The hemodynamic effects of in-tandem carotid artery stenosis: Implications for carotid endarterectomy

Objectives: It remains controversial whether patients with severe disease of the internal carotid artery and a coexisting stenotic lesion downstream would benefit from a carotid endarterectomy (CEA) of the proximal lesion. The aim of this study was to simulate the hemodynamic and wall shear effects of in-tandem internal carotid artery stenosis using a computational fluid dynamic (CFD) idealized model to give insight into the possible consequences of CEA on these lesions. Methods: A CFD model of steady viscous flow in a rigid tube with two asymmetric stenoses was introduced to simulate blood flow in arteries with multiple constrictions. The effect of varying the distance between the two stenoses, and the severity of the upstream stenosis on the pressure and wall shear stress (WSS) distributions on the second plaque, was investigated. The influence of the relative positions of the two stenoses was also assessed. Results: The distance between the plaques was found to have minimal influence on the overall hemodynamic effect except for the presence of a zone of low WSS (range -20 to 30 dyne/cm2) adjacent to both lesions when the two stenoses were sufficiently close (<4 times the arterial diameter). The upstream stenosis was protective if it was larger than the downstream stenosis. The relative positions of the stenoses were found to influence the WSS but not the pressure distribution. Conclusions: The geometry and positions of the lesions need to be considered when considering the hemodynamic effects of an in-tandem stenosis. Low WSS is thought to cause endothelial dysfunction and initiate atheroma formation. The fact that there was a flow recirculation zone with low WSS in between the two stenoses may demonstrate how two closely positioned plaques may merge into one larger lesion. Decision making for CEA may need to take into account the hemodynamic situation when an in-tandem stenosis is found. CFD may aid in the risk stratification of patients with this problem.

Utility of USPIO-enhanced MR imaging to identify inflammation and the fibrous cap: A comparison of symptomatic and asymptomatic individuals

Background and purpose: Inflammation is a risk factor the vulnerable atheromatous plaque. This can be detected in vivo on high-resolution magnetic resonance (MR) imaging using a contrast agent, Sinerem™, an ultra-small super-paramagnetic iron oxide (USPIO). The aim of this study was to explore whether there is a difference in the degree of MR defined inflammation using USPIO particles, between symptomatic and asymptomatic carotid plaques. We report further on its T1 effect of enhancing the fibrous cap, which may allow dual contrast resolution of carotid atheroma. Methods: Twenty patients with carotid stenosis (10 symptomatic and 10 asymptomatic) underwent multi-sequence MR imaging before and 36 h post-USPIO infusion. Images were manually segmented into quadrants and signal change in each quadrant was calculated following USPIO administration. Mean signal change across all quadrants were compared between the two groups. Results: Symptomatic patients had significantly more quadrants with a signal drop than asymptomatic individuals (75% vs. 32%, p < 0.01). Asymptomatic plaques had more quadrants with signal enhancement than symptomatic ones (68% vs. 25%, p < 0.05); their mean signal change was also higher (46% vs. 15%, p < 0.01) and this appeared to correlate with a thicker fibrous cap on histology. Conclusions: Symptomatic patients had more quadrants with signal drop suggesting larger inflammatory infiltrates. Asymptomatic individuals showed significantly more enhancement possibly suggesting greater stability as a result of thicker fibrous caps. However, some asymptomatic plaques also had focal areas of signal drop, suggesting an occult macrophage burden. If validated by larger studies, USPIO may be a useful dual contrast agent able to improve risk stratification of patients with carotid stenosis and inform selection for intervention.

