA. MATERIALS AND METHODS: 151 consecutive patients were prospectively included and randomly divided into three groups. Group 1 (n = 47 underwent combined heart, neck, and head CTA using prospectively ECG-triggered high-pitch spiral (Flash scan protocol with a single-phase intravenous injection of iodinated contrast and saline flush; Group 2 (n = 51 underwent single coronary CTA with Flash scan protocol; and Group 3 (n = 53 underwent single coronary CTA with prospective sequence scan protocol. All patients were examined on a dual source CT (Definition FLASH. The image quality was determined for each CT study. RESULTS: Patients of scanning protocol Group 1, 2, and 3 showed no significant differences in age, sex, heart rates, and BMI. Evaluation of coronary artery image quality showed comparable results in the three scanning protocol groups on a per patient-based analysis. In group 1, image quality was found to be sufficient to be diagnostic in all arterial segments of carotid arteries. The mean dose-length product (DLP for group 1 was 256.3±24.5 mGy×cm and was significantly higher in comparison with group 2 (93.4±19.9 mGy×cm; p < 0.001. However, there was no significant difference of DLP between group 1 and group 3 (254.1±69.9 mGy×cm. CONCLUSIONS: The combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose.

  1. Penile angiography and superselective embolization therapy in arterial priapism; Penisangiographie und superselektive Embolisationstherapie bei high-flow Priapismus

    Energy Technology Data Exchange (ETDEWEB)

    Dinkel, H.P.; Triller, J. [Inst. fuer Diagnostische Radiologie, Inselspital, Univ. Bern (Switzerland); Hochreiter, W. [Urologische Klinik, Inselspital, Univ. Bern (Switzerland)

    2003-08-01

    Purpose: To report feasibility, benefit and complications of penile angiography and superselective penile embolization in arterial priapism. Materials and Methods: Four consecutive patients (aged 28, 29, 40 and 49 years), who underwent penile angiography for arterial priapism (high-flow priapism) within a four-year period, were identified by a keyword search of our radiology information system. One patient had sustained a direct penile trauma (severe blow to the erected penis) and three patients suffered from recurrent spontaneous priapism. All patients had previously undergone corporeal aspiration and noradrenaline injection to achieve detumescence. Two patients had one or several unsuccessful spongiocavernous shunt procedures. Results: In three of the four patients, superselective pudendal and penile angiography demonstrated pathologic arteriocavernous shunting. In two of the three patients, superselective embolization using a coaxial micro-catheter was attempted. In one of the two patients, the cavernous artery became spastic before embolization material was actually injected, inducing immediate and lasting detumescence. In the other patient, unilateral Gelfoam embolization led to immediate detumescence but the priapism recurred 12 hours after the procedure. A subsequent contralateral Gelfoam embolization was successful. Erectile function was preserved in all cases. No procedure-related complications occurred. Conclusion: Our experience supports the prevailing opinion found in the current literature that superselective coaxial embolization constitutes the treatment of choice in patients with high-flow priapism. Prognosis is good with high probability of preserving the erectile function. (orig.) [German] Ziel: Untersuchung der Interventionsmoeglichkeiten bei arteriellem (high-flow) Priapismus durch endovaskulaere superselektive Embolisation der Penisarterien. Methode: Alle innerhalb eines Vierjahreszeitraums (1/99-5/2002) wegen Priapismus zur Angiographie

  2. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2017-01-01

    Full Text Available Background: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Material and Method: Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI, systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 , global end-diastolic volume, and extravascular lung water (EVLW, using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU and corrected according to GDT protocol. A total of 163 patients consented for the study. Result: Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. Conclusion: The length of stay in hospital (LOS-H (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001 and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001 were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0

  3. Compliance with RSV prophylaxis: Global physicians’ perspectives

    Directory of Open Access Journals (Sweden)

    Kari S Anderson

    2009-07-01

    Full Text Available Kari S Anderson, Victoria M Mullally, Linda M Fredrick, Andrew L CampbellAbbott Laboratories, Abbott Park, IL, USAAbstract: Respiratory syncytial virus (RSV is a significant cause of morbidity in high-risk infants. Palivizumab is proven to prevent serious RSV disease, but compliance with prophylaxis (monthly doses during the RSV season is essential to ensure protection. We invited 453 pediatricians to participate in a survey to identify their perspectives of barriers to compliance and interventions to improve compliance with palivizumab prophylaxis schedules. One hundred physicians from five continents completed the survey, identifying caregiver inconvenience, distance to clinic, cost of prophylaxis, and lack of understanding of the severity of RSV as the most common reasons for noncompliance. They recommended provision of educational materials about RSV, reminders from hospital or clinic, and administration of prophylaxis at home to increase compliance. Globally, physicians recognize several obstacles to prophylaxis compliance. This survey suggests that focused proactive interventions such as empowering caregivers with educational materials and reducing caregiver inconvenience may be instrumental to increase compliance.Keywords: medication adherence, respiratory syncytial virus infections, infant, premature, immunization, passive

  4. "High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial" (HIGHLOW trial).

    Science.gov (United States)

    Mari, Giulio; Maggioni, Dario; Costanzi, Andrea; Miranda, Angelo; Rigamonti, Luca; Crippa, Jacopo; Magistro, Carmelo; Di Lernia, Stefano; Forgione, Antonello; Carnevali, Pietro; Nichelatti, Michele; Carzaniga, Pierluigi; Valenti, Francesco; Rovagnati, Marco; Berselli, Mattia; Cocozza, Eugenio; Livraghi, Lorenzo; Origi, Matteo; Scandroglio, Ildo; Roscio, Francesco; De Luca, Antonio; Ferrari, Giovanni; Pugliese, Raffaele

    2015-01-27

    The position of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision can affect genito-urinary function, bowel function, oncological outcomes, and the incidence of anastomotic leakage. Ligation to the inferior mesenteric artery at the origin or preservation of the left colic artery are both widely performed in rectal surgery. The aim of this study is to compare the incidence of genito-urinary dysfunction, anastomotic leak and oncological outcomes in laparoscopic anterior rectal resection with total mesorectal excision with high or low ligation of the inferior mesenteric artery in a controlled randomized trial. The HIGHLOW study is a multicenter randomized controlled trial in which patients are randomly assigned to high or low inferior mesenteric artery ligation during laparoscopic anterior rectal resection with total mesorectal excision for rectal cancer. Inclusion criteria are middle or low rectal cancer (0 to 12 cm from the anal verge), an American Society of Anesthesiologists score of I, II, or III, and a body mass index lower than 30. The primary end-point measure is the incidence of post-operative genito-urinary dysfunction. The secondary end-point measure is the incidence of anastomotic leakage in the two groups. A total of 200 patients (100 per arm) will reliably have 84.45 power in estimating a 20% difference in the incidence of genito-urinary dysfunctions. With a group size of 100 patients per arm it is possible to find a significant difference (α = 0.05, β = 0.1555). Allowing for an estimated dropout rate of 5%, the required sample size is 212 patients. The HIGHLOW trial is a randomized multicenter controlled trial that will provide evidence on the merits of the level of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision in terms of better preserved post-operative genito-urinary function. ClinicalTrials.gov Identifier: NCT02153801 Protocol Registration Receipt 29/5/2014.

  5. Transcatheter coil embolization of an intercostal artery to pulmonary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Cantasdemir, Murat; Kantarci, Fatih; Islak, Civan; Kocer, Naci; Numan, Furuzan [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University (Turkey); Saltuk, Levent [Institute of Cardiology, Cerrahpasa Medical Faculty, Istanbul University (Turkey)

    2002-02-01

    An 18-year-old asymptomatic male was found to have a high-flow systemic arterial to pulmonary arterial fistula fed by dilated lower intercostal arteries draining via pulmonary artery toward the left main pulmonary trunk. Transcatheter Guglielmi Detachable Coil (GDC; Target Ther, Fremont, Calif.) embolization was performed. Transcatheter embolization is a reasonable and less invasive mode in the treatment of systemic artery to pulmonary artery fistula, and GDC offers more precise coil placement over other conventional coils. (orig.)

  6. Magnetic resonance angiography of the aortic arch and its main arteries directed to the brain with use of head neck coil. With special reference to relation between high position of the aortic arch and kinked vertebral and carotid arteries

    Energy Technology Data Exchange (ETDEWEB)

    Morita, Hitoshi [Saitama Medical School, Moroyama (Japan)

    1996-12-01

    We studied 316 individuals who requested general health examinations (March 1993 to February 1995), and who underwent blood tests, urinalysis and MRA with a head neck coil, and 25 volunteers underwent the same examinations. The head neck coil used covered the head, neck and upper thorax, and each individual coil could transmit and receive signals. Three-dimensional time of flight MRA was employed in the investigation. The saturation pulse was placed in a coronal direction behind the slab to suppress the venous inflow signals. Our results indicate that in all individuals, MRA clearly demonstrated the aorta and its main branches extending up to the circle of Willis. It was possible to rotate the reconstructed 3-D image around the body axis permitting the visualization of secondary or more peripheral branches, depending on their size and direction. The severity of V1 kinking, classified by using the modified Mets criteria, correlated well with advancing age. V1 kinking was first evident in the third decade of life, while kinking of the internal carotid artery appeared in the fourth decade. The highest level of the aortic arch was evaluated in terms of the aorto-C2 (A-C2) distance, i.e., the distance measured from the C2 level, where the vertebral artery curved laterally in the transverse foramen of C2, and the A level, where the upper margin of the aortic arch was highest. Shortening of the A-C2 distance was noted with aging, and a good correlation between increased height of the aortic arch and aging was seen. As compared to conventional contrast arteriography, MRA of the aortic arch and its branch arteries extending into the cranium does provide accurate data. A high position of the aortic arch, buckling of the great vessels, and tortuosity, kinking and coiling of the vertebral and carotid arteries are clearly shown. (K.H.)

  7. Middle Cerebral Artery Atherosclerotic Plaques in Recent Small Subcortical Infarction: A Three-Dimensional High-resolution MR Study

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Zou

    2015-01-01

    Full Text Available Purpose. Conventional two-dimensional vessel wall imaging has been used to depict the middle cerebral artery (MCA wall in patients with recent small subcortical infarctions (RSSIs. However, its clinical use has been limited by restricted spatial coverage, low signal-to-noise ratio (SNR, and long scan time. We used a novel three-dimensional high-resolution MR imaging (3D HR-MRI technique to investigate the presence, locations, and contrast-enhanced patterns of MCA plaques and their relationship with RSSI. Methods. Nineteen consecutive patients with RSSI but no luminal stenosis on MR angiography were prospectively enrolled. 3D HR-MRI was performed using a T1w-SPACE sequence at 3.0 T. The presence, locations, and contrast-enhanced patterns of the MCA plaques on the ipsilateral and contralateral sides to the RSSI were analyzed. Results. Eighteen patients successfully completed the study. MCA atherosclerotic plaques occurred more frequently on the ipsilateral than the contralateral side to the RSSI (72.2% versus 33.3%, P=0.044. The occurrence of superiorly located plaques was significantly higher on the ipsilateral than the contralateral side of the MCA (66.7% versus 27.8%; P=0.044. Conclusions. Superiorly located plaques are closely associated with RSSI. 3D high-resolution vessel wall imaging may be a potential tool for etiologic assessment of ischemic stroke.

  8. Association of High Density Lipoprotein with Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios in Coronary Artery Disease Patients

    Directory of Open Access Journals (Sweden)

    Jayesh H. Prajapati

    2014-01-01

    Full Text Available Background. We aimed to evaluate a relationship between platelet-lymphocyte ratio (PLR and neutrophil-lymphocyte ratio (NLR with high density lipoprotein (HDL cholesterol levels in coronary artery disease (CAD patients. Methods. A total of 354 patients with angiographically confirmed coronary blockages were enrolled in the study. Hematological indices and lipid profiling data of all the patients were collected. Results. We have observed significant association between HDL and PLR (P=0.008 and NLR (P=0.009; however no significant relationship was obtained with HDL and isolated platelet (P=0.488, neutrophil (P=0.407, and lymphocyte (P=0.952 counts in CAD patients. The association was subjected to gender specific variation as in males PLR (P=0.024 and NLR (P=0.03 were highly elevated in low HDL patients, whereas in females the elevation could not reach the statistically significant level. The PLR (217.47 versus 190.3; P=0.01 and NLR (6.33 versus 5.10; P=0.01 were significantly higher among the patients with acute coronary syndrome. In young patients the PLR (P=0.007 and NLR (P=0.001 were inversely associated with HDL, whereas in older population only NLR (P=0.05 had showed a significant association. Conclusion. We conclude that PLR and NLR are significantly elevated in CAD patients having low HDL levels.

  9. [Frequency dependance of compliance].

    Science.gov (United States)

    Gayrard, P

    1975-01-01

    Resistance of peripheral or "small" airways is only a small part of the total pulmonary resistance (Raw). Even considerable obstruction in these airways will have little effect on total resistance. Conversely this will lead to inequality in the time constants of units in parallel, and dynamic lung compliance (C dyn) shall fall as respiratory frequence increases. C dyn is measured from simultaneous recordings of transpulmonary pressure (esophageal balloon) and volume obtained from a volume displacement plethysmograph. If Raw and static compliance are found to be normal, the frequency dependance of compliance will result from peripheral airway obstruction only. Early stages of chronic airway obstruction can be established by this method. However this appear not suitable for wide-scale studies.

  10. ICIS FE&C Compliance Monitoring Screens

    Data.gov (United States)

    U.S. Environmental Protection Agency — Web Based Training for Integrated Compliance Information System Updated Compliance Monitoring Training for ICIS Federal Enforcement and Compliance User. This...

  11. Influencia de la sustitución de medicamentos de marca por genéricos en el cumplimiento terapéutico de la hipertensión arterial y la dislipidemia Influence of substitution of brand name for generic drugs on therapeutic compliance in hypertension and dyslipidemia

    Directory of Open Access Journals (Sweden)

    Antoni Sicras Mainar

    2010-12-01

    Full Text Available Objetivo: Determinar el cumplimiento terapéutico al sustituir amlodipino y simvastatina de marca por genéricos (especialidad farmacéutica genérica [EFG], y conocer la opinión de médicos y pacientes sobre ello. Pacientes y métodos: Diseño observacional con grupo control, realizado mediante revisión de los registros de seis centros de atención primaria. Pacientes >40 años de edad que iniciaron tratamiento con marca (periodo inicial y posteriormente se cambió por una EFG (periodo final. Subgrupos de estudio: hipertensión arterial (amlodipino y dislipidemia (simvastatina. Principales mediciones: comorbilidad, cumplimiento, tiempo de tratamiento, determinaciones bioquímicas y opinión de los profesionales y los pacientes (entrevistas. Seguimiento: antes de la fecha de la sustitución, cada paciente estuvo como mínimo 1 año con un medicamento de marca, y luego al menos 1 año con una EFG (seguimiento mínimo por paciente: 24 meses. Resultados: De los 1.252 pacientes, el 49,5% recibían amlodipino y el 50,5% simvastatina. Los tratados con amlodipino (comparando los periodos muestran un mejor cumplimiento (65,8 frente a 61,3%; p=0,037 y un mejor control de la presión arterial (48,5 frente a 45,8%; p=0,039 con el tratamiento de marca. Con simvastatina los porcentajes fueron del 62,8 frente al 58,4% (p=0,041, respectivamente. Un 73,6% de los médicos entrevistados prescriben EFG y un 59,2% creen que tienen igual eficacia. De los pacientes entrevistados, el 79,8% (intervalo de confianza del 95% [IC95%]: 74,3-85,3% aceptaron la sustitución; un 55,3% (IC95%: 48,5-62,1% recibió la información adecuada y a un 61,5% les generan confusión los diferentes productos. Un 18,2% manifiestan que incumplen el tratamiento. Conclusión: En los pacientes en tratamiento con amlodipino o simvastatina, el cumplimiento desciende con el tiempo independientemente de que se cambie o no a una EFG.Objective: To determine therapeutic compliance when brand name

  12. Drugs targeting high-density lipoprotein cholesterol for coronary artery disease management.

    Science.gov (United States)

    Katz, Pamela M; Leiter, Lawrence A

    2012-01-01

    Many patients remain at high risk for future cardiovascular events despite levels of low-density lipoprotein cholesterol (LDL-C) at, or below, target while taking statin therapy. Much effort is therefore being focused on strategies to reduce this residual risk. High-density lipoprotein cholesterol (HDL-C) is a strong, independent, inverse predictor of coronary heart disease risk and is therefore an attractive therapeutic target. Currently available agents that raise HDL-C have only modest effects and there is limited evidence of additional cardiovascular risk reduction on top of background statin therapy associated with their use. It was hoped that the use of cholesteryl ester transfer protein (CETP) inhibitors would provide additional benefit, but the results of clinical outcome studies to date have been disappointing. The results of ongoing trials with other CETP inhibitors that raise HDL-C to a greater degree and also lower LDL-C, as well as with other emerging therapies are awaited.

  13. SU-E-T-620: Dosimetric Compliance Study for a New Prostate Protocol of Combined High Dose Rate Brachytherapy and Stereotactic Body Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Peng, C; Giaddui, T; Den, R; Harrison, A; Yu, Y [Thomas Jefferson University, Philadelphia, PA (United States)

    2014-06-15

    Purpose: To investigate the adherence of treatment plans of prostate cancer patients with the dosimetric compliance criteria of the new in house phase I trial of high dose rate (HDR) brachytherapy combined with stereotactic body radiotherapy (SBRT) for intermediate risk prostate cancer patients. Methods: Ten prostate cancer patients were treated using this trial. They received one fraction of HDR to 15Gy, followed by external beam(EB) boost of 3.2Gy(Level 1, five patients) or 3.94Gy(level 2, five patients) per fraction for 10 or 7 fractions, respectively, both equivalent to EB treatments of 113.5Gy in 2Gy fractions. The EB plans were either IMRT or VMAT plans. DVH analysis was performed to verify the adherence of treatment plans to the dosimetric criteria of the trial. Results: For Level 1 patients, target coverage were adequate, with CTV V32Gy(%) of 99.0±1.0 (mean ± 1 standard deviation), and PTV V31Gy(%) of 99.6±0.3. PTV V32.9Gy(%) is 1.4±3.1 and PTVmax is 32.9±0.2Gy. Rectum, bladder and femoral heads sparing were well within protocol criteria. For Level 2 patients, CTV V27.6Gy(%) is 98.7±1.8; PTV V26.7Gy(%) is 99.0±1.4. PTV V28.4Gy(%) is 1.3±1.4, with three patients having minor deviation from protocol. Again critical structures were spared compliant to the protocol. The analysis of HDR plans show similar results, with adequate dose coverage to the prostate and sparing of critical structures including urethra and rectum. V100(%) and V90(%) of prostate are 96.0±1.1 and 98.9±0.5. Urethra D10(%) is 113.1±2.9. Rectum V80(cc) is 1.4±0.5. Hotspot in prostate is substantially higher than what the protocol specifies. But the criteria for hotspot are only guidelines, serving to lower the dose to urethra . Conclusion: This new high biological equivalent dose prostate trial has been carried out successfully for ten patients. Based on dosimetric analysis, all HDR and external plans were compliant to the protocol criteria, with only minor deviations.

  14. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease

    Directory of Open Access Journals (Sweden)

    Yang Phillip

    2008-05-01

    Full Text Available Abstract Background Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR was used to investigate the vasodilatory response to nitroglycerine (NTG of asymptomatic patients at high risk for CAD. Methods A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM, 5 with end stage renal disease (ESRD] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre- and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA was measured on pre- and post-NTG images and % coronary vasodilation was calculated. Results Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 ± 7.3% vs. 25.6 ± 7.1%, p = 0.002. This remained significant for ESRD patients alone (14.8 ± 7.7% vs. 25.6 ± 7.1%; p = 0.003 and for DM patients alone (19.8 ± 6.3% vs. 25.6 ± 7.1%; p = 0.049, with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 ± 7.7% vs. 19.8 ± 6.3%; p = 0.23. Conclusion Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance.

  15. Effect of High-Calcium Diet on Coronary Artery Disease in Ossabaw Miniature Swine With Metabolic Syndrome

    OpenAIRE

    Phillips-Eakley, Alyssa K; McKenney-Drake, Mikaela L; Bahls, Martin; Newcomer, Sean C; Radcliffe, John S.; Wastney, Meryl E; Van Alstine, William G; Jackson, George; Alloosh, Mouhamad; Martin, Berdine R.; Sturek, Michael; Weaver, Connie M.

    2015-01-01

    Background Calcium is a shortfall essential nutrient that has been a mainstay of osteoporosis management. Recent and limited findings have prompted concern about the contribution of calcium supplementation to cardiovascular risk. A proposed mechanism is through the acceleration of coronary artery calcification. Determining causality between calcium intake and coronary artery calcification has been hindered by a lack of sensitive methodology to monitor early vascular calcium accumulation. The ...

  16. Differential effects of relaxin deficiency on vascular aging in arteries of male mice.

    Science.gov (United States)

    Jelinic, Maria; Tare, Marianne; Conrad, Kirk P; Parry, Laura J

    2015-08-01

    Exogenous treatment with the naturally occurring peptide relaxin increases arterial compliance and reduces vascular stiffness. In contrast, relaxin deficiency reduces the passive compliance of small renal arteries through geometric and compositional vascular remodeling. The role of endogenous relaxin on passive mechanical wall properties in other vascular beds is unknown. Importantly, no studies have investigated the effects of aging in arteries of relaxin-deficient mice. Therefore, we tested the hypothesis that mesenteric and femoral arteries stiffen with aging, and this is exacerbated with relaxin deficiency. Male wild-type (Rln (+/+)) and relaxin knockout (Rln (-/-)) mice were aged to 3, 6, 12, 18, and 23 months. Passive mechanical wall properties were assessed by pressure myography. In both genotypes, there was a significant increase in circumferential stiffening in mesenteric arteries with aging, whereas in the femoral artery, aging reduced volume compliance. This was associated with a reduced ability of the artery to lengthen with aging. The predominant phenotype observed in Rln (-/-) mice was reduced volume compliance in young mice in both mesenteric and femoral arteries. In summary, aging induces circumferential stiffening in mesenteric arteries and axial stiffening in femoral arteries. Passive mechanical wall properties of Rln (-/-) mouse arteries predominantly differ at younger ages compared with Rln (+/+) mice, suggesting that a lack of endogenous relaxin only has a minor effect on vascular aging.

  17. Compliance and persistence with treatment with parathyroid hormone for osteoporosis

    DEFF Research Database (Denmark)

    Thorsteinsson, Anne-Luise; Vestergaard, Peter; Eiken, Pia

    2015-01-01

    UNLABELLED: Medical intervention is important in the treatment of osteoporosis, and compliance with medical treatment is essential for an optimal outcome. Based on Danish national registers, we found that compliance with parathyroid hormone (PTH) treatment is high and associated with marital status......, working status, and type of PTH treatment. PURPOSE: Compliance and persistence are essential for an optimal outcome during medical treatment of osteoporosis. We aimed to evaluate compliance and persistence with treatment with PTH in daily clinical practice in Danish patients and to describe factors...... affecting compliance. METHODS: Register-based nationwide cohort study on all patients in Denmark initiates PTH or analogue treatment for osteoporosis in 2003-2010 (n = 4281). PTH drugs included were the PTH analogue teriparatide(1-34) and recombinant human PTH (rhPTH(1-84)). Compliance with treatment...

  18. Hemodynamics and wall mechanics of a compliance matching stent: in vitro and in vivo analysis.

    Science.gov (United States)

    Berry, Joel L; Manoach, Emil; Mekkaoui, Choukri; Rolland, Pierre H; Moore, J E; Rachev, Alexander

    2002-01-01

    Evidence is emerging that the abrupt compliance mismatch that exists at the junction between the stent ends and the host arterial wall disturbs both the vascular hemodynamics and the natural wall stress distribution. These stent-induced alterations are greatly reduced by smoothing the compliance mismatch between the stent and host vessel. A stent that provides this smooth transition in compliance, the compliance matching stent (CMS), has been developed. This study attempts to evaluate the hemodynamics and wall mechanical consequences of the CMS both in vitro and in vivo. Finite element analysis was used to assess the solid mechanical behavior (compliance and stress) of the CMS in a stent/artery hybrid structure. A similar analysis was performed with a Palmaz stent. In vivo hemodynamics and wall mechanical changes induced by the CMS were investigated in a swine model from direct measurements of flow, pressure, diameter, and histology in the stented segment of superficial femoral arteries after 7 days. Finite element analysis showed that the abrupt compliance mismatch was substantially smoothed between the vessel portions with and without the stent with CMS segments. Circumferential stress was also markedly reduced with the CMS compared to other stent. The in vivo results showed that the CMS was efficient in compliance matching and did not dampen flow or pressure waves downstream the stent. Concurrent histology showed limited thrombus and inflammatory cell accumulation around the stent struts. These results indicate that the stent/artery hybrid structure can be compliance matched with proper stent design and that this structure limits solid mechanical stress and hemodynamic disturbances. It remains to be seen whether compliance-matched vascular stents reduce in-stent restenosis.

  19. Biochemical characterization of blood plasma of coronary artery disease patients by in vitro high-resolution proton NMR spectroscopy

    Indian Academy of Sciences (India)

    Anu Malik; Uma Sharma; R Lakshmy; Rajiv Narang; Naranamanglam R Jagannathan

    2015-03-01

    This study aimed to investigate the biochemical profile of blood plasma of patients with coronary artery disease (CAD) and angiographically normal subjects (controls) to determine biomarkers for their differentiation. In this double blind study, 5 mL venous blood was drawn before angiography from CAD patients (n=60) and controls (n=13) comprising angiography normal individuals. In vitro high-resolution NMR spectroscopy of these blood plasma samples was carried out at 400 MHz, and intensity data were analysed with partial least square discriminant analysis. Categorization of subjects as controls or CAD patients and the patients further as single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) was done at the end of the study based on their angiography reports. Raised levels of lipids, alanine (Ala) and isoleucine/leucine/valine (Ile/Leu/Val) were observed in CAD patients compared with controls. Partial least square discriminant analysis showed separation between controls vs CAD patients. TVD patients showed increased levels of Ile/Leu/Val and Ala compared with controls and SVD. Alanine, Ile/Leu/Val, and LDL/VLDL appear as possible biomarkers for distinguishing between controls and patients with SVD and TVD. A metabolic adaptation of myocardium may play a role in raising the Ala level.

