Relationship between haemodynamics and morphology in pulmonary hypertension. A quantitative intravascular ultrasound study

BACKGROUND: Intravascular ultrasound imaging of the pulmonary arteries has been demonstrated to be a reliable method of quantifying vessel diameter, luminal area and pulsatility. Simultaneous measurement of flow velocity and its response to vasodilators allows the relationship between morphology and functional compromise to be studied, especially endothelial dysfunction. METHODS: In 51 patients (mean age = 49.8 +/- 12.6 years, 17 female) we performed right heart catheterization and simultaneous intravascular ultrasound of pulmonary artery branches. The patients were divided in two groups: group 1 with normal pulmonary artery pressure and pulmonary vascular resistance, and group 2 with pulmonary hypertension (peak pulmonary artery pressure > 30 mmHg and/or mean pulmonary artery pressure > 20 mmHg). Vessel wall and lumen were studied using a 2.9 F intravascular ultrasound catheter with a 30 MHz phased array transducer. Measurement of blood flow velocity was accomplished by a Doppler flow wire (0.018 inch). The maximal flow change during acetylcholine infusion (adjusted to 10(-6); 10(-5), and 10(-4) M concentration in the blood vessel) was measured. RESULTS: There were no significant differences between groups 1 and 2 with respect to age (48.5 +/- 14.3 years vs 50.3 +/- 12.3 years; P = ns), gender (4 female/8 male vs 13 female/26 male; P = ns), luminal area of the vessel segment in which the intravascular ultrasound measurements were obtained (11.8 +/- 6.1 mm2 vs 16.7 +/- 14.3 mm2; P = ns), internal diameter (3.9 +/- 1.2 mm vs 4.2 +/- 1.7 mm; P = ns), and external diameter (6.1 +/- 1.3 mm vs 6.9 +/- 2.1 mm; P = ns). Cross-sectional images of the pulmonary artery wall demonstrated a single ring with high echodensity with a thin inner layer regarded as intima in group 1. In contrast, the majority of patients (n = 35/39) in group 2 demonstrated a thickening of the intimal layer and/or a disturbance of layering of the echogenic arterial wall. The relative wall thickness was higher in group 2 than in group 1 (22.5 +/- 10.4% vs 15.3 +/- 6.5%; P < 0.05). There were no significant correlations between pulmonary artery pressure and wall thickness pulmonary artery pressure and area change in the cardiac cycle, acetylcholine-dependent increase in pulmonary flow and morphological changes in the vessel wall. CONCLUSION: We conclude that intravascular ultrasound is capable of detecting morphological changes in the pulmonary vessel wall in pulmonary hypertension and that vessel wall hypertrophy of small pulmonary segment arteries, as detected by intravascular ultrasound, is not predictive of functional vasodilatory response of resistance vessels of the same vessel area.     

Management of multidimensional discrete data

Spatial database management involves two main categories of data: vector and raster data. The former has received a lot of in-depth investigation; the latter still lacks a sound framework. Current DBMSs either regard raster data as pure byte sequences where the DBMS has no knowledge about the underlying semantics, or they do not complement array structures with storage mechanisms suitable for huge arrays, or they are designed as specialized systems with sophisticated imaging functionality, but no general database capabilities (e.g., a query language). Many types of array data will require database support in the future, notably 2-D images, audio data and general signal-time series (1-D), animations (3-D), static or time-variant voxel fields (3-D and 4-D), and the ISO/IEC PIKS (Programmer's Imaging Kernel System) BasicImage type (5-D). In this article, we propose a comprehensive support ofmultidimensional discrete data (MDD) in databases, including operations on arrays of arbitrary size over arbitrary data types. A set of requirements is developed, a small set of language constructs is proposed (based on a formal algebraic semantics), and a novel MDD architecture is outlined to provide the basis for efficient MDD query evaluation.     

Fixed mesh front‐tracking methodology for finite element simulations

A direct front‐tracking method using an Eulerian–Lagrangian formulation is developed in two space dimensions. The front‐tracking method is general in that it can track any type of interface once its local velocity is specified or has been determined by calculation. The method uses marker points to describe the interface position and tracks the interface evolution on a fixed finite‐element mesh, including growth, contraction, splitting and merging. Interfacial conditions are applied directly at the interface position. The method is applied to three scenarios that involve different interface conditions and are based on energy and mass diffusion. The three calculations are for the dendritic solidification of a pure substance, the cellular growth of an alloy, and the Ostwald ripening of silica particles in silicon. Numerical results show that very complicated interface morphologies and topological changes can be simulated properly and efficiently. Copyright © 2004 John Wiley & Sons, Ltd.     

