Atomically resolved study of the morphology change of InAs/GaAs quantum dot layers induced by rapid thermal annealing

The optoelectronic properties of InAs/GaAs quantum dots can be tuned by rapid thermal annealing. In this study, the morphology change of InAs/GaAs quantum dots layers induced by rapid thermal annealing was investigated at the atomic-scale by cross-sectional scanning tunneling microscopy. Finite elements calculations that model the outward relaxation of the cleaved surface were used to determine the indium composition profile of the wetting layer and the quantum dots prior and post rapid thermal annealing. The results show that the wetting layer is broadened upon annealing. This broadening could be modeled by assuming a random walk of indium atoms. Furthermore, we show that the stronger strain gradient at the location of the quantum dots enhances the intermixing. Photoluminescence measurements show a blueshift and narrowing of the photoluminescence peak. Temperature dependent photoluminescence measurements show a lower activation energy for the annealed sample. These results are in agreement with the observed change in morphology. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4770371]

Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between videodensitometric method and histological examination

Abstract Background To establish the correlation between quantitative analysis based on B-mode ultrasound images of vulnerable carotid plaque and histological examination of the surgically removed plaque, on the basis of a videodensitometric digital texture characterization. Methods Twenty-five patients (18 males, mean age 67 ± 6.9 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing) underwent to quantitative ultrasonic tissue characterization of carotid plaque before surgery. A computer software (Carotid Plaque Analysis Software) was developed to perform the videodensitometric analysis. The patients were divided into 2 groups according to symptomatology (group I, 15 symptomatic patients; and group II, 10 patients asymptomatic). Tissue specimens were analysed for lipid, fibromuscular tissue and calcium. Results The first order statistic parameter mean gray level was able to distinguish the groups I and II (p = 0.04). The second order parameter energy also was able to distinguish the groups (p = 0,02). A histological correlation showed a tendency of mean gray level to have progressively greater values from specimens with < 50% to >75% of fibrosis. Conclusion Videodensitometric computer analysis of scan images may be used to identify vulnerable and potentially unstable lipid-rich carotid plaques, which are less echogenic in density than stable or asymptomatic, more densely fibrotic plaques.

Histological composition and progression of carotid plaque

Abstract Background To analyse histological composition and progression of carotid plaque. Methods Thirty-one patients (22 males, mean age 68.03 ± 7.3 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing) were enrolled. The patients were divided into 2 groups according to symptomatology (group I, 17 symptomatic patients; and group II, 14 asymptomatic patients). A histological analysis and inflammatory cell quantification of each excised carotid plaque was made. Nine carotid arteries were removed from human cadavers that were not preselected for carotid artery disease. These specimens were used as a control tissue without any macroscopic signs of atherosclerotic plaques. Results Fifty eight percent of all carotid plaques were classified as complex plaque with possible surface defect, hemorrhage or thrombus. The inflammatory cells concentration did not differ between the two groups. All specimens from human cadavers were classified as preatheroma with extracellular lipid pools. Conclusion Asymptomatic and symptomatic patients could have the same histological components on their carotid plaques. Fibrotic and calcific plaques could become vulnerable as complex plaques with surface defect, hemorrhage and thrombus could remain silent. Asymptomatic carotid stenosis should be followed close with no invasive diagnostic methods and clinical evaluation.

Mapping the lignin distribution in pretreated sugarcane bagasse by confocal and fluorescence lifetime imaging microscopy