Characterisation of carotid atheroma in symptomatic and asymptomatic patients using high resolution MRI

Background and purpose: To prospectively evaluate differences in carotid plaque characteristics in symptomatic and asymptomatic patients using high resolution MRI. Methods: 20 symptomatic and 20 asymptomatic patients, with at least 50% carotid stenosis as determined by Doppler ultrasound, underwent preoperative in vivo multispectral MRI of the carotid arteries. Studies were analysed both qualitatively and quantitatively in a randomised manner by two experienced readers in consensus, blinded to clinical status, and plaques were classified according to the modified American Heart Association (AHA) criteria. Results: After exclusion of poor quality images, 109 MRI sections in 18 symptomatic and 19 asymptomatic patients were available for analysis. There were no significant differences in mean luminal stenosis severity (72.9% vs 67.6%; p = 0.09) or plaque burden (median plaque areas 50 mm2 vs 50 mm 2; p = 0.858) between the symptomatic and asymptomatic groups. However, symptomatic lesions had a higher incidence of ruptured fibrous caps (36.5% vs 8.7%; p = 0.004), haemorrhage or thrombus (46.5% vs 14.0%; p<0.001), large necrotic lipid cores (63.8% vs 28.0%; p = 0.002) and complicated type VI AHA lesions (61.5% vs 28.1%; p = 0.001) compared with asymptomatic lesions. The MRI findings of plaque haemorrhage or thrombus had an odds ratio of 5.25 (95% CI 2.08 to 13.24) while thin or ruptured fibrous cap (as opposed to a thick fibrous cap) had an odds ratio of 7.94 (95% CI 2.93 to 21.51) for prediction of symptomatic clinical status. Conclusions: There are significant differences in plaque characteristics between symptomatic and asymptomatic carotid atheroma and these can be detected in vivo by high resolution MRI.

In vivo positive contrast IRON sequence and quantitative T2* measurement confirms inflammatory burden in a patient with asymptomatic carotid atheroma after USPIO-enhanced MR Imaging

The authors report an in vivo human examination of carotid atheroma by using the inversion-recovery ON resonance (IRON) sequence, which is able to produce positive contrast after the infusion of an ultrasmall super paramagnetic iron oxide (USPIO) contrast medium. This technique provides a method of potentially identifying inflammatory burden within carotid atheroma. This may be particularly useful in patients who currently do not meet criteria for intervention (ie, moderate symptomatic stenosis or <70% asymptomatic stenosis) to further risk-stratify this important patient cohort. A 63-year-old man was imaged at 1.5 T before and 36 hours after USPIO infusion by using the IRON sequence. Regions of interest showing profound signal loss at T2*-weighted imaging corresponded well with regions of positive contrast at IRON imaging after the administration of USPIO. These regions also showed a profound decrease in T2* measurements after USPIO infusion, whereas surrounding tissue did not. It has been shown that such strong signal loss on T2*-weighted images after USPIO infusion is indicative of USPIO uptake.

Low PAPR Square STBCs from Complex Partial-Orthogonal Designs (CPODs)

Space-time codes from complex orthogonal designs (CODs) with no zero entries offer low Peak to Average Power Ratio (PAPR) and avoid the problem of switching off antennas. But square CODs for 2(a) antennas with a + 1. complex variables, with no zero entries were discovered only for a <= 3 and if a + 1 = 2(k), for k >= 4. In this paper, a method of obtaining no zero entry (NZE) square designs, called Complex Partial-Orthogonal Designs (CPODs), for 2(a+1) antennas whenever a certain type of NZE code exists for 2(a) antennas is presented. Then, starting from a so constructed NZE CPOD for n = 2(a+1) antennas, a construction procedure is given to obtain NZE CPODs for 2n antennas, successively. Compared to the CODs, CPODs have slightly more ML decoding complexity for rectangular QAM constellations and the same ML decoding complexity for other complex constellations. Using the recently constructed NZE CODs for 8 antennas our method leads to NZE CPODs for 16 antennas. The class of CPODs do not offer full-diversity for all complex constellations. For the NZE CPODs presented in the paper, conditions on the signal sets which will guarantee full-diversity are identified. Simulation results show that bit error performance of our codes is same as that of the CODs under average power constraint and superior to CODs under peak power constraint.