  20. Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

    Science.gov (United States)

    Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

    2004-01-01

    Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

  1. Mock Circulatory Loop Compliance Chamber Employing a Novel Real-Time Control Process.

    Science.gov (United States)

    Taylor, Charles E; Miller, Gerald E

    2012-12-01

    The use of compliance chambers in mock circulatory loop construction is the predominant means of simulating arterial compliance. Utilizing mock circulatory loops as bench test methods for cardiac assist technologies necessitates that they must be capable of reproducing the circulatory conditions that would exist physiologically. Of particular interest is the ability to determine instantaneous compliance of the system, and the ability to change the compliance in real-time. This capability enables continuous battery testing of conditions without stopping the flow to change the compliance chamber settings, and the simulation of dynamic changes in arterial compliance. The method tested involves the use of a compliance chamber utilizing a circular natural latex rubber membrane separating the fluid and air portions of the device. Change in system compliance is affected by the airspace pressure, which creates more reaction force at the membrane to the fluid pressure. A pressure sensor in the fluid portion of the chamber and a displacement sensor monitoring membrane center deflection allow for real-time inputs to the control algorithm. A predefined numerical model correlates the displacement sensor data to the volume displacement of the membrane. The control algorithm involves a tuned π loop maintaining the volume distention of the membrane via regulation of the air space pressure. The proportional integral (PI) controller tuning was achieved by creating a computational model of the compliance chamber using Simulink™ Simscape(®) toolboxes. These toolboxes were used to construct a model of the hydraulic, mechanical, and pneumatic elements in the physical design. Parameter Estimation™ tools and Design Optimization™ methods were employed to determine unknown physical parameters in the system, and tune the process controller used to maintain the compliance setting. It was found that the resulting control architecture was capable of maintaining compliance along a

  2. Interpersonal Communication and Compliance

    NARCIS (Netherlands)

    Fennis, Bob M.; Das, Enny; Pruyn, Ad Th.H.

    2006-01-01

    Two field experiments examined the impact of the Disrupt-Then-Reframe (DTR) technique on compliance. This recently identified technique consists of a subtle, odd element in a typical scripted request (the disruption) followed by a persuasive phrase (the reframing). The authors argued that its impact

  3. Environmental compliance and cleanup

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed.

  4. Pharmacodynamic effects of standard dose prasugrel versus high dose clopidogrel in non-diabetic obese patients with coronary artery disease.

    Science.gov (United States)

    Darlington, Andrew; Tello-Montoliu, Antonio; Rollini, Fabiana; Ueno, Masafumi; Ferreiro, José Luis; Patel, Ronakkumar; Desai, Bhaloo; Guzman, Luis A; Bass, Theodore A; Angiolillo, Dominick J

    2014-02-01

    Increased body weight is independently associated with impaired clopidogrel pharmacodynamic (PD) response. Prasugrel has more potent PD effects compared with clopidogrel, although its PD effects in obese patients are unknown. The aim of this prospective, randomised, study was to compare the PD effects of standard-dose prasugrel [60 mg loading dose (LD)/10 mg daily maintenance dose (MD)] with high-dose clopidogrel (900 mg LD/150 mg daily MD) in non-diabetic obese [body mass index (BMI) ≥30 kg/m²] patients, with coronary artery disease (CAD) on aspirin therapy. PD assessments (baseline, 2 hours post-LD and 6 ± 2 days after MD) were conducted using four platelet function assays, and the platelet reactivity index (PRI) assessed by VASP was used for sample size estimation. A total of 42 patients with a BMI of 36.42 ± 5.6 kg/m² completed the study. There were no differences in baseline PD measures between groups. At 2 hours post-LD, prasugrel was associated with lower PRI compared with clopidogrel (24.3 ± 5.5 vs 58.7 ± 5.7, p≤0.001), with consistent findings for all assays. At one-week, PRI values on prasugrel MD were lower than clopidogrel MD without reaching statistical significance (34.7 ± 5.8 vs 42.9 ± 5.8, p=0.32), with consistent findings for all assays. Accordingly, rates of high on-treatment platelet reactivity were markedly reduced after prasugrel LD, but not after MD. In conclusion, in non-diabetic obese patients with CAD, standard prasugrel dosing achieved more potent PD effects than high-dose clopidogrel in the acute phase of treatment, but this was not sustained during maintenance phase treatment. Whether an intensified prasugrel regimen is required in obese patients warrants investigation.

  5. Acute Effect of High-Intensity Eccentric Exercise on Vascular Endothelial Function in Young Men.

    Science.gov (United States)

    Choi, Youngju; Akazawa, Nobuhiko; Zempo-Miyaki, Asako; Ra, Song-Gyu; Shiraki, Hitoshi; Ajisaka, Ryuichi; Maeda, Seiji

    2016-08-01

    Choi, Y, Akazawa, N, Zempo-Miyaki, A, Ra, S-G, Shiraki, H, Ajisaka, R, and Maeda, S. Acute effect of high-intensity eccentric exercise on vascular endothelial function in young men. J Strength Cond Res 30(8): 2279-2285, 2016-Increased central arterial stiffness is as an independent risk factor for cardiovascular disease. Evidence regarding the effects of high-intensity resistance exercise on vascular endothelial function and central arterial stiffness is conflicting. The purpose of this study was to examine the effects of acute high-intensity eccentric exercise on vascular endothelial function and central arterial stiffness. We evaluated the acute changes in endothelium-dependent flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and arterial stiffness after high-intensity eccentric exercise. Seven healthy, sedentary men (age, 24 ± 1 year) performed maximal eccentric elbow flexor exercise using their nondominant arm. Before and 45 minutes after eccentric exercise, carotid arterial compliance and brachial artery FMD and L-FMC in the nonexercised arm were measured. Carotid arterial compliance was significantly decreased, and β-stiffness index significantly increased after eccentric exercise. Brachial FMD was significantly reduced after eccentric exercise, whereas there was no significant difference in brachial L-FMC before and after eccentric exercise. A positive correlation was detected between change in arterial compliance and change in FMD (r = 0.779; p ≤ 0.05), and a negative correlation was detected between change in β-stiffness index and change in FMD (r = -0.891; p eccentric exercise. In this study, acute high-intensity eccentric exercise increased central arterial stiffness; this increase was accompanied by a decrease in endothelial function caused by reduced endothelium-dependent vasodilation but not by a change in endothelium-dependent vasoconstriction.

  6. Making corporate compliance programs work.

    Science.gov (United States)

    Chibbaro, M J; Colyer, C

    2000-05-01

    Healthcare organizations have created corporate compliance programs in an effort to adhere to Federal government recommendations, minimize the risk of wrongful behavior, and possibly reduce fines that may result from a government investigation. Compliance programs may have undetected weaknesses. Corporate compliance officers, executives, and board members need to be certain that their organization's program has sufficient infrastructure, oversight, and resources; effective education and training; an effective mechanism (hotline) to receive reports of compliance problems; and ongoing auditing and monitoring capabilities.

  7. Regulator's Workshop on The Role of Future Society and Biosphere in Demonstrating Compliance with High-Level Radioactive Waste Disposal Standards and Regulations

    Energy Technology Data Exchange (ETDEWEB)

    Avila, R. [Swedish Radiation Protection Authority, Stockholm (Sweden); Blommaert, W. [Agence Federale de Controle Nucleaire, Bruxelles (Belgium); Clark, R. [US Environmental Protection Agency (United States)] [and others

    2002-09-01

    This report summarizes the proceedings of a workshop, co-sponsored by the U.S. Environmental Protection Agency (US EPA) and the Swedish Radiation Protection Authority (SSI). The invitations to participate in the Workshop were primarily extended to authorities in countries with major nuclear waste programs involving geological disposal and using performance assessment methodology. The main objective of the Workshop was to develop a common understanding among regulators of the role of society and the biosphere in demonstrating compliance with regulations.

  8. Arterial enhancement at abdominal CT angiography: Low- versus high-osmolality contrast media

    Energy Technology Data Exchange (ETDEWEB)

    Rouviere, O.; Berger, P.; Pangaud, C.; Lyonnet, D. [Hopital E. Herriot, Lyon (France). Dept. of Vascular and Genitourinary Radiology; Ecochard, R. [Hospices Civils de Lyon (France). Dept of Biostatistics; Fontaine, B. [Laboratoire Guerbet, Roissy (France)

    2000-09-01

    Purpose: To evaluate the effects of contrast media pharmokinetic differences on aortic enhancement at abdominal CT angiography and to determine whether these effects are of clinical relevance. Material and Methods: Two hundred and twelve patients referred for abdominal CT angiography were included in the study. All abdominal CT angiograms were performed with the same parameters (collimation 3 mm, pitch ratio 1.7, scan delay 30 s) after i.v. injection of 120 ml of contrast medium at 3 ml/s. After randomization, patients received either iobitridol 300 (low-osmolar, 300 mg I/ml), iobitridol 350 (low-osmolar, 350 mg I/ml) or ioxithalamate 350 (high-osmolar, 350 mg I/ml). The time attenuation curves obtained with the three contrast media were compared. Results: The time attenuation curve obtained with ioxithalamate 350 was not parallel to those obtained with iobitridol 300 and iobitridol 350. Mean peak enhancements obtained with iobitridol 350 and ioxithalamate 350 were not significantly different but iobitridol 350 provided higher mean peak enhancement than iobitridol 300. Mean delays of the peak enhancements were the same with the three contrast media. After peak enhancement, the decrease of aortic opacification under a selected threshold of 200 HU was significantly slower with iobitridol 350 than with iobitridol 300 and ioxithalamate 350, whereas iobitridol 300 and ioxithalamate 350 showed no significant differences. Conclusion: For a given iodine concentration, low-osmolality contrast media provide longer aortic opacification and may be recommended for CT angiography when long acquisition times are needed.

  9. Heritabilities and genetic correlations of pulmonary arterial pressure and performance traits in Angus cattle at high altitude.

    Science.gov (United States)

    Crawford, N F; Thomas, M G; Holt, T N; Speidel, S E; Enns, R M

    2016-11-01

    Pulmonary arterial pressure (PAP) is an indicator trait for pulmonary hypertension and for the risk of developing high-altitude disease (HAD) in cattle. Pulmonary arterial pressures provide a tool for selection of breeding cattle for tolerance to high altitude in mountainous regions of the United States. The objective of this study was to evaluate relationships between growth performance traits and yearling PAP (42.4 ± 9.9 mmHg; = 5,776; elevation 2,150 m) using data from 1993 to 2014 in the John E. Rouse Colorado State University Beef Improvement Center (CSU-BIC) Angus herd. The breeding program used sires ( = 299) from both low- and high-elevation environments. We hypothesized that little to no genetic relationship exists between PAP and birth weight (BWT; direct and maternal), weaning weight (WW; direct and maternal), yearling weight (YW; direct and maternal), and postweaning gain (PWG). Historic selection of natural service sires from within the herd required a PAP of ≤ 42 mmHg. Outside AI sires ( = 156) used in this breeding program were not PAP tested and therefore were used with little knowledge of these sires' high-altitude adaptability. Performance traits (± SD) routinely recorded included BWT (36.2 ± 5.1 kg; = 8,695), WW (213.5 ± 31.8 kg; = 8,010), YW (345.6 ± 83.8 kg; = 5,580), and PWG (122.0 ± 63.7 kg; = 5,449), where PWG represented the total weight gained from weaning to yearling age. Four-trait analyses using REML were conducted with an animal model. The heritability estimates (± SE) for PAP (0.26 ± 0.03), BWT direct (0.42 ± 0.04) and maternal (0.14 ± 0.02), WW direct (0.29 ± 0.04) and maternal (0.19 ± 0.03), YW direct (0.45 ± 0.04) and maternal (0.23 ± 0.03), and PWG (0.14 ± 0.02) were in the range of those reported in previous literature. Estimates of genetic correlations (± SE) revealed weak relationships between PAP and direct and maternal BWT, direct and maternal WW, direct and maternal YW, and PWG of 0.15 ± 0.09, 0.14 ± 0

  10. Short-Term Therapy with High Dose Atorvastatin in Patients with Coronary Artery Disease Can Reduce Inflammatory Process

    Directory of Open Access Journals (Sweden)

    Vida Nesar Hossein

    2010-08-01

    Full Text Available Coronary heart disease is the leading cause of death and disability in adults. The association between acute coronary syndrom (ACS and elevated serum high sensitivity c-reactive protein (hsCRP suggests that chronic inflammation of the coronary arterial wall may play an important role. A number of drugs used in the treatment of cardiovascular disease reduce serum CRP. It* is therefore possible that reduced inflammation contributes to the beneficial effects of these medications. This was a double blind randomized clinical trial on 52 patients were admitted because of ACS at the Mazandaran Heart Center, Iran in 2007. The patients were divided to three randomized groups which received 20, 40, 80* mg Atorvastatin daily for 6 months. At the time of study enrollment and 1, 3 and 6 months after initiation hsCRP were measured. 1 and 3 month after 20mg atorvastatin therapy the median serum concentration of hsCRP did not decrease significantly, but at the end of 6th month it was* significant difference. At 40mg dosage from 3th month to 6th month versus 1st month to 3th month it was significant decrease, at the end of 1th month and 3rd month it was not significant. At 80mg dose at the end of 1th month it was not significant but at the* end of 3th month and end of 6th month it was significant. Intensive lipid-lowering therapy with high-dose atorvastatin therapy relative to moderate lipid-lowering therapy with low-dose atorvastatin reduces hsCRP better. We found that treatment with greater dose of atorvastatin might decrease greater in plasma level of hsCRP.

  11. Scan-Rescan Reproducibility of High Resolution Magnetic Resonance Imaging of Atherosclerotic Plaque in the Middle Cerebral Artery.

    Directory of Open Access Journals (Sweden)

    Xuefeng Zhang

    Full Text Available To evaluate the scan-rescan reproducibility of high-resolution magnetic resonance imaging (MRI of middle cerebral artery (MCA plaque, and calculate the number of subjects needed for future longitudinal clinical studies.Twenty two patients with MCA plaque were scanned twice by a T2-weighted fast-spin-echo sequence at 3T. Areas and volumes of MCA lumen, total vessel and plaque were quantified and compared between two repeated scans. Agreement and measurement error was quantified by intraclass correlation coefficient (ICC and coefficient of variance (CV as defined by standard deviation (SD of pair wise difference / mean. Sample size needed to detect 5% to 20% changes in area/volume was calculated using 80% power and 5% significance level.There was no significant different between the area and volume measurements of two repeated scans (p>0.05 with good agreement (ICC range 0.97-0.98 for area and 0.99 for volume. Relatively small measurement errors were observed with CVs range 6.1%-11.8% for area quantification and 4.9%-8.0% for volume quantification. Volume measurements tended to have 19.7% to 32.2% smaller CVs compared with area measurements. Sample size calculation showed a group of 47 patients was sufficient to detect 5% to 10% changes in MCA area/volume.High resolution MRI is feasible for quantifying intracranial plaque area and volume in longitudinal clinical studies with low scan-rescan variability. Volume measurement tends to be more reproducible compared with area measurements.

  12. High-fat diet increases O-GlcNAc levels in cerebral arteries: a link to vascular dysfunction associated with hyperlipidaemia/obesity?

    Science.gov (United States)

    Lima, Victor V; Giachini, Fernanda R; Matsumoto, Takayuki; Li, Weiguo; Bressan, Alecsander F M; Chawla, Dhruv; Webb, R Clinton; Ergul, Adviye; Tostes, Rita C

    2016-06-01

    Obesity and high fat intake induce alterations in vascular function and structure. Aberrant O-GlcNAcylation (O-GlcNAc) of vascular proteins has been implicated in vascular dysfunction associated with cardiovascular and metabolic diseases. In the present study, we tested the hypothesis that high-fat diet (HFD)-mediated increases in O-GlcNAc-modified proteins contribute to cerebrovascular dysfunction. O-GlcNAc-protein content was increased in arteries from male Wistar rats treated with a HFD (45% fat) for 12 weeks compared with arteries from rats on control diet (CD). HFD augmented body weight [(g) 550±10 compared with 502±10 CD], increased plasma triacylglycerols [(mg/dl) 160±20 compared with 95±15 CD] and increased contractile responses of basilar arteries to serotonin [5-hydroxytryptamine (5-HT)] [(pD2) 7.0±0.1 compared with 6.7±0.09 CD] and the thromboxane analogue 9,11-dideoxy-9α,11α-methanoepoxy prostaglandin F2α (U-46619) [(pD2) 7.2±0.1 compared with 6.8±0.09 CD]. Of importance, increased levels of O-GlcNAc [induced by 24 h-incubation of vessels with a potent inhibitor of O-GlcNAcase (OGA), O-(2-acetamido-2-deoxy-D-glucopyranosylidene)amino-N-phenylcarbamate (PugNAc)] increased basilar artery contractions in response to U-46619 [(pD2) 7.4±0.07 compared with 6.8±0.08 CD] and 5-HT [(pD2) 7.5±0.06 compared with 7.1±0.1 CD]. Vessels from rats on the HFD for 12 weeks and vessels treated with PugNAc displayed increased phosphorylation of p38 (Thr(180/182)) and extracellular signal-regulated kinase 1/2 (Erk1/2) (Ser(180/221)). Increased 5HT-induced contractions in arteries from rats on the HFD or in arteries incubated with PugNAc were abrogated by mitogen-activated protein kinase (MAPK) inhibitors. Our data show that HFD augments cerebrovascular O-GlcNAc and this modification contributes to increased contractile responses and to the activation of the MAPK pathway in the rat basilar artery.

  13. Reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance.

    Science.gov (United States)

    Sickbert-Bennett, Emily E; DiBiase, Lauren M; Schade Willis, Tina M; Wolak, Eric S; Weber, David J; Rutala, William A

    2016-05-02

    Hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. A novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections.

  14. High-Dose versus Low-Dose Vitamin D Supplementation and Arterial Stiffness among Individuals with Prehypertension and Vitamin D Deficiency

    Directory of Open Access Journals (Sweden)

    Amanda Zaleski

    2015-01-01

    Full Text Available Introduction. Vitamin D deficiency is associated with the onset and progression of hypertension and cardiovascular disease (CVD. However, mechanisms underlying vitamin D deficiency-mediated increased risk of CVD remain unknown. We sought to examine the differential effect of high-dose versus low-dose vitamin D supplementation on markers of arterial stiffness among ~40 vitamin D deficient adults with prehypertension. Methods. Participants were randomized to high-dose (4000 IU/d versus low-dose (400 IU/d oral vitamin D3 for 6 months. 24 hr ambulatory blood pressure (BP, carotid-femoral pulse wave velocity, and pulse wave analyses were obtained at baseline and after 6 months of vitamin D supplementation. Results. There were no changes in resting BP or pulse wave velocity over 6 mo regardless of vitamin D dose (all p>0.202. High-dose vitamin D decreased augmentation index and pressure by 12.3 ± 5.3% (p=0.047 and 4.0 ± 1.5 mmHg (p=0.02, respectively. However, these decreases in arterial stiffness were not associated with increases in serum 25-hydroxyvitamin D over 6 mo (p=0.425. Conclusion. High-dose vitamin D supplementation appears to lower surrogate measures of arterial stiffness but not indices of central pulse wave velocity. Clinical Trial Registration. This trial is registered with www.clinicaltrials.gov (Unique Identifier: NCT01240512.

  15. Compliance of laser-assisted microvascular anastomosis: a comparative study with manual anastomosis (preliminary results)

    Science.gov (United States)

    Demaria, Roland G.; Lhote, Francois-Marie; Dauzat, Michel; Juan, Jean-Marie; Oliva-Lauraire, Marie-Claire; Durrleman, Nicolas; Delacretaz, Guy P.; Albat, Bernard; Frapier, Jean-Marc; Chaptal, Paul-Andre; Godlewski, Guilhem

    1999-01-01

    The compliance of microvascular anastomosis is an important predictive factor for long term patency of graft or vascular reconstruction. This experimental study compare the compliance of manual suture and laser assisted end to end microvascular anastomosis. In nine New-Zealand white rabbits we performed manual end-to-end suture anastomosis on the left femoral artery and laser assisted anastomosis on the right femoral artery, with a diode laser (wavelength 988 nm, power output 500 mW). Compliance was obtained by echotracking (CBI 8000 sonomicrometry system with 20 MHz implantable microprobe from Crystal-Biotech, USA) on the anastomosis site as well as upstream, and downstream from the anastomosis. Vessel compliance was lower on the manual suture side compared to the laser assisted anastomosis side, especially downstream from the anastomosis.

  16. Restaurant inspection frequency and food safety compliance.

    Science.gov (United States)

    Newbold, K Bruce; McKeary, Marie; Hart, Robert; Hall, Robert

    2008-11-01

    Although food premises are regularly inspected, little information is available on the effect of inspections on compliance records, particularly with respect to the impact of the frequency of inspection on compliance. The following presents the outcome of a study designed to assess the impact of increased inspection frequency on compliance measures in Hamilton, Ontario, in the absence of any other changes to food handler/safety programs or legislation. High-risk food inspection premises were randomly assigned three, four, or five inspections per year. Results indicate that no statistical difference existed in outcome measures based on frequency of inspection. When premises were grouped based on the average time between inspections, premises with greater time between inspections scored better compliance measures relative to premises that were inspected more frequently. The study was also unique for the level of consultation and collaboration sought from the public health inspectors (PHIs) assigned to the Food Safety Program. Their knowledge and experience with respect to the critical variables associated with compliance were a complementary component to the literature review conducted by the research team.

  17. Low-Density Lipoprotein Cholesterol, Non-High-Density Lipoprotein Cholesterol, Triglycerides, and Apolipoprotein B and Cardiovascular Risk in Patients With Manifest Arterial Disease.

    Science.gov (United States)

    van den Berg, M Johanneke; van der Graaf, Yolanda; de Borst, Gert Jan; Kappelle, L Jaap; Nathoe, Hendrik M; Visseren, Frank L J

    2016-09-15

    Low-density lipoprotein cholesterol (LDL-C) only partly represents the atherogenic lipid burden, and a growing body of evidence suggests that non-high-density lipoprotein cholesterol (non-HDL-C), triglycerides, and apolipoprotein B (apoB) are more accurate in estimating lipid-related cardiovascular disease risk. Our objective was to compare the relation among LDL-C, non-HDL-C, triglycerides, and apoB and the occurrence of future vascular events and mortality in patients with manifest arterial disease. This is a prospective cohort study of 7,216 patients with clinically manifest arterial disease in the Secondary Manifestations of Arterial Disease Study. Cox proportional hazard models were used to quantify the risk of major cardiovascular events (MACE; i.e., stroke, myocardial infarction, and vascular mortality) and all-cause mortality. Interaction was tested for type of vascular disease at inclusion. MACE occurred in 1,185 subjects during a median follow-up of 6.5 years (interquartile range 3.4 to 9.9 years). Adjusted hazard ratios (HRs) of MACE per 1 SD higher were for LDL-C (HR 1.15, 95% confidence interval [CI] 1.09 to 1.22), for non-HDL-C (HR 1.17, 95% CI 1.11 to 1.23), for log(triglycerides) (HR 1.12, 95% CI 1.06 to 1.19), and for apoB HR (1.12, 95% CI 0.99 to 1.28). The relation among LDL-C, non-HDL-C, and cardiovascular events was comparable in patients with cerebrovascular disease, coronary artery disease, or polyvascular disease and absent in those with aneurysm of abdominal aorta or peripheral artery disease. In conclusion, in patients with a history of cerebrovascular, coronary artery, or polyvascular disease, but not aneurysm of abdominal aorta or peripheral artery disease, higher levels of LDL-C and non-HDL-C are related to increased risk of future MACE and of comparable magnitude. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. High-flow bypass and wrap-clipping for ruptured blood blister-like aneurysm of the internal carotid artery using intraoperative monitoring of cerebral hemodynamics

    Directory of Open Access Journals (Sweden)

    Kubo Y

    2015-06-01

    Full Text Available Yoshitaka Kubo, Takahiro Koji, Kenji Yoshida, Hideo Saito, Akira Ogawa, Kuniaki Ogasawara Department of Neurosurgery, Iwate Medical University, Morioka, Japan Abstract: Aneurysms at non-branching sites in the supraclinoid internal carotid artery (ICA can be classified as “blood blister-like aneurysms” (BBAs, which have blood blister-like configurations and fragile walls. While surgical treatment for the BBA in the acute stage is recommended, the optimal surgical procedure remains controversial. In the study reported here, we describe the case of a 37-year-old woman with a ruptured BBA in the ophthalmic segment of the right ICA who underwent wrap-clipping with external carotid artery–internal carotid artery bypass by intraoperative estimation of the measurement of cortical cerebral blood flow (CoBF using a thermal diffusion flow probe. Trapping of the ICA in the acute stage of subarachnoid hemorrhage may result in ischemic complications secondary to hemodynamic hypoperfusion or occlusion of the perforating artery, and/or delayed vasospasm, even with concomitant bypass surgery. We believe that it is important to perform scheduled external carotid artery–internal carotid artery bypass before trapping of the ICA in patients with a ruptured BBA in the acute stage of subarachnoid hemorrhage and to perform wrap-clipping rather than trapping. This would provide much more CoBF if a reduction of CoBF occurs after trapping occlusion of the ICA including a ruptured BBA according to intraoperative CoBF monitoring. As far as we are aware, the case reported here is the first report on high-flow bypass and wrap-clipping for a ruptured BBA of the ICA using intraoperative monitoring of cerebral hemodynamics. Keywords: surgery, cortical blood flow, external carotid artery–internal carotid artery bypass, subarachnoid hemorrhage

  19. Treatment of hypertension with thiazides: benefit or damage-effect of low- and high-dose thiazide diuretics on arterial elasticity and metabolic parameters in hypertensive patients with and without glucose intolerance.

    Science.gov (United States)

    Shargorodsky, Marina; Boaz, Mona; Davidovitz, Ina; Asherov, Jack; Gavish, Dov; Zimlichman, Reuven

    2007-01-01

    Thiazide diuretics may cause multiple metabolic abnormalities. The authors investigated the effects of varying doses of hydrochlorothiazide (HCTZ) on arterial elasticity and metabolic parameters in patients with hypertension (HTN), HTN and impaired fasting glucose (HTN+IFG), and HTN and type 2 diabetes mellitus (HTN+DM). The patients received low and high doses of HCTZ. Systolic and diastolic blood pressures declined significantly during the first 3 months in all patients, but no additional decrease was seen following the increase in HCTZ dose. In HTN, large artery elasticity index and small artery elasticity increased during the study. In HTN+IFG, large artery elasticity index increased without improvement in small artery elasticity index. In HTN+DM, both large artery elasticity index and small artery elasticity index did not improve during follow-up. Low-dose HCTZ improves arterial elasticity in hypertensive patients, but this effect is diminished with concomitant DM or IFG. The HCTZ dose increase worsened parameters of glucose metabolism and did not further decrease blood pressure or improve arterial elasticity.

  20. Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: vera.froeling@charite.de; Meckelburg, K., E-mail: katrin.meckelburg@charite.de; Scheurig-Muenkler, C., E-mail: christian.scheurig-muenkler@charite.de; Schreiter, N. F., E-mail: nils.schreiter@charite.de; Kamp, J., E-mail: julia.kamp@charite.de; Maurer, M. H., E-mail: martin.maurer@charite.de; Beck, A., E-mail: alexander.beck@charite.de; Hamm, B., E-mail: bernd.hamm@charite.de; Kroencke, T. J., E-mail: Thomas.kroencke@charite.de [Charite-Universitaetsmedizin Berlin, Department of Radiology (Germany)

    2013-12-15

    Purpose: To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. Results: The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). Conclusion: UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

  1. Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Cardiovascular Events in Diabetics With Coronary Artery Disease.

