Regression of severe atherosclerotic plaque in patients with mild elevation of LDL cholesterol

BACKGROUND: Intensive risk factor reduction in patients with dyslipidemias and coronary atherosclerosis has been shown to result in alterations in coronary artery morphology and reduced clinical events. However, the impact of such interventions in populations with relatively normal levels of low-density lipoproteins (LDL) is unclear. METHODS: To test the hypothesis that intensive risk factor reduction results in angiographic regression in patients with only mildly elevated levels of LDL, 14 patients with angiographically proven coronary atherosclerosis were entered into the University of California Davis Coronary Artery Disease Regression Program and intensively treated with pharmacologic and nonpharmacologic interventions for 2 years. Quantitative angiography was performed prior to and after 2 years of therapy to determine changes in coronary artery diameter. RESULTS: As a result of this program, dietary fat intake was reduced by 58% and LDL fell from 120 +/- 7 mg/dL to 104 +/- 6 mg/dL (p = 0.05). The average diameter of the measured arterial locations (including all 53 stenoses and 292 nondiscrete regions) on study entry was 2.74 +/- 0.05 mm. After 24 months, there was a net increase in arterial diameter (regression) of +0.05 +/- 0.04 mm to 2.81 +/- 0.05 mm (p = 0.01). While there was no significant change in the average diameter of discrete stenoses, all 8 lesions > or = 50% initial diameter narrowing regressed, with a mean diameter change of + 0.2 mm. Conversely, only 1 of 8 mild lesions < or = 20% regressed, while 4 progressed. Intermediate lesions (20% to 50%, n = 37) had balanced progression and regression. CONCLUSIONS: When examined as a continuous variable, there was a significant linear correlation between initial lesion severity (% stenosis) and the extent of regression (mm). Therefore, risk factor reduction (dietary therapy, exercise, psycho-social counseling, and lipid lowering therapy) in patients with only mild dyslipidemia results in angiographic regression of more severe lesions (> 50% initial stenosis), but does not prevent progression of mild lesions (< 20%). These findings demonstrate that intensive risk factor reduction in patients with only mild elevation of lipids beneficially influences the morphology of the most severe lesions.     

An efficient electromagnetic-physics-based numerical technique for modeling and optimization of high-frequency multifinger transistors

We present a fast wavelet-based time-domain modeling technique to study the effect of electromagnetic (EM)-wave propagation on the performance of high-power and high-frequency multifinger transistors. The proposed approach solves the active device model that combines the transport physics, and Maxwell's equations on nonuniform self-adaptive grids, obtained by applying wavelet transforms followed by hard thresholding. This allows forming fine and coarse grids in the locations where variable solutions change rapidly and slowly, respectively. A CPU time reduction of 75% is achieved compared to a uniform-grid case, while maintaining the same degree of accuracy. After validation, the potential of the developed technique is demonstrated by EM-physical modeling of multifinger transistors. Different numerical examples are presented, showing that accurate modeling of high-frequency devices should incorporate the effect of EM-wave propagation and electron-wave interactions within and around the device. Moreover, high-frequency advantages of multifinger transistors over single-finger transistors are underlined through numerical examples. To our knowledge, this is the first time in the literature a fully numerical EM-physics-based simulator for accurate modeling of high-frequency multifinger transistors is introduced and implemented.     

Robust weighted likelihood estimation of exponential parameters

The problem of estimating the parameter of an exponential distribution when a proportion of the observations are outliers is quite important to reliability applications. The method of weighted likelihood is applied to this problem, and a robust estimator of the exponential parameter is proposed. Interestingly, the proposed estimator is an /spl alpha/-trimmed mean type estimator. The large-sample robustness properties of the new estimator are examined. Further, a Monte Carlo simulation study is conducted showing that the proposed estimator is, under a wide range of contaminated exponential models, more efficient than the usual maximum likelihood estimator in the sense of having a smaller risk, a measure combining bias & variability. An application of the method to a data set on the failure times of throttles is presented.     

Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial

OBJECTIVE: We examined the effects of aprotinin on graft patency, prevalence of myocardial infarction, and blood loss in patients undergoing primary coronary surgery with cardiopulmonary bypass. METHODS: Patients from 13 international sites were randomized to receive intraoperative aprotinin (n = 436) or placebo (n = 434). Graft angiography was obtained a mean of 10.8 days after the operation. Electrocardiograms, cardiac enzymes, and blood loss and replacement were evaluated. RESULTS: In 796 assessable patients, aprotinin reduced thoracic drainage volume by 43% (P < .0001) and requirement for red blood cell administration by 49% (P < .0001). Among 703 patients with assessable saphenous vein grafts, occlusions occurred in 15.4% of aprotinin-treated patients and 10.9% of patients receiving placebo (P = .03). After we had adjusted for risk factors associated with vein graft occlusion, the aprotinin versus placebo risk ratio decreased from 1.7 to 1.05 (90% confidence interval, 0.6 to 1.8). These factors included female gender, lack of prior aspirin therapy, small and poor distal vessel quality, and possibly use of aprotinin-treated blood as excised vein perfusate. At United States sites, patients had characteristics more favorable for graft patency, and occlusions occurred in 9.4% of the aprotinin group and 9.5% of the placebo group (P = .72). At Danish and Israeli sites, where patients had more adverse characteristics, occlusions occurred in 23.0% of aprotinin- and 12.4% of placebo-treated patients (P = .01). Aprotinin did not affect the occurrence of myocardial infarction (aprotinin: 2.9%; placebo: 3.8%) or mortality (aprotinin: 1.4%; placebo: 1.6%). CONCLUSIONS: In this study, the probability of early vein graft occlusion was increased by aprotinin, but this outcome was promoted by multiple risk factors for graft occlusion.     

Multi-indicator Active Queue Management Method

A considerable number of applications are running over IP networks. This increased the contention on the network resource, which ultimately results in congestion. Active queue management (AQM) aims to reduce the serious consequences of network congestion in the router buffer and its negative effects on network performance. AQM methods implement different techniques in accordance with congestion indicators, such as queue length and average queue length. The performance of the network is evaluated using delay, loss, and throughput. The gap between congestion indicators and network performance measurements leads to the decline in network performance. In this study, delay and loss predictions are used as congestion indicators in a novel stochastic approach for AQM. The proposed method estimates the congestion in the router buffer and then uses the indicators to calculate the dropping probability, which is responsible for managing the router buffer. The experimental results, based on two sets of experiments, have shown that the proposed method outperformed the existing benchmark algorithms including RED, ERED and BLUE algorithms. For instance, in the first experiment, the proposed method resides in the third-place in terms of delay when compared to the benchmark algorithms. In addition, the proposed method outperformed the benchmark algorithms in terms of packet loss, packet dropping, and packet retransmission. Overall, the proposed method outperformed the benchmark algorithms because it preserves packet loss while maintaining reasonable queuing delay.     

State estimation and experimental verification of a robotic vehicle with six in-wheel drives using Kalman filter

Microsystem Technologies - In this research we present an algorithm for a six-wheeled robotic vehicle with articulated suspension (RVAS) to estimate the vehicle velocity and acceleration states,...     

Modeling and control of a finger-like mechanism using bending shape memory alloys

Microsystem Technologies - In this research a biologically inspired finger-like mechanism similar to human musculoskeletal system is developed based on Shape Memory Alloys (SMAs). SMA actuators are...