Short-term nutritional supplementation during management of pulmonary exacerbations in cystic fibosis: A controlled study, including effects of protein turnover

Effects of nutritional supplements on minimizing weight loss and abnormalities of protein turnover during pulmonary exacerbations in cystic fibrosis (CF) were studied by controlled trial. Patients received pulmonary therapy and either standard diet (n = 10) or adjunctive enteral supplements (n = 12). Initial protein turnover, measured by [15N]glycine kinetics, showed alterations of protein synthesis (P Syn) and catabolism (P Cat), which correlated with the degree of underweight, and negligible net protein deposition (P Dep). With treatment both groups had significant increases in mean body weight and forced expiratory volume in 1 s, expressed as percent predicted value for height (FEV1) by 3 wk, but a significant correlation between initial underweight and subsequent weight gain was observed only in supplemented patients. Mean P Syn and P Dep increased significantly (p < 0.001) only in the supplemented group. Pulmonary exacerbations in CF have important adverse effects on body-protein metabolism, similar to changes in protein-energy malnutrition and infection. These effects are reversed by short-term nutritional support. Strategic nutritional intervention should thus be considered in management, especially in malnourished patients.

The use of a synthetic prostaglandin e1 analogue (misoprostol) as an adjunct to pancreatic enzyme replacement in cystic fibrosis

Eleven cystic fibrosis children (mean age, 9.6 years) were chosen at random to participate in a study to observe the effects of concurrently stimulating gastric/duodenal bicarbonate secretion and inhibiting gastric acid secretion, using a methylated prostaglandin E1 analogue in patients with pancreatic insufficiency and taking pancreatic enzymes. Percentage fat absorption in 3-day stool collections were calculated before and after commencing therapy with misoprostol, 400 μg/day in divided doses. We found a significant reduction in fat output (14.7 ± 11.7 versus 7.5 ± 3.5 g/day, p < 0.05) in the study group as a whole and a significant reduction in steatorrhoeic level as a percentage of fat intake in all of the patients with abnormal base-line collections (23.1% versus 9.2% p < 0.002). We conclude that misoprostol should be considered in cystic fibrosis patients with steatorrhoea as a means of improving nutrient absorption. © 1988 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Aavan meren täällä puolen : Arkkityyppiset piirteet ja amerikkalaisvaikutteet suosituimmissa suomalaisissa molli-iskelmissä

What are the musical features that turn a song into a hit? The aim of this research is to explore the musical features of hit tunes by studying the 224 most popular Finnish evergreens from the 1930s to the 1990s. It is remarkable, that 80-90% of Finnish oldies are in a minor key, though parallel major keys have also been widely employed within single pieces through, for example, modulations. Furthermore, melodies are usually diatonic, staying mostly in the same key. Consequently, chromatically altered tones in the melody and short modulations in the bridge sections become more prominent. I have concentrated in particular on the melodic lines in order to find the most typical melodic formulas from the data. These analyzed melodic formulas play an important role, because they serve as leading phrases and punchlines in songs. Analysis has revealed three major melodic formulas, which most often appear in the melodic lines of hit tunes. All of these formulas share common thematic ground, because they originate from the triadic tonic chord. Because the tonic chord is the most conventional opening chord in the verse parts, it is logical that these formulas occur most often in verses. The strong dominance of these formulas is very much a result of the rhythmic flexibility they possess; for instance, they can be found in every musical style from waltz to foxtrot. Alongside the major formulas lies a miscellaneous group of other tonic-related melodic formulas. One group of melodic formulas consists of melodic quotations. These quotations appear in a different musical context, for instance in a harmonically altered form, and are therefore often difficult to recognize as such. Yet despite the contextual manipulation, the distinctive character of the cited melody usually remains the same. Composers have also made use of certain popular chord-progressions in order to create new but familiar-sounding melodies. The most important individual progression in this case is what is known as a "circle of fifths" and its shortened, prolonged and altered versions. Because that progression is harmonically strong, it is also a contrastive tool used especially in chorus parts and middle sections (AABA). I have also paid attention to ragtime and jazz influences, which can be found in harmony parts and certain melody notes, which extend, suspend or alter the accompaning chords. Other influences from jazz and ragtime in the Finnish evergreen are evident in the use of typical Tin Pan Alley popular song forms. The most important is the AABA form, which dominates over the data along with the verse/chorus-type popular song form. To briefly illustrate the main results, the basic concept of the hit tune can be traced back to Tin Pan Alley songs, whereas the major stylistic aspects, such as minor keys and musical styles, bear influences from Russian, Western European, and Finnish traditions.