    Science.gov (United States)

    Yang, Sheng-Hua; Du, Ying; Li, Xiao-Lin; Zhang, Yan; Li, Sha; Xu, Rui-Xia; Zhu, Cheng-Gang; Guo, Yuan-Lin; Wu, Na-Qiong; Qing, Ping; Gao, Ying; Cui, Chuan-Jue; Dong, Qian; Sun, Jing; Li, Jian-Jun

    2017-08-01

    It has been demonstrated that an elevated ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) is a risk factor of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) and is also found to be associated with cardiovascular events (CVEs) in the general population. However, its prognostic value in patients with T2DM along with CAD remains to be determined. A total of 1,447 consecutive patients with T2DM with angiographic-proven stable CAD were enrolled in the present study and followed-up for an average of 20.3 months. The characteristics of all patients including fasting lipid profile were obtained at baseline and multivariate Cox proportional hazards models were constructed using log TG/HDL-C as a predictor variable. The relationships between CVEs and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apolipoprotein B/ apolipoprotein AI (apoB/apoAI) were also explored. Compared with patients without CVEs, the ones who experienced CVEs had a higher TG/HDL-C ratio. Univariable regression revealed a significant association of log TG/HDL-C with CVEs (hazard ratio = 2.5, P = 0.015). After adjusting for multiple traditional risk factors of cardiovascular disease, the association was still found (hazard ratio = 2.47, P = 0.047). Moreover, results suggested that the ratios of non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apoB/apoAI were not predictors for CVEs in T2DM. In our primary study, data suggested that elevated TG/HDL-C value might be a useful predictor for future CVEs in Chinese patients with T2DM with stable CAD. Further study is needed to confirm our findings. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  2. High-flavanol and high-theobromine versus low-flavanol and low-theobromine chocolate to improve uterine artery pulsatility index: a double blind randomized clinical trial.

    Science.gov (United States)

    Bujold, Emmanuel; Leblanc, Vicky; Lavoie-Lebel, Élise; Babar, Asma; Girard, Mario; Poungui, Lionel; Blanchet, Claudine; Marc, Isabelle; Lemieux, Simone; Belkacem, Abdous; Sidi, Elhadji Laouan; Dodin, Sylvie

    2017-09-01

    To evaluate the impact of high-flavanol and high-theobromine (HFHT) chocolate in women at risk of preeclampsia (PE). We conducted a single-center randomized controlled trial including women with singleton pregnancy between 11 and 14 weeks gestation who had bilateral abnormal uterine artery (UtA) waveforms (notching) and elevated pulsatility index (PI). Participants were randomized to either HFHT or low-flavanol and low-theobromine (LFLT) chocolate (30 grams daily for a total of 12 weeks). UtA PI, reported as multiple of medians (MoM) adjusted for gestational age, was assessed at baseline and 12 weeks after randomization. One hundred thirty-one women were randomized with mean gestational age of 12.4 ± 0.6 weeks and a mean UtA PI of 1.39 ± 0.31 MoM. UtA PI adjusted for gestational age significantly decreased from baseline to the second visit (12 weeks later) in the two groups (p chocolate, daily intake of HFHT chocolate was not associated with significant changes of UtA PI. Nevertheless, the improvement observed in both groups suggests that chocolate could improve placental function independently of flavanol and/or theobromine content.

  3. Agent Architectures for Compliance

    Science.gov (United States)

    Burgemeestre, Brigitte; Hulstijn, Joris; Tan, Yao-Hua

    A Normative Multi-Agent System consists of autonomous agents who must comply with social norms. Different kinds of norms make different assumptions about the cognitive architecture of the agents. For example, a principle-based norm assumes that agents can reflect upon the consequences of their actions; a rule-based formulation only assumes that agents can avoid violations. In this paper we present several cognitive agent architectures for self-monitoring and compliance. We show how different assumptions about the cognitive architecture lead to different information needs when assessing compliance. The approach is validated with a case study of horizontal monitoring, an approach to corporate tax auditing recently introduced by the Dutch Customs and Tax Authority.

  4. Orchestrated Session Compliance

    Directory of Open Access Journals (Sweden)

    Franco Barbanera

    2015-08-01

    Full Text Available We investigate the notion of orchestrated compliance for client/server interactions in the context of session contracts. Devising the notion of orchestrator in such a context makes it possible to have orchestrators with unbounded buffering capabilities and at the same time to guarantee any message from the client to be eventually delivered by the orchestrator to the server, while preventing the server from sending messages which are kept indefinitely inside the orchestrator. The compliance relation is shown to be decidable by means of 1 a procedure synthesising the orchestrators, if any, making a client compliant with a server, and 2 a procedure for deciding whether an orchestrator behaves in a proper way as mentioned before.

  5. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients

    DEFF Research Database (Denmark)

    Jensen, Birte Østergaard; Hughes, Pia; Rasmussen, Lars S;

    2006-01-01

    Previous trials comparing coronary artery bypass grafting (CABG) with or without extracorporeal circulation have mainly enrolled selected patients at younger age and low risk. Patient-reported health-related quality of life has not been significantly different. We compared health-related quality...... of life in elderly moderate to high-risk patients randomized to either off-pump or on-pump surgery....

  6. Identification by ultrasound evaluation of the carotid and femoral arteries of high-risk subjects missed by three validated cardiovascular disease risk algorithms.

    Science.gov (United States)

    Postley, John E; Luo, Yanting; Wong, Nathan D; Gardin, Julius M

    2015-11-15

    Atherosclerotic cardiovascular disease (ASCVD) events are the leading cause of death in the United States and globally. Traditional global risk algorithms may miss 50% of patients who experience ASCVD events. Noninvasive ultrasound evaluation of the carotid and femoral arteries can identify subjects at high risk for ASCVD events. We examined the ability of different global risk algorithms to identify subjects with femoral and/or carotid plaques found by ultrasound. The study population consisted of 1,464 asymptomatic adults (39.8% women) aged 23 to 87 years without previous evidence of ASCVD who had ultrasound evaluation of the carotid and femoral arteries. Three ASCVD risk algorithms (10-year Framingham Risk Score [FRS], 30-year FRS, and lifetime risk) were compared for the 939 subjects who met the algorithm age criteria. The frequency of femoral plaque as the only plaque was 18.3% in the total group and 14.8% in the risk algorithm groups (n = 939) without a significant difference between genders in frequency of femoral plaque as the only plaque. Those identified as high risk by the lifetime risk algorithm included the most men and women who had plaques either femoral or carotid (59% and 55%) but had lower specificity because the proportion of subjects who actually had plaques in the high-risk group was lower (50% and 35%) than in those at high risk defined by the FRS algorithms. In conclusion, ultrasound evaluation of the carotid and femoral arteries can identify subjects at risk of ASCVD events missed by traditional risk-predicting algorithms. The large proportion of subjects with femoral plaque only supports the use of including both femoral and carotid arteries in ultrasound evaluation.

  7. The Non-Invasive Functional Tissue Characterization for Arteriosclerosis by Artery Wall Motion Analysis with Time Series High-Speed Echo Images and Continuous Spygmo-Manometer

    Science.gov (United States)

    2007-11-02

    Abstract- The evaluation method of arteriosclerosis has been established, but most of them are invasive way. In late years, non-invasive diagnostic...method for arteriosclerosis can be done by the diagnosis with high resolution echography. However, even this new diagnostic method can not diagnose...until beginning the morphologic changes of the arteries by stenosis. There is little value even if it could be detected the arteriosclerosis after the

  8. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

    Energy Technology Data Exchange (ETDEWEB)

    Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2016-02-15

    PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  9. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study.

    Science.gov (United States)

    Sobiecki, Jakub G; Appleby, Paul N; Bradbury, Kathryn E; Key, Timothy J

    2016-05-01

    The aim of this study was to investigate differences in dietary intakes between 30251 participants in the European Prospective Investigation into Cancer and Nutrition-Oxford study, comprising 18 244 meat eaters, 4 531 fish eaters, 6 673 vegetarians, and 803 vegans aged 30 to 90 years who completed semiquantitative food frequency questionnaires. We hypothesized that these groups characterized by varying degrees of animal product exclusion have significantly different intakes of many nutrients, with possible implications for dietary adequacy and compliance with population dietary goals. Nutrient intakes were estimated including fortification in foods, but excluding dietary supplements. Dietary supplementation practices were also evaluated. Highly significant differences were found in estimated nutrient intakes between meat eaters and vegans, with fish eaters and vegetarians usually having intermediate values. Meat eaters had the highest energy intakes, followed by fish eaters and vegetarians, whereas vegans had the lowest intakes. Vegans had the highest intakes of polyunsaturated fatty acids, dietary fiber, vitamins C and E, folate, magnesium, iron, and copper. Meat eaters had the highest intake of saturated fatty acids, protein, vitamin B2, vitamin B12, vitamin D, zinc, and iodine. Fish eaters had the highest intakes of calcium and selenium. There were no statistically significant differences in sodium and potassium intakes between dietary groups. With the exception of sodium intake, compliance with population dietary goals was high across diet groups. The results suggested a high prevalence of inadequacy for dietary vitamin B12 and iodine in vegans. The diet groups under study showed striking differences in dietary intakes, with possible implications for compliance with dietary recommendations, as well as cardiometabolic diseases risk. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  10. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition–Oxford study☆☆☆

    Science.gov (United States)

    Sobiecki, Jakub G.; Appleby, Paul N.; Bradbury, Kathryn E.; Key, Timothy J.

    2016-01-01

    The aim of this study was to investigate differences in dietary intakes between 30 251 participants in the European Prospective Investigation into Cancer and Nutrition–Oxford study, comprising 18 244 meat eaters, 4 531 fish eaters, 6 673 vegetarians, and 803 vegans aged 30 to 90 years who completed semiquantitative food frequency questionnaires. We hypothesized that these groups characterized by varying degrees of animal product exclusion have significantly different intakes of many nutrients, with possible implications for dietary adequacy and compliance with population dietary goals. Nutrient intakes were estimated including fortification in foods, but excluding dietary supplements. Dietary supplementation practices were also evaluated. Highly significant differences were found in estimated nutrient intakes between meat eaters and vegans, with fish eaters and vegetarians usually having intermediate values. Meat eaters had the highest energy intakes, followed by fish eaters and vegetarians, whereas vegans had the lowest intakes. Vegans had the highest intakes of polyunsaturated fatty acids, dietary fiber, vitamins C and E, folate, magnesium, iron, and copper. Meat eaters had the highest intake of saturated fatty acids, protein, vitamin B2, vitamin B12, vitamin D, zinc, and iodine. Fish eaters had the highest intakes of calcium and selenium. There were no statistically significant differences in sodium and potassium intakes between dietary groups. With the exception of sodium intake, compliance with population dietary goals was high across diet groups. The results suggested a high prevalence of inadequacy for dietary vitamin B12 and iodine in vegans. The diet groups under study showed striking differences in dietary intakes, with possible implications for compliance with dietary recommendations, as well as cardiometabolic diseases risk. PMID:27101764

  11. Measuring arterial oxygenation in a high altitude field environment: comparing portable pulse oximetry with blood gas analysis.

    Science.gov (United States)

    Ross, Elliot M; Matteucci, Michael J; Shepherd, Matthew; Barker, Matthew; Orr, Lance

    2013-06-01

    High altitude environments present unique medical treatment challenges. Medical providers often use small portable pulse oximetry devices to help guide their clinical decision making. A significant body of high altitude research is based on the use of these devices to monitor hypoxia, yet there is a paucity of evidence that these devices are accurate in these environments. We studied whether these devices perform accurately and reliably under true mountain conditions. Healthy unacclimatized active-duty military volunteers participating in mountain warfare training at 2100 m (6900 feet) above sea level were evaluated with several different pulse oximetry devices while in a cold weather, high altitude field environment and then had arterial blood gases (ABG) drawn using an i-STAT for comparison. The pulse oximeter readings were compared with the gold standard ABG readings. A total of 49 individuals completed the study. There was no statistically significant difference between any of the devices and the gold standard of ABG. The best performing device was the PalmSAT (PS) 8000SM finger probe with a mean difference of 2.17% and SD of 2.56 (95% CI, 1.42% to 2.92%). In decreasing order of performance were the PS 8000AA finger probe (mean ± SD, 2.54% ± 2.68%; 95% CI, 1.76% to 3.32%), the PS 8000Q ear probe (2.47% ± 4.36%; 95% CI, 1.21% to 3.75%), the Nonin Onyx 9500 (3.29% ± 3.12%; 95% CI, 2.39% to 4.20%), and finally the PS 8000R forehead reflectance sensor (5.15% ± 2.97%; 95% CI, 4.28% to 6.01%). Based on the results of this study, results of the newer portable pulse oximeters appear to be closely correlated to that of the ABG measurements when tested in true mountain conditions. Copyright © 2013 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  12. [Compliance in schizophrenia: predictive factors, therapeutical considerations and research implications].

    Science.gov (United States)

    Misdrahi, D; Llorca, P M; Lançon, C; Bayle, F J

    2002-01-01

    Compliance has been defined as the extent to which a person's behavior coincides with the medical advice given. Medication compliance is one of the foremost problems affecting neuroleptic efficacy in psychiatric patients. Since chlorpromazine introduction in 1952, antipsychotics are the principal element of schizophrenia treatment. Actually progress links to the use of new antipsychotics are conditioned by quality of compliance. The problem of nonadherence to medication could concern 50% of prescription. The reported incidence of non-compliance with antipsychotic medication ranges from 11 to 80%. In a two thirds of case rehospitalization is the result of complete or partial noncompliance. After one year of first hospitalisation, 40% of relapse results from non adherence to medication. Medication adherence problems increase hospitalisation, morbidity and mortality. Social consequences, professional problems and family troubles linked to hospitalisations lead to low quality of life for patients and high cost for society. There are three main methods of measuring compliance. These include patient and clinical self-report, pill counts, and biological measures. Self-report methods are generally the most cost-effective and time-efficient way of obtaining an indication of compliance. In psychiatric research, the most commonly used self-report measure of compliance is the Drug Attitude Inventory (DAI) originally devised by Hogan et al. On the basis of criticism concerning DAI reliability, a new questionnaire of medication compliance was proposed: the Medication Adherence Rating scale (MARS). The main goal of compliance evaluation is to quantify this phenomenon with accuracy and to find predictive factors of medication nonadherence. Three types of factors influencing compliance are identified: factors due to medications, factors linked to patients and factors depending on the therapeutic relation with the clinician. Tolerance is considered as the principal reason explaining

  13. Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia

    National Research Council Canada - National Science Library

    Dockery, Frances; Bulpitt, Christopher J; Agarwal, Sanjiv; Donaldson, Mandy; Rajkumar, Chakravarthi

    2003-01-01

    .... Arterial stiffness (or 'compliance') was measured in 16 men (71+/-9 years, mean+/-S.D.) prior to, and 3 months after, complete androgen suppression with gonadotrophin-releasing hormone analogues as treatment for prostate cancer...

  14. Therapeutic compliance of first line disease-modifying therapies in patients with multiple sclerosis. COMPLIANCE Study.

    Science.gov (United States)

    Saiz, A; Mora, S; Blanco, J

    2015-05-01

    Non-adherence to disease-modifying therapies (DMTs) in multiple sclerosis may be associated with reduced efficacy. We assessed compliance, the reasons for non-compliance, treatment satisfaction, and quality of life (QoL) of patients treated with first-line therapies. A cross-sectional, multicenter study was conducted that included relapsing multiple sclerosis patients. Compliance in the past month was assessed using Morisky-Green test. Seasonal compliance and reasons for non-compliance were assessed by an ad-hoc questionnaire. Treatment satisfaction and QoL were evaluated by means of TSQM and PRIMUS questionnaires. A total of 220 patients were evaluated (91% relapsing-remitting); the mean age was 39.1 years, 70% were female, and the average time under treatment was 5.4 years. Subcutaneous interferon (IFN) β-1b was used in 23% of the patients, intramuscular IFN β-1a in 21%, subcutaneous IFN β-1a in 37%, and with glatiramer acetate in 19%. The overall compliance was 75%, with no significant differences related to the therapy, and 81% did not report any seasonal variation. Compliant patients had significantly lower disability scores and time of diagnosis, and greater satisfaction with treatment and its effectiveness. Discomfort and flu-like symptoms were the most frequent reasons for non-compliance. The satisfaction and QoL were associated with less disability and number of therapeutic switches. The rate of compliance, satisfaction and QoL in multiple sclerosis patients under DMTs is high, especially for those newly diagnosed, less disabled, and with fewer therapeutic switches. Discomfort and flu-like symptoms associated with injected therapies significantly affect adherence. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  16. High prevalence of risk factors in coronary artery disease in EUROPA gives HOPE for ACE inhibitors after PEACE

    DEFF Research Database (Denmark)

    Pedersen, S.A.; Galatius, S.; Olsen, M.H.;

    2008-01-01

    Background: Routine use of ACE inhibitors (ACE-I) as secondary preventive therapy for all patients with coronary artery disease (CAD) is challenged by the PEACE trial. Currently it is unclear to what extent ACE-I should be used in CAD populations. Purpose: To analyze the prevalence of left ventri...

  17. NT-proBNP, echocardiographic abnormalities and subclinical coronary artery disease in high risk type 2 diabetic patients

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Wiinberg, Niels;

    2012-01-01

    -NT-proBNP and the putative residual abnormalities in such patients are not well described. This study examined echocardiographic measurements of LV hypertrophy, atrial dilatation and LV dysfunction and their relation to P-NT-proBNP levels or subclinical coronary artery disease (CAD) in type 2 diabetic patients...

  18. Arterial responses during migraine headache

    DEFF Research Database (Denmark)

    Iversen, Helle Klingenberg; Nielsen, T H; Olesen, J

    1990-01-01

    The superficial temporal artery has been thought to be the main focus of pain during migraine attacks, but its diameter has never been measured directly. The use of a new, high-resolution ultrasound machine to measure arterial size in 25 migraine patients with unilateral head pain showed...... that the lumen was wider on the painful than on the non-painful side during a migraine attack. The diameters of both radial arteries and the temporal artery on the non-painful side were smaller during than between attacks. The generalised vasoconstriction was not shared by the temporal artery on the affected...... side, which suggests a local vasodilatory response. The findings suggest that cephalic arteries may play a role in migraine pathogenesis....

  19. High trans but not saturated fat beverage causes an acute reduction in postprandial vascular endothelial function but not arterial stiffness in humans.

    Science.gov (United States)

    Lane-Cordova, Abbi D; Witmer, Jordan R; Dubishar, Kaitlyn; DuBose, Lyndsey E; Chenard, Catherine A; Siefers, Kyle J; Myers, Janie E; Points, Lauren J; Pierce, Gary L

    2016-10-01

    A diet high in trans-fatty acids (TFAs) is associated with a higher risk of cardiovascular disease (CVD) than a diet high in saturated fatty acids (SFAs), but the mechanisms remain unclear. We hypothesized that a beverage high in TFAs would cause a larger reduction in postprandial endothelial function and an increase in arterial stiffness, in part from greater reductions in insulin sensitivity, compared with a beverage high in SFAs. Eleven healthy adults (aged 47±5 years) ingested a warm test beverage (520 kcal, 56 g total fat, 5 g carbohydrate, 1 g protein) high in either TFAs or SFAs in a randomized cross-over study. Ingestion of the beverage high in TFAs (p<0.01) but not high in SFAs (p=0.49) decreased endothelial function (brachial artery flow-mediated dilation, mmΔ) at 3-4 hours (p<0.01 for time; p=0.034 for interaction), but did not alter aortic stiffness or carotid β-stiffness. The homeostasis model of insulin resistance (interaction p=0.062) tended to decrease after SFAs but not TFAs. A beverage high in TFAs but not SFAs results in a postprandial reduction in endothelial function and a trend for decreased insulin sensitivity, potentially explaining the higher risk of CVD with a diet high in TFAs. © The Author(s) 2016.

  20. Pulmonary arterial hypertension in pregnancy.

    Science.gov (United States)

    Običan, Sarah G; Cleary, Kirsten L

    2014-08-01

    Pulmonary hypertension is a medical condition characterized by elevated pulmonary arterial pressure and secondary right heart failure. Pulmonary arterial hypertension is a subset of pulmonary hypertension, which is characterized by an underlying disorder of the pulmonary arterial vasculature. Pulmonary hypertension can also occur secondarily to structural cardiac disease, autoimmune disorders, and toxic exposures. Although pregnancies affected by pulmonary hypertension and pulmonary arterial hypertension are rare, the pathophysiology exacerbated by pregnancy confers both high maternal and fetal mortality and morbidity. In light of new treatment modalities and the use of a multidisciplinary approach to care, maternal outcomes may be improving.

  1. Comparison of benazepril plus amlodipine or hydrochlorothiazide in high-risk patients with hypertension and coronary artery disease.

    Science.gov (United States)

    Bakris, George; Briasoulis, Alexandros; Dahlof, Bjorn; Jamerson, Kenneth; Weber, Michael A; Kelly, Roxzana Y; Hester, Allen; Hua, Tsushung; Zappe, Dion; Pitt, Bertram

    2013-07-15

    Combination therapy with benazepril 40 mg and amlodipine 10 mg (B+A) has been shown to be more effective than benazepril 40 mg and hydrochlorothiazide (HCTZ) 25 mg (B+H) in reducing cardiovascular (CV) events in high-risk patients with stage 2 hypertension with similar blood pressure reductions. In the present post hoc analysis, we evaluated whether B+A is more effective than B+H for reducing CV events in patients with known coronary artery disease (CAD) at baseline in a subgroup analysis of the Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) study. The main trial randomized 11,506 patients. Of those, 5,744 received B+A and 5,762 received B+H. Of the 11,506 patients, 5,314 (46%) were classified as having CAD at baseline. The mean patient follow-up period was 35.7 months for the B+A group and 35.6 months for the B+H group. The primary end point was the interval to the first event of composite CV morbidity and mortality. At baseline, significant differences were present between the 5,314 with CAD and the 6,192 without CAD. The patients with CAD had a lower systolic blood pressure and heart rate, a lower incidence of diabetes, and greater incidence of dyslipidemia. However, no baseline differences were found between the randomized B+A and B+H groups. In the patients with CAD, an 18% reduction occurred in the hazard ratio for CV events (primary end point) with B+A versus B+H (p = 0.0016). In a prespecified secondary analysis of the composite end point, including only CV death, myocardial infarction, and stroke, the hazard ratio in the patients with CAD was reduced by 25% (p = 0.0033) in the B+A group compared with the B+H group. B+A was more effective than B+H at comparable blood pressure reductions for reducing CV events in patients, regardless of the presence of CAD. In conclusion, our findings suggest that the combination of B+A should be preferentially used for older patients with high

  2. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    von Segesser Ludwig K

    2008-07-01

    Full Text Available Abstract Background Cardiopulmonary bypass (CPB with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Methods Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6% selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 ± 7 years and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF was 27 ± 8%. The majority of them (88% suffered of tri-vessel coronary disease and 6 (24% had a left main stump disease. Nine patients (35% were on severe cardiac failure and seven among them (28% received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%. Results All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 ± 0.6 and the internal mammary artery was used in 23 patients (92%. The mean CPB time was 84 ± 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 ± 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 ± 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an

  3. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.

    Science.gov (United States)

    Ferrari, Enrico; Stalder, Nicolas; von Segesser, Ludwig K

    2008-07-02

    Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%). All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One

  4. SERUM LEVEL OF LIPIDS, APOLIPOPROTEINS AND VITAMIN D IN CHILDREN AT HIGH RISK OF CORONARY ARTERY DISEASE

    Directory of Open Access Journals (Sweden)

    M BASHTAM

    2002-06-01

    Full Text Available Introduction. Coronary artery disease (CAD is one of the most prevalent disease in human population that has high prevalence and mortality in lsfahan (Iran. As positive family history and changes in serum lipids and lipoproteins are risk factors of these diseases, and also studies have showed the relationship between serum vitamin D and CAD, we studied serum level of lipids, lipoproteins and vitamin D in high risk children compared with control group, and the relation between serum vitamin D and other factors. Methods. This case-control study was done on 44 subjects (25 boys, 19 girls aged 2-18 years old with positive CAD family history as case group and also 44 persons with negative CAD family history as control group with the same age groups. The subjects were selected by convenience sampling method. Children who consumed antiepilepthic drugs as phenytoin or phenobarbital and those who had positive family histroy for renal stone were excluded for variable vitamin D levels due to drug interaction and genetic susceptibility, respectively. All subjects were invited to Isfahan Cardiovascular Research Center. Using a questionnaire, information on personal characteristics, CVD family history and ... were obtained. A fasting (12-14 hr blood sample was drawn from each one. Serum APOA1, APO B100 and vitamin Dwere measured by radioimmunoassay and serum lipids by ELAN 2000 autoanalyzer. Statistical analysis was done by SPSS. The level of serum APOA1, APO B100 and vitamin D were compared between two groups by independent t test and the relation of the mentioned apolipoproteins with vitamin D was studied using multiple linear regression. Results. Serum vitamin D was significantly lower in case group (P < 0.045. Among studied factors, only triglyceride was significantly higher in control group (P < 0.0001 and also no significant relaitonship was observed between serum APO A1, APO B100 and vitamin D. Sex comparision in case group showed those mean levels

  5. Wall Imaging for Unilateral Intracranial Vertebral Artery Hypoplasia with Three-dimensional High-isotropic Resolution Magnetic Resonance Images

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wu Wang; Bin Du; Lei Liu; Xin-Xin He; Li-Bin Hu; Xue-Bin Zhang

    2015-01-01

    Background:There are few studies for evaluating wall characteristics of intracranial vertebral artery hypoplasia (VAH).The aim of this study was to determine wall characteristics of VAH with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA) images and differentiate between acquired atherosclerotic stenosis and VAH.Methods:Thirty patients with suspicious VAH by luminograms were retrospectively enrolled between January 2014 and February 2015.The patients were classified as "acquired atherosclerotic stenosis" or "VAH" based on 3D VISTA images.The wall characteristics of VAH were assessed to determine the presence of atherosclerotic lesions,and the patients were classified into two subgroups (VAH with atherosclerosis and VAH with normal wall).Wall characteristics of basilar arteries and vertebral arteries were also assessed.The clinical and wall characteristics were compared between the two groups.Results:Five of 30 patients with suspicious VAH were finally diagnosed as acquired atherosclerotic stenosis by 3D VISTA images.25 patients were finally diagnosed as VAH including 16 (64.00%) patients with atherosclerosis and 9 (36.00%) patients with normal wall.In the 16 patients with atherosclerosis,plaque was found in 9 patients,slight wall thickening in 6 patients,and thrombus and wall thickening in 1 patient.Compared with VAH patients with normal wall,VAH patients with atherosclerosis showed atherosclerotic basilar arteries and dominant vertebral arteries more frequently (P =0.000).Conclusions:Three-dimensional VISTA images enable differentiation between the acquired atherosclerotic stenosis and VAH.VAH was also prone to atherosclerotic processes.

  6. High compliance randomized controlled field trial of solar disinfection of drinking water and its impact on childhood diarrhea in rural Cambodia.

