32 research outputs found
Variations in coronary lumen dimensions measured In vivo
No full textLetter to the EditorRishi Puri, Adam J. Nelson, Gary Y. H. Liew, Stephen J. Nicholls, Angelo Carbone, Dennis T. L. Wong, James E. Harvey, Kiyoko Uno, Barbara Copus, Darryl P. Leong, John F. Beltrame, Stephen G. Worthley, Matthew I. Worthle
Coronary atheroma composition predicts endothelial dysfunction in non-ST segment myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography (IVUS)
No full textPoster abstract TCT-648Abstract not availableRishi Puri, Stephen J. Nicholls, Danielle M. Brennan, Jordan Andrews, Gary Y. Liew, Angelo Carbone, Barbara Copus, Adam J. Nelson, Samir R. Kapadia, E. Murat Tuzcu, John F. Beltrame, Stephen G. Worthley, Matthew I. Worthle
Sub-National Governance in England
No full textThis discussion is concerned with sub-national governance in England. It will suggest that the most striking characteristic of English sub-national governance is its fragmentary and incoherent nature, embracing regions (if they can still be said to exist), city-regions (which are subject to a number of different definitions) and local government (which itself is sub-divided from place to place into metropolitan, non-metropolitan, unitary and two-tier systems, with a range of differing political management arrangements). This pattern of sub-national provision has grown ever-more varied, subject to ad hoc initiatives, and with no overall rationale. It will be argued that - in contrast to other parts of the United Kingdom - there is currently no political incentive to address the nature of
English sub-national governance. Hence there is little likelihood that the pattern of governance depicted here will change, unless new factors are brought into play. Some of these are suggested at the end of this paper
Locus of control in prison inmates
No full textPurpose: The purpose of this research is to collect normative data on two Internal-External Locus of Control (I-E) Scales (Levenson's I-E Scale and the Adult Nowicki-Strickland Scale), using samples of both male and female inmate populations. It was hypothesized that 1) prison inmates will be at least as external (as measured by the I-E control scales) as college students and community adults, and more so with respect to the beliefs that powerful others and chance control their lives; 2) that black inmates, as well as inmates belonging to other minority groups, will be more external than white inmates; 3) that inmates with low educational levels will be more external than those with higher educational levels (lower vesus middle or upper class environments); and 4) that inmates who have been in prison for long periods of time will be more external than those who have been in prison for a shorter time period, at least on the powerful others dimension. These data will provide support of past studies and provide new normative data on these I-E scales to be used
in future studies. Since externality is associated with maladjustment and marginal groups, confirmation of the above hypothesis will provide a rationale for treatment. This normative data can further be used to assess various treatment methods by providing baseline figures for comparison purposes
Farmer and Rancher Suicide Prevention Posters
No full textTo develop a poster for farmer and rancher suicide awareness, the author first researched general suicide prevention and awareness posters to see analyze successful examples and to get ideas for potential themes, colors, and content. The ideas generated in this process needed to be methodically applied to make the content relevant and relatable for those in the agricultural industry. In this process, the author chose to incorporate a word cloud filled with words that represent agricultural issues and influence farmer and rancher suicide. The phrase “Suicide does not solve agricultural issues,” was chosen to use as the title at the top of the poster. This phrase is relevant when distributed through agricultural organizations because those organizations are responsible for working with farmers and ranchers to develop solutions for agricultural issues, including the issues listed in the word cloud
Coronary beta(2)-adrenoreceptors mediate endothelium-dependent vasoreactivity in humans: novel insights from an in vivo intravascular ultrasound study