Estimation of cosmological parameters from neutral hydrogen observations of the post-reionization epoch

The emission from neutral hydrogen (HI) clouds in the post-reionization era (z <= 6), too faint to be individually detected, is present as a diffuse background in all low frequency radio observations below 1420MHz. The angular and frequency fluctuations of this radiation (similar to 1 mK) are an important future probe of the large-scale structures in the Universe. We show that such observations are a very effective probe of the background cosmological model and the perturbed Universe. In our study we focus on the possibility of determining the redshift-space distortion parameter beta, coordinate distance r(nu), and its derivative with redshift r(nu)('). Using reasonable estimates for the observational uncertainties and configurations representative of the ongoing and upcoming radio interferometers, we predict parameter estimation at a precision comparable with supernova Ia observations and galaxy redshift surveys, across a wide range in redshift that is only partially accessed by other probes. Future HI observations of the post-reionization era present a new technique, complementing several existing ones, to probe the expansion history and to elucidate the nature of the dark energy.

On the Cubicity of Interval Graphs

A k-cube (or ``a unit cube in k dimensions'') is defined as the Cartesian product R-1 x . . . x R-k where R-i (for 1 <= i <= k) is an interval of the form [a(i), a(i) + 1] on the real line. The k-cube representation of a graph G is a mapping of the vertices of G to k-cubes such that the k-cubes corresponding to two vertices in G have a non-empty intersection if and only if the vertices are adjacent. The cubicity of a graph G, denoted as cub(G), is defined as the minimum dimension k such that G has a k-cube representation. An interval graph is a graph that can be represented as the intersection of intervals on the real line - i. e., the vertices of an interval graph can be mapped to intervals on the real line such that two vertices are adjacent if and only if their corresponding intervals overlap. We show that for any interval graph G with maximum degree Delta, cub(G) <= inverted right perpendicular log(2) Delta inverted left perpendicular + 4. This upper bound is shown to be tight up to an additive constant of 4 by demonstrating interval graphs for which cubicity is equal to inverted right perpendicular log(2) Delta inverted left perpendicular.

Production of microalgal concentrates by flocculation and their assessment as aquaculture feeds

A novel technique was developed for the flocculation of marine microalgae commonly used in aquaculture. The process entailed an adjustment of pH of culture to between 10 and 10.6 using NaOH, followed by addition of a non-ionic polymer Magnafloc LT-25 to a final concentration of 0.5 mg L-1. The ensuing flocculate was harvested, and neutralised giving a final concentration factor of between 200- and 800-fold. This process was successfully applied to harvest cells of Chaetoceros calcitrans, C. muelleri, Thalassiosira pseudonana, Attheya septentrionalis, Nitzschia closterium, Skeletonema sp., Tetraselmis suecica and Rhodomonas salina, with efficiencies >=80%. The process was rapid, simple and inexpensive, and relatively cost neutral with increasing volume (cf. concentration by centrifugation). Harvested material was readily disaggregated to single cell suspensions by dilution in seawater and mild agitation. Microscopic examination of the cells showed them to be indistinguishable from corresponding non-flocculated cells. Chlorophyll analysis of concentrates prepared from cultures of Concentrates of T. pseudonana prepared using pH-induced flocculation gave better growth of juvenile Pacific oysters (Crassostrea gigas) than concentrates prepared by ferric flocculation, or centrifuged concentrates using a cream separator or laboratory centrifuge. In follow up experiments, concentrates prepared from 1000 L Chaetoceros muelleri cultures were effective as supplementary diets to improve the growth of juvenile C. gigas and the scallop Pecten fumatus reared under commercial conditions, though not as effective as the corresponding live algae. The experiments demonstrated a proof-of-concept for a commercial application of concentrates prepared by flocculation, especially for use at a remote nursery without on-site mass-algal culture facilities.