Balloon dilatation in acute myocardial infarct in routine clinical practice: results of the register of the Working Society of Leading Cardiologic Hospital Physicians in 4,625 patients

Balloon angioplasty as the treatment of first choice in the setting of an acute myocardial infarction (AMI) is gaining widespread acceptance because of favourable results from specialised centres concerning high patency rates and low mortality. This study reports the results of angioplasty for AMI at large community hospitals during 1992-1995. 4625 procedures were performed at 68 centres of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhaus?rzte (ALKK). The age of the patients was 60.8 +/- 11.3 years, with 75.1% men. The infarct related artery was the left anterior descendent in 43%, the right coronary artery in 37%, the circumflex artery in 16%, a bypass graft in 2.3% and the left main stem in 1.4% of patients. The success rate (residual stenosis < 50%) of the intervention was 86%. There was a wide range of procedures per centre, with a median of 40 AMI angioplasties per year and centre. The amount of angioplasties for AMI in relation to all angioplasties performed during this period rose from 5.2% in 1992 to 5.9% in 1995 (p = 0.01). Local complications at the puncture site occurred in 3.2%, with the need for a surgical intervention in 1.1% of patients. In 273 (5.9%) of the patients a second angioplasty was performed during the hospital stay. Aortocoronary bypass surgery was performed in 3% of the patients. Hospital mortality was 9.5% (438/4625 patients). The mortality rate remained constant during the years investigated (1992: 10.6%; 1993: 8.6%; 1994: 9.7%; 1995: 9.8%; p = ns). Higher mortality was observed in older patients, patients with multiple vessel disease, the left anterior descending artery or a bypass graft as infarct related artery as well as in patients with failed reperfusion (residual stenoses > 50%). Hospitals with a case load of more than 40 angioplasties for AMI per year showed a lower mortality as compared to the others. In clinical practice at large community hospitals results of angioplasty for AMI concerning mortality, complications and technical success rate are comparable to those of highly specialised centres. The absolute numbers of angioplasties for AMI increased constantly over the years.     

Kinetocardiotocography--follow-up of diazepam poisoning

Report about continuous fetal monitoring of heart rate and movements 9-30 hours after diazepam-intoxication. in an early stage after intoxication fetal movements are associated with FHF-decelerations, later on with accelerations. A sinusoidal like pattern may be caused by fetal suckling movements.     

Uncertainty in Quantitative Electron Probe Microanalysis

Quantitative electron probe analysis is based on models based on the physics or x-ray generation, empirically adjusted to the analyses of specimens of known composition. Their accuracy can be estimated by applying them to a set of specimens of presumably well-known composition.     

Analysis of the Survivability of GaN Low-Noise Amplifiers

This paper presents a detailed analysis of the stressing mechanisms for highly rugged low-noise GaN monolithic-microwave integrated-circuit amplifiers operated at extremely high input powers. As an example, a low-noise amplifier (LNA) operating in the 3-7-GHz frequency band is used. A noise figure (NF) below 2.3 dB is measured from 3.5 to 7 GHz with NF<1.8 dB between 5-7 GHz. This device survived 33 dBm of available RF input power for 16 h without any change in low-noise performance. The stress mechanisms at high input powers are identified by systematic measurements of an LNA and a single high electron-mobility transistor in the frequency and time domains. It is shown that the gate dc current, which occurs due to self-biasing, is the most critical factor regarding survivability. A series resistance in the gate dc feed can reduce this gate current by feedback, and may be used to improve LNA ruggedness     

Synthesis of Aminopyridazines from Aminocyclopropenylium Salts and Diazomethyl Compounds [1]

Amino-substituted cyclopropenylium salts ( 11a,b ) react with diazomethyl compounds ( 12a-i ) in dichloromethane or acetonitrile in the presence of a base (ethyldiisopropylamine, 1,5-diazabicyclo[4.3.0] non-5-ene) to form 4-aminopyridazines ( 13a-i ) specifically. The reaction is interpreted in terms of an initial electrophilic diazoalkane substitution to give diazomethylcyclopropenes ( 11 + 12 → 14 ) which undergo a [1.5]-cyclisation to form the betaines 16 which, in turn, isomerise with opening of the bridging bond to give the aminopyridazines 13 . In a similar manner, the tris[amino] cyclopropenylium salts 8a,b and 10a-c are converted to the 3,4,5-tris[amino]-pyridazines ( 21a-k ) by treatment with diazomethyl compounds ( 12a, c-f ).