    Science.gov (United States)

    McGuigan, Kevin G; Samaiyar, Priyajit; du Preez, Martella; Conroy, Ronán M

    2011-09-15

    Recent solar disinfection (SODIS) studies in Bolivia and South Africa have reported compliance rates below 35% resulting in no overall statistically significant benefit associated with disease rates. In this study, we report the results of a 1 year randomized controlled trial investigating the effect of SODIS of drinking water on the incidence of dysentery and nondysentery diarrhea among children of age 6 months to 5 years living in rural communities in Cambodia. We compared 426 children in 375 households using SODIS with 502 children in 407 households with no intervention. Study compliance was greater than 90% with only 5% of children having less than 10 months of follow-up and 2.3% having less than 6 months. Adjusted for water source type, children in the SODIS group had a reduced incidence of dysentery, with an incidence rate ratio (IRR) of 0.50 (95% CI 0.27-0.93, p = 0.029). SODIS also had a protective effect against nondysentery diarrhea, with an IRR of 0.37 (95% CI 0.29-0.48, p SODIS is an effective and culturally acceptable point-of-use water treatment method in the culture of rural Cambodia and may be of benefit among similar communities in neighboring South East Asian countries.

  7. Nighttime aircraft noise impairs endothelial function and increases blood pressure in patients with or at high risk for coronary artery disease.

    Science.gov (United States)

    Schmidt, Frank; Kolle, Kristoffer; Kreuder, Katharina; Schnorbus, Boris; Wild, Philip; Hechtner, Marlene; Binder, Harald; Gori, Tommaso; Münzel, Thomas

    2015-01-01

    Epidemiological studies suggest the existence of a relationship between aircraft noise exposure and increased risk for myocardial infarction and stroke. Patients with established coronary artery disease and endothelial dysfunction are known to have more future cardiovascular events. We therefore tested the effects of nocturnal aircraft noise on endothelial function in patients with or at high risk for coronary artery disease. 60 Patients (50p 1-3 vessels disease; 10p with a high Framingham Score of 23%) were exposed in random and blinded order to aircraft noise and no noise conditions. Noise was simulated in the patients' bedroom and consisted of 60 events during one night. Polygraphy was recorded during study nights, endothelial function (flow-mediated dilation of the brachial artery), questionnaires and blood sampling were performed on the morning after each study night. The mean sound pressure levels L eq(3) measured were 46.9 ± 2.0 dB(A) in the Noise 60 nights and 39.2 ± 3.1 dB(A) in the control nights. Subjective sleep quality was markedly reduced by noise from 5.8 ± 2.0 to 3.7 ± 2.2 (p aircraft noise markedly impairs endothelial function in patients with or at risk for cardiovascular disease. These vascular effects appear to be independent from annoyance and attitude towards noise and may explain in part the cardiovascular side effects of nighttime aircraft noise.

  8. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  9. Relation of high cytomegalovirus antibody titres to blood pressure and brachial artery flow-mediated dilation in young men: the Cardiovascular Risk in Young Finns Study.

    Science.gov (United States)

    Haarala, A; Kähönen, M; Lehtimäki, T; Aittoniemi, J; Jylhävä, J; Hutri-Kähönen, N; Taittonen, L; Laitinen, T; Juonala, M; Viikari, J; Raitakari, O T; Hurme, M

    2012-02-01

    Human cytomegalovirus (CMV) infection is associated with a higher risk of cardiovascular disease in immunocompromised organ transplant patients. It has been linked with the pathogenesis of elevated arterial blood pressure. However, controversy exists as to whether CMV infection is associated with endothelial function, and little is known about its role as a potential risk factor for early atherosclerosis development at a young age. We aimed to discover if CMV antibody titres are associated with early vascular changes (carotid intima-media thickness, carotid artery distensibility and brachial artery flow-mediated dilation), blood pressure elevation or other traditional cardiovascular risk factors. CMV antibody titres were measured in 1074 women and 857 men (aged 24-39 years) taking part in the Cardiovascular Risk in Young Finns study. CMV antibody titres were significantly higher in women compared to men. In men, high CMV antibody titres were associated directly with age (P blood pressure elevation, and associated inversely with flow-mediated dilation (P = 0·014). In women, CMV antibody titres did not associate with any of the analysed parameters. In a multivariate regression model, which included traditional atherosclerotic risk factors, CMV antibody titres were independent determinants for systolic (P = 0·029) and diastolic (P = 0·004) blood pressure elevation and flow-mediated dilation (P = 0·014) in men. High CMV antibody titres are associated independently with blood pressure and brachial artery flow-mediated dilation in young men. This association supports the hypothesis that common CMV infection and/or an immune response to CMV may lead to impaired vascular function at a young age. © 2012 The Authors. Clinical and Experimental Immunology © 2012 British Society for Immunology.

  10. Abnormal arterial flows by a distributed model of the fetal circulation.

    Science.gov (United States)

    van den Wijngaard, Jeroen P H M; Westerhof, Berend E; Faber, Dirk J; Ramsay, Margaret M; Westerhof, Nico; van Gemert, Martin J C

    2006-11-01

    Modeling the propagation of blood pressure and flow along the fetoplacental arterial tree may improve interpretation of abnormal flow velocity waveforms in fetuses. The current models, however, either do not include a wide range of gestational ages or do not account for variation in anatomical, vascular, or rheological parameters. We developed a mathematical model of the pulsating fetoumbilical arterial circulation using Womersley's oscillatory flow theory and viscoelastic arterial wall properties. Arterial flow waves are calculated at different arterial locations from which the pulsatility index (PI) can be determined. We varied blood viscosity, placental and brain resistances, placental compliance, heart rate, stiffness of the arterial wall, and length of the umbilical arteries. The PI increases in the umbilical artery and decreases in the cerebral arteries, as a result of increasing placental resistance or decreasing brain resistance. Both changes in resistance decrease the flow through the placenta. An increased arterial stiffness increases the PIs in the entire fetoplacental circulation. Blood viscosity and peripheral bed compliance have limited influence on the flow profiles. Bradycardia and tachycardia increase and decrease the PI in all arteries, respectively. Umbilical arterial length has limited influence on the PI but affects the mean arterial pressure at the placental cord insertion. The model may improve the interpretation of arterial flow pulsations and thus may advance both the understanding of pathophysiological processes and clinical management.

  11. [Haemodynamic role of blood-plasma circulating cell-free DNA and contained therein high-molecular-weight CpG-rich fraction in pathogenesis of arterial hypertension and atherosclerosis obliterans of carotid arteries].

    Science.gov (United States)

    Konorova, I L; Veĭko, N N; Ershova, E S; Antelava, A L; Chechetkin, A O

    2009-01-01

    The hydrodynamic resistance (HR) of blood is one of the components of the total peripheral resistance. High-molecular-weight DNA appears to decrease the HR in accordance with the Toms's effect. The present study was undertaken to investigate the HR and properties of cell-free DNA circulating in the blood plasma (hereinafter referred to as pDNA) of the control donors, patients suffering from either arterial hypertension (AH) alone or that combined with atherosclerotic lesions of the carotid arteries (CAs). Within the normal concentrations of pDNA, we revealed an inverse dependence of the HR thereupon and upon the content in pDNA of the high-molecular-weight CpG-rich fraction (CpG-DNA), i. e., a transcribed region of the ribosomal repeat (rDNA). A decrease or an increase in the pDNA concentration in all the patients examined was accompanied by an elevation of the rDNA concentration in the blood plasma. Exceeding a certain level thereof appeared to give rise to an increase in both the HR and arterial pressure (AP). Patients presenting with degree I essential AH were found to have a decreased endonuclease activity of the blood plasma, with the pDNA concentration being more than two-fold higher with no change in the rDNA content. Their HR appeared to be increased (parteries were typically revealed on the background of a lowered HR (parterial intima. In some of them, the pDNA concentration does not differ from the normal values, but in its composition, there is an increased content of rDNA, elevating as obliteration of the vessels' lumen increases, with the HR being decreased. The majority of them have degree II AH. In others, the pDNA concentration is by an order of magnitude higher than the normal values, while the rDNA content in pDNA is decreased, with the HR being elevated. Most of them have degree III AH. Pronounced and rough stenoses take an asymptomatic course in patients with decreased values of the HR and a slightly elevated level of pDNA and/or rDNA in the

  12. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2011-01-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  13. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2014-07-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  14. Extrinsic incentives and tax compliance

    OpenAIRE

    Sour, Laura; Gutiérrez Andrade, Miguel Ángel

    2011-01-01

    This paper models the impact of extrinsic incentives in a tax compliance model. It also provides experimental evidence that confirms the existence of a positive relationship between rewards and tax compliance. If individuals are audited, rewards for honest taxpayers are effective in increasing the level of tax compliance. These results are particularly relevant in countries where there is little respect for tax law since rewards can contribute to crowding in the intrinsic motivation to comply.

  15. Extrinsic incentives and tax compliance

    OpenAIRE

    Sour, Laura; Gutiérrez Andrade, Miguel Ángel

    2011-01-01

    This paper models the impact of extrinsic incentives in a tax compliance model. It also provides experimental evidence that confirms the existence of a positive relationship between rewards and tax compliance. If individuals are audited, rewards for honest taxpayers are effective in increasing the level of tax compliance. These results are particularly relevant in countries where there is little respect for tax law since rewards can contribute to crowding in the intrinsic motivation to comply.

  16. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  17. Influence of Self-Efficacy on Compliance to Workplace Exercise

    DEFF Research Database (Denmark)

    Pedersen, Mette Merete; Zebis, Mette K; Jørgensen, Henning Langberg

    2013-01-01

    the influence of exercise-specific self-efficacy on compliance to workplace physical exercise. PURPOSE: To determine the influence of exercise-specific self-efficacy on compliance to specific strength exercises during working hours for laboratory technicians. METHODS: We performed a cluster...... of compliance was 2.37 for moderate versus low self-efficacy, and 2.93 for high versus low self-efficacy. No significant difference was found in company B (public sector) or in the intervention group as a whole. CONCLUSION: We did not find self-efficacy to be a general statistically significant predictor...... of compliance to exercises during 20 weeks, but found self-efficacy to be a predictor of compliance in a private sector setting. Workplace-specific differences might be present and should be taken into account....

  18. A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease.

    Science.gov (United States)

    Ducrocq, Gregory; Amarenco, Pierre; Labreuche, Julien; Alberts, Mark J; Mas, Jean-Louis; Ohman, E Magnus; Goto, Shinya; Lavallée, Philippa; Bhatt, Deepak L; Steg, Ph Gabriel

    2013-02-12

    Randomized trials of antithrombotics in coronary artery disease have identified previous stroke/transient ischemic attack (TIA) as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with coronary artery disease. From the international REduction of Atherothrombosis for Continued Health (REACH) registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26,389 patients with coronary artery disease, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with previous stroke/TIA had a higher rate of recurrent cardiovascular events (cardiovascular death, myocardial infarction, or stroke) than patients without (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.40-1.65; Phistory of stroke/TIA is associated with an independent increase in risk of death, myocardial infarction, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the 1st year after stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients.

  19. Varying the Quality of Business Communication Caused by Compliance of Different Accounting Rules

    Directory of Open Access Journals (Sweden)

    Agus Setyadi

    2009-06-01

    Full Text Available This study examines the extent of Indonesian companies‟ compliance with the Indonesian accounting regulations (IARC of inventory, fixed assets, and depreciation by analyzing 160 Indonesian listed companies‟ 2006 annual reports. This study also looks at potential factors that explain the level of this compliance. Analysis reveals a high level of 71.63% inventory compliance, 51.13% fixed assets compliance, and 99.69% depreciation compliance with accounting rules. T-test and regression analysis show that firm size is a significant predictor of accounting compliance. Importantly, ownership and governance structures do not influence the level of compliance. Although Indonesian firms complied with more than 50% of the key accounting rule provisions, regulatory intervention appears needed to improve compliance. Such regulation might include sanctions as promulgated by multilateral financial organizations (World Bank 2005.

  20. The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study

    Directory of Open Access Journals (Sweden)

    Zhao Xihai

    2010-07-01

    Full Text Available Abstract Background Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. However, associations of plaque eccentricity with plaque morphology and plaque composition are unclear. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR. Methods Twenty-eight subjects with an ankle-brachial index less than 1.00 were examined with 1.5T high-spatial-resolution, multi-contrast weighted CMR. One hundred and eighty diseased locations of the proximal superficial femoral artery (about 40 mm were analyzed. The eccentric lesion was defined as [(Maximum wall thickness- Minimum wall thickness/Maximum wall thickness] ≥ 0.5. The arterial morphology and plaque components were measured using semi-automatic image analysis software. Results One hundred and fifteen locations were identified as eccentric lesions and sixty-five as concentric lesions. The eccentric lesions had larger wall but similar lumen areas, larger mean and maximum wall thicknesses, and more calcification and lipid rich necrotic core, compared to concentric lesions. For lesions with the same lumen area, the degree of eccentricity was associated with an increased wall area. Eccentricity (dichotomous as eccentric or concentric was independently correlated with the prevalence of calcification (odds ratio 3.78, 95% CI 1.47-9.70 after adjustment for atherosclerotic risk factors and wall area. Conclusions Plaque eccentricity is associated with preserved lumen size and advanced plaque features such as larger plaque burden, more lipid content, and increased calcification in the superficial femoral artery.

  1. Incremental replacement of saturated fats by n-3 fatty acids in high-fat, high-cholesterol diets reduces elevated plasma lipid levels and arterial lipoprotein lipase, macrophages and atherosclerosis in LDLR-/- mice.

    Science.gov (United States)

    Chang, Chuchun L; Torrejon, Claudia; Jung, Un Ju; Graf, Kristin; Deckelbaum, Richard J

    2014-06-01

    Effects of progressive substitution of dietary n-3 fatty acids (FA) for saturated FA (SAT) on modulating risk factors for atherosclerosis have not been fully defined. Our previous reports demonstrate that SAT increased, but n-3 FA decreased, arterial lipoprotein lipase (LpL) levels and arterial LDL-cholesterol deposition early in atherogenesis. We now questioned whether incremental increases in dietary n-3 FA can counteract SAT-induced pro-atherogenic effects in atherosclerosis-prone LDL-receptor knockout (LDLR-/-) mice and have identified contributing mechanisms. Mice were fed chow or high-fat diets enriched in SAT, n-3, or a combination of both SAT and n-3 in ratios of 3:1 (S:n-3 3:1) or 1:1 (S:n-3 1:1). Each diet resulted in the expected changes in fatty acid composition in blood and aorta for each feeding group. SAT-fed mice became hyperlipidemic. By contrast, n-3 inclusion decreased plasma lipid levels, especially cholesterol. Arterial LpL and macrophage levels were increased over 2-fold in SAT-fed mice but these were decreased with incremental replacement with n-3 FA. n-3 FA partial inclusion markedly decreased expression of pro-inflammatory markers (CD68, IL-6, and VCAM-1) in aorta. SAT diets accelerated advanced atherosclerotic lesion development, whereas all n-3 FA-containing diets markedly slowed atherosclerotic progression. Mechanisms whereby dietary n-3 FA may improve adverse cardiovascular effects of high-SAT, high-fat diets include improving plasma lipid profiles, increasing amounts of n-3 FA in plasma and the arterial wall. Even low levels of replacement of SAT by n-3 FA effectively reduce arterial lipid deposition by decreasing aortic LpL, macrophages and pro-inflammatory markers. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. A longitudinal study of cerebral blood flow under hypoxia at high altitude using 3D pseudo-continuous arterial spin labeling

    Science.gov (United States)

    Liu, Wenjia; Liu, Jie; Lou, Xin; Zheng, Dandan; Wu, Bing; Wang, Danny J. J.; Ma, Lin

    2017-01-01

    Changes in cerebral blood flow (CBF) may occur with acute exposure to high altitude; however, the CBF of the brain parenchyma has not been studied to date. In this study, identical magnetic resonance scans using arterial spin labeling (ASL) were performed to study the haemodynamic changes at both sea level and high altitude. We found that with acute exposure to high altitude, the CBF in acute mountain sickness (AMS) subjects was higher (P  0.05) compared with those at sea level. Moreover, magnetic resonance angiography in both AMS and non-AMS subjects showed a significant increase in the cross-sectional areas of the internal carotid, basilar, and middle cerebral arteries on the first day at high altitude. These findings support that AMS may be related to increased CBF rather than vasodilation; these results contradict most previous studies that reported no relationship between CBF changes and the occurrence of AMS. This discrepancy may be attributed to the use of ASL for CBF measurement at both sea level and high altitude in this study, which has substantial advantages over transcranial Doppler for the assessment of CBF. PMID:28240265

  3. Short-term effects of nitrate-rich green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure.

    Science.gov (United States)

    Bondonno, Catherine P; Liu, Alex H; Croft, Kevin D; Ward, Natalie C; Yang, Xingbin; Considine, Michael J; Puddey, Ian B; Woodman, Richard J; Hodgson, Jonathan M

    2014-12-01

    Evidence for a beneficial effect of dietary nitrate, through the nitrate-nitrite-NO pathway, on measures of cardiovascular function in healthy individuals is accumulating. It is less clear whether increased dietary nitrate intake from green leafy vegetables would have similar beneficial vascular effects in those at increased risk of developing hypertension. Our aim was to assess the effects of short-term regular consumption of increased nitrate from green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure. Thirty-eight men and women ages 30-70 years with systolic blood pressure 120 to 139 mm Hg were recruited to a randomized controlled crossover trial. The effects of a 7-day high-nitrate diet intervention (increased nitrate intake by at least 300 mg/day from green leafy vegetables) were compared to a 7-day low-nitrate diet intervention. Outcome measures included pre- and postintervention salivary and plasma nitrate and nitrite concentrations; ambulatory, home, and office blood pressure; augmentation index; and carotid-femoral pulse wave velocity. The high-nitrate diet intervention resulted in at least a fourfold increase in salivary and plasma nitrate and nitrite (Pblood pressure and arterial stiffness were not different between the high-nitrate diet and the low-nitrate diet. Increasing dietary nitrate intake in those with high-normal blood pressure and at increased risk of hypertension may not be an effective short-term strategy to lower blood pressure.

  4. Structural and functional changes of the coronary arteries in elderly senile patients with essential hypertension.

    Science.gov (United States)

    Hu, Jun; Zhu, Fu; Xie, Jun; Cheng, Xinhai; Chen, Guiyu; Tai, Haifen; Fan, Shaohua

    2013-11-01

    The aim of this study was to evaluate the effect of aging on the changes to the structure and function of coronary arteries in senile elderly patients with essential hypertension. Patients (aged 60-80 years) were divided into three groups. The 195 hypertensive patients were divided into four sub-groups according to the duration of hypertension. The changes to the coronary arteries (left and right) of all those patients were tested using the following index by 64 coronary computed tomography (CT) scans. The 24 h systolic blood pressure (SBP) and other blood biochemical parameters were assayed for all patients. We found that the value of the body mass index (BMI), total cholesterol (TC) and low density lipoproteins (LDL) were lower, but age and high density lipoproteins (HDL) were higher in the group of very elderly patients with hypertension (Group I; Phypertension (Group III). The left anterior descending branch calcification score (CSLAD), total calcification score (CST), pulse pressure (PP), the left main branch calcification score (CSLM), the left circumflex branch calcification score (CSLCX) were significantly increased in Group I compared with Group III (Phypertension' group (Group II). Hence, in elderly patients, a decrease in the levels of BMI, HDL, TC and LDL accompanies aging. Furthermore, the decline of arterial compliance and increase in arterial stiffness develops with age. Aging is more likely to lead to atherosclerosis in the coronary arteries, particularly in the left main coronary artery and its main branches. Aging is an uncontrollable risk factor, which plays a crucial role in coronary artery atherosclerosis.

  5. The Strategic Nature of Compliance

    DEFF Research Database (Denmark)

    König, Thomas; Mäder, Lars Kai

    2014-01-01

    This compliance study models correct and timely implementation of policies in a multilevel system as a strategic game between a central monitoring agency and multiple implementers and evaluates statistically the empirical implications of this model. We test whether compliance is determined...

  6. Correlation Between Biophysical Profile and Middle Cerebral/Umbilical Artery Resistance Index Ratio in the Assessment of Prenatal Outcome in High Risk Pregnancies

    Directory of Open Access Journals (Sweden)

    Nazanin Eshraghi

    2009-01-01

    Full Text Available  Introduction: Antenatal fetal surveillance tests have led to a significant decrease in perinatal mortality and morbidity rates, especially in high risk pregnancies (e.g placenta previa, intrauterine growth retardation. But there is no concurrence on the best and accurate modality yet. The aim of this study is to evaluate the accuracy of antenatal assessment with biophysical profile and Doppler sonography (cerebral and umbilical artery regarding fetal acidosis and asphyxia. "nMaterials and Methods: This is a cross-sectional study on fetuses of seventy women with a 28-42 week singleton pregnancy who had hypertension (pre eclampsia, diabetes mellitus or intra uterine growth retardation and were admitted as high risk pregnancies to AL-Zahra hospital. The study population routinely underwent sonographic evaluation of cerebral and umbilical arteries and a biophysical profile twice a week until the end of pregnancy. "nResults: Infants who had a lower score of biophysical profile, had a lower umbilical PH and a negative base deficit. Fetuses with a lower MCA/Umb. A RI had a higher base deficit and acidosis (measured from umbilical blood after birth. Apgar on minute 5 was higher in infants with a history of higher profile score as well as a higher MCA/Umb. A. RI ratio. On the other hand; there was no significant correlation between MCA RI and umbilical PH. Correlation between Umb. A. RI and umbilical PH was not significant either. "nConclusion: Biophysical profile and assessment of the umbilical and cerebral arteries are valuable modalities for predicting the fetal condition and the outcome in high risk pregnancies. MCA/Umb. A RI Index ratio is a better indicator compared to its components.

  7. Fatores de risco associados à pressão arterial elevada em adolescentes Risk factors associated with high blood pressure in adolescents

    Directory of Open Access Journals (Sweden)

    Kelly Samara da Silva

    2007-08-01

    Full Text Available Níveis elevados de pressão arterial (PA na infância e adolescência têm sido freqüentemente associados a outros fatores de risco cardiovasculares, além de hipertensão arterial na fase adulta da vida. O presente estudo objetivou identificar fatores de risco associados à PA elevada em adolescentes. Participaram do estudo 674 adolescentes de escolas públicas e privadas, de ambos os sexos (303 rapazes e 371 moças, com idade de 14 a 17 anos (16,5 DP 0,9, da cidade de João Pessoa, Paraíba. Mediante aplicação de um questionário, foram levantadas informações sobre: a indicadores sociodemográficos; b nível de prática da atividade física; c hábitos alimentares; c índice de massa corporal; e fumo e bebidas alcoólicas; e foram realizadas medidas de PA. A prevalência de PA elevada foi de 7,4%, sendo maior nos rapazes (10,2% quando comparada com a das moças (5,1%, p High levels of arterial blood pressure in childhood and adolescence have been often associated with other cardiovascular risk factors apart from arterial hypertension in the adult stage of life. The present study aimed at identifying risk factors associated with high blood pressure in adolescents. The subjects were 674 adolescents from public and private schools in the city of João Pessoa, Paraíba. These subjects were of both sexes (i.e., 303 boys and 371 girls and their ages spanned from 14 to 17 years old. By means of a questionnaire, information about the following aspects was gathered: a socio-demographic status; b physical activity levels; c eating habits; d body mass index; e consumption of alcohol and smoking. Moreover, measurements of arterial pressure (AP showed that the prevalence of high AP was 7.4 %, being higher in boys (10.2% when compared with girls (5.1%, p < 0.01. The results of the multivaried analysis indicated that overweight adolescents displayed from five to six times more chance of having high AP than adolescents with light/normal weight (boys: OR

  8. Compliance with Segment Disclosure Initiatives

    DEFF Research Database (Denmark)

    Arya, Anil; Frimor, Hans; Mittendorf, Brian

    2013-01-01

    Regulatory oversight of capital markets has intensified in recent years, with a particular emphasis on expanding financial transparency. A notable instance is efforts by the Financial Accounting Standards Board that push firms to identify and report performance of individual business units...... (segments). This paper seeks to address short-run and long-run consequences of stringent enforcement of and uniform compliance with these segment disclosure standards. To do so, we develop a parsimonious model wherein a regulatory agency promulgates disclosure standards and either permits voluntary...... compliance or mandates strict compliance from firms. Under voluntary compliance, a firm is able to credibly withhold individual segment information from its competitors by disclosing data only at the aggregate firm level. Consistent with regulatory hopes, we show that mandatory compliance enhances welfare...

  9. Compliance in public utilities. A practice handbook; Compliance in Energieversorgungsunternehmen. Ein Praxishandbuch

    Energy Technology Data Exchange (ETDEWEB)

    Zenke, Ines; Schaefer, Ralf [BBH Becker Buettner Held, Berlin (Germany); Brocke, Holger [Staatsanwaltschaft Berlin (Germany)

    2011-07-01

    The concept of compliance comprises all measures taken to prevent violations of the law and their consequences. This implies the allocation of competences and supervision as well as behaviour guidelines to prevent violations of the law by staff members. Together with measures to detect and remedy deficits, effective organization of compliance is achieved, the risk of liability is minimized, and corporate management is made more transparent. In view of the high risk of liability, compliance is rapidly becoming part of corporate culture in Germany. The recommendations of this book are aimed not only at big utilities but also at small and medium-sized private and public utilities that may profit from compliance measures. The contributions present practically relevant recommmendations for action and examples for compliance organization in the various fields of law, i.e. industrial law, data protection law, energy industry law, energy cartel law, electricity and energy taxation law, corporate law, capital market law, pnal law, taxation penal law, and the Public Corporate Governance Codex. The complex matter is presented in a manner that is clear and understandable even for non-expert readers.

  10. Functional impairment of precerebral arteries in Huntington disease.

    Science.gov (United States)

    Kobal, Jan; Cankar, Ksenija; Pretnar, Janja; Zaletel, Marjan; Kobal, Lucijan; Teran, Natasa; Melik, Ziva

    2017-01-15

    Cardiovascular pathology of Huntington disease (HD) appears to be complex; while microvascular dysfunction seems to appear early, deaths from cardiomyopathy and stroke might occur in the late phase of HD. Our study evaluated global risk factors for coronary heart disease (CHD), structure and function of precerebral arteries in 41 HD subjects and 41 matched controls. HD subjects were divided into groups by the United Huntington disease rating scale (presymptomatic-PHD, early-EHD, midstage-MHD and late-LHD). CHD risk factors assessment and Doppler examination of precerebral arteries were performed, including measurements of the carotid artery intima-media thickness (IMT), and parameters indicating local carotid artery distensibility (stiffness index β, pulse wave velocity, pressure strain elasticity module and carotid artery compliance). In the HD and controls we identified a comparable number of non-obstructive plaques (50% lumen narrowing) were found. There was significantly increased IMT in MHD. In PHD and EHD the parameters of arterial stiffness were significantly higher and the carotid artery compliance was significantly lower. Our results reveal functional vascular pathology in PHD, EHD, and MHD. Precerebral arteries dysfunction in HD therefore appears to be mostly functional and in agreement with recently described autonomic nervous system changes in HD. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

    Science.gov (United States)

    Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

    2016-01-01

    Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

  12. Unámonos contra la presión arterial alta (Teaming Up Against High Blood Pressure)

    Centers for Disease Control (CDC) Podcasts

    2012-09-04

    Este podcast se basa en el informe Vital Signs de los CDC de septiembre del 2012. Una de las mejores formas de tratar la presión arterial que no está controlada es con un enfoque de equipo con participación del paciente, del sistema de salud y de los proveedores de atención médica.  Created: 9/4/2012 by Centers for Disease Control and Prevention (CDC).   Date Released: 9/4/2012.