Abstract Background Delignification pretreatments of biomass and methods to assess their efficacy are crucial for biomass-to-biofuels research and technology. Here, we applied confocal and fluorescence lifetime imaging microscopy (FLIM) using one- and two-photon excitation to map the lignin distribution within bagasse fibers pretreated with acid and alkali. The evaluated spectra and decay times are correlated with previously calculated lignin fractions. We have also investigated the influence of the pretreatment on the lignin distribution in the cell wall by analyzing the changes in the fluorescence characteristics using two-photon excitation. Eucalyptus fibers were also analyzed for comparison. Results Fluorescence spectra and variations of the decay time correlate well with the delignification yield and the lignin distribution. The decay dependences are considered two-exponential, one with a rapid (τ1) and the other with a slow (τ2) decay time. The fastest decay is associated to concentrated lignin in the bagasse and has a low sensitivity to the treatment. The fluorescence decay time became longer with the increase of the alkali concentration used in the treatment, which corresponds to lignin emission in a less concentrated environment. In addition, the two-photon fluorescence spectrum is very sensitive to lignin content and accumulation in the cell wall, broadening with the acid pretreatment and narrowing with the alkali one. Heterogeneity of the pretreated cell wall was observed. Conclusions Our results reveal lignin domains with different concentration levels. The acid pretreatment caused a disorder in the arrangement of lignin and its accumulation in the external border of the cell wall. The alkali pretreatment efficiently removed lignin from the middle of the bagasse fibers, but was less effective in its removal from their surfaces. Our results evidenced a strong correlation between the decay times of the lignin fluorescence and its distribution within the cell wall. A new variety of lignin fluorescence states were accessed by two-photon excitation, which allowed an even broader, but complementary, optical characterization of lignocellulosic materials. These results suggest that the lignin arrangement in untreated bagasse fiber is based on a well-organized nanoenvironment that favors a very low level of interaction between the molecules.

Polymorphic-induced transformations in CaTa2O6 single-crystal fibers obtained by laser-heated pedestal growth

Calcium tantalite (CaTa2O6) single crystal fibers were obtained by the laser-heated pedestal growth method (LHPG). At room temperature, this material can present three polymorphic modifications. The rapid crystallization inherent to the LHPG method produced samples within the Pm3 space group, with some chemical disorder. In order to check for polymorphic-induced transformations, the CaTa2O6 fibers have been submitted to different thermal treatments and investigated by micro-Raman spectroscopy. For short annealing times (15 min) at 1200 °C, the cubic modification was maintained, though with an improved crystalline quality, as evidenced by the enhanced inelastic scattered intensity (by ca. 250%) and narrowing of Raman bands. The polarized Raman spectra respected very well the predicted symmetries and the selection rules for this cubic modification. On the other hand, long annealing times (24 h) at 1200 °C led to a complete (irreversible) polymorphic transformation. The Raman bands became still more intense (ca. 15 times larger than for the as-grown fibers), narrower, and several new modes appeared. Also, the spectra became unpolarized, demonstrating a polycrystalline nature of the transformed crystals. The observed Raman modes could be fully assigned to an orthorhombic modification of CaTa2O6 belonging to the Pnma space group.

Morphogenesis of the Ourense plains:(NW of Spain)

[EN] We present a geomorphological analysis of Ourense Province (NW Spain) characterized by: a general narrowing of the fluvial network, highlands with smooth reliefs partially eroded and lowlands with residual reliefs, several extensive plains of erosion frequently limited by fractures -among which Tertiary grabens are inserted-, some ?Hollow Surface?-type morphology, absence of sedimentary deposits outside the grabens, and a generalized outcrop of the Hercynian Massif substratum. Traditionally, this ?piano?s keyboard morphology? has been interpreted as expression of block tectonics in tensile regimen; instead we suggest the existence of: an isostatic upheaval simultaneous to a sequence of tectonic pulses of compressive regimen with activity in favour of transcurrent faults, a General Surface (R600), several plains that present a ?Hollow Surface?-type morphology (R1600 R1400 R1000), a generalized alteration that correspond to a same process of decomposition associated to fluctuating conditions of redox equilibrium, a erosional terraces related principaly to the palaeo-fluvial nets; moreover, we propose the existence of two morphoestructural lineament: the first one represented by the Fault of Vila Real (NE-SW) -a ramification of the ?Basal Pyrenean Overthrust?-, that would have been active at an early moment of the tectonic sequence with a left transcurrent fault, secondly the lineament represented by the Fault of Maceda (NNW-SSE) that would be related to the ?Fault System NW-SE? and would have produced a right transcurrent fault during a late tectonic pulse.

