Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients. METHODS: This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS: The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027). CONCLUSION: The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.

Active design of diffuse acoustic fields in enclosures.

This paper presents a numerical framework for designing diffuse fields in rooms of any shape and size, driven at arbitrary frequencies. That is, we aim at overcoming the Schroeder frequency limit for generating diffuse fields in an enclosed space. We formulate the problem as a Tikhonov regularized inverse problem and propose a low-rank approximation of the spatial correlation that results in significant computational gains. Our approximation is applicable to arbitrary sets of target points and allows us to produce an optimal design at a computational cost that grows only linearly with the (potentially large) number of target points. We demonstrate the feasibility of our approach through numerical examples where we approximate diffuse fields at frequencies well below the Schroeder limit.

Safety of conservative management for non-stenotic culprit lesions in STEMI patients treated with a two-step reperfusion strategy: a SUPER-MIMI sub-study.

Background: In the observational SUPER-MIMI study, a minimalist immediate mechanical intervention (MIMI) technique-which involves restoring blood flow in the acute phase and postponing stenting-was shown to be safe and effective among patients with a high thrombotic burden after ST-segment elevation myocardial infarction (STEMI). We aim to assess whether a non-stenting strategy after a SUPER-MIMI strategy was safe at 4-year follow-up in patients enrolled in the SUPER-MIMI study who were not stented. Methods: This prospective cohort study assessed the long-term outcomes of a subgroup of patients included in the SUPER-MIMI study. Results: Among the 155 patients enrolled in the SUPER-MIMI study, 57 patients (36.8%) benefited from a conservative management (without stenting or balloon angioplasty) and were included in the current substudy. The mean duration of follow-up was 4.1±1.0 years. Four patients (7.0%) presented definite culprit lesion re-thrombosis, all of which occurred in the right coronary artery. The re-thrombosis rate appeared to be higher among patients with larger vessels: 2.9%, 8.3%, and 28.6% in arteries with diameters of 3-<4, 4-<5, and ≥5 mm, respectively. The overall rate of target lesion revascularization was 10.5%. There was one cardiac death and three rehospitalizations for heart failure. Overall, 82.5% of patients remained event free at a mean of 4.1±1.0 years. Conclusions: Conservative management of non-stenotic culprit lesions after a SUPER-MIMI strategy was associated with a high rate of re-thrombosis, particularly in patients with large coronary arteries.

Warmer winters are associated with lower levels of the cryoprotectant glycerol, a slower decrease in vitellogenin expression and reduced virus infections in winter honeybees.

Within the context of climate change, winter temperatures at high latitudes are predicted to rise faster than summer temperatures. This phenomenon is expected to negatively affect the diapause performance and survival of insects, since they largely rely on low temperatures to lower their metabolism and preserve energy. However, some insects like honeybees, remain relatively active during the winter and elevate their metabolic rate to produce endothermic heat when temperatures drop. Warming winters are thus expected to improve overwintering performance of honeybees. In order to verify this hypothesis, for two consecutive years, we exposed honeybee colonies to either a mild or cold winter. We then monitored the influence of wintering conditions on several parameters of honeybee overwintering physiology, such as levels of the cryoprotectant glycerol, expression levels of immune and antioxidant genes, and genes encoding multifunctional proteins, including vitellogenin, which promotes bee longevity. Winter conditions had no effect on the expression of antioxidant genes, and genes related to immunity were not consistently affected. However, mild winters were consistently associated with a lower investment in glycerol synthesis and a higher expression of fat body genes, especially apidaecin and vitellogenin. Finally, while we found that viral loads generally decreased through the winter, this trend was more pronounced under mild winter conditions. In conclusion, and without considering how warming temperatures might affect other aspects of honeybee biology before overwintering, our data suggest that warming temperatures will likely benefit honeybee vitality by notably reducing their viral loads over the winter.

Principal image decomposition for multi-detector backscatter electron topography reconstruction.

