Preliminary Results of a Prospective Randomized Trial of Restrictive Versus Standard Fluid Regime in Elective Open Abdominal Aortic Aneurysm Repair

Background: Open abdominal aortic aneurysm (AAA) repair is associated with a significant morbidity (primarily respiratory and cardiac complications) and an overall mortality rate of 4% to 10%. We tested the hypothesis that perioperative fluid restriction would reduce complications and improve outcome after elective open AAA repair.

The Influence of COX-2 Single Nucleotide Polymorphisms on Abdominal Aortic Aneurysm Development and the Associated Inflammation

Introduction: Cyclooxygenase (COX)-2 influences cardiovascular disease and serum concentration of high-sensitivity C-reactive protein (hsCRP). The study purpose was to determine the influence of single nucleotide polymorphisms (SNPs) of the COX-2 gene on abdominal aortic aneurysm (AAA) development and serum hsCRP concentrations. Patients and Methods: Patients with AAA and disease-free controls were recruited. High-sensitivity C-reactive protein was measured by an enzyme-linked immunosorbent assay (ELISA) test. The distributions of COX-2 SNPs were investigated (rs20417 and rs4648307). The influence of the COX-2 SNPs on the hsCRP serum concentration was assessed.Results: A total of 230 patients with AAA and 279 controls were included. No difference was found in the genotype distribution of the COX-2 SNPs rs20417 (P = .26) and rs4648307 (P = .90). They did not influence the hsCRP concentration (P = .24 and P = .61, respectively). Haplotype analysis of COX-2 SNPs revealed no difference. Conclusion: These COX-2 SNPs do not play any role in AAA development and do not influence serum hsCRP. These results differentiate AAA development from atherosclerotic diseases.

Retroperitoneal Approach to Abdominal Aortic Aneurysm Repair Preserves Splanchnic Perfusion as Measured by Gastric Tonometry

Background: We investigated if minimizing bowel manipulation and mesenteric traction using the retroperitoneal approach in open abdominal aortic aneurysm (AAA) repair preserves splanchnic perfusion, as measured by gastric tonometry, and reduces the systemic inflammatory response and dysfunction of the various organs.

Retroperitoneal Repair of Abdominal Aortic Aneurysm Reduces Bowel Dysfunction

Objective: To assess the effect of intestinal manipulation and mesenteric traction on gastro-intestinal function and postoperative recovery in patients undergoing abdominal aortic aneurysm (AAA) repair. Methods: Thirty-five patients undergoing AAA repair were randomised into 3 groups. Group I (n = II) had repair via retroperitoneal approach while Group II (n = 12) and Group III (n = 12) were repaired via transperitoneal approach with bowel packed within the peritoneal cavity or exteriorised in a bowel bag respectively. Gastric emptying was measured pre-operatively (day 0), day 1 and day 3 using paracetamol absorption test (PAT) and area under curve (P-AUC) was calculated. Intestinal permeability was measured using the Lactulose-Mannitol test. Results: Aneurysm size, operation time and PAT (on day 0 and day 3) were similar in the three groups. On day 1, the P-AUC was significantly higher in Group I, when compared with Group II and Group III (P = .02). Resumption of diet was also significantly earlier in Group I as compared to Group II and Group III. The intestinal permeability was significantly increased in Group II and Group III at day 1 when compared with day 0, with no significant increase in Group I. Retroperitoneal repair was also associated with significantly shorter intensive care unit (P = .04) and hospital stay (P = .047), when compared with the combined transperitoneal repair group (Group II and III). Conclusion: Retroperitoneal AAA repair minimises intestinal dysfunction and may lead to quicker patient recovery when compared to transperitoneal repair.