Peripheral arterial disease and diabetes: effects on endothelial progenitor cell differentiation and nitric oxide metabolism

In the recent years it is emerged that peripheral arterial disease (PAD) has become a growing health problem in Western countries. This is a progressive manifestation of atherothrombotic vascular disease, which results into the narrowing of the blood vessels of the lower limbs and, as final consequence, in critical leg ischemia. PAD often occurs along with other cardiovascular risk factors, including diabetes mellitus (DM), low-grade inflammation, hypertension, and lipid disorders. Patients with DM have an increased risk of developing PAD, and that risk increases with the duration of DM. Moreover, there is a growing population of patients identified with insulin resistance (IR), impaired glucose tolerance, and obesity, a pathological condition known as “metabolic syndrome”, which presents increased cardiovascular risk. Atherosclerosis is the earliest symptom of PAD and is a dynamic and progressive disease arising from the combination of endothelial dysfunction and inflammation. Endothelial dysfunction is a broad term that implies diminished production or availability of nitric oxide (NO) and/or an imbalance in the relative contribution of endothelium-derived relaxing factors. The secretion of these agents is considerably reduced in association with the major risks of atherosclerosis, especially hyperglycaemia and diabetes, and a reduced vascular repair has been observed in response to wound healing and to ischemia. Neovascularization does not only rely on the proliferation of local endothelial cells, but also involves bone marrow-derived stem cells, referred to as endothelial progenitor cells (EPCs), since they exhibit endothelial surface markers and properties. They can promote postnatal vasculogenesis by homing to, differentiating into an endothelial phenotype, proliferating and incorporating into new vessels. Consequently, EPCs are critical to endothelium maintenance and repair and their dysfunction contributes to vascular disease. The aim of this study has been the characterization of EPCs from healthy peripheral blood, in terms of proliferation, differentiation and function. Given the importance of NO in neovascularization and homing process, it has been investigated the expression of NO synthase (NOS) isoforms, eNOS, nNOS and iNOS, and the effects of their inhibition on EPC function. Moreover, it has been examined the expression of NADPH oxidase (Nox) isoforms which are the principal source of ROS in the cell. In fact, a number of evidences showed the correlation between ROS and NO metabolism, since oxidative stress causes NOS inactivation via enzyme uncoupling. In particular, it has been studied the expression of Nox2 and Nox4, constitutively expressed in endothelium, and Nox1. The second part of this research was focused on the study of EPCs under pathological conditions. Firstly, EPCs isolated from healthy subject were cultured in a hyperglycaemic medium, in order to evaluate the effects of high glucose concentration on EPCs. Secondly, EPCs were isolated from the peripheral blood of patients affected with PAD, both diabetic or not, and it was assessed their capacity to proliferate, differentiate, and to participate to neovasculogenesis. Furthermore, it was investigated the expression of NOS and Nox in these cells. Mononuclear cells isolated from peripheral blood of healthy patients, if cultured under differentiating conditions, differentiate into EPCs. These cells are not able to form capillary-like structures ex novo, but participate to vasculogenesis by incorporation into the new vessels formed by mature endothelial cells, such as HUVECs. With respect to NOS expression, these cells have high levels of iNOS, the inducible isoform of NOS, 3-4 fold higher than in HUVECs. While the endothelial isoform, eNOS, is poorly expressed in EPCs. The higher iNOS expression could be a form of compensation of lower eNOS levels. Under hyperglycaemic conditions, both iNOS and eNOS expression are enhanced compared to control EPCs, as resulted from experimental studies in animal models. In patients affected with PAD, the EPCs may act in different ways. Non-diabetic patients and diabetic patients with a higher vascular damage, evidenced by a higher number of circulating endothelial cells (CECs), show a reduced proliferation and ability to participate to vasculogenesis. On the other hand, diabetic patients with lower CEC number have proliferative and vasculogenic capacity more similar to healthy EPCs. eNOS levels in both patient types are equivalent to those of control, while iNOS expression is enhanced. Interestingly, nNOS is not detected in diabetic patients, analogously to other cell types in diabetics, which show a reduced or no nNOS expression. Concerning Nox expression, EPCs present higher levels of both Nox1 and Nox2, in comparison with HUVECs, while Nox4 is poorly expressed, probably because of uncompleted differentiation into an endothelial phenotype. Nox1 is more expressed in PAD patients, diabetic or not, than in controls, suggesting an increased ROS production. Nox2, instead, is lower in patients than in controls. Being Nox2 involved in cellular response to VEGF, its reduced expression can be referable to impaired vasculogenic potential of PAD patients.