Kokoomus, Kekkonen ja NKP:n luottamus : Kansallisen Kokoomuksen toiminta hallitusaseman saavuttamiseksi 1969-1981

Tutkielmani käsittelee Kokoomuksen suhdetta presidentti Urho Kekkoseen ja Neuvostoliiton Kommunistiseen puolueeseen NKP:hen. Tutkielmassa selvitetään, mitä kokoomuslaiset poliitikot tekivät näiden suhteiden kehittämiseksi ja puolueensa hallitusaseman saavuttamiseksi vuosina 1969-1981. Suomi solmi toisen maailmansodan jälkeen yya-sopimuksen Neuvostoliiton kanssa ja sitoutui noudattamaan ystävällismielistä politiikkaa Neuvostoliittoa kohtaan. Presidentti J. K. Paasikiven kaudella (1946-56) aloitettu ystävyyspolitiikka oli kehittynyt varsin pitkälle 1960-luvun loppuun mennessä. Vuonna 1956 presidentiksi valitun Urho Kekkosen johdolla hyvistä neuvostosuhteista muodostui Suomessa huipputason politiikan teon edellytys. Kekkonen vaati ehdotonta kuuliaisuutta Paasikivi-Kekkosen ulkopoliittiselle linjalle, niin puolueilta kuin yksittäisiltä poliitikoiltakin. Tämän linjan noudattaminen merkitsi Neuvostoliiton arvostelusta pidättäytymistä ja sitä kautta luottamusta Kekkosen ja NKP:n piirissä. Suomettumisen kaudeksi kutsuttuna aikana 1960-70-luvuilla Kokoomuksen asema oli erityisen vaikea, sillä tietyt puolueen poliitikot jatkoivat Kekkosen ja NL:n arvostelua. Muut keskeiset puolueet olivat päässeet Kekkosen ja Neuvostoliiton suosioon, mutta Kokoomusta ei näiden taholta hyväksytty hallituspuolueeksi vuoden 1966 jälkeen. Suurista puolueista SDP lunasti ulkopoliittisen luottamuksen Kekkoselta ja NKP:ltä 1966, eikä Kokoomusta enää välttämättä tarvittu enemmistöhallituksiin Keskustapuolueen pariksi. Kokoomuksen nuorempi polvi ymmärsi, että vaalimenestyksestä riippumatta hallitusasemaa ei enää saavuteta ilman Kekkosen ja NKP:n luottamusta. Vanhempi polvi puolestaan vastusti Urho Kekkosta ja hänen johdollaan kehittynyttä poliittista kulttuuria. Kokoomuksessa alkoi vuonna 1969 taistelu suhtautumisesta Kekkosen presidenttiyteen ja toiminta puolueen neuvostosuhteiden parantamiseksi. Tutkielma perustuu Porvarillisen Työn Arkiston lähdemateriaaliin, aiheesta julkaistuun kirjallisuuteen, Urho Kekkosen päiväkirjoihin ja arkistomateriaaliin sekä henkilöhaastatteluihin.