  13. Aldose reductase inhibitor improves insulin-mediated glucose uptake and prevents migration of human coronary artery smooth muscle cells induced by high glucose.

    Science.gov (United States)

    Yasunari, K; Kohno, M; Kano, H; Minami, M; Yoshikawa, J

    2000-05-01

    We examined involvement of the polyol pathway in high glucose-induced human coronary artery smooth muscle cell (SMC) migration using Boyden's chamber method. Chronic glucose treatment for 72 hours potentiated, in a concentration-dependent manner (5.6 to 22.2 mol/L), platelet-derived growth factor (PDGF) BB-mediated SMC migration. This potentiation was accompanied by an increase in PDGF BB binding, because of an increased number of PDGF-beta receptors, and this potentiation was blocked by the aldose reductase inhibitor epalrestat. Epalrestat at concentrations of 10 and 100 nmol/L inhibited high glucose-potentiated (22.2 mmol/L), PDGF BB-mediated migration. Epalrestat at 100 nmol/L inhibited a high glucose-induced increase in the reduced/oxidized nicotinamide adenine dinucleotide ratio and membrane-bound protein kinase C (PKC) activity in SMCs. PKC inhibitors calphostin C (100 nmol/L) and chelerythrine (1 micromol/L) each inhibited high glucose-induced, PDGF BB-mediated SMC migration. High glucose-induced suppression of insulin-mediated [(3)H]-deoxyglucose uptake, which was blocked by both calphostin C (100 nmol/L) and chelerythrine (1 micromol/L), was decreased by epalrestat (100 nmol/L). Chronic high glucose treatment for 72 hours increased intracellular oxidative stress, which was directly measured by flow cytometry using carboxydichlorofluorescein diacetate bis-acetoxymethyl ester, and this increase was significantly suppressed by epalrestat (100 nmol/L). Antisense oligonucleotide to PKC-beta isoform inhibited high glucose-mediated changes in SMC migration, insulin-mediated [(3)H]-deoxyglucose uptake, and oxidative stress. These findings suggest that high glucose concentrations potentiate SMC migration in coronary artery and that the aldose reductase inhibitor epalrestat inhibits high glucose-potentiated, PDGF BB-induced SMC migration, possibly through suppression of PKC (PKC-beta), impaired insulin-mediated glucose uptake, and oxidative stress.

  14. Compliance with a three-day course of artesunate-mefloquine combination and baseline anti-malarial treatment in an area of Thailand with highly multidrug resistant falciparum malaria

    Directory of Open Access Journals (Sweden)

    Na-Bangchang Kesara

    2010-02-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is presently recommended by the World Health Organization as first-line treatment for uncomplicated Plasmodium falciparum malaria in several countries, as a mean of prolonging the effectiveness of first-line malaria treatment regimens. A three-day course of artesunate-mefloquine (4 mg/kg body weight once daily for three consecutive days, plus 15 and 10 mg/kg body weight mefloquine on the first and second days has been adopted by Malaria Control Programme of Thailand as first-line treatment for uncomplicated falciparum malaria all over the country since 2008. The gametocytocydal anti-malarial drug primaquine is administered at the dose of 30 mg (0.6 mg/kg on the last day. The aim of the present study was to assess patient compliance of this combination regimen when applied to field condition. Methods A total of 240 patients (196 males and 44 females who were attending the malaria clinics in Mae-Sot, Tak Province and presenting with symptomatic acute uncomplicated falciparum malaria, with no reappearance of Plasmodium vivax parasitaemia during follow-up were included into the study. The first dose of the treatment was given to the patients under direct supervision. All patients were given the medication for self-treatment at home and were requested to come back for follow-up on day 3 of the initial treatment. Baseline (day 0 and day 3 whole blood mefloquine and plasma primaquine concentrations were determined by high performance liquid chromatography. Results Two patients had recrudescence on days 28 and 35. The Kaplan-Meier estimate of the 42-day efficacy rate of this combination regimen was 99.2% (238/240. Based on whole blood mefloquine and plasma primaquine concentrations on day 3 of the initial treatment, compliance with mefloquine and primaquine in this three-day artesunate-mefloquine combination regimen were 96.3% (207/215, and 98.5% (197/200, respectively. Baseline mefloquine

  15. Assessment of Pulmonary Artery Stiffness of Repaired Congenital Heart Disease Patients

    Science.gov (United States)

    Lee, Namheon; Banerjee, Rajit; Taylor, Michael; Hor, Kan

    2012-10-01

    Surgical correction or palliation of congenital heart disease (CHD) often requires augmenting the main pulmonary artery (MPA) with non-native material or placing a cylindrical graft. The degree to which this intervention affects PA compliance is largely unknown. In this study, the MPA stiffness characteristics were assessed by its compliance, distensibility, and pressure-strain modulus. Coregistered velocity encoded phase-contrast MRI and cardiac catheterization data were available for a cohort of repaired CHD patients (n=8) and controls (n=3). All patients were repaired with either an RV-PA conduit or a RV outflow tract patch. We measured the MPA area change by MRI and MPA pressure during the cath. The measurements were taken through or just distal to the conduit. The MPA compliance and distensibility for the patients were significantly lower than the controls: compliance (9.8±10.8 vs 28.3±7.7mm^2/mmHg, p<0.05), distensibility (2.2±1.5 vs 6.6±2.1%Area change/mmHg, p=0.05). The patients had a significantly higher pressure-strain modulus (152.3±116.4mmHg, p<0.05) than the controls (35.8±10.6mmHg). The abnormally elevated PA stiffness due to the rigidity of the conduit or patch material may cause a compliance mismatch resulting in high stress levels contributing to the observed progressive PA dilatation. This may be a factor in the progressive RV dilatation seen in this cohort of repaired CHD patients.

  16. HIV感染高危人群暴露前预防用药临床试验依从性分析%Pre-exposure prophylaxis for HIV high-risk groups: an analysis of clinical compliance

    Institute of Scientific and Technical Information of China (English)

    高菲菲; 黄文祥; 黄爱龙; 钟晓妮; 彭斌; 张燕; 梁浩; 邹云峰; 戴江红; 刘倩萍; 宋本莉

    2012-01-01

    To investigate the factors influencing the compliance of pre-exposure prophylaxis (PrEP) amonghigh-risk groups of human immunodeficiency virus (HIV). Methods A total of 352 subjects were selected into the cohort by non-probability sampling, including 153 men who have sex with men (MSM) , 36 female sex workers (FSMs) , and 163 fixed sex partners(PARs) of HIV carriers. Each subject was randomly given a medication regimen of either once daily or twice a week. The pre-exposure prophylaxis compliance was evaluated by observing the maintenance of the cohort and medication omission every 4 weeks from week 0 to week 28. Cochran-Mantel-Haenszel (CMH) test was employed to conduct univariate analysis and logistic regression was adopted for multiple variable analysis. Results It was found that 76. 70% (270/352) of the subjects finished the 28-week-observation in this PrEP clinical trial among high-risk groups of HIV. The medication omission rate fluctuated around 35% during the follow-up, with the total compliance score being 82. 12 + 27. 48 and the median score being 95. 24. Logistic regression suggested that the monthly income, presence of worries or difficulties during the trials, need for medical service, and the way of follow-up were the factors influencing the maintenance of cohort. The marital status, medication method, presence of worries or difficulties during the trial, and presence of adverse effect were the influencing factors of medication omission. The population type, number of sex partners, taking of other drugs at the same time, need of medical service during the trial, and way of follow-up were the factors impacting the overall compliance score. Conclusion The compliance of the present PrEP clinical trials among high-risk groups of HIV is high, and it has multiple influencing factors. Compliance management should be reinforced among MSM and FSW populations with greater motility. The cohort management model of follow-up by fixed specialists should be continued

  17. DOE standard compliance demonstration program: An office building example

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, S.A.; Keller, J.M.; Wrench, L.E.; Williams, C.J.

    1993-06-01

    The US Department of Energy (DOE) issued interim new building energy standards (10 CFR 435 1989) to achieve maximum energy efficiency in the designs of new buildings. DOE then entered into a project to demonstrate and assess the impact of these standards on the design community. One area of focus was a test to see how a less conventional design-focused building would meet the standards` requirements -- DOE wanted to demonstrate that compliance with energy standards does not mean compromising the architectural intent of a building. This study, which was initiated at Pacific Northwest Laboratory (PNL), illustrated the process by which compliance with the standards can be proven for a highly {open_quotes}design-oriented{close_quotes} office building. The study also assessed the impact of the whole building simulation compliance alternatives on design. This report documents the compliance requirements, gives a description of the sample building chosen for the study, provides general guidance for the compliance process, documents the method of compliance that was undertaken for the sample building, presents the results of the study, and provides a recommendation on how the compliance requirements could be improved to reflect more realistic use types.

  18. Ultrasound speckle tracking for radial, longitudinal and circumferential strain estimation of the carotid artery--an in vitro validation via sonomicrometry using clinical and high-frequency ultrasound.

    Science.gov (United States)

    Larsson, Matilda; Heyde, Brecht; Kremer, Florence; Brodin, Lars-Åke; D'hooge, Jan

    2015-02-01

    Ultrasound speckle tracking for carotid strain assessment has in the past decade gained interest in studies of arterial stiffness and cardiovascular diseases. The aim of this study was to validate and directly contrast carotid strain assessment by speckle tracking applied on clinical and high-frequency ultrasound images in vitro. Four polyvinyl alcohol phantoms mimicking the carotid artery were constructed with different mechanical properties and connected to a pump generating carotid flow profiles. Gray-scale ultrasound long- and short-axis images of the phantoms were obtained using a standard clinical ultrasound system, Vivid 7 (GE Healthcare, Horten, Norway) and a high-frequency ultrasound system, Vevo 2100 (FUJIFILM, VisualSonics, Toronto, Canada) with linear-array transducers (12L/MS250). Radial, longitudinal and circumferential strains were estimated using an in-house speckle tracking algorithm and compared with reference strain acquired by sonomicrometry. Overall, the estimated strain corresponded well with the reference strain. The correlation between estimated peak strain in clinical ultrasound images and reference strain was 0.91 (pspeckle tracking demonstrates that carotid strain assessment by ultrasound speckle tracking is feasible. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Family history of hypertension and arterial elasticity characteristics in healthy young people.

    Science.gov (United States)

    Zhou, Lin; Chen, Yuanyuan; Sun, Ningling; Liu, Xirong

    2008-05-01

    Family history of hypertension is a primary predictor of high blood pressure (BP). This study attempted to determine whether there is a gradual increase in BP and an early change in arterial elasticity characteristics between young healthy individuals with or without a family history of hypertension and whether or not this increase is apparent in males as well as in females. A total of 270 normotensive healthy individuals (112 men and 158 women, aged 16 to 30 years) with or without a family history of hypertension, participated in conventional BP measurement and completed questionnaires covering basic information and a detailed family history of cardiovascular disease. Large arterial (capacitive) compliance (C1) and small arterial (oscillatory or reflective) compliance (C2) were derived from HDI/PulseWave CR-2000 (Hypertension Diagnostics, Minneapolis, USA). Based on family history information about parents and grandparents, three groups were formed: subjects with at least one hypertensive parent (group A), subjects with only hypertensive grandparents (group B), and subjects with normotensive parents and grandparents (group C). Men in group A had lower C1 and C2 along with higher systolic BP (SBP), diastolic BP (DBP), and heart rate than men in group C. Those in group B had intermediate C1, C2 and BP levels. C1 had a linear relationship with SBP, DBP, and heart rate. In the logistic regression model of family history of hypertension, C2 was lower in young normotensive males with parental hypertension (B = -0.315, exp B = 0.73, p = 0.03), independently of SBP, DBP, and heart rate. Among females, subjects with parental hypertension had higher systolic, mean arterial pressure, and pulse pressure (p young non-hypertensive subjects may be a risk factor for hypertension and may contribute to the progression to hypertension later in life.

  20. Evaluation of corporate income tax compliance costs and compliance behaviour under the self-assessment system

    OpenAIRE

    Sapiei, Noor Sharoja

    2017-01-01

    Commitment to compliance may cause taxpayers to experience unnecessary compliance costs burden resulting in non-compliance behaviour. This study evaluates the tax compliance costs of corporate taxpayers and their compliance with the corporate income tax (CIT) reporting requirements under the Self-Assessment System (SAS) environment. Tax compliance costs, corporate characteristics, tax attitudinal aspects and the likely compliance behaviour of public listed companies (PLCs) are integrated into...

  1. Influence of the work in high voltage in the health of the man (behavioral of the arterial stress and pulse); Influencia do trabalho em alta tensao na saude do homem (comportamento da pressao arterial e pulso)

    Energy Technology Data Exchange (ETDEWEB)

    Hellmeister, C.R.; Ferreira, B.J.; Rodrigues, M.A.F. [Companhia Paulista de Forca e Luz, Campinas, SP (Brazil); Fernandes, C.; Franca, A.M. [Centro de Pesquisas de Energia Eletrica, Rio de Janeiro, RJ (Brazil)

    1987-12-31

    This work aims to observe the probable alterations of the arterial pressure and pulse, in function of the physical stress, in a determined routine of job, in the presence of the electromagnetic field 8 refs., 10 figs., 1 tab.

  2. The ability of the 2013 American College of Cardiology/American Heart Association cardiovascular risk score to identify rheumatoid arthritis patients with high coronary artery calcification scores.

    Science.gov (United States)

    Kawai, Vivian K; Chung, Cecilia P; Solus, Joseph F; Oeser, Annette; Raggi, Paolo; Stein, C Michael

    2015-02-01

    Patients with rheumatoid arthritis (RA) have increased risk of atherosclerotic cardiovascular disease that is underestimated by the Framingham Risk Score (FRS). We undertook this study to test the hypothesis that the 2013 American College of Cardiology/American Heart Association (ACC/AHA) 10-year risk score would perform better than the FRS and the Reynolds Risk Score (RRS) in identifying RA patients known to have elevated cardiovascular risk based on high coronary artery calcification (CAC) scores. Among 98 RA patients eligible for risk stratification using the ACC/AHA risk score, we identified 34 patients with high CAC (defined as ≥300 Agatston units or ≥75th percentile of expected coronary artery calcium for age, sex, and ethnicity) and compared the ability of the 10-year FRS, RRS, and ACC/AHA risk scores to correctly assign these patients to an elevated risk category. All 3 risk scores were higher in patients with high CAC (P risk category was similar among the 3 scores (FRS 32%, RRS 32%, ACC/AHA risk score 41%) (P = 0.223). The C statistics for the FRS, RRS, and ACC/AHA risk score predicting the presence of high CAC were 0.65, 0.66, and 0.65, respectively. The ACC/AHA 10-year risk score does not offer any advantage compared to the traditional FRS and RRS in the identification of RA patients with elevated risk as determined by high CAC. The ACC/AHA risk score assigned almost 60% of patients with high CAC to a low risk category. Risk scores and standard risk prediction models used in the general population do not adequately identify many RA patients with elevated cardiovascular risk.

  3. Optimal Body Mass Index Cut-offs for Identification of Patients with Coronary Artery Disease at High Risk of Obstructive Sleep Apnoea.

    Science.gov (United States)

    Chan, Po-Fun; Tai, Bee-Choo; Loo, Germaine; Koo, Chieh-Yang; Ong, Thun-How; Yeo, Tiong-Cheng; Lee, Chi-Hang

    2016-08-01

    We sought to evaluate the relationship between Body Mass Index (BMI) and obstructive sleep apnoea (OSA) in Chinese patients hospitalised with coronary artery disease, and to determine the optimal BMI cut-off for prediction of OSA. Consecutive Chinese patients who were hospitalised with symptomatic coronary artery disease were recruited to undergo an in-hospital sleep study. A total of 587 patients were recruited. Using cut-off for Asians, 81.2% of the cohort was overweight (BMI ≥23kg/m(2)) and 31.6% was obese (≥27kg/m(2)). A total of 59.5% was diagnosed with OSA, defined as apnoea-hypopnoea index ≥15. Body mass index, hypertension and smoking were predictors of OSA. Multiple logistic regression analysis showed that BMI remains an independent predictor of OSA (odds ratio: 1.11 [95% confidence interval: 1.06 to 1.17], poptimal BMI cut-offs to screen for OSA were 27.3kg/m(2), 23.0-23.9kg/m(2), and 20kg/m(2) for patients with neither, either, or both predictors (smoking and hypertension) respectively. The area under the curve for the adjusted and unadjusted models were similar (0.6013 vs 0.6262, p=0.118). Body mass index represents a convenient and readily available tool for bedside identification of patients at high risk of OSA. Body mass index cut-offs to predict risks of OSA in Chinese patients with symptomatic coronary artery disease are defined in this study. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  4. Efficacy of chronic statin therapy on major cardiac events after coronary artery bypass grafting: low-dose versus high-dose

    Directory of Open Access Journals (Sweden)

    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To investigate whether chronic statin treatment after coronary artery bypass grafting (CABG protects patients from major cardiac events and provides percutaneous coronary intervention (PCI free survival. Methods A total of 232 patients with previous CABG and chronic statin therapy were selected retrospectively and were divided into two groups according to a dosage of atorvastatin per day, e. g., 20 mg or 40 mg. Groups were compared for the major cardiac events and freedom from PCI by Kaplan Meier analysis as the primary end point. Patency of grafts including left internal thoracic artery (LITA and saphenous vein (SVG and progression of non-grafted native vessel disease were also evaluated as secondary end points. Results Cardiac mortality, periprocedural myocardial infarction (MI, target vessel revascularization and percutaneous coronary intervention free survival were as follows: 2.9% versus 2.1% (p=1.000; 16.1% versus 21.1% (p=0.331; 56.93% versus 52.63% (p>0.005; 58.4% versus 63.2% (log-rank test; p= 0.347 in atorvastatin 20 mg and atorvastatin 40 mg groups, respectively. However, these results were not statistically significant between two groups (p>0.005. Patency of openness of grafts including LITA and SVG and progression of non-grafted native vessel disease were similar between groups (p=0.112, p=0.779, p=0.379 and p=0.663, respectively. Conclusion Low-dose long-term statin treatment had similar outcomes on major cardiac events and identical rate of freedom from percutaneous coronary intervention after coronary artery bypass grafting compared with high-dose long-term statin treatment. It is better to start from low dose statin treatment after surgical interventions.

  5. Arterial microcalcification in atherosclerotic patients with and without chronic kidney disease: a comparative high-resolution scanning X-ray diffraction analysis.

    Science.gov (United States)

    Fischer, Dagmar-Christiane; Behets, Geert J; Hakenberg, Oliver W; Voigt, Mathias; Vervaet, Benjamin A; Robijn, Stef; Kundt, Günther; Schareck, Wolfgang; D'Haese, Patrick C; Haffner, Dieter

    2012-06-01

    Vascular calcification, albeit heterogeneous in terms of biological and physicochemical properties, has been associated with ageing, lifestyle, diabetes, and chronic kidney disease (CKD). It is unknown whether or not moderately impaired renal function (CKD stages 2-4) affects the physiochemical composition and/or the formation of magnesium-containing tricalcium phosphate ([Ca,Mg](3)[PO(4)](2), whitlockite) in arterial microcalcification. Therefore, a high-resolution scanning X-ray diffraction analysis (European Synchrotron Radiation Facility, Grenoble, France) utilizing histological sections of paraffin-embedded arterial specimens derived from atherosclerotic patients with normal renal function (n = 15) and CKD (stages 2-4, n = 13) was performed. This approach allowed us to spatially assess the contribution of calcium phosphate (apatite) and whitlockite to arterial microcalcification. Per group, the number of samples (13 vs. 12) with sufficient signal intensity and total lengths of regions (201 vs. 232 μm) giving rise to diffractograms ("informative regions") were comparable. Summarizing all informative regions per group into one composite sample revealed calcium phosphate/apatite as the leading mineral phase in CKD patients, whereas in patients with normal renal function the relative contribution of whitlockite and calcium phosphate/apatite was on the same order of magnitude (CKD, calcium phosphate/apatite 157 μm, whitlockite 38.7 μm; non-CKD, calcium phosphate/apatite 79.0 μm, whitlockite 94.1 μm; each p < 0.05). Our results, although based on a limited number of samples, indicate that chronic impairment of renal function affects local magnesium homeostasis and thus contributes to the physicochemical composition of microcalcification in atherosclerotic patients.

  6. Determination of bilateral symmetry of carotid artery structure and function in children and adolescents

    Directory of Open Access Journals (Sweden)

    Uithoven KE

    2017-01-01

    Full Text Available Katelyn E Uithoven,1 Justin R Ryder,2 Roland Z Brown,3 Kyle D Rudser,3 Nicholas G Evanoff,1 Donald R Dengel,1,2 Aaron S Kelly2,4 1School of Kinesiology, University of Minnesota, 2Department of Pediatrics, University of Minnesota Medical School, 3Division of Biostatistics, School of Public Health, University of Minnesota, 4Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA Abstract: The carotid artery represents an ideal location for noninvasive assessment of subclinical atherosclerosis in youth. Examination of arterial structure and function is generally conducted in the left common carotid. However, if the left common carotid is inaccessible or provides a poor acoustic window, it is unknown if the right common carotid can provide comparable values. The symmetry of carotid arteries in youth with high-resolution ultrasound was compared. Participants (N=230 [121 females], 13.8±2.9 years old were assessed for carotid intima media thickness (cIMT, carotid lumen diameter (cLD, carotid incremental elastic modulus (cIEM, carotid diameter compliance (cDC, carotid cross-sectional compliance (cCSC, carotid diameter distensibility (cDD, and carotid cross-sectional distensibility (cCSD. No significant differences (P>0.05 all were found for cIMT (0.49±0.09 vs 0.49±0.08 mm, cIEM (1095±382 vs 1116±346 mmHg, cDC (0.01±0.0 vs 0.01±0.0 mm/mmHg, cCSC (0.01±0.001/mmHg vs 0.01±0.001/mmHg, cDD (14.0%±3.16% vs 13.7%±3.18%, and cCSD (30.1%±7.37% vs 29.4%±7.36%. Significant differences were found for cLD (6.06±0.62 mm vs 6.33±0.64 mm, P<0.001. The majority of measures for arterial structure and function are comparable between the left and right common carotid arteries. There were differences present for cLD; however, these discrepancies are likely due to anatomical differences between the left and right common carotid arteries. Therefore, if the left common carotid is unable to be assessed properly, the right common

  7. The Effect of High Dose Cholecalciferol on Arterial Stiffness and Peripheral and Central Blood Pressure in Healthy Humans

    DEFF Research Database (Denmark)

    Bressendorff, Iain; Brandi, Lisbet; Schou, Morten

    2016-01-01

    and blood pressure in healthy normotensive adults. METHODS: 40 healthy adults were randomised in this double-blinded study to either oral cholecalciferol 3000 IU/day or matching placebo and were followed for 16 weeks to examine any effects on pulse wave velocity (PWV), augmentation index (AIx), peripheral...... and central blood pressure and 24-hour ambulatory blood pressure. RESULTS: 22 subjects in the cholecalciferol arm and 18 subjects in the placebo arm completed the 16 weeks of follow-up. There was no difference in changes in PWV, AIx corrected for heart rate or central or peripheral blood pressure between...... the two groups. There was no correlation between serum 25-hydroxy vitamin D and any of these parameters. CONCLUSIONS: Oral cholecalciferol 3000 IU/day does not affect arterial stiffness or blood pressure after 16 weeks of treatment in healthy normotensive adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT...

  8. NT-proBNP, echocardiographic abnormalities and subclinical coronary artery disease in high risk type 2 diabetic patients

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Wiinberg, Niels;

    2012-01-01

    Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P-NT-proBNP and the put......Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P-NT......-proBNP and the putative residual abnormalities in such patients are not well described. This study examined echocardiographic measurements of LV hypertrophy, atrial dilatation and LV dysfunction and their relation to P-NT-proBNP levels or subclinical coronary artery disease (CAD) in type 2 diabetic patients...

  9. Acetylcholine's effect on vascular resistance and compliance in the pulmonary circulation.

    Science.gov (United States)

    Barman, S A; Senteno, E; Smith, S; Taylor, A E

    1989-10-01

    Acetylcholine's effect on the distribution of vascular resistance and compliance in the canine pulmonary circulation was determined under control and elevated vascular tone by the arterial, venous, and double occlusion techniques in isolated blood-perfused dog lungs at both constant flow and constant pressure. Large and small blood vessel resistances and compliances were studied in lungs given concentrations of acetylcholine ranging from 2.0 ng/ml to 200 micrograms/ml. The results of this study indicate that acetylcholine dilates large arteries at low concentrations (less than or equal to 20 ng/ml) and constricts small and large veins at concentrations of at least 2 micrograms/ml. Characterization of acetylcholine's effects at constant pulmonary blood flow indicates that 1) large artery vasodilation may be endothelial-derived relaxing factor-mediated because the dilation is blocked with methylene blue; 2) a vasodilator of the arachidonic acid cascade (blocked by ibuprofen), probably prostacyclin, lessens acetylcholine's pressor effects; 3) when vascular tone was increased, acetylcholine's hemodynamic effects were attenuated; and 4) acetylcholine decreased middle compartment and large vessle compliance under control but not elevated vascular tone. Under constant pressure at control vascular tone acetylcholine increases resistance in all segments except the large artery, and at elevated vascular tone the pressor effects were enhanced, and large artery resistance was increased.

  10. THE EVALUATION OF COMPLIANCE TO ANTIHYPERTENSIVE THERAPY IN PATIENTS AFTER STROKE AND POSTSTROKE DEPRESSION DURING ANTIDEPRESSANT THERAPY

    Directory of Open Access Journals (Sweden)

    B. B. Fishman

    2010-01-01

    Full Text Available Aim. To study the effect of the antidepressant paroxetine on the compliance to antihypertensive therapy in patients with arterial hypertension (HT and post-stroke depression.Material and methods. Patients (n=24 aged 55-73 with controlled HT (blood pressure, BP<140/90 mm Hg and with subclinical poststroke depression after rehabilitation course were included into the study. Patients were split into two groups. Patients of group 1 (n=12 received adequate antihypertensive therapy and selective serotonin reuptake inhibitor paroxetine. Patients of group 2 (n=12 received antihypertensive therapy only. The study duration was 16 weeks. Patient compliance to antihypertensive therapy, BP and severity of depressive disorders, motor and intellectual functions was evaluated initially and after 16 weeks.Results. BP>140/80 mmHg after 16 weeks was found in 10 (41.6% patients. Clinical post-stroke depression was found in 7 (30.4% patients, 5 (41.6% of them were from group 2 (OR=0.35, 95% CI 0.12-0.78. High treatment compliance was in 15 (65.2% patients, and 9 (81.8% of them were from group 1. Nine (39.1% patients did not receive an adequate antihypertensive therapy, 5 (41.6% of them were from group 2 and could not explain their refusal from medication. General index of intellectual function was higher in patients of group 1 (p=0.034 than this in group 2; index of motor function did not change significantly (p>0.05.Conclusion. Reduction of compliance to antihypertensive therapy and rehabilitation in hypertensive patients after stroke is associated with unmotivated refusal from treatment because of clinical post-stroke depression.