Heteronuclear recoupling methods in solid-state NMR

This thesis is focused on the development of heteronuclear correlation methods in solid-state NMR spectroscopy, where the spatial dependence of the dipolar coupling is exploited to obtain structural and dynamical information in solids. Quantitative results on dipolar coupling constants are extracted by means of spinning sideband analysis in the indirect dimension of the two-dimensional experiments. The principles of sideband analysis were established and are currently widely used in the group of Prof. Spiess for the special case of homonuclear 1H double-quantum spectroscopy. The generalization of these principles to the heteronuclear case is presented, with special emphasis on naturally abundant 13C-1H systems. For proton spectroscopy in the solid state, line-narrowing is of particular importance, and is here achieved by very-fast sample rotation at the magic angle (MAS), with frequencies up to 35 kHz. Therefore, the heteronuclear dipolar couplings are suppressed and have to be recoupled in order to achieve an efficient excitation of the observed multiple-quantum modes. Heteronuclear recoupling is most straightforwardly accomplished by performing the known REDOR experiment, where pi-pulses are applied every half rotor period. This experiment was modified by the insertion of an additional spectroscopic dimension, such that heteronuclear multiple-quantum experiments can be carried out, which, as shown experimentally and theoretically, closely resemble homonuclear double-quantum experiments. Variants are presented which are well-suited for the recording of high-resolution 13C-1H shift correlation and spinning-sideband spectra, by means of which spatial proximities and quantitative dipolar coupling constants, respectively, of heteronuclear spin pairs can be determined. Spectral editing of 13C spectra is shown to be feasible with these techniques. Moreover, order phenomena and dynamics in columnar mesophases with 13C in natural abundance were investigated. Two further modifications of the REDOR concept allow the correlation of 13C with quadrupolar nuclei, such as 2H. The spectroscopic handling of these nuclei is challenging in that they cover large frequency ranges, and with the new experiments it is shown how the excitation problem can be tackled or circumvented altogether, respectively. As an example, one of the techniques is used for the identification of a yet unknown motional process of the H-bonded protons in the crystalline parts of poly(vinyl alcohol).