Formulation of Locally Reacting Surfaces in FDTD/K-DWM Modelling of Acoustic Spaces

In this paper, we present new methods for constructing and analysing formulations of locally reacting surfaces that can be used in finite difference time domain (FDTD) simulations of acoustic spaces. Novel FDTD formulations of frequency-independent and simple frequency-dependent impedance boundaries are proposed for 2D and 3D acoustic systems, including a full treatment of corners and boundary edges. The proposed boundary formulations are designed for virtual acoustics applications using the standard leapfrog scheme based on a rectilinear grid, and apply to FDTD as well as Kirchhoff variable digital waveguide mesh (K-DWM) methods. In addition, new analytic evaluation methods that accurately predict the reflectance of numerical boundary formulations are proposed. numerical experiments and numerical boundary analysis (NBA) are analysed in time and frequency domains in terms of the pressure wave reflectance for different angles of incidence and various impedances. The results show that the proposed boundary formulations structurally adhere well to the theoretical reflectance. In particular, both reflectance magnitude and phase are closely approximated even at high angles of incidence and low impedances. Furthermore, excellent agreement was found between the numerical boundary analysis and the experimental results, validating both as tools for researching FDTD boundary formulations.

Abdominal aortic aneurysm is associated with a variant in low-density lipoprotein receptor-related protein 1

Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significant heritability. We carried out a genome-wide association discovery study of 1866 patients with AAA and 5435 controls and replication of promising signals (lead SNP with a p value < 1 × 10 -5) in 2871 additional cases and 32,687 controls and performed further follow-up in 1491 AAA and 11,060 controls. In the discovery study, nine loci demonstrated association with AAA (p < 1 × 10 -5). In the replication sample, the lead SNP at one of these loci, rs1466535, located within intron 1 of low-density-lipoprotein receptor-related protein 1 (LRP1) demonstrated significant association (p = 0.0042). We confirmed the association of rs1466535 and AAA in our follow-up study (p = 0.035). In a combined analysis (6228 AAA and 49182 controls), rs1466535 had a consistent effect size and direction in all sample sets (combined p = 4.52 × 10 -10, odds ratio 1.15 [1.10-1.21]). No associations were seen for either rs1466535 or the 12q13.3 locus in independent association studies of coronary artery disease, blood pressure, diabetes, or hyperlipidaemia, suggesting that this locus is specific to AAA. Gene-expression studies demonstrated a trend toward increased LRP1 expression for the rs1466535 CC genotype in arterial tissues; there was a significant (p = 0.029) 1.19-fold (1.04-1.36) increase in LRP1 expression in CC homozygotes compared to TT homozygotes in aortic adventitia. Functional studies demonstrated that rs1466535 might alter a SREBP-1 binding site and influence enhancer activity at the locus. In conclusion, this study has identified a biologically plausible genetic variant associated specifically with AAA, and we suggest that this variant has a possible functional role in LRP1 expression.

Investigation on localisation accuracy for first and higher order ambisonics reproduced sound sources

Ambisonics and higher order ambisonics (HOA) technologies aim at reproducing sound field either synthesised or previously recorded with dedicated microphones. Based on a spherical harmonic decomposition, the sound field is more precisely described when higher-order components are used. The presented study evaluated the perceptual and objective localisation accuracy of the sound field encoded with four microphones of order one to four and decoded over a ring of loudspeakers. A perceptual test showed an improvement of the localisation with higher order ambisonic microphones. Reproduced localisation indices were estimated for the four microphones and the respective synthetic systems of order one to four. The perceptual and objective analysis revealed the same conclusions. The localisation accuracy depends on the ambisonic order as well as the source incidence. Furthermore, impairments linked to the microphones were highlighted.