Scanning Electron Microscopes (SEMs) often generate images with a shaded appearance which gives a natural 3D impression. Ergo, quite a few methods to reconstruct the 3D surface topography from these using shape-from-shading methods are available in the literature. Here, a novel approach is discussed which uses BackScatter Electron (BSE) images from multiple detectors to reconstruct the topography. Classically, algorithms exist which resort to a quad-BSE detector setup. However, other detector configurations are often found in SEMs. A set of images of these non-conforming detectors still contains enough information to allow for reconstruction, but requires a more general algorithm to do so. This article discusses a method based on a modal decomposition of the principal image components. The resulting method is shown to be efficient and independent of the number of detectors or their orientation. In fact, the orientation is identified as part of the algorithm and thus requires very little calibration.

Development of a Risk Score Based on Aortic Calcification to Predict 1-Year Mortality After Transcatheter Aortic Valve Replacement.

OBJECTIVES: The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality. BACKGROUND: A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders. METHODS: The C4CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts. RESULTS: Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model's predictive power was fair (AUC 68% [95% confidence interval [CI]: 64% to 72%]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts. CONCLUSIONS: The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures.

Successful Treatment of Spontaneous Coronary Artery Dissection With Subintimal Tracking and Re-Entry Technique.

Percutaneous coronary intervention (PCI) remains necessary in patients with spontaneous coronary dissection (SCAD) with ongoing ischemia. However, PCI in SCAD is associated with poor results. Fenestration with a cutting balloon has been described to release the extraluminal compression. The authors describe 2 cases managed successfully with another fenestration technique-the subintimal tracking and re-entry technique. (Level of Difficulty: Advanced.).

Nosema ceranae, Fipronil and their combination compromise honey bee reproduction via changes in male physiology.

The honey bee is threatened by biological agents and pesticides that can act in combination to induce synergistic effects on its physiology and lifespan. The synergistic effects of a parasite/pesticide combination have been demonstrated on workers and queens, but no studies have been performed on drones despite their essential contribution to colony sustainability by providing semen diversity and quality. The effects of the Nosema ceranae/fipronil combination on the life traits and physiology of mature drones were examined following exposure under semi-field conditions. The results showed that the microsporidia alone induced moderate and localized effects in the midgut, whereas fipronil alone induced moderate and generalized effects. The parasite/insecticide combination drastically affected both physiology and survival, exhibiting an important and significant generalized action that could jeopardize mating success. In terms of fertility, semen was strongly impacted regardless of stressor, suggesting that drone reproductive functions are very sensitive to stress factors. These findings suggest that drone health and fertility impairment might contribute to poorly mated queens, leading to the storage of poor quality semen and poor spermathecae diversity. Thus, the queens failures observed in recent years might result from the continuous exposure of drones to multiple environmental stressors.

Assessment of the toxic effect of pesticides on honey bee drone fertility using laboratory and semifield approaches: A case study of fipronil.

Concern about the reproductive toxicity of plant protection products in honey bee reproducers is increasing. Because the reproductive capacity of honey bees is not currently considered during the risk assessment procedure performed during plant protection product registration, it is important to provide methods to assess such potential impairments. To achieve this aim, we used 2 different approaches that involved semifield and laboratory conditions to study the impact of fipronil on drone fertility. For each approach, the drones were reared for 20 d, from emergence to sexual maturity, and exposed to fipronil via a contaminated sugar solution. In both groups, the effects of fipronil were determined by studying life traits and fertility indicators. The results showed that the survival and maturity rates of the drones were better under laboratory conditions than under semifield conditions. Moreover, the drones reared under laboratory conditions produced more seminal fluid. Although these differences could be explained by environmental factors that may vary under semifield conditions, it was found that regardless of the approach used, fipronil did not affect survival rates, maturity rates, or semen volumes, whereas it did affect fertility by inducing a decrease in spermatozoa quantity that was associated with an increase in spermatozoa mortality. These results confirm that fipronil affects drone fertility and support the relevance of each approach for assessing the potential reproductive toxicity of plant protection products in honey bees. Environ Toxicol Chem 2017;36:2345-2351. © 2017 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.