Elektrokinetik konzentrierter kolloidaler Suspensionen

In dieser Arbeit wurden wässrige Suspensionen ladungsstabilisierter kolloidaler Partikel bezüglich ihres Verhaltens unter dem Einfluss elektrischer Felder untersucht. Insbesondere wurde die elektrophoretische Mobilität µ über einen weiten Partikelkonzentrationsbereich studiert, um das individuelle Verhalten einzelner Partikel mit dem bisher nur wenig untersuchten kollektiven Verhalten von Partikelensembles (speziell von fluid oder kristallin geordneten Ensembles) zu vergleichen. Dazu wurde ein superheterodynes Dopplervelocimetrisches Lichtstreuexperiment mit integraler und lokaler Datenerfassung konzipiert, das es erlaubt, die Geschwindigkeit der Partikel in elektrischen Feldern zu studieren. Das Experiment wurde zunächst erfolgreich im Bereich nicht-ordnender und fluid geordneter Suspensionen getestet. Danach konnte mit diesem Gerät erstmals das elektrophoretische Verhalten von kristallin geordneten Suspensionen untersucht werden. Es wurde ein komplexes Fließverhalten beobachtet und ausführlich dokumentiert. Dabei wurden bisher in diesem Zusammenhang noch nicht beobachtete Effekte wie Blockfluss, Scherbandbildung, Scherschmelzen oder elastische Resonanzen gefunden. Andererseits machte dieses Verhalten die Entwicklung einer neuen Auswertungsroutine für µ im kristallinen Zustand notwendig, wozu die heterodyne Lichtstreutheorie auf den superheterodynen Fall mit Verscherung erweitert werden musste. Dies wurde zunächst für nicht geordnete Systeme durchgeführt. Diese genäherte Beschreibung genügte, um unter den gegebenen Versuchbedingungen auch das Lichtstreuverhalten gescherter kristalliner Systeme zu interpretieren. Damit konnte als weiteres wichtiges Resultat eine generelle Mobilitäts-Konzentrations-Kurve erhalten werden. Diese zeigt bei geringen Partikelkonzentrationen den bereits bekannten Anstieg und bei mittleren Konzentrationen ein Plateau. Bei hohen Konzentrationen sinkt die Mobilität wieder ab. Zur Interpretation dieses Verhaltens bzgl. Partikelladung stehen derzeit nur Theorien für nicht wechselwirkende Partikel zur Verfügung. Wendet man diese an, so findet man eine überraschend gute Übereinstimmung der elektrophoretisch bestimmten Partikelladung Z*µ mit numerisch bestimmten effektiven Partikelladungen Z*PBC.

High quality colloidal crystals with different architectures and their optical properties

In this present work high quality PMMA opals with different sphere sizes, silica opals from large size spheres, multilayer opals, and inverse opals were fabricated. Highly monodisperse PMMA spheres were synthesized by surfactant-free emulsion polymerization (polydispersity ~2%). Large-area and well-ordered PMMA crystalline films with a homogenous thickness were produced by the vertical deposition method using a drawing device. Optical experiments have confirmed the high quality of these PMMA photonic crystals, e.g., well resolved high-energy bands of the transmission and reflectance spectra of the opaline films were observed. For fabrication of high quality opaline photonic crystals from large silica spheres (diameter of 890 nm), self-assembled in patterned Si-substrates a novel technique has been developed, in which the crystallization was performed by using a drawing apparatus in combination with stirring. The achievements comprise a spatial selectivity of opal crystallization without special treatment of the wafer surface, the opal lattice was found to match the pattern precisely in width as well as depth, particularly an absence of cracks within the size of the trenches, and finally a good three-dimensional order of the opal lattice even in trenches with a complex confined geometry. Multilayer opals from opaline films with different sphere sizes or different materials were produced by sequential crystallization procedure. Studies of the transmission in triple-layer hetero-opal revealed that its optical properties cannot only be considered as the linear superposition of two independent photonic bandgaps. The remarkable interface effect is the narrowing of the transmission minima. Large-area, high-quality, and robust photonic opal replicas from silicate-based inorganic-organic hybrid polymers (ORMOCER® s) were prepared by using the template-directed method, in which a high quality PMMA opal template was infiltrated with a neat inorganic-organic ORMOCER® oligomer, which can be photopolymerized within the opaline voids leading to a fully-developed replica structure with a filling factor of nearly 100%. This opal replica is structurally homogeneous, thermally and mechanically stable and the large scale (cm2 size) replica films can be handled easily as free films with a pair of tweezers.