Estimation of Clarinet Reed Parameters by Inverse Modelling

Analysis of the acoustical functioning of musical instruments invariably involves the estimation of model parameters. The broad aim of this paper is to develop methods for estimation of clarinet reed parameters that are representative of actual playing conditions. This presents various challenges because of the di?culties of measuring the directly relevant variables without interfering with the control of the instrument. An inverse modelling approach is therefore proposed, in which the equations governing the sound generation mechanism of the clarinet
are employed in an optimisation procedure to determine the reed parameters from the mouthpiece pressure and volume ?ow signals. The underlying physical model captures most of the reed dynamics and is simple enough to be used in an inversion process. The optimisation procedure is ?rst tested by applying it to numerically synthesised signals, and then applied to mouthpiece signals acquired during notes blown by a human player. The proposed inverse modelling approach raises the possibility of revealing information about the way in which the embouchure-related reed parameters are controlled by the player, and also facilitates physics-based re-synthesis of clarinet sounds.

A single microphone capillary-based system for measuring the complex input impedance of musical wind instruments

Capillary-based systems for measuring the input impedance of musical wind instruments were first developed in the mid-20th century and remain in widespread use today. In this paper, the basic principles and assumptions underpinning the design of such systems are examined. Inexpensive modifications to a capillary-based impedance measurement set-up made possible due to advances in computing and data acquisition technology are discussed. The modified set-up is able to measure both impedance magnitude and impedance phase even though it only contains one microphone. In addition, a method of calibration is described that results in a significant improvement in accuracy when measuring high impedance objects on the modified capillary-based system. The method involves carrying out calibration measurements on two different objects whose impedances are well-known theoretically. The benefits of performing two calibration measurements (as opposed to the one calibration measurement that has been traditionally used) are demonstrated experimentally through input impedance measurements on two test objects and a Boosey and Hawkes oboe. © S. Hirzel Verlag · EAA.

A Variant in LDLR is Associated with Abdominal Aortic Aneurysm

Background—Abdominal aortic aneurysm (AAA) is a common cardiovascular disease among older people and demonstrates significant heritability. In contrast to similar complex diseases, relatively few genetic associations with AAA have been confirmed. We reanalysed our genome-wide study and carried through to replication suggestive discovery associations at a lower level of significance.

Methods and Results—A genome-wide association study was conducted using 1,830 cases from the UK, New Zealand and Australia with infra-renal aorta diameter =30mm or ruptured AAA and 5,435 unscreened controls from the 1958 Birth Cohort and National Blood Service cohort from the Wellcome Trust Case Control Consortium. Eight suggestive associations with P<1x10-4 were carried through to in silico replication in 1,292 AAA cases and 30,503 controls. One SNP associated with P<0.05 after Bonferroni correction in the in silico study underwent further replication (706 AAA cases and 1,063 controls from the UK, 507 AAA cases and 199 controls from Denmark and 885 AAA cases and 1,000 controls from New Zealand). Low density lipoprotein receptor (LDLR) rs6511720 A, was significantly associated overall and in three of five individual replication studies. The full study showed an association that reached genome-wide significance (odds ratio 0.76; 95% confidence interval 0.70 to 0.83; P=2.08x10-10).

Conclusions—LDLR rs6511720 is associated with abdominal aortic aneurysm. This finding is consistent with established effects of this variant on coronary artery disease. Shared aetiological pathways with other cardiovascular diseases may present novel opportunities for preventative and therapeutic strategies for AAA.

Off-Centre Localisation Performance of Ambisonics and HOA For Large and Small Loudspeaker Array Radii

Ambisonics and Higher Order Ambisonics (HOA) are scalable spatial audio techniques that attempt to present a sound scene to listeners over as large an area as possible. A localisation experiment was carried out to investigate the performance of a first and third order system at three listening positions - one in the centre and two off-centre - using a 5 m radius loudspeaker array. The results are briefly presented and compared to those of an earlier experiment on a 2.2 m loudspeaker array. In both experiments the off-centre listeners were placed such that the ratio of distance from the centre to the array radius was constant in both experiments. The test used a reverse target-pointer adjustment method to determine the error, both signed and absolute, for each combination of listening position and system. The results for both arrays were found to be very similar, suggesting that the relative amplitude of the loudspeakers, which were the same in both cases, was more dominant for localisation than the arrival time differences, which differed between array sizes.