  11. Oil Mist Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Lazarus, Lloyd

    2009-02-02

    This report summarizes activities at the KCP related to evaluating and modifying machine tools in order to be in compliance with Section 23 of DOE 10 CFR 851, Worker Safety and Health Program. Section 851.23 (a) states that “Contractors must comply with the following safety and health standards that are applicable to the hazards in their covered workplace”, and subsection 9 contains the following applicable standard: “American Congress of Governmental Industrial Hygienists (ACGIH), ‘Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices,’ (2005) (incorporated by reference, see §851.27) when the ACGIH Threshold Limit Values are lower (more protective) than permissible exposure limits in 29 CFR 1910.” In the 2005 ACGIH – Threshold Limit Value book a Notice of Change was issued for exposure to mineral oil mist used in metalworking fluids (MWFs). The effects of planning for the new facility and which machine tools would be making the transition to the new facility affected which machine tools were modified.

  12. Management of Giant Splenic Artery Aneurysm

    Science.gov (United States)

    Akbulut, Sami; Otan, Emrah

    2015-01-01

    remaining 3 patients is unclear. Range of follow-up period for the surviving patients varies from 3 weeks to 42 months. Either rupture or fistulization into hollow organs risk increase in compliance with aneurysm diameter. Mortality is significantly high in rupture cases. Patients with an evident risk should undergo either surgical or interventional radiological treatment without delay. PMID:26166071

  13. Aerobic exercise training increases plasma Klotho levels and reduces arterial stiffness in postmenopausal women.

    Science.gov (United States)

    Matsubara, Tomoko; Miyaki, Asako; Akazawa, Nobuhiko; Choi, Youngju; Ra, Song-Gyu; Tanahashi, Koichiro; Kumagai, Hiroshi; Oikawa, Satoshi; Maeda, Seiji

    2014-02-01

    The Klotho gene is a suppressor of the aging phenomena, and the secretion as well as the circulation of Klotho proteins decrease with aging. Although habitual exercise has antiaging effects (e.g., a decrease in arterial stiffness), the relationship between Klotho and habitual exercise remains unclear. In the present study, we investigated the effect of habitual exercise on Klotho, with a particular focus on arterial stiffness. First, we examined the correlation between plasma Klotho concentration and arterial stiffness (carotid artery compliance and β-stiffness index) or aerobic exercise capacity [oxygen uptake at ventilatory threshold (VT)] in 69 healthy, postmenopausal women (50-76 years old) by conducting a cross-sectional study. Second, we tested the effects of aerobic exercise training on plasma Klotho concentrations and arterial stiffness. A total of 19 healthy, postmenopausal women (50-76 years old) were divided into two groups: control group and exercise group. The exercise group completed 12 wk of moderate aerobic exercise training. In the cross-sectional study, plasma Klotho concentrations positively correlated with carotid artery compliance and VT and negatively correlated with the β-stiffness index. In the interventional study, aerobic exercise training increased plasma Klotho concentrations and carotid artery compliance and decreased the β-stiffness index. Moreover, the changes in plasma Klotho concentration and arterial stiffness were found to be correlated. These results suggest a possible role for secreted Klotho in the exercise-induced modulation of arterial stiffness.

  14. Air Compliance Complaint Database (ACCD)

    Data.gov (United States)

    U.S. Environmental Protection Agency — THIS DATA ASSET NO LONGER ACTIVE: This is metadata documentation for the Region 7 Air Compliance Complaint Database (ACCD) which logs all air pollution complaints...

  15. Integrated Compliance Information System (ICIS)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The purpose of ICIS is to meet evolving Enforcement and Compliance business needs for EPA and State users by integrating information into a single integrated data...

  16. 10 CFR 434.604 - Compliance.

    Science.gov (United States)

    2010-01-01

    ... energy consumption shall be measured at the building five foot line for all fuels. Energy consumed from... BUILDINGS Building Energy Compliance Alternative § 434.604 Compliance. 604.1 Compliance with this section is... 10 Energy 3 2010-01-01 2010-01-01 false Compliance. 434.604 Section 434.604 Energy DEPARTMENT...

  17. 14 CFR 26.49 - Compliance plan.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Compliance plan. 26.49 Section 26.49... Data for Repairs and Alterations § 26.49 Compliance plan. (a) Compliance plan. Except for applicants... January 11, 2008, each person identified in §§ 26.43, 26.45, and 26.47, must submit a compliance...

  18. 40 CFR 469.11 - Compliance dates.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Compliance dates. 469.11 Section 469... Compliance dates. The compliance deadline for the BAT fluoride limitation shall be as soon as possible as... determined by the permit writer, but in no event later than July 1, 1984. The compliance date for PSES...

  19. 40 CFR 469.21 - Compliance dates.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Compliance dates. 469.21 Section 469....21 Compliance dates. The compliance date for the BAT fluoride limitation is as soon as possible as determined by the permit writer but in no event later than November 8, 1985. The compliance date for PSES...

  20. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of ...

  1. Unilateral symptomatic intracranial arterial stenosis and myopathy in an adolescent with Graves disease: a case report of an high-resolution magnetic resonance imaging study.

    Science.gov (United States)

    Yin, Jia; Zhu, Jiajia; Huang, Dongling; Shi, Changzheng; Guan, Yuqing; Zhou, Liang; Pan, Suyue

    2015-01-01

    Vascular and muscular involvements in Graves disease (GD) are rare. Here, we report a case of a 17-year-old patient with unilateral symptomatic middle cerebral artery stenosis concurrent with GD and myopathy. He presented with a 1-day history of acute severe right-sided hemiparesis and aphasia and a 3-week history of high metabolic syndrome. The pathogenesis of the stenosis is most likely vasculitis rather than atherosclerosis, based on contrast-enhanced high-resolution magnetic resonance imaging showing concentric wall enhancement. We suggest that lipid storage myopathy is secondary to GD, and it is likely mitochondrial dysfunction or immune dysfunction induced by GD responsible for the myopathy and that magnetic resonance spectroscopy (MRS) is capable of establishing the diagnosis of myopathy. Thus, MRS can be used for follow-up evaluations of the myopathy along with the pathology biopsy.

  2. An investigation into beef calf mortality on five high-altitude ranches that selected sires with low pulmonary arterial pressures for over 20 years.

    Science.gov (United States)

    Neary, Joseph M; Gould, Daniel H; Garry, Franklyn B; Knight, Anthony P; Dargatz, David A; Holt, Timothy N

    2013-03-01

    Producer reports from ranches over 2,438 meters in southwest Colorado suggest that the mortality of preweaned beef calves may be substantially higher than the national average despite the selection of low pulmonary pressure herd sires for over 20 years. Diagnostic investigations of this death loss problem have been limited due to the extensive mountainous terrain over which these calves are grazed with their dams. The objective of the current study was to determine the causes of calf mortality on 5 high-altitude ranches in Colorado that have been selectively breeding sires with low pulmonary pressure (branding (6 weeks of age) in the spring to weaning in the fall (7 months of age). Clinical signs were recorded, and blood samples were taken from sick calves. Postmortem examinations were performed, and select tissue samples were submitted for aerobic culture and/or histopathology. On the principal study ranch, 9.6% (59/612) of the calves that were branded in the spring either died or were presumed dead by weaning in the fall. In total, 28 necropsies were performed: 14 calves (50%) had lesions consistent with pulmonary hypertension and right-sided heart failure, and 14 calves (50%) died from bronchopneumonia. Remodeling of the pulmonary arterial system, indicative of pulmonary hypertension, was evident in the former and to varying degrees in the latter. There is a need to better characterize the additional risk factors that complicate pulmonary arterial pressure testing of herd sires as a strategy to control pulmonary hypertension.

  3. Increased carotid intima-media thickness associated with high hs-CRP levels is a predictor of unstable coronary artery disease.

    Science.gov (United States)

    Abhashi, Sejran Ahmet; Kryeziu, Fadil Uke; Nazreku, Feim Durak

    2013-08-01

    Increased values of carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (hs-CRP) are predictors of acute coronary events. We analysed the link between CIMT and hs-CRP in cases with coronary artery disease (CAD). From 1 January to 30 June 2012, we evaluated 43 patients with acute coronary syndrome (group A), 50 patients with stable coronary artery disease (group B) and 50 healthy volunteers (group C). All were analysed for CIMT and hs-CRP levels. CIMT values were higher in groups A and B (0.94 ± 0.21 mm, 0.89 ± 0.19 mm, respectively) and lower in group C (0.64 ± 0.09 mm), and this was statistically significant (p hs-CRP were higher in group A (1.87 ± 0.36 mg/l) and lower in groups B and C (1.07 ± 0.28 mg/l, 0.97 ± 0.45 mg/l, respectively) and this was also statistically significant (p < 0.0001).

  4. Validity and reliability of the Malay version of the Hill-Bone compliance to high blood pressure therapy scale for use in primary healthcare settings in Malaysia: A cross-sectional study.

    Science.gov (United States)

    Cheong, A T; Tong, S F; Sazlina, S G

    2015-01-01

    Hill-Bone compliance to high blood pressure therapy scale (HBTS) is one of the useful scales in primary care settings. It has been tested in America, Africa and Turkey with variable validity and reliability. The aim of this paper was to determine the validity and reliability of the Malay version of HBTS (HBTS-M) for the Malaysian population. HBTS comprises three subscales assessing compliance to medication, appointment and salt intake. The content validity of HBTS to the local population was agreed through consensus of expert panel. The 14 items used in the HBTS were adapted to reflect the local situations. It was translated into Malay and then back-translated into English. The translated version was piloted in 30 participants. This was followed by structural and predictive validity, and internal consistency testing in 262 patients with hypertension, who were on antihypertensive agent(s) for at least 1 year in two primary healthcare clinics in Kuala Lumpur, Malaysia. Exploratory factor analyses and the correlation between HBTS-M total score and blood pressure were performed. The Cronbach's alpha was calculated accordingly. Factor analysis revealed a three-component structure represented by two components on medication adherence and one on salt intake adherence. The Kaiser-Meyer-Olkin statistic was 0.764. The variance explained by each factors were 23.6%, 10.4% and 9.8%, respectively. However, the internal consistency for each component was suboptimal with Cronbach's alpha of 0.64, 0.55 and 0.29, respectively. Although there were two components representing medication adherence, the theoretical concepts underlying each concept cannot be differentiated. In addition, there was no correlation between the HBTS-M total score and blood pressure. HBTS-M did not conform to the structural and predictive validity of the original scale. Its reliability on assessing medication and salt intake adherence would most probably to be suboptimal in the Malaysian primary care setting.

  5. Transcatheter Arterial Embolization of Cystic Artery Pseudoaneurysm in Acalculous Cholecystitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyung Ook; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University College of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-04-15

    A pseudoaneurysm of the cystic artery is a rare complication of cholecystitis, and is manifested by hemobilia or hematemesis. An early diagnosis is required for the successful treatment by cholecystectomy and ligation of the cystic artery. Herein, we report a case of a pseudoaneurysm of the cystic artery diagnosed by color Doppler ultrasonography and CT, and successfully treated by transcatheter arterial embolization with N-butyl cyanoacrylate in a high-risk surgical patient.

  6. Optimizing Adhesive Design by Understanding Compliance.

    Science.gov (United States)

    King, Daniel R; Crosby, Alfred J

    2015-12-23

    Adhesives have long been designed around a trade-off between adhesive strength and releasability. Geckos are of interest because they are the largest organisms which are able to climb utilizing adhesive toepads, yet can controllably release from surfaces and perform this action over and over again. Attempting to replicate the hierarchical, nanoscopic features which cover their toepads has been the primary focus of the adhesives field until recently. A new approach based on a scaling relation which states that reversible adhesive force capacity scales with (A/C)(1/2), where A is the area of contact and C is the compliance of the adhesive, has enabled the creation of high strength, reversible adhesives without requiring high aspect ratio, fibrillar features. Here we introduce an equation to calculate the compliance of adhesives, and utilize this equation to predict the shear adhesive force capacity of the adhesive based on the material components and geometric properties. Using this equation, we have investigated important geometric parameters which control force capacity and have shown that by controlling adhesive shape, adhesive force capacity can be increased by over 50% without varying pad size. Furthermore, we have demonstrated that compliance of the adhesive far from the interface still influences shear adhesive force capacity. Utilizing this equation will allow for the production of adhesives which are optimized for specific applications in commercial and industrial settings.

  7. EUB Directive 019 : EUB compliance assurance : enforcement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-27

    The Alberta Energy and Utilities Board (EUB) ensures that the discovery, development and delivery of Alberta's resources takes place in a fair and responsible manner by enforcing EUB requirements that are written on behalf of Albertans. Compliance ensures that resource activities are conducted in a manner that protects public safety, minimizes environmental impact, preserves equity and ensures effective resource conservation. This directive addresses the enforcement aspect of compliance assurance. It applies to all EUB requirements and processes except matters dealing with utility rates. It explains what licensees must do when a noncompliance is identified by the EUB; the enforcement process and the consequences for low and high risk noncompliance; the EUB appeal process; the EUB voluntary self-disclosure policy, including the rules and benefits of voluntary self-disclosure; and, the availability of compliance information. The risk assessment matrix used by the EUB to predetermine whether the level of noncompliance risk is low or high for each EUB requirement, is based on health and safety, environmental impact, conservation, and stakeholder confidence in the regulatory process. 2 tabs.

  8. Hazardous Waste Compliance Program Plan

    Energy Technology Data Exchange (ETDEWEB)

    Potter, G.L.; Holstein, K.A.

    1994-05-01

    The Hazardous Waste Compliance Program Plan (HWCPP) describes how the Rocky Flats Plant institutes a more effective waste management program designed to achieve and maintain strict adherence to the Resource Conservation and Recovery Act (RCRA) requirements. Emphasis is given to improve integration of line operations with programmatic and functional support activities necessary to achieve physical compliance to RCRA regulated equipment, facilities and operations at the floor level. This program focuses on specific activities occurring or which need to occur within buildings containing RCRA regulated units and activities. The plan describes a new approach to achieving and maintaining compliance. This approach concentrates authority and accountability for compliance with the line operating personnel, with support provided from the programmatic functions. This approach requires a higher degree of integration and coordination between operating and program support organizations. The principal changes in emphases are; (1) increased line operations involvement, knowledge and accountability in compliance activities, (2) improved management systems to identify, correct and/or avoid deficiencies and (3) enhanced management attention and employee awareness of compliance related matters.

  9. Carotid artery stenosis with a high-intensity signal plaque on time-of-flight magnetic resonance angiography and association with evidence of intraplaque hypoxia.

    Science.gov (United States)

    Ogata, Atsushi; Kawashima, Masatou; Wakamiya, Tomihiro; Nishihara, Masashi; Masuoka, Jun; Nakahara, Yukiko; Ebashi, Ryo; Inoue, Kohei; Takase, Yukinori; Irie, Hiroyuki; Abe, Tatsuya

    2017-06-01

    OBJECTIVE Hypoxia induces angiogenesis and plays a major role in the progression of carotid plaques. During carotid intervention, plaques with high-intensity signals on time-of-flight (TOF) magnetic resonance angiography (MRA) often cause ischemic stroke and embolic complications. However, the role of intraplaque hypoxia before carotid endarterectomy (CEA) and carotid artery stenting is not presently understood. In this study the authors aimed to investigate the relationship between intraplaque hypoxia and MRA findings. METHODS Nineteen consecutive patients with 20 carotid artery stenoses who underwent CEA at Saga University Hospital between August 2008 and December 2014 were enrolled in the study. The expressions of hypoxia-inducible transcription factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were analyzed by immunohistochemical analysis. In addition, the relationship between the findings on TOF MRA and pathology for the carotid plaques was analyzed. RESULTS High-intensity plaques on TOF MRA showed higher expression levels of HIF-1α (p = 0.015) and VEGF (p = 0.007) compared with isointensity plaques. The rate of intraplaque hemorrhage (IPH) on TOF MRA was also significantly higher in the high-intensity plaques than in the isointensity plaques (p = 0.024). Finally, the mean number of neovessels was significantly higher in those without plaque hemorrhage than in those with plaque hemorrhage (p = 0.010). CONCLUSIONS Plaques with high-intensity signals on TOF MRA were associated with IPH and evidence of intraplaque hypoxia. This fact may represent an opportunity to establish novel therapeutic agents targeting intraplaque hypoxia.

  10. Obesidad e hipertensión arterial: señales ateroscleróticas tempranas en los escolares Obesity and high blood pressure: early atherosclerosis signs

    Directory of Open Access Journals (Sweden)

    Marlene Ferrer Arrocha

    2010-12-01

    Full Text Available INTRODUCCIÓN. La hipertensión arterial y la obesidad son dos importantes factores de riesgo, muy relacionados con la aterosclerosis. Su detección desde edades tempranas permite prevenir o modificar favorablemente el desarrollo de esta enfermedad en la adultez. El objetivo de este trabajo fue identificar la presencia de obesidad e hipertensión en escolares de 3 escuelas primarias. MÉTODOS. Se realizó un estudio observacional y analítico de tipo transversal en 3 escuelas primarias del municipio Plaza de la Revolución en Ciudad de La Habana, que incluyó a 986 niños de 5 a 12 años de edad. Se utilizaron estadísticas descriptivas (medias y desviación estándar, la prueba de la t de Student y ji al cuadrado, y se consideró significativo un valor de p INTRODUCTION. The obesity and the high blood pressure are two important risk factor very related to atherosclerosis. Its detection from early ages allows to prevent or to modify favourably the development of this disease in adulthood. The aim of present paper was to identify the presence of obesity and high blood pressure in pupils from three primary schools. METHODS. A observational, analytical and cross-sectional study was conducted in three primary schools from the Plaza de la Revolución municipality in Ciudad de La Habana including 986 children aged from 5 to 12. Descriptive statistics were used (means and standard deviation, Student t test and Chi² test taking into account as significant a value of p<0,05. RESULTS. From the 482 males pupils 79 were obeses (16,3% and 58 (12% had a excess weight; from the total of girls pupils, 86 (17,6% were obeses and 63 (12,9% had excess weight. Regarding the study pupils, these figures represent a 17% of obesity and a 12,5% of excess weight. Analyzing the arterial pressure it was possible to note that from the 58 hypertensive pupils there were 23 males (40% and 35 girls (60%. Among the 66 pre-hypertensives 31 were males (47% and 35 (53% were girls

  11. Off-pump coronary artery bypass grafting versus optimal medical therapy alone:effectiveness of incomplete revascularization in high risk patients

    Institute of Scientific and Technical Information of China (English)

    Filippo Prestipino; Cristiano Spadaccio; Antonio Nenna; Fraser WH Sutherland; Gwyn W Beattie; Mario Lusini; Francesco Nappi; Massimo Chello

    2016-01-01

    BackgroundGeriatric patients with multivessel coronary artery disease (CAD) are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass (OPCAB) provides good quality graft on left anterior descending (LAD) without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included: 42 were treated with incomplete off-pump revascularization using left internal mammary artery (LIMA) on LAD; 41 were discharged in optimal medical therapy (OMT), having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events (MACEs).ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT (Log Rank < 0.001), and OMT group carries a propensity score-adjusted hazard ratio of 3.862 (P < 0.001). With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in

  12. High frequency of Neuropeptide Y Leu7Pro polymorphism in an Iranian population and its association with coronary artery disease.

    Science.gov (United States)

    Masoudi-Kazemabad, Ali; Jamialahmadi, Khadijeh; Moohebati, Mohsen; Mojarrad, Majid; Dehghan-Manshadi, Raheleh; Forghanifard, Mohammad Mahdi; Akhlaghi, Saeed; Ferns, Gordon A; Ghayour-Mobarhan, Majid

    2012-03-15

    Neuropeptide Y (NPY), a 36-amino acid peptide, is widely expressed in the central and peripheral nervous systems as well as in the heart. A relationship has been reported between NPY gene variants and coronary artery disease (CAD) in some populations. However, there are few data on the NPY gene polymorphism and CAD in the Persian population. In the current study we have investigated the relationship between the NPY Leu7Pro polymorphism and CAD within a population from Iran. A total of 1061 subjects were recruited; 609 patients and 452 healthy subjects. Four hundred and twenty eight of the patients had >50% stenosis; with the remaining 181 patients having Leu7Pro polymorphism was performed using a PCR-RFLP technique. A significantly higher frequency of the Leu7Pro genotype was observed in CAD patients compared with the control group (PLeu7Pro polymorphism of NPY was 5.9% in our Iranian population; higher than reported for other Asian populations. The Leu7Pro polymorphism was associated with CAD in an Iranian population. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Abnormal pulmonary artery stiffness in pulmonary arterial hypertension: in vivo study with intravascular ultrasound.

    Directory of Open Access Journals (Sweden)

    Edmund M T Lau

    Full Text Available BACKGROUND: There is increasing recognition that pulmonary artery stiffness is an important determinant of right ventricular (RV afterload in pulmonary arterial hypertension (PAH. We used intravascular ultrasound (IVUS to evaluate the mechanical properties of the elastic pulmonary arteries (PA in subjects with PAH, and assessed the effects of PAH-specific therapy on indices of arterial stiffness. METHOD: Using IVUS and simultaneous right heart catheterisation, 20 pulmonary segments in 8 PAH subjects and 12 pulmonary segments in 8 controls were studied to determine their compliance, distensibility, elastic modulus and stiffness index β. PAH subjects underwent repeat IVUS examinations after 6-months of bosentan therapy. RESULTS: AT BASELINE, PAH SUBJECTS DEMONSTRATED GREATER STIFFNESS IN ALL MEASURED INDICES COMPARED TO CONTROLS: compliance (1.50±0.11×10(-2 mm(2/mmHg vs 4.49±0.43×10(-2 mm(2/mmHg, p<0.0001, distensibility (0.32±0.03%/mmHg vs 1.18±0.13%/mmHg, p<0.0001, elastic modulus (720±64 mmHg vs 198±19 mmHg, p<0.0001, and stiffness index β (15.0±1.4 vs 11.0±0.7, p = 0.046. Strong inverse exponential associations existed between mean pulmonary artery pressure and compliance (r(2 = 0.82, p<0.0001, and also between mean PAP and distensibility (r(2 = 0.79, p = 0.002. Bosentan therapy, for 6-months, was not associated with any significant changes in all indices of PA stiffness. CONCLUSION: Increased stiffness occurs in the proximal elastic PA in patients with PAH and contributes to the pathogenesis RV failure. Bosentan therapy may not be effective at improving PA stiffness.

  14. Experimental exposure to diesel exhaust increases arterial stiffness in man

    Directory of Open Access Journals (Sweden)

    Newby David E

    2009-03-01

    Full Text Available Abstract Introduction Exposure to air pollution is associated with increased cardiovascular morbidity, although the underlying mechanisms are unclear. Vascular dysfunction reduces arterial compliance and increases central arterial pressure and left ventricular after-load. We determined the effect of diesel exhaust exposure on arterial compliance using a validated non-invasive measure of arterial stiffness. Methods In a double-blind randomized fashion, 12 healthy volunteers were exposed to diesel exhaust (approximately 350 μg/m3 or filtered air for one hour during moderate exercise. Arterial stiffness was measured using applanation tonometry at the radial artery for pulse wave analysis (PWA, as well as at the femoral and carotid arteries for pulse wave velocity (PWV. PWA was performed 10, 20 and 30 min, and carotid-femoral PWV 40 min, post-exposure. Augmentation pressure (AP, augmentation index (AIx and time to wave reflection (Tr were calculated. Results Blood pressure, AP and AIx were generally low reflecting compliant arteries. In comparison to filtered air, diesel exhaust exposure induced an increase in AP of 2.5 mmHg (p = 0.02 and in AIx of 7.8% (p = 0.01, along with a 16 ms reduction in Tr (p = 0.03, 10 minutes post-exposure. Conclusion Acute exposure to diesel exhaust is associated with an immediate and transient increase in arterial stiffness. This may, in part, explain the increased risk for cardiovascular disease associated with air pollution exposure. If our findings are confirmed in larger cohorts of susceptible populations, this simple non-invasive method of assessing arterial stiffness may become a useful technique in measuring the impact of real world exposures to combustion derived-air pollution.

  15. Comparision of high sensitivity C-reactive protein and matrix metalloproteinase 9 in patients with unstable angina between with and without significant coronary artery plaques

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; L(U) Shu-zheng; ZHANG Wei-jun; SONG Xian-tao; CHEN Hui; ZHANG Li-jie

    2011-01-01

    Background Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque.Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.Methods Patients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected.These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study.We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.Results There was a significant difference in the serum levels of MMP-9 between the two groups (P<0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P=0.034, P=0.031, and P=0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95% Cl 1.02-3.75).Hypertension, diabetes mellitus

  16. Tax penalties in SME tax compliance

    Directory of Open Access Journals (Sweden)

    Artur Swistak

    2016-03-01

    Full Text Available Small business tax compliance requires special attention. On the one hand small businesses are often incapable of rigorously fulfilling their tax obligations, more vulnerable to external risks and tempted to exploit opportunities to be non-compliant. On the other hand, unlike larger businesses, they are usually sole proprietors or owner-operated businesses, hence highly responsive to personal, social, cognitive and emotional factors. These attributes pave the way to a better use of measures designed to influence their behavior and choices. This paper discusses the role and effectiveness of tax penalties in enhancing tax compliance in small businesses. It argues that tax penalties, although indispensable for tax enforcement, may not be a first-choice tool in ensuring tax compliance. Too punitive a tax regime is an important barrier to business formalization and increasing severity of tax penalties does not produce the intended results. To be effective, tax penalties should deter and motivate taxpayers rather than exert repressive measures against them.

  17. Increased risk of coronary artery calcification progression in subjects with high baseline Lp(a) levels: The Kangbuk Samsung Health Study.

