[Show abstract][Hide abstract] ABSTRACT: Background: While area detector computed tomography (ADCT) is a useful tool for coronary artery disease (CAD) evaluation, myocardial perfusion imaging (MPI) with single photon emission computed tomography is a well-established method of predicting functional relevance of CAD. Purpose: We assess the usefulness for decision making using both ADCT and MPI and discussed from the standpoint of cost for diagnostic work-up and contrast agent. Method: Between January, 2013 to September, 2014, 78 patients underwent both ADCT and MPI within two months were analyzed their therapeutic strategy. From ADCT, severity of stenosis was divided non-significant(less than 50%), moderate (over or equal to 50% and less than 75%) and severe (over or equal to 75%). Summed difference score of MPI was judged as ischemia positive.
Result: Table showed the result and executed treatment strategy. Patients with significant stenosis by ADCT were 40 patients (51.3%) and patients with ischemia positive were 25 patients (33.8%). Invasive revasculization was performed higher (82.3%, p<0.01) for the patients with significant stenosis and ischemia than moderate stenosis with ischemia (25%) or significant stenosis without ischemia (39.1%). Before taking invasive therapy, examination with ADCT and MPI saved 63700 yen and about 100ml of contrast agent in each case based study as it was compared with the case with ADCT and coronary angiography without MPI in spite of slightly higher radiation dose (4mSv). Conclusion: The combined use of ADCT and MPI could choose effectively treatment strategy of CAD with a reduction of cost and contrast agent.
European heart journal cardiovascular Imaging; 05/2015
[Show abstract][Hide abstract] ABSTRACT: Patients with end-stage renal failure (ESRF) are high risk patients for cardiovascular events and are usually evaluated in what concerns myocardial left ventricular ejection fraction (LVEF) and myocardial perfusion before renal transplant. Gated-SPECT myocardial perfusion imaging (G-SPECT MPI) could be used for this evaluation. The aim of this study was to find the prevalence and the predictors of left ventricular dysfunction (LVEF under 45%) and / or an abnormal myocardial perfusion in patients referred for G-SPECT MPI with ESRF before renal transplantation.
112 consecutive patients with ESRF and without known CAD were included. Perfusion was abnormal in 22.3%, LVEF was ≤ 45% in 13.4% and one or both features in 27.7%. Using logistic regression analysis it was found that the predictors LV dysfunction and / or abnormal perfusion imaging were the rest heart rate, (OR=1.1; CI 0.0–1.1; p = 0.007), the QRS width (OR=1.0; CI 1.0–1.1; p = 0.003) and an ECG suggestive of ischemia (OR=2.6; CI 1.0–6.4; p = 0.04). Patients age (OR=1.0; CI 0.9–1.0; p = 0.7) and male gender (OR=1.3; CI 0.5–3.6; p = 0.6), presence of risk factors, namely, diabetes (OR=1.5; CI 0.7–3.6; p = 0.3) or hypertension (OR=0.5; CI 0.2–1.2; p = 0.1), or the presence of angina (OR=1.4; CI 0.4–4.9; p = 0.6) were not predictors of an abnormal perfusion and / or left ventricular dysfunction.
In this study, an abnormal G-SPECT MPI study was found in 27.7% of ESRF patients and it was mainly related with ECG findings (rest heart rate, QRS width and an ECG suggestive of ischemia). Atherosclerotic risk factors or even the presence of symptoms were not related with abnormal images.
European heart journal cardiovascular Imaging; 05/2015
[Show abstract][Hide abstract] ABSTRACT: We present a measurement of the cosmic ray (e[superscript +] + e[superscript -]) flux in the range 0.5 GeV to 1 TeV based on the analysis of 10.6 million (e[superscript +] + e[superscript -]) events collected by AMS. The statistics and the resolution of AMS provide a precision measurement of the flux. The flux is smooth and reveals new and distinct information. Above 30.2 GeV, the flux can be described by a single power law with a spectral index γ = -3.170 ± 0.008(stat + syst) ± 0.008(energy scale).
[Show abstract][Hide abstract] ABSTRACT: Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. Results: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 +/- 16 years, SAPS II score 39 +/- 16, SOFA score 7.6 +/- 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for <= 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. Conclusions: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.
[Show abstract][Hide abstract] ABSTRACT: A facility that can deliver beams of electron and muon neutrinos from the
decay of a stored muon beam has the potential to unambiguously resolve the
issue of the evidence for light sterile neutrinos that arises in short-baseline
neutrino oscillation experiments and from estimates of the effective number of
neutrino flavors from fits to cosmological data. In this paper, we show that
the nuSTORM facility, with stored muons of 3.8 GeV/c $\pm$ 10%, will be able to
carry out a conclusive muon neutrino appearance search for sterile neutrinos
and test the LSND and MiniBooNE experimental signals with 10$\sigma$
sensitivity, even assuming conservative estimates for the systematic
uncertainties. This experiment would add greatly to our knowledge of the
contribution of light sterile neutrinos to the number of effective neutrino
flavors from the abundance of primordial helium production and from constraints
on neutrino energy density from the cosmic microwave background. The appearance
search is complemented by a simultaneous muon neutrino disappearance analysis
that will facilitate tests of various sterile neutrino models.
