Association between atherosclerotic aortic plaques and left ventricular hypertrophy in patients with cerebrovascular events

Background and Purpose - the purpose of this research was to evaluate whether an association exists between the presence of atherosclerotic plaque in the thoracic aorta and left ventricular hypertrophy (LVH) in patients with a cerebrovascular event.Methods - We included 116 consecutive patients ( 79 men; mean age, 62 +/- 12.4 years) with previous history of stroke or transient ischemic attack in a cross-sectional study. Transthoracic echocardiogram was performed to diagnose LVH and transesophageal echocardiogram for the detection of atheromas of the thoracic aorta. Continuous variables were analyzed by Student t or Mann-Whitney tests and categorized variables by Goodman test. From the significant association of LVH and age with atheromatous disease of the aorta, an adjustment to the multivariate logistic model was made using high blood pressure history or age as covariates. All of the statistical tests were carried out at a level of 5% significance.Results - Almost half of the patients (43.1%) presented atherosclerotic lesions in the aorta. LVH was present in 90.0% of patients with plaque and in only 30.3% of patients without plaque. Using high blood pressure as a covariate, the risk of patients with LVH presenting atherosclerotic plaque in the aorta was 18.23-fold greater than the risk for patients without LVH (95% CI, 5.68 to 58.54; P < 0.0001). Adding age into the model, the risk increased to 26.36 ( 95% CI, 7.14 to 97.30; P < 0.0001).Conclusions - LVH detected by conventional echocardiogram is associated with high risk of atherosclerotic plaque in the aorta and would be used as a criterion for indication of transesophageal echocardiography in patients with previous stroke or transient ischemic attack LVH.

Carotid artery atherosclerotic profile as a predictor of the aorta atherosclerotic profile in patients with cerebrovascular events

Background: It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events. We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. Methods: We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ2 test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. Results: All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). Conclusions: The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram. © 2013 S. Karger AG, Basel.

Stroke as the First Clinical Manifestation of Takayasu's Arteritis

Takayasu's arteritis is a chronic inflammatory disease, and neurological symptoms occur in 50% of cases, most commonly including headache, dizziness, visual disturbances, convulsive crisis, transient ischemic attack, stroke and posterior reversible encephalopathy syndrome. The aim of this study was to report the case of a young Brazilian female with a focal neurological deficit. She presented with asymmetry of brachial and radial pulses, aphasia, dysarthria and right hemiplegia. Stroke was investigated extensively in this young patient. Only nonspecific inflammatory markers such as velocity of hemosedimentation and C-reactive protein were elevated. During hospitalization, clinical treatment was performed with pulse therapy showing improvement in neurological recuperation on subsequent days. In the chronic phase, the patient was submitted to medicated angioplasty of the brachiocephalic trunk with paclitaxel, with significant improvement of the stenosis. At the 6-month follow-up, the neurological exam presented mild dysarthria, faciobrachial predominant disproportionate hemiparesis, an NIHSS score of 4 and a modified Rankin Scale score of 3 (moderate incapacity). In conclusion, Takayasu's arteritis must be recognized as a potential cause of ischemic stroke in young females.

Transient bilateral diabetic cataracts in a Brazilian Terrier puppy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Time reduction in a forced-convection thermal process using simplified transient analysis

This study investigates the utilisation of a simplified model in the transient analysis of a thermal cooling process. In such process the external thermal resistance between the surface and the surroundings is high compared to the system internal thermal resistance, so that the first controls the heat transfer process. In this case the Biot number is lower than 0.1. Aluminium reels were utilised, which, with proper internal instrumentation, furnished experimental results for the thermal cooling process. Based on experimental data, a simplified model for the determination of the process film coefficient was used. Subsequently, experimental and theoretical results were compared. The change of the airflow direction was also investigated for the cooling process, aiming at process time optimisation. (C) 2001 Elsevier B.V. Ltd.