Einzelmolekülspektroskopie an einer homologen Reihe von Rylendiimiden und an einem bichromophoren Modellsystem für elektronischen Energietransfer

In dieser Arbeit wurden Untersuchungen zur Fluoreszenzdynamik und zum Mechanismus des Photobleichens einzelner Farbstoffmoleküle einer homologen Reihe von Rylentetracarbonsäurediimiden durchgeführt. Mit der Erweiterung des elektronischen π-Systems verringert sich die HOMO/LUMO-Energiedifferenz, so dass strahlungslose Relaxationsprozesse gemäß des Energielückengesetzes zunehmen. Die konfokale Einzelmolekülspektroskopie in Kombination mit zeitkorrelierter Einzelphotonenzählung ermöglicht es, Fluktuationen der inneren Konversionsrate zu detektieren. Der limitierende Faktor jedes Einzelmolekülexperiments ist die Photostabilität der Moleküle. Für die homologe Reihe konnten mindestens zwei Photobleichmechanismen identifiziert werden. Wenn Singulett-Sauerstoff durch Selbstsensibilisierung erzeugt werden kann, ist unter Luft die Photooxidation der wahrscheinlichste Mechanismus. Unter Ausschluss von Luftsauerstoff spielt die Bildung langlebiger Dunkelzustände eine entscheidende Rolle, die bevorzugt über höher angeregte Triplett- und Singulett-Zustände abläuft. Es wird angenommen, dass es sich hierbei um einen reversiblen Ionisierungsprozess handelt, bei dem das Radikal-Kation der Rylendiimide gebildet wird. Es konnte gezeigt werden, dass durch eine geeignete Wahl der Anregungsbedingungen die Dunkelzustandspopulierung verhindert und zugleich die Photostabilität der Fluorophore deutlich erhöht wird. Durch die Verknüpfung der beiden niedrigsten Homologen erhält man ein Donor-Akzeptor-Modellsystem, bei dem die Anregungsenergie mit hoher Effizienz vom Donor- auf den Akzeptor-Chromophor übertragen wird. In der Fluoreszenz einzelner Bichromophore wurden bei selektiver Anregung des Donors kollektive Auszeiten beobachtet, die durch effiziente Singulett-Triplett-Annihilation verursacht werden.

Il fascicolo sanitario elettronico tra Semantic Web e diritto alla privacy

Principale obiettivo della ricerca è quello di ricostruire lo stato dell’arte in materia di sanità elettronica e Fascicolo Sanitario Elettronico, con una precipua attenzione ai temi della protezione dei dati personali e dell’interoperabilità. A tal fine sono stati esaminati i documenti, vincolanti e non, dell’Unione europea nonché selezionati progetti europei e nazionali (come “Smart Open Services for European Patients” (EU); “Elektronische Gesundheitsakte” (Austria); “MedCom” (Danimarca); “Infrastruttura tecnologica del Fascicolo Sanitario Elettronico”, “OpenInFSE: Realizzazione di un’infrastruttura operativa a supporto dell’interoperabilità delle soluzioni territoriali di fascicolo sanitario elettronico nel contesto del sistema pubblico di connettività”, “Evoluzione e interoperabilità tecnologica del Fascicolo Sanitario Elettronico”, “IPSE - Sperimentazione di un sistema per l’interoperabilità europea e nazionale delle soluzioni di Fascicolo Sanitario Elettronico: componenti Patient Summary e ePrescription” (Italia)). Le analisi giuridiche e tecniche mostrano il bisogno urgente di definire modelli che incoraggino l’utilizzo di dati sanitari ed implementino strategie effettive per l’utilizzo con finalità secondarie di dati sanitari digitali , come Open Data e Linked Open Data. L’armonizzazione giuridica e tecnologica è vista come aspetto strategico per ridurre i conflitti in materia di protezione di dati personali esistenti nei Paesi membri nonché la mancanza di interoperabilità tra i sistemi informativi europei sui Fascicoli Sanitari Elettronici. A questo scopo sono state individuate tre linee guida: (1) armonizzazione normativa, (2) armonizzazione delle regole, (3) armonizzazione del design dei sistemi informativi. I principi della Privacy by Design (“prottivi” e “win-win”), così come gli standard del Semantic Web, sono considerate chiavi risolutive per il suddetto cambiamento.