    Science.gov (United States)

    Cho, Jung Hwan; Lee, Da Young; Lee, Eun Seo; Kim, Jihyun; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

    2016-11-01

    Results from previous studies support the association of lipoprotein(a) [Lp(a)] levels and coronary artery disease risk. In this study, we analyzed the association between baseline Lp(a) levels and future progression of coronary artery calcification (CAC) in apparently healthy Korean adults. A total of 2611 participants (mean age: 41years, 92% mend) who underwent a routine health check-up in 2010 and 2014 were enrolled. Coronary artery calcium score (CACS) were measured by multi-detector computed tomography. Baseline Lp(a) was measured by high-sensitivity immunoturbidimetric assay. Progression of CAC was defined as a change in CACS >0 over four years. Bivariate correlation analyses with baseline Lp(a) and other metabolic parameters revealed age, total cholesterol, HDL-C, LDL-C and CACS to have a significant positive correlation, while body weight, fasting glucose level, blood pressure and triglyceride level were negatively correlated with baseline Lp(a) level. After four years of follow-up, 635 subjects (24.3%) had CAC progression. The participants who had CAC progression were older, composed of more men, more obese, and had higher fasting glucose levels and worse baseline lipid profiles compared to those who did not have CAC progression. The mean serum Lp(a) level was significantly higher in subjects who had CAC progression compared to those who did not (32.5 vs. 28.9mg/dL, p<0.01). When the risk for CAC progression according to baseline Lp(a) was calculated, those with Lp(a) level≥50mg/dL had an odds ratio of 1.333 (95% CI 1.027-1.730) for CAC progression compared to those with Lp(a)<50mg/dL after adjusting for confounding factors. In this study, the subjects who had higher Lp(a) were at significantly higher risk for CAC progression after four years of follow-up, suggesting the role of high Lp(a) in CAC progression. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Current status of high on-treatment platelet reactivity in patients with coronary or peripheral arterial disease:Mechanisms,evaluation and clinical implications

    Institute of Scientific and Technical Information of China (English)

    Stavros Spiliopoulos; Georgios Pastromas

    2015-01-01

    Antiplatelet therapy with aspirin or clopidogrel or both is the standard care for patients with proven coronary or peripheral arterial disease,especially those undergoing endovascular revascularization procedures. However,despite the administration of the antiplatelet regiments,some patients still experience recurrent cardiovascular ischemic events. So far,it is well documented by several studies that in vitro response of platelets may be extremely variable. Poor antiplatelet effect of clopidogrel or high on-treatment platelet reactivity(HTPR) is under investigation by numerous recent studies. This review article focuses on methods used for the ex vivo evaluation of HTPR,as well as on the possible underlying mechanisms and the clinical consequences of this entity. Alternative therapeutic options and future directions are also addressed.

  19. Soluble urokinase plasminogen activator receptor is in contrast to high-sensitive C-reactive-protein associated with coronary artery calcifications in healthy middle-aged subjects

    DEFF Research Database (Denmark)

    Sørensen, Mette Hjortdal; Gerke, Oke; Eugen-Olsen, Jesper;

    2014-01-01

    OBJECTIVE: The main objective of this study was to investigate the association between two markers of low-grade inflammation; soluble urokinase plasminogen activator receptor (suPAR) and high-sensitive C-reactive protein (hs-CRP); and coronary artery calcification (CAC) score detected by cardiac...... computed tomography (CT) scan. DESIGN: A cross sectional study of 1126 randomly sampled middle-aged men and women. METHODS: CAC score was measured by a non-contrast cardiac CT scan and total 10-year cardiovascular mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE). Plasma...... samples were analysed for suPAR and hs-CRP. The association of suPAR and hs-CRP to CAC was evaluated by logistic regression analyses adjusting for categorised SCORE. The additive effect of suPAR to SCORE was evaluated by comparing area under curve (AUC) and net reclassification improvement (NRI). RESULTS...

  20. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  1. Carotid artery stenting by non-femoral arterial approach in patients with difficult anatomy

    Directory of Open Access Journals (Sweden)

    R V Narayana

    2013-01-01

    Full Text Available Background: Carotid endarterectomy (CEA and carotid artery stenting (CAS are safe, effective, and standard methods to treat significant carotid artery stenosis. CAS is generally performed through femoral arterial access. We had six patients with significant carotid artery stenosis, who had difficult anatomy prohibiting a trans-femoral CAS. Those patients were given an option for CEA. However, they refused for surgical intervention. Aim: We investigated the feasibility of performing CAS from a non-femoral arterial approach in patients with difficult anatomies like severe aortic/aorto-iliac disease, tortuous aortic arch, and tortuous carotid artery origin. Materials and Methods: Six patients with difficult anatomy presented to us with either transient ischemic attack or stroke with high-grade carotid artery stenosis. Out of the six patients, three had aorto-iliac disease, one had high-grade coarctation of aorta, two had tortuous aortic arch and or tortuous carotid artery origin. All these patients were treated with CAS though non-femoral arterial route. Results: CAS could be done successfully in all these six patients; four of them were done through trans-brachial arterial route and two were done through a direct carotid artery puncture. There were no new neurological deficits seen in any of the patient post-procedure. Conclusion: CAS can be done safely through non-femoral arterial approach in patients with difficult anatomy.

  2. Plaques of Nonstenotic Basilar Arteries with Isolated Pontine Infarction on Three-dimensional High Isotropic Resolution Magnetic Resonance Imaging

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wei-Jian Jiang; Lei Liu; Li-Bin Hu; Wu Wang; Zun-Jing Liu

    2015-01-01

    Background:There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries (BA).Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition (VISTA) and investigate the differences between the patients with and without isolated pontine infarction (IPI).Methods:Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography (TOF MRA) were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014.BA was classified as "normal" or"irregular" based on TOF MRA,and "normal wall","slight wall-thickening",and "plaque" based on three-dimensional VISTA images.Outcomes from MRA and VISTA were compared.Patients were categorized as IPI and non-IPI groups based on the diffusion-weighted imaging.Clinical and plaque characteristics were compared between the two groups.Results:A total of 1024 image slices including 311 (30.37%) plaque slices,427 (41.70%) slight wall-thickening slices,and 286 (27.93%) normal wall slices for the entire BA from 23 patients were finally included for analysis.VISTA images detected plaques in all the 9 (100%) irregular MRA patients and 7 of 14 (50%) normal MRA patients.IPI was found in 1 1 (47.83%) patients.Compared to non-IPI group,the IPI group had a higher percentage of plaque slices (P =0.001) and lower percentage of normal wall slices (P =0.014) than non-IPI group.Conclusions:Three-dimensional VISTA images enable detection of BA plaques not visualized by MRA.BA plaques could be found in both the IPI and non-IPI group.However,IPI group showed plaques more extensively in BA than the non-IPI group.

  3. Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Carrascosa, Patricia M., E-mail: investigacion@diagnosticomaipu.com.ar; Deviggiano, Alejandro; Capunay, Carlos; Campisi, Roxana; López Munain, Marina de; Vallejos, Javier; Tajer, Carlos; Rodriguez-Granillo, Gaston A.

    2015-04-15

    Highlights: •We evaluated myocardial perfusion by dual energy computed tomography (DECT). •We included patients with intermediate to high likelihood of coronary artery disease. •Stress myocardial perfusion by DECT had a reliable accuracy for the detection of ischemia. •Stress myocardial perfusion with DECT showed an incremental value over anatomical evaluation. •DECT imaging was associated to a significant reduction in radiation dose compared to SPECT. -- Abstract: Purpose: We sought to explore the diagnostic performance of dual energy computed tomography (DECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease (CAD). Materials and methods: Consecutive patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT) constituted the study population and were scanned using a DECT scanner equipped with gemstone detectors for spectral imaging, and a SPECT. The same pharmacological stress was used for both scans. Results: Twenty-five patients were prospectively included in the study protocol. The mean age was 63.4 ± 10.6 years. The total mean effective radiation dose was 7.5 ± 1.2 mSv with DECT and 8.2 ± 1.7 mSv with SPECT (p = 0.007). A total of 425 left ventricular segments were evaluated by DECT, showing a reliable accuracy for the detection of reversible perfusion defects [area under ROC curve (AUC) 0.84 (0.80–0.87)]. Furthermore, adding stress myocardial perfusion provided a significant incremental value over anatomical evaluation alone by computed tomography coronary angiography [AUC 0.70 (0.65–0.74), p = 0.003]. Conclusions: In this pilot investigation, stress myocardial perfusion by DECT demonstrated a significant incremental value over anatomical evaluation alone by CTCA for the detection of reversible perfusion defects.

  4. TINGGINYA KONSENTRASI HIGH SENSITIVITY C-REACTIVE PROTEIN SEBAGAI RISIKO KEJADIAN PENYAKIT ARTERI PERIFER PADA PENDERITA DIABETES MELITUS TIPE 2 LANJUT USIA

    Directory of Open Access Journals (Sweden)

    Tuty Kuswardhani RA

    2012-11-01

    Full Text Available Pada orang lanjut usia (Lansia yang menderita diabetes melitus (DM tipe 2, tingginya konsentrasi penanda inflamasi sistemik High Sensitivity C-Reactive Protein (hs-CRP, dapat memprediksi kejadian penyakit kardiovaskular dan stroke. Tidak diketahui apakah tingginya konsentrasi hs-CRP juga berhubungan dengan terjadinya Penyakit Arteri Perifer (PAP pada DM tipe 2 lansia. Dengan menggunakan rancangan penelitian kasus kontrol untuk mengukur konsentrasi hs-CRP pada pasien DM tipe 2 lansia yang berobat di Poliklinik Geriatri RSUP Sanglah Denpasar dan terjadinya PAP/ Penyakit Arteri Perifer (nilai Ankle Brachial Index ??0.90 atau non PAP. Subjek di eksklusi apabila pasien (pria maupun wanita menderita penyakit ginjal kronis (serum kreatinin >3 mg/dl dan menderita kondisi-kondisi yang berpotensi mempengaruhi konsentrasi hs-CRP contohnya penyakit autoimun, infark miocardium, keganasan dan juga infeksi akut (konsentrasi hs-CRP >10mg/L. Variabel confounding adalah profil lipid (High Density Lipoprotein (HDL, Low density lipoprotein (LDL, Triglyceride (TG and Total Cholesterol, hipertensi dan obesitas sentral. Subjek yang dimasukkan dalam kelompok kasus dan kontrol telah melalui proses matching (berdasarkan umur dan jenis kelamin. Terdapat 24 kasus dan 21 kontrol yang memenuhi kriteria tersebut. Tidak ditemukan adanya perbedaan rerata pada karakteristik kelompok kasus dan kontrol berdasarkan umur (p=.185 dan jenis kelamin (p=.183. hubungan antara tingginya konsentrasi hs-CRP (cut off point 1 mg/l sebagai faktor risiko terjadinya PAP pada DM lansia tidak signifikan (OR=2.000, Pvalue=.205. Hal ini diperkirakan karena kuantitas sampel yang didapat tidak mencukupi kriteria dari analisis statistik atau mungkin hubungan itu sendiri terlalu lemah. Bukti tingginya konsentrasi hs-CRP dapat memprediksi risiko terjadinya PAP pada DM tipe 2 lansia pada penelitian ini belum terbukti perlu dilakukan penelitian lanjutan dengan sampel yang lebih banyak.

  5. Pulmonary artery haemodynamic properties in patients with pulmonary hypertension secondary to rheumatic mitral stenosis.

    Science.gov (United States)

    Yan, Tao; Zhang, Guan-xin; Li, Bai-lin; Zhong, Keng; Xu, Zhi-yun; Han, Lin

    2012-12-01

    We sought to explore the pulmonary haemodynamic changes in rheumatic mitral stenosis patients with secondary pulmonary hypertension. The pulmonary artery resistance and compliance of 35 patients with rheumatic mitral stenosis and 12 controls without cardiopulmonary vascular disease were evaluated by using an improved method, which is based on making calculations with parameters obtained from right heart catheterisation. The results are as follows: (1) pulmonary artery compliance in patients with secondary pulmonary hypertension was significantly lower than that of the control group (P0.05) The walls of pulmonary artery vessels in patients with pulmonary hypertension secondary to rheumatic mitral stenosis appeared to be remodelled by varying degrees as indicated by their haemodynamic properties. Structural remodelling may be a factor affecting preoperative pulmonary artery pressure. Mitral stenosis patients with severe pulmonary hypertension have significantly lower responses to sodium nitroprusside possibly due to aggradation and deposition of collagen in the artery walls, decreasing constriction and dilation, or atrophy of smooth muscle cells.

  6. Disease management and medication compliance.

    Science.gov (United States)

    Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

    2012-02-01

    Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

  7. Compliance with antimicrobial therapy: Evaluating the related factors

    Directory of Open Access Journals (Sweden)

    Mandana Moradi

    2015-10-01

    Full Text Available Background: Uncontrolled and irrational use of antibiotics increases the rate of antimicrobial resistance and treatment failure. Compliance with antibiotics is an important indicator to show how patients use their prescribed drugs and it can explain the relationship between drug administration and treatment outcome that needs to be monitored and promoted. We decided to evaluate compliance to antimicrobial drugs in this study.Methods: In a cross-sectional study, 100 patients referring to 4 different specialists’ offices were enrolled. The rate and type of non prescribed antibiotic administration were evaluated using predesigned questionnaires. The data were analyzed by SPSS 17.0 software using descriptive statistics and chi-square test for categorical data.Results: Our results showed that 62.4% of the study population had poor compliance and 37.6 % had good compliance with their prescribed regimen. “Feeling better “and “getting worse” on prescribed regimen were major reasons for drug discontinuation. About 70% of our study population get non prescribed antibiotic from pharmacies at least once a year. Most of the requested antibiotics were not first line options. Level of education was the only factor significantly related to the rate of patient compliance. Conclusion: This study shows the high rate of non prescribed antibiotic administration and low rate of compliance among the study population that emerge the need for particular patient education and putting restrictive rules to bound  non-prescribed and unsupervised  antibiotic marketing.

  8. Social-physiological compliance as a determinant of team performance.

    Science.gov (United States)

    Henning, R A; Boucsein, W; Gil, M C

    2001-04-01

    A cybernetic model of behavior predicts that team performance may depend on physiological compliance among participants. This laboratory study tested if compliance in electrodermal activity (EDA), heart rate or breathing in two-person teams (N=16) was predictive of team performance or coordination in a continuous tracking task simulating teleoperation. Visual contact among participants was manipulated. Physiological compliance was scored with weighted coherence and cross correlation. Separate multiple regression analyses revealed that the task completion time was predicted by coherence measures for EDA and heart, but only at a trend level for breathing. Task completion time was also predicted by heart cross correlation. Team tracking error was predicted by coherence measures for EDA, heart and breathing, and also heart cross correlation. While social-visual contact did not have an impact, physiological compliance was predictive of improved performance, with coherence robust over all three physiological measures. Heart cross correlation showed the strongest predictive relationships. These results provide evidence that physiological compliance among team members may benefit team performance. While further study is needed, physiological compliance may someday provide a needed tool for the study of team work, and an objective means to guide the ergonomic design of complex sociotechnical systems requiring a high degree of team proficiency.

  9. Time constant of the cerebral arterial bed.

    Science.gov (United States)

    Kasprowicz, Magdalena; Diedler, Jennifer; Reinhard, Matthias; Carrera, Emmanuel; Smielewski, Peter; Budohoski, Karol P; Sorrentino, Enrico; Haubrich, Christina; Kirkpatrick, Peter J; Pickard, John D; Czosnyka, Marek

    2012-01-01

    We have defined a novel cerebral hemodynamic index, a time constant of the cerebral arterial bed (τ), the product of arterial compliance (C(a)) and cerebrovascular resistance (CVR). C(a) and CVR were calculated based on the relationship between pulsatile arterial blood pressure (ABP) and transcranial Doppler cerebral blood flow velocity. This new parameter theoretically estimates how fast the cerebral arterial bed is filled by blood volume after a sudden change in ABP during one cardiac cycle. We have explored this concept in 11 volunteers and in 25 patients with severe stenosis of the internal carotid artery (ICA). An additional group of 15 subjects with non-vascular dementia was studied to assess potential age dependency of τ. The τ was shorter (p = 0.011) in ICA stenosis, both unilateral (τ = 0.18 ± 0.04 s) and bilateral (τ = 0.16 ± 0.03 s), than in controls (τ = 0.22 ± 0.0 s). The τ correlated with the degree of stenosis (R = -0.62, p = 0.001). In controls, τ was independent of age. Further study during cerebrovascular reactivity tests is needed to establish the usefulness of τ for quantitative estimation of haemodynamics in cerebrovascular disease.

  10. Correlation analysis between the carotid artery ather osclerosis severity of patients with lacunar infarct and the level of serum uric acid, high-sensitivity C-reactive protein

    Directory of Open Access Journals (Sweden)

    WANG Shu

    2013-01-01

    Full Text Available Background Nowadays, clinical practice shows that the number of patients with cerebral infarction increases year by year in young and middle-aged adults with unclear causes. This paper aims to investigate the correlation between the level of serum uric acid (UA, high-sensitivity C-reactive protein (hsCRP and the degree of carotid atherosclerosis by detecting the level of UA, hsCRP and carotid intima-media thickness (IMT in young and middle-aged patients with lacunar infarct. Methods By using Holland Philips HT-11 color Doppler ultrasonic diagnostic apparatus with linear type probe and 7.50MHz frequency, IMT of end-diastolic distal and bifurcation of arteria carotis communis and proximal internal carotid artery were measured respectively on 186 patients with definitely diagnosed lacunar infarct. As a result, average values were taken as the IMT values. IMT < 1.00 mm was regarded as negative result and 1.00 mm ≤IMT < 1.20 mm was thickening of carotid artery intima. Carotid artery plaque formation was regarded with echo structure existing in the lumen or abnormal blood flow deficits into the lumen, or local IMT ≥1.20 mm at vertical and horizontal scan. At the same time, the levels of UA and hsCRP were detected, and correlation analysis was made between them and IMT. Results The values of UA, hsCRP and IMT in the case group were higher than that in the control group (P = 0.000. The differences among the case subgroups including IMT thickening group, plaque formation group and IMT normal group were statistically significant (P < 0.01, for all. There was linear correlation between the levels of UA, hsCRP and IMT ( r = 0.923, P = 0.000; r = 0.955, P = 0.008. Conclusion UA and hsCRP involve in the formation of atherosclerosis plaque and play an important role in the first-onset lacunar infarct patients without hypertension and other risk factors.

  11. Coronary artery bypass graft (CABG) patency: Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Anders, Katharina [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)]. E-mail: katharina.anders@idr.imed.uni-erlangen.de; Baum, Ulrich [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Michael [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Ropers, Dieter [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Axel [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Pohle, Karsten [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Daniel, Werner G. [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Bautz, Werner [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Achenbach, Stephan [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)

    2006-03-15

    Purpose: To investigate the ability of 16-slice multidetector-row computed tomography (MDCT) to visualize coronary artery bypass graft (CABG) patency and to detect bypass stenoses. Materials and methods: Thirty-two patients with 94 grafts (20 mammary artery grafts, 74 venous grafts) were investigated by 16-slice MDCT using a scan protocol with 12 x 0.75 mm slice collimation (pitch 0.3), 420 ms rotation time and simultaneous electrocardiogram (ECG)-registration. One hundred milliliters iodinated contrast agent were injected with a delay according to the individually determined contrast agent transit time. Patients with heart rates above 60 bpm received oral beta-blockade. Cross-sectional images with a slice width of 1.0 mm (0.5 mm increment) were reconstructed using an ECG-gated half-scan reconstruction or a multisegment reconstruction algorithm depending on the heart rate. Bypass grafts were evaluated concerning patency and presence of stenoses {>=}50% diameter reduction on cross-sectional images, multiplanar reformations and maximum intensity projections by two independent observers. Results were compared to coronary bypass angiography. Results: Sixteen-slice MDCT results were compared to those of invasive coronary angiography concerning absence or presence of bypass graft occlusion or relevant stenosis {>=}50% lumen reduction. Coronary CT angiography (CTA) permitted detection of bypass occlusion with 100% sensitivity (28/28) and 98% specificity (64/65). Seventy-eight percent (observer 1) and 84% (observer 2) of all patent grafts were found to be evaluable concerning presence or absence of stenosis. In 34 of 40 (observer 1) and 38 of 43 (observer 2) bypass grafts, high-grade stenoses were correctly ruled out (specificity 85% versus 88%, sensitivity 80% and 82%). Yet, if all patients with either unevaluable grafts/graft anastomosis or relevant graft stenosis were excluded, only 8/32 patients (25%) had fully diagnostic 'negative' graft-CTA. According to

  12. 4-Dimensionally Guided 3-Dimensional Color-Doppler Ultrasonography Quantifies Carotid Artery Stenosis With High Reproducibility and Accuracy.

    Science.gov (United States)

    Macharzina, Roland Richard; Kocher, Sascha; Messé, Steven R; Rutkowski, Thomas; Hoffmann, Fabian; Vogt, Matthias; Vach, Werner; Fan, Nian; Rastan, Aljoscha; Neumann, Franz-Josef; Zeller, Thomas

    2017-07-13

    The purpose was to analyze the agreement and binary accuracy of the degree of internal carotid artery stenosis (ICAS) as determined by 4-dimensionally (4D) real-time gray-scale guided 3-dimensional (3D) color-Doppler ultrasonography (3DC-US) (4D/3DC-US) compared with catheter angiography (CA) and duplex ultrasonography (DUS). This study hypothesized that 4D/3DC-US is noninferior to CA and DUS in grading ICAS in selected patients. Clinical stratification in patients with ICAS largely depends on a patient's symptomatic status and the degree of stenosis. Screening with 4D/3DC-US was prospectively performed in 93 study patients (with 122 ICASs), thus yielding 80 patients for analysis (with 103 ICASs) after excluding patients with insufficient image quality, previous revascularization, and contraindications to CA. The ultrasound examination (10 MHz) consisted of consensus conform DUS examination and independent real-time 4D-guided gray-scale views for orientation followed by static 3DC-US NASCET (North American Symptomatic Carotid Endarterectomy Trial) percent stenosis quantification using off-line multiplanar rendering. Multiplanar selective CA of the same ICASs was quantified with dedicated software in a blinded fashion. Quantitative CA of 103 stenoses with a mean degree of 65 ± 17% was compared with 4D/3DC-US, with a resulting concordance correlation coefficient of 0.89 and a standard deviation of differences (SDD) of 8.1% at a bias of +1.7%. Binary 50% and 70% stenosis detection with 4D/3DC-US revealed a sensitivity of 97% and 87%, respectively, and a specificity of 92% and 84%, respectively. Interobserver SDD for CA of 52 stenoses (7.2%) did not differ from SDD for 4D/3DC-US and CA (p = 0.274). Accuracy of 50% stenosis detection by 4D/3DC-US was tendentially higher compared with DUS (96% vs. 91%). The 4D/3DC-US method provides reliable and accurate stenosis quantification and binary classification with good diagnostic accuracy compared with CA and DUS. Copyright

  13. Corporate compliance and voluntary disclosure.

    Science.gov (United States)

    Schiff, A B

    1995-09-01

    In any event, the decision to institute a corporate compliance program is a relatively simple one. In view of the ambiguity surrounding certain fraud and abuse provisions, and the corporate "death sentence" that may result from program exclusion, a compliance program is always sound corporate policy. To be sure, if the compliance program is administered improperly, it can actually increase the likelihood of whistleblower actions and create a body of potentially hurtful documentation. But these dangers can be minimized by structuring the program to protect the self-evaluative process through relevant privileges. The risks also pale in comparison to the exposure to criminal or exclusionary sanctions when improper conduct goes undetected by an organization.

  14. Continuous stroke volume monitoring by modelling flow from non-invasive measurement of arterial pressure in humans under orthostatic stress

    NARCIS (Netherlands)

    Harms, M.P.M.; Wesseling, K.H.; Pott, F.; Jenstrup, M.; Goudoever, J. van; Secher, N.H.; Lieshout, J.J. van

    1999-01-01

    The relationship between aortic flow and pressure is described by a three-element model of the arterial input impedance, including continuous correction for variations in the diameter and the compliance of the aorta (Modelflow). We computed the aortic flow from arterial pressure by this model, and

  15. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Science.gov (United States)

    Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder; Mehta, Yatin

    2016-01-01

    Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP) through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2) using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025), hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025), and Intensive Care Unit (ICU) stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012) was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  16. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2016-01-01

    Full Text Available Goal-directed therapy (GDT encompasses guidance of intravenous (IV fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG analysis. In addition, cardiac index (CI monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2 using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025, hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025, and Intensive Care Unit (ICU stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012 was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  17. Prevalence of colorectal neoplasm in Chinese patients with high-risk coronary artery disease classified by the Asia-Pacific Colorectal Screening score.

    Science.gov (United States)

    Yang, Xiao Bo; Xu, Qing Ling; Xu, Chen Ying; Wu, Chao; Yu, Li Fen

    2015-05-01

    The aim of this study was to investigate the prevalence of colorectal neoplasms in patients coronary artery disease (CAD) with or without a family history of colorectal cancer (CRC). In this cross-sectional study, individuals with suspected CAD in the absence of cancer-related symptoms underwent coronary angiography for the first time, and were divided into CAD and non-CAD groups. Colonoscopy was performed in individuals at high-risk tier based on their Asia-Pacific colorectal screening (APCS) score. Their waist circumference (WC), height and body weight were measured. There were 634 of 1157 individuals at a high risk of developing advanced colorectal neoplasms, 91.0% (577/634) of whom were male smokers. The proportion of CAD patients in the high-risk tier was 81.5% (517/634), while the prevalences of adenomas (32.1% vs 22.2%, P prevalence of adenomas was still significantly higher in the CAD group than in the non-CAD group (25.5% vs 16.0%, P colorectal neoplasms classified by the APCS score still showed a remarkably high prevalence of colorectal adenomas. Moreover, the association between the occurrence of adenomas and CAD was stronger in overweight (BMI ≥ 25 kg/m(2)) individuals. © 2015 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  18. Modeling and Analysis of a Compliance Model and Rotational Precision for a Class of Remote Center Compliance Mechanisms

    Directory of Open Access Journals (Sweden)

    Lei-Jie Lai

    2016-11-01

    Full Text Available The remote center compliance (RCC mechanism is of great use for practical designs, especially if a pure rotation about a virtual point is required. The analysis of compliance properties and rotational precision for RCC mechanisms are very important for mechanical design in applications where precision is required. This paper formulates an analytical method for the compliance and rotational precision calculations of a class of RCC mechanisms, combined in parallel with two round beam-based isosceles-trapezoidal flexural pivots. The analytical model of the mechanism is established based on the stiffness matrix method to directly obtain the compliance factors that completely define the elastic response of the mechanism. The rotational precision of the mechanism—That is, the position of rotation center—Is then derived using screw theory and a compliance matrix. The validity of this model is demonstrated using finite element analysis simulation and experimental tests. The results of both simulation and experiment verify that the analytical model has high accuracy and promising practical applications. Moreover, the influences of the geometry parameters on the compliance factors and the center shifts are also graphically evaluated and discussed using the analytical model. The results in this paper provide an effective configuration and analytical method for the design and optimization of RCC mechanisms, and are of great practical significance.