Transient stability analysis of electric energy systems via a fuzzy ART-ARTMAP neural network

This work presents a methodology to analyze transient stability (first oscillation) of electric energy systems, using a neural network based on ART architecture (adaptive resonance theory), named fuzzy ART-ARTMAP neural network for real time applications. The security margin is used as a stability analysis criterion, considering three-phase short circuit faults with a transmission line outage. The neural network operation consists of two fundamental phases: the training and the analysis. The training phase needs a great quantity of processing for the realization, while the analysis phase is effectuated almost without computation effort. This is, therefore the principal purpose to use neural networks for solving complex problems that need fast solutions, as the applications in real time. The ART neural networks have as primordial characteristics the plasticity and the stability, which are essential qualities to the training execution and to an efficient analysis. The fuzzy ART-ARTMAP neural network is proposed seeking a superior performance, in terms of precision and speed, when compared to conventional ARTMAP, and much more when compared to the neural networks that use the training by backpropagation algorithm, which is a benchmark in neural network area. (c) 2005 Elsevier B.V. All rights reserved.

Sensitivity analysis by neural networks applied to power systems transient stability

This work presents a procedure for transient stability analysis and preventive control of electric power systems, which is formulated by a multilayer feedforward neural network. The neural network training is realized by using the back-propagation algorithm with fuzzy controller and adaptation of the inclination and translation parameters of the nonlinear function. These procedures provide a faster convergence and more precise results, if compared to the traditional back-propagation algorithm. The adaptation of the training rate is effectuated by using the information of the global error and global error variation. After finishing the training, the neural network is capable of estimating the security margin and the sensitivity analysis. Considering this information, it is possible to develop a method for the realization of the security correction (preventive control) for levels considered appropriate to the system, based on generation reallocation and load shedding. An application for a multimachine power system is presented to illustrate the proposed methodology. (c) 2006 Elsevier B.V. All rights reserved.

Sensitivity analysis for transient stability studies

The paper presents a method for security control of electric power systems effected by generation reallocation, determined by sensitivity analysis and optimisation. The model is developed considering the dynamic aspects of the network (transient stability). Security control methodology is developed using sensitivity analysis of the security margin in relation to the mechanical power of synchronous machines in the system. The power reallocated to each machine is determined by means of linear programming. To illustrate the proposed methodology, an example is presented which considers a multimachine system composed of 10 synchronous machines, 45 buses, and 72 transmission lines, based on the configuration of a southern Brazilian system.

Neural network based on adaptive resonance theory with continuous training for multi-configuration transient stability analysis of electric power systems

This work presents a methodology to analyze electric power systems transient stability for first swing using a neural network based on adaptive resonance theory (ART) architecture, called Euclidean ARTMAP neural network. The ART architectures present plasticity and stability characteristics, which are very important for the training and to execute the analysis in a fast way. The Euclidean ARTMAP version provides more accurate and faster solutions, when compared to the fuzzy ARTMAP configuration. Three steps are necessary for the network working, training, analysis and continuous training. The training step requires much effort (processing) while the analysis is effectuated almost without computational effort. The proposed network allows approaching several topologies of the electric system at the same time; therefore it is an alternative for real time transient stability of electric power systems. To illustrate the proposed neural network an application is presented for a multi-machine electric power systems composed of 10 synchronous machines, 45 buses and 73 transmission lines. (C) 2010 Elsevier B.V. All rights reserved.

Transient and d.c. analysis of the operation mechanism of light-emitting electrochemical cells

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sudden changes in chaotic attractors and transient basins in a model for rattling in gearboxes

We consider a model for rattling in single-stage gearbox systems with some backlash consisting of two wheels with a sinusoidal driving; the equations of motions are analytically integrated between two impacts of the gear teeth. Just after each impact, a mapping is used to obtain the dynamical variables. We have observed a rich dynamical behavior in such system, by varying its control parameters, and we focus on intermittent switching between laminar oscillations and chaotic bursting, as well as crises, which are sudden changes in the chaotic behavior. The corresponding transient basins in phase space are found to be riddled-like, with a highly interwoven fractal structure. (C) 2004 Elsevier Ltd. All rights reserved.