[Show abstract][Hide abstract] ABSTRACT: Background
Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AimsWe used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II one-day point-prevalence study to better define the characteristics of infection in these patients. Methods
We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. ResultsThe EPIC II database includes 13,796 adult patients from 1,265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, p<0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, p<0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, p<0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (p<0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, p<0.05). Conclusions
Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly due to Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 03/2014; DOI:10.1111/liv.12520 · 4.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The nuSTORM facility has been designed to deliver beams of electron neutrinos
and muon neutrinos (and their anti-particles) from the decay of a stored muon
beam with a central momentum of 3.8 GeV/c and a momentum acceptance of 10%. The
facility is unique in that it will: 1. Allow searches for sterile neutrinos of
exquisite sensitivity to be carried out; 2. Serve future long- and
short-baseline neutrino-oscillation programs by providing definitive
measurements of electron neutrino and muon neutrino scattering cross sections
off nuclei with percent-level precision; and 3. Constitutes the crucial first
step in the development of muon accelerators as a powerful new technique for
particle physics. The document describes the facility in detail and
demonstrates its physics capabilities. This document was submitted to the
Fermilab Physics Advisory Committee in consideration for Stage I approval.
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT BACKGROUND: In a recent multicenter randomized trial comparing unfractionated heparin (UFH) with low-molecular-weight heparin (dalteparin) for thromboprophylaxis in 3746 critically-ill patients, 17 (0.5%) patients developed heparin-induced thrombocytopenia (HIT) based on serotonin-release assay-positive (SRA+) status. A trend to lower frequency of HIT with dalteparin vs UFH was observed in the intention-to-treat analysis (5 vs 12 patients; P=0.14), which was statistically significant (3 vs 12 patients; P=0.046) in a prespecified per-protocol analysis which excluded patients with deep-vein thrombosis (DVT) at study entry. We sought to characterize HIT outcomes and to determine how dalteparin thromboprophylaxis might reduce HIT frequency in ICU patients. METHODS: In 17 patients with HIT, we analyzed platelet counts and thrombotic events in relation to study drug and other open-label heparin, to determine whether study drug plausibly explained seroconversion to SRA+ status and/or breakthrough of thrombocytopenia/thrombosis. We also compared antibody frequencies (dalteparin vs UFH) in 409 patients serologically investigated for HIT. RESULTS: HIT-associated thrombosis occurred in 10/17 (58.8%) patients (8:1:1 venous:arterial:both). Dalteparin was associated with fewer study drug-attributable HIT-related events (P=0.020), including less seroconversion (P=0.058) and less breakthrough of thrombocytopenia/thrombosis (P=0.032). Anti-PF4/heparin IgG antibodies by ELISA were less frequent among patients receiving dalteparin vs UFH (13.5% vs 27.3%; P<0.001). One patient with HIT-associated DVT died post-UFH bolus, whereas platelet counts recovered in two others with HIT-associated VTE despite continuation of therapeutic-dose UFH. CONCLUSIONS: The lower risk of HIT in ICU patients receiving dalteparin appears related to both decreased antibody formation and decreased clinical breakthrough of HIT among patients forming antibodies.
[Show abstract][Hide abstract] ABSTRACT: The nuSTORM facility has been designed to deliver beams of electron and muon
neutrinos from the decay of a stored muon beam with a central momentum of 3.8
GeV/c and a momentum spread of 10%. The facility is unique in that it will:
serve the future long- and short-baseline neutrino-oscillation programmes by
providing definitive measurements of electron-neutrino- and
muon-neutrino-nucleus cross sections with percent-level precision; allow
searches for sterile neutrinos of exquisite sensitivity to be carried out; and
constitute the essential first step in the incremental development of muon
accelerators as a powerful new technique for particle physics.
Of the world's proton-accelerator laboratories, only CERN and FNAL have the
infrastructure required to mount nuSTORM. Since no siting decision has yet been
taken, the purpose of this Expression of Interest (EoI) is to request the
resources required to: investigate in detail how nuSTORM could be implemented
at CERN; and develop options for decisive European contributions to the nuSTORM
facility and experimental programme wherever the facility is sited.
The EoI defines a two-year programme culminating in the delivery of a
Technical Design Report.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Whether an anticoagulant prophylaxis is needed for patients with cancer with a central venous catheter is a highly controversial subject. We designed a study to compare different prophylactic strategies over 3 months of treatment.