Aspects of reproduction and diet of the Australian endemic skate Dipturus polyommata (Ogilby) (Elasmobranchii: Rajidae), by-catch of a commercial prawn trawl fishery

The Australian endemic skate Dipturus polyommata collected from by-catch of a benthic prawn fishery off southern Queensland was examined to provide information on reproduction and diet. Morphological relationships of total length (LT) to disc width and LT to mass were estimated. Size at birth was estimated at c. 100-110 mm and size at first feeding at c. 105-110 mm LT. Size at 50% maturity (LT50 and 95% CI) was 321 (305-332) and 300 (285-306) mm LT for females and males, respectively. Size at first maturity corresponded to 87.7% of observed maximum size in females (366 mm LT) and 87.5% in males (343 mm L T). Two females, representing 18.2% of mature females sampled in the austral winter were each carrying two egg cases. Descriptions of egg cases are given. Diet described by the index of relative importance as a percentage (%IRI) was predominantly crustacean based with carid shrimps (53.64%) and penaeoid prawns (23.30%) the most significant prey groups. Teleosts (11.72%), gammarid amphipods (5.31%) and mysids (4.72%) were also important to the diet of the species, while a further six prey groups made only a minor contribution to diet (1.31%). An ontogenetic change was evident between the diets of immature and mature skates. Immature animals fed more extensively on carids and amphipods and mature animals on penaeoids, teleosts and mysids.

Genetic analysis of foot-and-mouth disease virus serotype A of Indian origin and detection of positive selection and recombination in leader protease- and capsid-coding regions

The leader protease (L-pro) and capsid-coding sequences (P1) constitute approximately 3 kb of the foot-and-mouth disease virus (FMDV). We studied the phylogenetic relationship of 46 FMDV serotype A isolates of Indian origin collected during the period 1968-2005 and also eight vaccine strains using the neighbour-joining tree and Bayesian tree methods. The viruses were categorized under three major groups - Asian, Euro-South American and European. The Indian isolates formed a distinct genetic group among the Asian isolates. The Indian isolates were further classified into different genetic subgroups (<5% divergence). Post-1995 isolates were divided into two subgroups while a few isolates which originated in the year 2005 from Andhra Pradesh formed a separate group. These isolates were closely related to the isolates of the 1970s. The FMDV isolates seem to undergo reverse mutation or onvergent evolution wherein sequences identical to the ancestors are present in the isolates in circulation. The eight vaccine strains included in the study were not related to each other and belonged to different genetic groups. Recombination was detected in the L-pro region in one isolate (A IND 20/82) and in the VP1 coding 1D region in another isolate (A RAJ 21/96). Positive selection was identified at aa positions 23 in the L-pro (P<0.05; 0.046*) and at aa 171 in the capsid protein VP1 (P<0.01; 0.003**).

3-D kinematical conservation laws (KCL): Evolution of a surface in R-3 - in particular propagation of a nonlinear wavefront

3-D KCL are equations of evolution of a propagating surface (or a wavefront) Omega(t), in 3-space dimensions and were first derived by Giles, Prasad and Ravindran in 1995 assuming the motion of the surface to be isotropic. Here we discuss various properties of these 3-D KCL.These are the most general equations in conservation form, governing the evolution of Omega(t) with singularities which we call kinks and which are curves across which the normal n to Omega(t) and amplitude won Omega(t) are discontinuous. From KCL we derive a system of six differential equations and show that the KCL system is equivalent to the ray equations of 2, The six independent equations and an energy transport equation (for small amplitude waves in a polytropic gas) involving an amplitude w (which is related to the normal velocity m of Omega(t)) form a completely determined system of seven equations. We have determined eigenvalues of the system by a very novel method and find that the system has two distinct nonzero eigenvalues and five zero eigenvalues and the dimension of the eigenspace associated with the multiple eigenvalue 0 is only 4. For an appropriately defined m, the two nonzero eigenvalues are real when m > 1 and pure imaginary when m < 1. Finally we give some examples of evolution of weakly nonlinear wavefronts.