Boundary crisis and transient in a dissipative relativistic standard map

Some dynamical properties for a problem concerning the acceleration of particles in a wave packet are studied. The model is described in terms of a two-dimensional nonlinear map obtained from a Hamiltonian which describes the motion of a relativistic standard map. The phase space is mixed in the sense that there are regular and chaotic regions coexisting. When dissipation is introduced, the property of area preservation is broken and attractors emerge. We have shown that a tiny increase of the dissipation causes a change in the phase space. A chaotic attractor as well as its basin of attraction are destroyed thereby leading the system to experience a boundary crisis. We have characterized such a boundary crisis via a collision of the chaotic attractor with the stable manifold of a saddle fixed point. Once the chaotic attractor is destroyed, a chaotic transient described by a power law with exponent 1 is observed. (C) 2011 Elsevier B.V. All rights reserved.

End-systolic pressure-diameter relation of the left ventricle during transient and sustained elevations of blood pressure

OBJECTIVE: To assess the effect of transient and sustained variations in cardiac load on the values of the end-systolic pressure-diameter relation (ESPDR) of the left ventricle. METHODS: We studied 13 dogs under general anesthesia and autonomic blockade. Variations of cardiac loads were done by elevation of blood pressure by mechanical constriction of the aorta. Two protocols were used in each animal: gradual peaking and decreasing pressure variation, the transient arterial hypertension protocol (TAH), and a quick and 10 min sustained elevation, the sustained arterial hypertension protocol(SAH). Then, we compared the ESDR in these two situations. RESULTS: Acute elevation of arterial pressure, being it transitory or sustained, did not alter the heart frequency and increased similarly the preload and after load. However, they acted differently in end systolic pressure-diameter relation. It was greater in the SAH than TAH protocol, 21.0±7.3mmHg/mm vs. 9.2±1.2mmHg/mm (p<0.05). CONCLUSION: The left ventricular ESPDR values determined during sustained pressure elevations were higher than those found during transient pressure elevations. The time-dependent activation of myocardial contractility associated with the Frank-Starling mechanism is the major factor in inotropic stimulation during sustained elevations of blood pressure, determining an increase in the ESPDR values.

Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia

A hiperbilirrubinemia é tóxica às vias auditivas e ao sistema nervoso central, deixando sequelas como surdez e encefalopatia. OBJETIVOS: avaliar a audição de neonatos portadores de hiperbilirrubinemia, utilizando-se a pesquisa das emissões otoacústicas evocadas transientes (EOAET) e dos potenciais evocados auditivos do tronco encefálico (PEATE). Estudo prospectivo. CASUÍSTICA E MÉTODOS: Constituíram-se dois grupos: GI (n-25), neonatos com hiperbilirrubinemia; GII (n-22), neonatos sem hiperbilirrubinemia e sem fatores de risco para surdez. Todos os neonatos tinham até 60 dias de vida e foram submetidos à EOAET e ao PEATE. RESULTADOS: 12 neonatos de GI e 10 de GII eram meninas e 13 de GI e 12 de GII eram meninos. As EOAET estavam presentes em todas as crianças, porém com amplitudes menores em GI, especialmente nas frequências de 2 e 3KHz (p < 0,05). No PEATE, observou-se discreto prolongamento de PV e de LI-V em GI. As alterações observadas nesses testes não se correlacionaram aos níveis séricos da bilirrubinemia. CONCLUSÕES: em neonatos portadores de hiperbilirrubinemia, menores amplitudes das EOAET e discreto prolongamento de PV e de LI-V foram constatados indicando comprometimento coclear e retrococlear das vias auditivas, salientando-se a importância da utilização e da interpretação minuciosa de ambos os testes nessas avaliações.

Does propofol and isoflurane protect the kidney against ischemia/reperfusion injury during transient hyperglycemia?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)