No full textAimsThe interaction between coronary β(2)-adrenoreceptors and segmental plaque burden is complex and poorly understood in humans. We aimed to validate intracoronary (IC) salbutamol as a novel endothelium-dependent vasodilator utilizing intravascular ultrasound (IVUS), and thus assess relationships between coronary β(2)-adrenoreceptors, regional plaque burden and segmental endothelial function.Methods and resultsIn 29 patients with near-normal coronary angiograms, IVUS-upon-Doppler Flowire imaging protocols were performed. Protocol 1: incremental IC salbutamol (0.15, 0.30, 0.60 μg/min) infusions (15 patients, 103 segments); protocol 2: salbutamol (0.30 μg/min) infusion before and after IC administration of N(G)-monomethyl-L-arginine (L-NMMA) (10 patients, 82 segments). Vehicle infusions (IC dextrose) were performed in 4 patients (21 segments). Macrovascular response [% change segmental lumen volume (ΔSLV)] and plaque burden [per cent atheroma volume (PAV)] were studied in 5-mm coronary segments. Microvascular response [per cent change in coronary blood flow (ΔCBF)] was calculated following each infusion. Intracoronary salbutamol demonstrated significant dose-response ΔSLV and ΔCBF from baseline, respectively (0.15 μg/min: 3.5 ± 1.3%, 28 ± 14%, P = 0.04, P = NS; 0.30 μg/min: 5.5 ± 1.4%, 54 ± 17%, P = 0.001, P < 0.0001; 0.60 μg/min: 4.8 ± 1.6%, 66 ± 15%, P = 0.02, P < 0.0001), with ΔSLV responses further exemplified in low vs. high plaque burden groups. Salbutamol vasomotor responses were suppressed by l-NMMA, supporting nitric oxide-dependent mechanisms. Vehicle infusions resulted in no significant ΔSLV or ΔCBF. Multivariate analysis including conventional cardiovascular risk factors, PAV, segmental remodelling and plaque eccentricity indices identified PAV as the only significant predictor of a ΔSLV to IC salbutamol (coefficient -0.18, 95% CI -0.32 to -0.044, P = 0.015). Conclusions Intracoronary salbutamol is a novel endothelium-dependent epicardial and microvascular coronary vasodilator. Intravascular ultrasound-derived regional plaque burden is a major determinant of segmental coronary endothelial function.Rishi Puri, Gary Y.H. Liew, Stephen J. Nicholls, Adam J. Nelson, Darryl P. Leong, Angelo Carbone, Barbara Copus, Dennis T.L. Wong, John F. Beltrame, Stephen G. Worthley, and Matthew I. Worthle
Coronary endothelium-dependent vasoreactivity and atheroma volume in subjects with stable, minimal angiographic disease versus non-ST-segment- elevation myocardial infarction: an intravascular ultrasound study
No full textBACKGROUND-Epicardial plaque burden and endothelial function are recognized predictors of coronary events. We aimed to investigate mechanistic relationships between atheroma volume and endothelial function in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) using intravascular ultrasound. METHODS AND RESULTS-In coronary vessels of patients with near-normal or minimal angiographic disease (n=23) and NSTEMI (n=24), intravascular ultrasound-derived measures (percent atheroma volume), arterial remodeling index, and segmental lumen volumes were performed in contiguous 5-mm epicardial segments. Repeat intravascular ultrasound imaging was performed after consecutive 5-minute intracoronary infusions (vehicle solution, 0.30 μg/min and 0.60 μg/min intracoronary salbutamol) to measure changes in segmental lumen volume (endothelium-dependent function). Male sex, diabetes mellitus, smoking, higher triglycerides, and lower high-density lipoprotein cholesterol were more prevalent in the NSTEMI group. Patients with NSTEMI demonstrated greater segmental percent atheroma volume (40.4±12 versus 27.5±14%, P2 mg/L (β=-3.1, P=0.03), diabetes mellitus (β=-6.9, P<0.0001), low-density lipoprotein cholesterol levels (β=-0.04, P=0.01), and smoking (β=-3.2, P=0.01) as independent associates. CONCLUSIONS-Although coronary endothelial vasoreactivity is blunted in the setting of NSTEMI, this is a reflection of the greater volume of atherosclerosis and cardiovascular risk factors. Thus, the relationship between coronary endothelium-dependent vasomotor reactivity and atheroma volume remains constant irrespective of the nature of the clinical presentation.Rishi Puri, Stephen J. Nicholls, Steven E. Nissen, Danielle M. Brennan, Jordan Andrews, Gary Y. Liew, Adam J. Nelson, Angelo Carbone, Barbara Copus, E. Murat Tuzcu, John F. Beltrame, Stephen G. Worthley, Matthew I. Worthle
Coronary atheroma composition and its association with segmental endothelial dysfunction in non-ST segment elevation myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography
No full textLittle is known of the relationship between coronary atheroma composition and corresponding endothelial dysfunction. We tested the hypothesis that segmental epicardial vasoreactivity relates to atheroma composition in patients with non-ST segment elevation myocardial infarction (NSTEMI) in vivo. In 23 NSTEMI patients referred for coronary angiography, a non-culprit vessel underwent intracoronary salbutamol (0.30 μg/min) provocation during automated IVUS pullback. A 40 MHz rotational IVUS catheter delivered radiofrequency signals at constant 67 μm intervals via a custom-built IVUS console (iMAP, iLAB, Boston Scientific). Macrovascular response [change in segmental lumen volume (SLV) at baseline and following salbutamol], percent atheroma volume (PAV) and tissue composition was evaluated in 187 contiguous non-overlapping 5 mm coronary segments. Compared with segments that dilated, constrictive segments showed similar SLV, but greater vessel volumes and PAV at baseline. The extent of necrotic and lipidic plaque was significantly greater in constrictive