  19. Crianças e adolescentes com história familiar de hipertensão arterial: indicadores de risco cardiovasculares Niños y adolescentes con historia familiar de hipertensión arterial: indicadores de riesgo cardiovasculares Children and adolescents with familiar history of high blood pressure: risk factors for cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Emília Soares Chaves

    2009-12-01

    Full Text Available Objetivo: Identificar emum grupo de crianças e adolescentes com história familiar de hipertensão arterial a presença de indicadores do risco para hipertensão arterial. Métodos: Estudo desenvolvido com 141 indivíduos de seis a 18 anos em uma comunidade de Fortaleza com coleta de dados realizada no domicílio. Resultados: Os indicadores de risco mais presentes foram a ingesta de sal, sedentarismo e ingesta inadequada de legumes. As médias de pressão arterial foram maiores nos indivíduos do sexo masculino. Aqueles que referiram fazer uso de sal na alimentação e não consumir diariamente frutas e legumes apresentaram menores médias. Conclusão: Considera-se a necessidade da identificação precoce de indicadores de risco para hipertensão arterial a fim de prevenir eventos cardiovasculares.Objetivo: Identificar en un grupo de niños y adolescentes con historia familiar de hipertensión arterial, la presencia de indicadores de riesgo para hipertensión arterial. Métodos: estudio desarrollado con 141 individuos de seis a 18 años en una comunidad de la ciudad de Fortaleza con recolección de datos realizada en el domicilio. Resultados: los indicadores de riesgo que aparecieron con más frecuencia fueron la ingestión de sal, sedentarismo y escasa ingestión de legumbres. Los promedios de presión arterial fueron mayores en los individuos del sexo masculino. Aquellos que refirieron hacer uso de sal en la alimentación y no consumir diariamente frutas y legumbres presentaron menores promedios. Conclusión: se considera la necesidad de identificar precozmente los indicadores de riesgo para hipertensión arterial a fin de prevenir eventos cardiovasculares.Objective: To identify the risk factor for cardiovascular diseases among children and adolescents with family history of high blood pressure. Methods: Descriptive Study with 141 individuals aged 6 to 18 years from a community in Fortaleza, Brazil. Data were collected at the participants

  20. Hemodynamic Assessment of Compliance of Pre-Stressed Pulmonary Valve-Vasculature in Patient Specific Geometry Using an Inverse Algorithm

    Science.gov (United States)

    Hebbar, Ullhas; Paul, Anup; Banerjee, Rupak

    2016-11-01

    Image based modeling is finding increasing relevance in assisting diagnosis of Pulmonary Valve-Vasculature Dysfunction (PVD) in congenital heart disease patients. This research presents compliant artery - blood interaction in a patient specific Pulmonary Artery (PA) model. This is an improvement over our previous numerical studies which assumed rigid walled arteries. The impedance of the arteries and the energy transfer from the Right Ventricle (RV) to PA is governed by compliance, which in turn is influenced by the level of pre-stress in the arteries. In order to evaluate the pre-stress, an inverse algorithm was developed using an in-house script written in MATLAB and Python, and implemented using the Finite Element Method (FEM). This analysis used a patient specific material model developed by our group, in conjunction with measured pressure (invasive) and velocity (non-invasive) values. The analysis was performed on an FEM solver, and preliminary results indicated that the Main PA (MPA) exhibited higher compliance as well as increased hysteresis over the cardiac cycle when compared with the Left PA (LPA). The computed compliance values for the MPA and LPA were 14% and 34% lesser than the corresponding measured values. Further, the computed pressure drop and flow waveforms were in close agreement with the measured values. In conclusion, compliant artery - blood interaction models of patient specific geometries can play an important role in hemodynamics based diagnosis of PVD.

  1. Social influence: compliance and conformity.

    Science.gov (United States)

    Cialdini, Robert B; Goldstein, Noah J

    2004-01-01

    This review covers recent developments in the social influence literature, focusing primarily on compliance and conformity research published between 1997 and 2002. The principles and processes underlying a target's susceptibility to outside influences are considered in light of three goals fundamental to rewarding human functioning. Specifically, targets are motivated to form accurate perceptions of reality and react accordingly, to develop and preserve meaningful social relationships, and to maintain a favorable self-concept. Consistent with the current movement in compliance and conformity research, this review emphasizes the ways in which these goals interact with external forces to engender social influence processes that are subtle, indirect, and outside of awareness.

  2. Tax Compliance Inventory: TAX-I Voluntary tax compliance, enforced tax compliance, tax avoidance, and tax evasion.

    Science.gov (United States)

    Kirchler, Erich; Wahl, Ingrid

    2010-06-01

    Surveys on tax compliance and non-compliance often rely on ad hoc formulated items which lack standardization and empirical validation. We present an inventory to assess tax compliance and distinguish between different forms of compliance and non-compliance: voluntary versus enforced compliance, tax avoidance, and tax evasion. First, items to measure voluntary and enforced compliance, avoidance, and evasion were drawn up (collected from past research and newly developed), and tested empirically with the aim of producing four validated scales with a clear factorial structure. Second, findings from the first analyses were replicated and extended to validation on the basis of motivational postures. A standardized inventory is provided which can be used in surveys in order to collect data which are comparable across research focusing on self-reports. The inventory can be used in either of two ways: either in its entirety, or by applying the single scales independently, allowing an economical and fast assessment of different facets of tax compliance.

  3. A high prevalence of carotid artery stenosis in male patients older than 65 years, irrespective of presenting clinical manifestation of atherosclerotic diseases

    NARCIS (Netherlands)

    Kazemi-Bajestani, S.M.; Vlugt, M.J. van der; Leeuw, F.E. de; Blankensteijn, J.D.; Bredie, S.J.H.

    2013-01-01

    This study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. Duplex sonography of the carotid arteries was performed in 434 of 473 eligible patients of whom 118 (27.8%) pat

  4. ASPRE trial: influence of compliance on beneficial effect of aspirin in prevention of preterm preeclampsia.

    Science.gov (United States)

    Wright, David; Poon, Liona C; Rolnik, Daniel L; Syngelaki, Argyro; Delgado, Juan Luis; Vojtassakova, Denisa; de Alvarado, Mercedes; Kapeti, Evgenia; Rehal, Anoop; Pazos, Andrea; Carbone, Ilma Floriana; Dutemeyer, Vivien; Plasencia, Walter; Papantoniou, Nikos; Nicolaides, Kypros H

    2017-09-06

    To examine the influence of compliance on the beneficial effect of aspirin in prevention of preterm preeclampsia in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial. This was a secondary analysis of data from the ASPRE trial. In this multicenter-study women with singleton pregnancies had screening by means of an algorithm that combines maternal factors and biomarkers (mean arterial pressure, uterine-artery pulsatility index, and maternal serum pregnancy-associated plasma protein A and placental growth factor) at 11-13 weeks' gestation. Those with an estimated risk for preterm preeclampsia of >1 in 100 were invited to participate in a double-blind trial of aspirin (150 mg per day) vs. placebo from 11 to 14 until 36 weeks' gestation. Preterm preeclampsia with delivery at 90%, after adjustment for the estimated risk of preterm preeclampsia at screening and the participating center. The choice of cut-off of 90% was based on an exploratory analysis of the treatment effect. Logistic regression analysis was used to investigate predictors of compliance >90% among maternal characteristics and medical history. Preterm preeclampsia occurred in 5/555 (0.9%) participants in the aspirin group with compliance ≥90%, in 8/243 (3.3%) of participants in the aspirin group with compliance 90% and 0.59 (95% confidence interval, 0.23 to 1.53) for compliance <90%. Compliance was positively associated with family history of preeclampsia and negatively associated with smoking, maternal age <25 years, Afro-Caribbean and South Asian racial origin, and history of preeclampsia in a previous pregnancy. The beneficial effect of aspirin in the prevention of preterm preeclampsia appears to depend on compliance. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. A Splice Region Variant in LDLR Lowers Non-high Density Lipoprotein Cholesterol and Protects against Coronary Artery Disease

    DEFF Research Database (Denmark)

    Gretarsdottir, Solveig; Helgason, Hannes; Helgadottir, Anna

    2015-01-01

    Through high coverage whole-genome sequencing and imputation of the identified variants into a large fraction of the Icelandic population, we found four independent signals in the low density lipoprotein receptor gene (LDLR) that associate with levels of non-high density lipoprotein cholesterol...

  6. 32. Incidence and predictors of progression of Coronary Artery Disease among high risk patients with recurrent symptoms

    Directory of Open Access Journals (Sweden)

    M. Bassam Bdeir

    2015-10-01

    Conclusions: Among high risk patients with recurrent symptoms, the short term rate of progression of CAD is high. A drop in LVEF >5% is the best predictor of progression of CAD. Further studies are needed to determine the prognostic value of CAD progression in the era of potent medical therapy.

  7. Application of the Polytomous Logistic Regression Model to Study of Tax Compliance of High Income Personal%运用Logistic回归模型加强高收入者纳税遵从的实证研究

    Institute of Scientific and Technical Information of China (English)

    韩晓琴; 李哲

    2012-01-01

    Strengthening tax collection and promoting tax compliance has been very important for all tax administrations.The authors will use the polytomous Logistic Model to analyze by using the sample,which is from the data of tax return of individual with annual income of 120000 yuan and above in one city,Jiangsu Province.The authors reject the missing values to make "grade five categories of owed tax" the response variable;and the independent variables are taxpayer's age,the taxable income amount,taxes,sex,occupation categories,industry categories,so that it is possible to carry out the Logistic regression analysis.The authors hope that such study can be useful to the tax officers in terms of administration on high income earners with annual income of 120000 yuan and above as well as improving compliance.%加强高收入者的个人所得税征管、促进纳税遵从一直是税务部门的重要工作之一。利用多元有序因变量Logistic回归模型,以江苏某市2010年度年所得12万元以上个人所得税纳税申报的数据为样本,以"应补税额"等级的五分类有序变量为因变量,以纳税申报表中纳税人的年龄、应纳税所得额、应纳税额、性别、职业大类、行业大类6个影响因素为自变量,进行多元有序因变量的Logistic回归分析,研究结果可为税务系统加强年所得12万元以上高收入者个人所得税的申报与征管、促进纳税遵从提供新的思路。

  8. High origin of the deep femoral artery: a case report and literature review Origem alta da artéria femoral profunda: relato de caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Vishal Kumar

    2011-09-01

    Full Text Available Arterial variations of the femoral triangle are rarely reported in the literature. In the present article, we have reported a case of high origin of the deep femoral artery, which was originating just lower to the inguinal ligament. It was also observed that the lateral circumflex femoral artery arose directly from the femoral artery instead from the deep femoral artery. We have discussed the anatomy, embryological basis, and clinical implications of these variations along with relevant literature review. The importance of knowledge about these variations in therapeutic and diagnostic interventions is discussed.Variações arteriais no triângulo femoral têm sido pouco relatadas na literatura. No presente artigo, relatou-se um caso de origem alta da artéria femoral profunda, que estava se originando pouco abaixo do ligamento inguinal. Também foi observado que a artéria femoral circunflexa originava-se diretamente da artéria femoral, ao invés de ser originada da artéria femoral profunda. Discutiu-se sobre anatomia, base embriológica e implicações clínicas dessas variações junto com uma revisão da literatura pertinente. A importância do conhecimento sobre essas variações no quadro das intervenções diagnósticas e terapêuticas é discutida.

  9. Arterial Spin Labeling - Fast Imaging with Steady-State Free Precession (ASL-FISP): A Rapid and Quantitative Perfusion Technique for High Field MRI

    Science.gov (United States)

    Gao, Ying; Goodnough, Candida L.; Erokwu, Bernadette O.; Farr, George W.; Darrah, Rebecca; Lu, Lan; Dell, Katherine M.; Yu, Xin; Flask, Chris A.

    2014-01-01

    Arterial Spin Labeling (ASL) is a valuable non-contrast perfusion MRI technique with numerous clinical applications. Many previous ASL MRI studies have utilized either Echo-Planar Imaging (EPI) or True Fast Imaging with Steady-State Free Precession (True FISP) readouts that are prone to off-resonance artifacts on high field MRI scanners. We have developed a rapid ASL-FISP MRI acquisition for high field preclinical MRI scanners providing perfusion-weighted images with little or no artifacts in less than 2 seconds. In this initial implementation, a FAIR (Flow-Sensitive Alternating Inversion Recovery) ASL preparation was combined with a rapid, centrically-encoded FISP readout. Validation studies on healthy C57/BL6 mice provided consistent estimation of in vivo mouse brain perfusion at 7 T and 9.4 T (249±38 ml/min/100g and 241±17 ml/min/100g, respectively). The utility of this method was further demonstrated in detecting significant perfusion deficits in a C57/BL6 mouse model of ischemic stroke. Reasonable kidney perfusion estimates were also obtained for a healthy C57/BL6 mouse exhibiting differential perfusion in the renal cortex and medulla. Overall, the ASL-FISP technique provides a rapid and quantitative in vivo assessment of tissue perfusion for high field MRI scanners with minimal image artifacts. PMID:24891124

  10. Arterial spin labeling-fast imaging with steady-state free precession (ASL-FISP): a rapid and quantitative perfusion technique for high-field MRI.

    Science.gov (United States)

    Gao, Ying; Goodnough, Candida L; Erokwu, Bernadette O; Farr, George W; Darrah, Rebecca; Lu, Lan; Dell, Katherine M; Yu, Xin; Flask, Chris A

    2014-08-01

    Arterial spin labeling (ASL) is a valuable non-contrast perfusion MRI technique with numerous clinical applications. Many previous ASL MRI studies have utilized either echo-planar imaging (EPI) or true fast imaging with steady-state free precession (true FISP) readouts, which are prone to off-resonance artifacts on high-field MRI scanners. We have developed a rapid ASL-FISP MRI acquisition for high-field preclinical MRI scanners providing perfusion-weighted images with little or no artifacts in less than 2 s. In this initial implementation, a flow-sensitive alternating inversion recovery (FAIR) ASL preparation was combined with a rapid, centrically encoded FISP readout. Validation studies on healthy C57/BL6 mice provided consistent estimation of in vivo mouse brain perfusion at 7 and 9.4 T (249 ± 38 and 241 ± 17 mL/min/100 g, respectively). The utility of this method was further demonstrated in the detection of significant perfusion deficits in a C57/BL6 mouse model of ischemic stroke. Reasonable kidney perfusion estimates were also obtained for a healthy C57/BL6 mouse exhibiting differential perfusion in the renal cortex and medulla. Overall, the ASL-FISP technique provides a rapid and quantitative in vivo assessment of tissue perfusion for high-field MRI scanners with minimal image artifacts. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Assessment of conduit artery vasomotion using photoplethysmography

    Science.gov (United States)

    Kanders, Karlis; Grabovskis, Andris; Marcinkevics, Zbignevs; Aivars, Juris Imants

    2013-11-01

    Vasomotion is a spontaneous oscillation of vascular tone. The phenomenon has been observed in small arterioles and capillaries as well as in the large conduit arteries. The layer of smooth muscle cells that surrounds a blood vessel can spontaneously and periodically change its tension and thereby the arterial wall stiffness also changes. As the understanding of the phenomenon is still rather obscure, researchers would benefit from a low-cost and reliable investigation technique such as photoplethysmography (PPG). PPG is an optical blood pulsation measurement technique that can offer substantial information about the arterial stiffness. The aims of this pilot study were to evaluate the usefulness of the PPG technique in the research of vasomotion and to investigate vasomotion in the relatively large conduit arteries. Continuous 15 minute long measurements of posterior tibial artery wall stiffness were taken. Artery diameter, electrocardiogram, blood pressure and respiration were also simultaneously registered. Fast Fourier Transform power spectra were calculated to identify unique stiffness oscillations that did not correspond to fluctuations in the systemic parameters and thus would indicate vasomotion. We concluded that photoplethysmography is a convenient method for the research of the vasomotion in large arteries. Local stiffness parameter b/a is more accurate to use and easier to measure than the pulse wave velocity which describes stiffness of a segment of an artery. Conduit arteries might exhibit a low amplitude high frequency vasomotion ( 9 to 27 cycles per minute). Low frequency vasomotion is problematic to distinguish from the passive oscillations imposed by the arterial pressure.

  12. Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease

    NARCIS (Netherlands)

    Sabatine, Marc S.; Morrow, David A.; Jablonski, Kathleen A.; Rice, Madeline Murguia; Warnica, J. Wayne; Domanski, Michael J.; Hsia, Judith; Gersh, Bernard J.; Rifai, Nader; Ridker, Paul M.; Pfeffer, Marc A.; Braunwald, Eugene

    2007-01-01

    Background-Data supporting the prognostic significance of high-sensitivity C-reactive protein (hs-CRP) are derived largely from individuals with no overt coronary artery disease or from patients with acute coronary syndromes. In contrast, the ability of hs-CRP to predict outcomes in patients with st

  13. Mobile Source Emissions Regulatory Compliance Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Engine and Vehicle Compliance Certification and Fuel Economy Inventory contains measured emissions and fuel economy compliance information for all types of...

  14. Clean Air Markets - Compliance Query Wizard

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Compliance Query Wizard is part of a suite of Clean Air Markets-related tools that are accessible at http://ampd.epa.gov/ampd/. The Compliance module provides...

  15. Client Compliance with Homework Directives during Counseling.

    Science.gov (United States)

    Worthington, Everett L., Jr.

    1986-01-01

    Investigated compliance as a function of counselor, client, and therapy variables. Results indicated that variables associated with the conduct of counseling more strongly influenced compliance with homework than did either counselor or client variables. (Author/BL)

  16. 24 CFR 108.25 - Compliance meeting.

    Science.gov (United States)

    2010-04-01

    ... COMPLIANCE PROCEDURES FOR AFFIRMATIVE FAIR HOUSING MARKETING § 108.25 Compliance meeting. (a) Scheduling... the goals of the AFHM plan may not be achieved, or that the implementation of the Plan should...

  17. Mobile Source Emissions Regulatory Compliance Data Inventory

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Mobile Source Emissions Regulatory Compliance Data Inventory data asset contains measured summary compliance information on light-duty, heavy-duty, and non-road...

  18. Anatomical and hemodynamic evaluations of the heart and pulmonary arterial pressure in healthy children residing at high altitude in China

    Directory of Open Access Journals (Sweden)

    Hai-Ying Qi

    2015-06-01

    Conclusions: Children living at high altitude in China have significantly higher mPAP, dilated right heart and slower regression of right ventricular hypertrophy in the first 14 years of life. Systolic and diastolic functions of both ventricles were reduced with a paradoxically higher CI. There was no significant difference in these features between the Hans and the Tibetans. These values provide references for the care of healthy children and the sick ones with cardiopulmonary diseases at high altitude.

  19. A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease

    Directory of Open Access Journals (Sweden)

    Clement Fiona M

    2011-11-01

    Full Text Available Abstract Background There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1 To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2 to explore whether the linear relationship exists in other jurisdictions. Methods Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection. Results In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006 than in time period 1(1995-2001, there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population. Conclusions Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding

  20. ETHICS AND COMPLIANCE IN BUSINESS

    Directory of Open Access Journals (Sweden)

    ANDREESCU Nicoleta Alina

    2015-05-01

    Full Text Available In this paper, we have studied the evolution of the business ethics concept through the prism of definitions from some renowned authors in the field and through the approach model of the business ethics and by implementing it in the company level. We have found out that in the last 40 years this concept has evolved from a theoretical aspect, as well as a practical one. Companies are motivated to implement ethics and compliance programs in business so that they can manage the changes that come from society. If, until recently, all that mattered for a company was profit, in the last decades, the situation changed. In order to develop a durable business, it is essential to have a good reputation. Owning and implementing an ethics and compliance program in business has become an imperative for companies, regardless of their activity sector. The role of the compliance department becomes more pregnant in each company: the employees need safety, the existence of communication lines provides comfort. From the partners in business’ point of view, owning such a program is a necessity, a condition, and not conforming to the principles of business ethics can lead to the isolation of the company. The ethics and compliance programs in business are instruments that protect the company by implementing certain proactive identification mechanisms that ensure the development of an ethical organizational culture.

  1. Corporate compliance: implications for trustees.

    Science.gov (United States)

    Commins, K

    1998-01-01

    In this era of fraud and abuse enforcement efforts, hospital trustees are facing potential liability in the event that an investigation reveals the hospital has violated state or federal provisions pertaining to fraud and abuse. This liability can be minimized, or avoided, by ensuring that an effective compliance plan is in place prior to such an investigation.

  2. Best Practices and Simultaneous Compliance

    Science.gov (United States)

    This wrap-up presentation to the workshop covers several topics concerning how lead and copper compliance under the Lead and Copper Rule should be integrated into an overall “simultaneous compliance” framework with other organizations. The LCR requires “optimization” of lead leve...

  3. Audit-based compliance control

    NARCIS (Netherlands)

    Cederquist, J.G.; Corin, R.; Dekker, M.A.C.; Etalle, S.; Hartog, J.I. den; Lenzini, G.

    2007-01-01

    In this paper we introduce a new framework for controlling compliance to discretionary access control policies [Cederquist et al. in Proceedings of the International Workshop on Policies for Distributed Systems and Networks (POLICY), 2005; Corin et al. in Proceedings of the IFIP Workshop on Formal A

  4. Project Compliance with Enterprise Architecture

    NARCIS (Netherlands)

    Foorthuis, R.M.

    2012-01-01

    This research project set out to identify effective practices and models for working with projects that are required to comply with Enterprise Architecture (EA), and investigate the benefits and drawbacks brought about by compliance. Research methods used are canonical action research, a statistical

  5. Project Compliance with Enterprise Architecture

    NARCIS (Netherlands)

    Foorthuis, R.M.

    2012-01-01

    This research project set out to identify effective practices and models for working with projects that are required to comply with Enterprise Architecture (EA), and investigate the benefits and drawbacks brought about by compliance. Research methods used are canonical action research, a statistical

  6. Association between uterine artery Doppler blood flow changes and arterial wall elasticity in pregnant women.

    Science.gov (United States)

    von Wowern, Emma; Andersson, Jakob; Skarping, Ida Dalene; Howie, Maria Teresa; Olofsson, Per

    2017-10-01

    Uterine artery (UtA) Doppler velocimetry changes and increased arterial stiffness are associated with preeclampsia. We aimed to investigate the relation between UtA velocimetry changes and arterial stiffness in pregnant women. Doppler velocimetry and photoplethysmographic digital pulse wave analysis (DPA) were performed in 173 pregnant women in the second or the third trimester, where UtA Doppler pulsatility index (PI), diastolic notching, and UtA score (UAS) combining notching and high PI were calculated. DPA stiffness parameters representing large arteries were ejection elasticity index (EEI) and b/a, small arteries dicrotic index (DI) and d/a, and global stiffness the aging index (AI). One hundred and thirty women had normal Doppler and 43 had diastolic notching, of whom nine had high PI. DI indicated increased stiffness in small arteries when notching was present (p = 0.044) and showed a significant but weak correlation to UAS (p = 0.025, tau 0.12). EEI and b/a indicated increased large artery stiffness (p ≤0.014), d/a small artery stiffness (p = 0.023), and AI a systemic stiffness (p = 0.040) when high PI. High UtA PI was associated with increased systemic arterial stiffness, whereas notching was related to increased stiffness in small arteries only. This indicates pathophysiological differences between the two Doppler parameters.

  7. Analysis of damping characteristics of arterial catheter blood ...

    African Journals Online (AJOL)

    part, by the damping characteristics of the arterial catheter blood pressure ... A cross-sectional, observational study of arterial line measurements in a large general ICU. ... and perfusion pressure, whilst preventing excessively high pressures.

  8. Framing of information on the use of public finances, regulatory fit of recipients and tax compliance.

    Science.gov (United States)

    Holler, Marianne; Hoelzl, Erik; Kirchler, Erich; Leder, Susanne; Mannetti, Lucia

    2008-08-01

    Information campaigns to increase tax compliance could be framed in different ways. They can either highlight the potential gains when tax compliance is high, or the potential losses when compliance is low. According to regulatory focus theory, such framing should be most effective when it is congruent with the promotion or prevention focus of its recipients. Two studies confirmed the hypothesized interaction effects between recipients' regulatory focus and framing of information campaigns, with tax compliance being highest under conditions of regulatory fit. To address taxpayers effectively, information campaigns by tax authorities should consider the positive and negative framing of information, and the moderating effect of recipients' regulatory focus.

  9. Developing a nursing corporate compliance program.

    Science.gov (United States)

    Bartis, Janice A; Sullivan, Trent

    2002-09-01

    This article presents the process that a large urban tertiary care hospital engaged in when developing a corporate compliance program for nursing. The purpose of this article is to demonstrate how nurse executives can successfully implement a comprehensive and practical nursing corporate compliance program. This article describes in detail the 5 steps the hospital took to develop its nursing corporate compliance program and provides examples of tools to guide you in developing a nursing corporate compliance program.

  10. Compliance Study of Endovascular Stent Grafts Incorporated with Polyester and Polyurethane Graft Materials in both Stented and Unstented Zones

    Directory of Open Access Journals (Sweden)

    Ying Guan

    2016-08-01

    Full Text Available Compliance mismatch between stent graft and host artery may induce complications and blood flow disorders. However, few studies have been reported on stent graft compliance. This study aims to explore the deformation and compliance of stent graft in stented and unstented zones under three pressure ranges. Compliance of two stent grafts incorporated with polyurethane graft (nitinol-PU and polyester graft (nitinol-PET materials respectively were tested; the stents used in the two stent grafts were identical. For the circumferential deformation of the stent grafts under each pressure range, the nitinol-PET stent graft was uniform in both zones. The nitinol-PU stent graft was circumferentially uniform in the stented zone, however, it was nonuniform in the unstented zone. The compliance of the PU graft material was 15 times higher than that of the PET graft. No significant difference in compliance was observed between stented and unstented zones of the nitinol-PET stent graft regardless of the applied pressure range. However, for the nitinol-PU stent graft, compliance of the unstented PU region was approximately twice that of the stented region; thus, compliance along the length of the nitinol-PU stent graft was not constant and different from that of the nitinol-PET stent graft.

  11. Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile

    DEFF Research Database (Denmark)

    Öhlin, Leif; Hesse, Morten; Fridell, Mats

    2011-01-01

    . In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Methods Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients......-IV-TR, and the Symptoms Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. Results Of 123 patients...... for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence....

  12. 42 CFR 3.308 - Compliance reviews.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Compliance reviews. 3.308 Section 3.308 Public... ORGANIZATIONS AND PATIENT SAFETY WORK PRODUCT Enforcement Program § 3.308 Compliance reviews. The Secretary may conduct compliance reviews to determine whether a respondent is complying with the applicable...

  13. 14 CFR 1252.400 - Compliance reviews.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Compliance reviews. 1252.400 Section 1252..., and Enforcement Procedures § 1252.400 Compliance reviews. (a) NASA may conduct compliance reviews and pre-award reviews of recipients or use other similar procedures that will permit it to investigate and...

  14. Monitoring Compliance with Open Access policies

    OpenAIRE

    Picarra, Mafalda

    2015-01-01

    In parallel to implementing Open Access policies, institutions and research funders are also engaged in developing mechanisms to monitor compliance with the existing policies. This study highlights why policy compliance must be monitored and how it can be done. A series of case studies illustrate where compliance is being effectively monitored.

  15. Tax compliance depends on voice of taxpayers

    NARCIS (Netherlands)

    Casal, Sandro; Kogler, C.; Mittone, Luigi; Kirchler, Erich

    2016-01-01

    Reducing the social distance between taxpayers and tax authorities boosts taxpayers' acceptance of tax load and tax compliance. In the present experiment participants had the opportunity to pay their tax due either as one single compliance decision or as separate compliance decisions for each type o