We performed a phase III prospective, open-label randomized trial. After the insertion of a central venous access device, consecutive patients with planned chemotherapy for cancer were randomized to no anticoagulant prophylaxis, low molecular weight heparin [low molecular weight heparin (LMWH); with isocoagulation doses], or warfarin 1 mg/day. Treatments were given over the first 3 months. Doppler ultrasound and venographies were performed on days 1 and 90, respectively, or sooner in case of clinical presumption of thrombosis.
A total of 420 patients were randomized, and 407 were evaluable. Forty-two catheter-related deep vein thrombosis (DVT) occurred (10.3 %), 20 in those with no anticoagulation, 8 in those receiving warfarin, and 14 in those receiving LMWH. Nine additional non-related catheter deep vein thrombosis (CDVT) occurred. Anticoagulation significantly reduced the incidence of catheter-related DVT (p = 0.035) and catheter non-related DVT (p = 0.007), with no difference between warfarin and LMWH. Safety was good (3.4 % of attributable events) but compliance with randomized prophylaxis was lower than expected.
Prophylaxis showed a benefit regarding catheter-related and non-catheter-related DVT with no increase in serious side effects.
Cancer Chemotherapy and Pharmacology 05/2013; 72(1). DOI:10.1007/s00280-013-2169-y · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: Atherosclerotic plaques progress in a highly individual manner. Plaque eccentricity has been associated with a rupture-prone phenotype and adverse coronary events in humans. Endothelial shear stress (ESS) critically determines plaque growth and low ESS leads to high-risk lesions. However, the factors responsible for rapid disease progression with increasing plaque eccentricity have not been studied. We investigated in vivo the effect of local hemodynamic and plaque characteristics on progressive luminal narrowing with increasing plaque eccentricity in humans.
Methods: Three-dimensional coronary artery reconstruction using angiographic and intravascular ultrasound data was performed in 374 patients at baseline (BL) and 6-10 months later (FU) to assess plaque natural history as part of the PREDICTION Trial. A total of 874 coronary arteries were divided into consecutive 3-mm segments. We identified 408 BL discrete luminal narrowings with a throat in the middle surrounded by gradual narrowing proximal and distal to the throat. Local BL ESS was assessed by computational fluid dynamics. The eccentricity index (EI) at BL and FU was computed as the ratio of max to min plaque thickness at the throat. Mixed-effects logistic regression was used to investigate the effect of BL variables on the combined endpoint of substantial worsening of luminal narrowing (decrease in lumen area >1.8 mm2 or >20%) with an increase in plaque EI.
Results: Lumen worsening with an increase in plaque EI was evident in 73 luminal narrowings (18%). Independent predictors of worsening lumen narrowing with plaque EI increase were low BL ESS (<1 Pa) distal to the throat (odds ratio [OR] =2.2 [95% CI: 1.3-3.7]; p=0.003) and large BL plaque burden (>51%) at the throat (OR=1.7 [95% CI: 1.0-2.8]; p=0.051). The incidence of worsening lumen narrowing with increasing plaque eccentricity was 30% in the presence of both predictors versus 15% in luminal narrowings without this combination of characteristics (OR=2.4 [95% CI: 1.4-4.3]; p=0.002).
Conclusions: Low local ESS independently predicts areas with rapidly progressive luminal narrowing and increasing plaque eccentricity. Coronary regions manifesting an abrupt anatomic change, i.e., at highest risk to cause an adverse event, can be identified early by assessment of ESS and plaque burden.
[Show abstract][Hide abstract] ABSTRACT: The E672/E706 Spectrometer, located in the MW beam at Fermilab, was used to collect data on events containing a pair of muons in the final state with large effective mass. The momentum of incident pions and protons was 530 GeV/c. Nuclear targets included Be, C, Al, Cu and Pb. We report on a preliminary measurement of the A-dependence of the per nucleus cross section for forward J/psi production. The apparatus also detected charged particles and gamma's produced in association with the muon pair. The expected physics results on the hadroproduction of chi states and beauty particles are discussed.
[Show abstract][Hide abstract] ABSTRACT: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection.
A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge.
EPIC II included 1265 intensive care units in 76 countries.
Patients in participating intensive care units on study day.
Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant.
Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use.
Critical care medicine 12/2010; 39(4):665-70. DOI:10.1097/CCM.0b013e318206c1ca · 6.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.
German medical science : GMS e-journal 06/2010; 8:Doc14. DOI:10.3205/000103
[Show abstract][Hide abstract] ABSTRACT: Neuroblastoma (NB) rarely occurs in adults, and less than 10% of the cases occur in patients older than 10 years. Currently, there are no standard treatment guidelines for adult NB patients. We report the case of a young man suffering from NB in adulthood with multiple recurrences. Treatment included multiple resections, chemotherapy, and radiotherapy. This patient remains free of clinical disease more than 7 years after diagnosis.
Case Reports in Oncology 02/2010; 3(1):45-48. DOI:10.1159/000286142