segments, whereas fibrotic plaque content was significantly greater in segments that dilated. Calcific plaque content did not relate to endothelium-dependent vasoreactivity. The change in SLV correlated inversely with the amount of lipidic and necrotic plaque (both r = −0.23, p = 0.002), and directly with fibrotic plaque content (r = 0.23, p = 0.002). In a multivariable model, the extent of both lipidic and necrotic plaque independently associated with segmental vasoconstriction (β = 1.2, p = 0.023; β = 0.66, p = 0.027). Following NSTEMI, both lipidic and necrotic plaque content each associate with segmental endothelial dysfunction. The link between plaque composition and vessel reactivity provides a mechanistic basis of the pathogenesis associated with vulnerable plaque in humans in vivo.Rishi Puri, Stephen J. Nicholls, Danielle M. Brennan, Jordan Andrews, Gary Y. Liew, Angelo Carbone, Barbara Copus, Adam J. Nelson, Samir R. Kapadia, E. Murat Tuzcu, John F. Beltrame, Stephen G. Worthley, Matthew I. Worthle
Left main coronary arterial endothelial function and heterogenous segmental epicardial vasomotor reactivity in vivo: novel insights with intravascular ultrasonography
No full textAIMS: While the relationship between epicardial coronary vasomotor reactivity and cardiovascular events is well established, this observation has yet to be evaluated within the left main coronary artery (LMCA) in humans in vivo. Our aims were to test the endothelium-dependent vasomotor properties of the LMCA, and to compare these responses to downstream epicardial segments. METHODS AND RESULTS: Thirty patients referred for coronary angiography underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound imaging within a non-critically diseased, left-sided conduit vessel. Macrovascular vasomotor response [change in average lumen area (LA) at baseline and following 5 min of 0.30 µg/min IC salbutamol] and percent atheroma volume (PAV) were evaluated in 30 LMCA, 42 proximal, 109 mid, and 132 distal epicardial coronary segments. In comparison with all other segments, the LMCA had the greatest lumen and vessel areas (P < 0.001), yet the proximal epicardial segments contained the greatest PAV (P < 0.02). The mid and distal epicardial segments displayed significant endothelium-dependent vasodilatation from baseline (P = 0.017 and <0.001, respectively); however, the proximal epicardial and LMCA segments did not (P = 0.45 and 0.16, respectively). Significant segmental vasomotor heterogeneity was noted in all 30 patients, with opposing vasomotor responses between adjacent LMCA and epicardial segments. Across all segments, baseline LA inversely correlated with the % change in LA (r = -0.16, P = 0.0005). CONCLUSION: Endothelium-dependent vasomotor reactivity is heterogenous within the conduit coronary system. Vascular dynamic responses were less prominent in the larger calibre LMCA and proximal epicardial segments. This may, in part, relate to higher shear stress in smaller, distal segments and yet also may explain the propensity for culprit plaques to cluster proximally.Rishi Puri, Stephen J. Nicholls, Danielle M. Brennan, Jordan Andrews, Karilane L. King, Gary Y. Liew, Angelo Carbone, Barbara Copus, Adam J. Nelson, Samir R. Kapadia, Emin Murat Tuzcu, John F. Beltrame, Stephen G.Worthley, and Matthew I.Worthle
Life-Threatening Nocardia Empyema: A Case Report
No full textPurpose (a): To highlight a rare presentation of empyema and osteomyelitis of the ribs caused by Nocardia species bacteria. This case discusses the clinical features, imaging, and treatment of this unusual infection.
Methods (b): A chart and literature review were performed with emphasis on disease presentation, imaging, cultures obtained, and treatment regimen involved in the management of osteomyelitis of the rib caused by Nocardia infection. The infection initially began as a pneumonia which was untreated due to the patient’s lack of health insurance coverage. The pneumonia then transformed into an empyema and eventually infiltrated the chest wall. This allowed bacteria to colonize in the rib causing an osteomyelitis that presented as a large subcutaneous mass of the chest.
Results (c): The unusual clinical presentation of a large, painful, subcutaneous mass prompted a CT scan at the emergency department which identified an empyema in the lung and a rib fracture suggestive of osteomyelitis. Infectious etiology was confirmed with culture of both the rib and empyema aspirate, showing colonization with Nocardia. The patient was treated with aggressive IV Bactrim for 6 weeks followed by 4 weeks of oral Bactrim. At follow up he had complete resolution of symptoms.
Conclusions (d): Adults with a history of untreated pneumonia who present weeks later with a large, subcutaneous mass on the thorax should be worked up for possible empyema and osteomyelitis of the ribs. In addition, it is important to obtain cultures and identify the correct infectious organism in order to ensure complete eradication of the infection