Screening renal artery angiography in hypertensive patients undergoing coronary angiography and 6-month follow-up after ad hoc percutaneous revascularization

OBJECTIVE: To determine the prevalence and independent predictors of significant atherosclerotic renal artery stenosis (RAS) in unselected hypertensive patients undergoing coronary angiography and to assess the 6-month outcome of those patients with a significant RAS. METHODS: One thousand, four hundred and three consecutive hypertensive patients undergoing drive-by renal arteriography were analyzed retrospectively. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of RAS. In patients with significant RAS (>or=50% luminal narrowing), 6-month follow-up was assessed and outcome was compared between patients with or without renal revascularization. RESULTS: The prevalence of significant RAS was 8%. After multivariate analysis, coronary [odds ratio 5.3; 95% confidence interval (CI) 2.7-10.3; P < 0.0001], peripheral (odds ratio 3.3; 95% CI 2.0-5.5; P < 0.0001), and cerebral artery (odds ratio 2.8; 95% CI 1.5-5.3; P = 0.001) diseases, and impaired renal function (odds ratio 2.9; 95% CI 1.8-4.5; P < 0.0001) were found as independent predictors. At least one of these predictors was present in 96% of patients with RAS. In 74 patients (66%) with significant RAS, an ad hoc revascularization was performed. At follow-up, creatinine clearance was significantly higher in revascularized than in nonrevascularized patients (69.2 vs. 55.5 ml/min per 1.73 m, P = 0.029). By contrast, blood pressure was comparable between both groups, but nonrevascularized patients were taking significantly more antihypertensive drugs as compared with baseline (2.7 vs. 2.1, follow-up vs. baseline; P = 0.0066). CONCLUSION: The prevalence of atherosclerotic RAS in unselected hypertensive patients undergoing coronary angiography was low. Coronary, peripheral, and cerebral artery diseases, and impaired renal function were independent predictors of RAS. Ad hoc renal revascularization was associated with better renal function and fewer intake of antihypertensive drugs at follow-up.

Computed tomographic coronary angiography in patients with surgically treated type A aortic dissection: preliminary results

Acute type A aortic dissection is a serious emergency with a mortality rate of up to 40% within the first 24 h when left untreated. Surgical therapy needs to be initiated promptly. Due to this urgent situation, preoperative evaluation of the coronary arteries is not routinely performed in these patients. The aim of this study was to evaluate the accuracy of 64-slice computed tomography angiography (CTA) for postoperative coronary artery assessment in these patients. Ten consecutive patients with two or more cardiovascular risk factors were prospectively enrolled. Patients had type A aortic dissection treated surgically with a supracoronary graft of the ascending aorta. Performance of CTA to exclude significant stenosis (>50% lumen narrowing) and/or coronary artery dissection was compared with quantitative coronary angiography. A total of 147 segments were evaluated. Three segments (2%) were excluded from analysis. CTA correctly assessed one of three significant stenoses in three patients and correctly excluded coronary artery disease (CAD) in six of ten patients. One patient was rated false positive. Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for identifying coronary artery disease by segment was 98%, 33%, 99%, 50%, and 99%, respectively (P<0.05). By patient, it was 70%, 33%, 86%, 50%, and 75%, respectively. No coronary artery dissection was found. Noninvasive CTA may be a viable alternative to conventional angiography for postoperative coronary artery evaluation in patients with surgically treated type A aortic dissection and cardiovascular risk factors. An NPV of 99% should allow for reliable exclusion of CAD. Further studies with higher patient numbers are warranted.

Awake tracheal intubation using the Sensascope in 13 patients with an anticipated difficult airway

We present the use of the SensaScope, an S-shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans-cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. In all cases, tracheal intubation was achieved using the SensaScope. The median (IQR [range]) insertion time (measured from the time the facemask was taken away from the face until an end-expiratory CO(2) reading was visible on the monitor) was 58 s (38-111 [28-300]s). In nine of the 13 cases, advancement of the SensaScope into the trachea was easy. Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway.