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Aim: The aim of this study is to report recent trends in the performance of endomyocardial biopsy (EMB) and its in-hospital complications (and their predictors) in the United States (US). Method: We analyzed Nationwide Inpatient Sample (NIS) database from years 2007 through 2014 to identify patients who underwent EMB. Once identified, the patients were subdivided into those with no history of heart transplant (HT) (cohort 1) and those with history of HT (cohort 2). We then studied the major complication of pericardial effusion, hemopericardium or/and cardiac tamponade that required a pericardiocentesis or a pericardial window (CTRPD) following the EMB procedure. Results: We observed a steady increase in the in-patient EMB procedures, with more EMB procedures being performed in males and in Caucasians. In cohort 1, the CTRPD was higher (0.70%) as compared to cohort 2 (0.19; p = 0.01). CTRPD in women was higher compared to men (0.94 vs. 0.53% p = 0.022). Most of the EMB procedures are performed in teaching hospitals. The CTRPD rate was significantly higher in the nonteaching hospitals when compared to teaching hospitals in both cohort 1 and cohort 2 (3.4 vs. 0.53% and 1 vs.0.18%, respectively; p = 0.01 and < 0.001, respectively). The overall mortality in cohort 1 was 4.3% as compared to 2.5% in cohort 2; p = 0.01. In cohort 1, the mortality was significantly higher in the group that had EMB-related complications versus the group without the complications (20 vs. 2.5%; p < 0.001). Conclusion: There has been an increase in the number of EMB procedures in the US in recent years. Though the overall risk of CTRPD is very low, the risk is significantly higher in cohort 1, women, and in nonteaching hospitals. The study results provide data benchmarks for assessing EMB outcomes in the US.

Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease. From this group, all patients readmitted with similar diagnosis within 30 days were recorded. Results Of the total 25,111 index hospitalization for critical limb ischemia, 1270 (5%) were readmitted with a primary diagnosis of critical limb ischemia within 30 days. The readmission rate was highest (9.5%) for the group that did not have any intervention (revascularization or major amputation) and was lowest for surgical revascularization and major amputation groups (2.6% and 1.3%, P value Conclusions In patients with primary diagnosis of critical limb ischemia, 30-day critical limb ischemia-related readmission rate was affected by initial management strategy and the severity of critical limb ischemia. Readmission was associated with a significantly higher rate of amputation, increased length of stay, and a more frequent discharge to an alternate care facility than index admission and thus may serve as a useful quality of care metric in critical limb ischemia patients.

A small percentage of patients with asymptomatic carotid artery stenosis (ACAS) who are on optimal medical management do go on to develop ischemic stroke or transient ischemic attacks (IS/TIA). Several diagnostic tools have been studied to identify those patients who are at increased risk. However, most of these diagnostic tools are not available for routine clinical use or are resource intensive. We performed a retrospective study to assess the incremental value of external carotid artery stenosis progression (ECASP) along with internal carotid artery stenosis progression (ICASP) in predicting risk of ipsilateral IS/TIA in a cohort of patients with ACAS. We conducted a retrospective analysis of patients with ACAS who had at least two serial duplex ultrasounds (DUS) at our center. A total of 356 patients (712 carotid arteries) were included in the study (mean age 74.7±9 years, 49.2% male) with a mean follow-up of 60.7±32.7 months. In univariate analysis, concurrent progression of ICA and ECA stenosis on the same side arteries was associated with a very significant increased risk of ipsilateral IS/TIA (14.7% vs 4.6%, p

Both QT interval and body mass index (BMI) are independently associated with mortality. Those with higher BMI have longer QT, although evidence is inconsistent. The joint association of QT and BMI with mortality merits investigation.To examine the association of QT with BMI, and to examine the joint association of QT and BMI with all-cause and cardiovascular mortality.We followed 4036 participants from NHANES III for a median of 14.7 years. Weighted sample was divided into 4 categories by BMI as: 18.5-24.9, 25-29.9, 30-34.9 and ≥35, and 2 categories by corrected QT interval (QTc) as: normal (450ms in males,460ms in females) or prolonged. Cox proportional hazards models were used with adjustment for demographic characteristics and cardiovascular risk factors.QTc was longer among those with higher BMI (mean QTc: 424.7, 425.8, 430.9 and 437.8 respectively for BMI 18.5-24.9, 25-29.9, 30-34.9 and ≥35, p-trend:0.001). Overall, longer QTc or higher BMI were associated with increased all-cause and cardiovascular mortality risk compared to mean QTc or mean BMI, respectively. When combined, cardiovascular mortality was significantly increased among obese individuals with prolonged QTc [hazard ratio (95% CI): 3.1 (1.2-8.0) and 4.8 (1.2-19.9) but not when QTc was normal [1.0 (0.5-2.0) and 1.4 (0.8-2.8)] for BMI 30-34.9 and ≥35, respectively compared to BMI 18.5-24.9 and normal QTc. Similar (although not statistically significant) findings were observed for all-cause mortality. Risk prediction for both all-cause and cardiovascular mortality improved when QTc was added to the adjusted model with BMI (net reclassification index 0.14, p=0.01 and 0.14, p0.0001 for all-cause and cardiovascular mortality, respectively).Individuals with higher BMI have a significantly longer QTc. BMI is associated with increased all-cause and cardiovascular mortality risk when QTc is prolonged but not when QTc is normal. These novel observations suggest that QTc should be factored into risk stratification of obese individuals with a screening electrocardiogram. This may help stratify individuals into lower risk categories when QTc is normal.

Location-based social discovery networks (LBSD) is an emerging category of location-based social networks (LBSN) that are specifically designed to enable users to discover and communicate with nearby people. In this paper, we present the first measurement study of the characteristics and evolution of location-based communities which are based on a social discovery network and geographic proximity. We measure and analyse more than 176K location-based communities with over 1.4 million distinct members of a popular social discovery network and more than 46 million locations. We characterise the evolution of the communities and study the user behaviour in LBSD by analysing the mobility features of users belonging to communities in comparison to non-community members. Using observed spatio-temporal similarity features, we build and evaluate a classifier to predict location-based community membership solely based on user mobility information.

Background and Purpose: To assess the effect of optimal medical management including atherosclerotic risk factor control on ischemic stroke (IS), transient ischemic attack (TIA), carotid revascularization (CRV), and progression of severity of carotid stenosis (PSCS) in patients with asymptomatic carotid artery stenosis (ACAS). Methods: We conducted a retrospective analysis of patients with ACAS (who had at least 3 serial carotid duplex ultrasounds) for incidence of IS, TIA, and PSCS. Results: Eight hundred sixty-four patients with a mean follow-up duration of 79 ± 36 months were included. IS/TIA and CRV occurred in 12.2% of the patients and PCSS was observed in 21.5% vessels. On univariate analysis it was found that low-density lipoprotein (LDL) levels >100 mg/dL, no statin or low-potency statins, average systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg and history of smoking were predictors of the combined endpoint of IS/TIA/CRV and PSCS. On multivariate analysis, it was found that LDL >100 mg/dL, no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, and Hx of smoking were independent predictors of PSCS. Similarly no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, Hx of atrial fibrillation/flutter, Hx of chronic kidney disease, and PSCS were independent predictors of IS/TIA. No statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, diabetes mellitus, baseline carotid artery stenosis ≥70%, and PSCS were found to be independent predictors of combined endpoint IS/TIA and CRV. Conclusion: Intensive medical therapy in the patients with ACAS results in lower incidence of IS/TIA, CRV, and PSCS with a significant incremental beneficial effect.

Objective: The aim of this paper was to study the association between body mass index (BMI) and coronary sinus (CS) brain natriuretic peptide (BNP) levels in patients with heart failure and reduced systolic function (HFrEF). Background: There is an inverse relationship between systemic venous BNP (V-BNP) levels and BMI in patients with HFrEF. It is unclear whether this finding is due to decreased production or due to an increased metabolism of BNP. Since CS-BNP levels reflect BNP production, we hypothesized that assessing the correlation of CS-BNP levels with BMI would provide insight into the mechanism of this inverse relationship of V-BNP and BMI. Methods: We prospectively enrolled 54 subjects with HFrEF who were to undergo cardiac resynchronization device implantation. CS-BNP, V-BNP, and arterial BNP (A-BNP) levels were measured during the implant procedure. Subjects were divided into 2 groups based on their BMI (group 1: BMI Results: The mean age of the overall study group was 64 ± 10 years. Average BMI for group 1 was 25.8 ± 2.8 and 36.8 ± 4.6 for group 2 (p < 0.03). A history of hypertension was present in 55% (n = 26) of the subjects, while diabetes was reported in 31% (n = 15). Serum creatinine was 1.0 ± 0.2 mg/dL and TSH 2.1 ± 1.4 mIU/L. 79% of the subjects were receiving β-blockers, while 94% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The mean CS-BNP, V-BNP, and A-BNP levels in group 2 were significantly lower than in group 1 (286.2 ± 170.5 vs. 417.5 ± 247.5 pg/mL, p = 0.04; 126.6 ± 32.5 vs. 228 ± 96.4 pg/mL, p = 0.01; and 151.9 ± 28.6 vs. 242 ± 88.8 pg/mL, p = 0.04, respectively). Univariate analysis and multivariate regression adjusted for age, diabetes mellitus, sex, glomerular filtration rate, and left atrial size confirmed BMI as an independent predictor of CS-BNP levels (β = -0.372, p = 0. 03) in our study. Conclusions: In this study, we demonstrate an inverse relationship between CS-BNP levels and BMI in patients with HFrEF. These findings suggest that the previously established inverse relationship between V-BNP and BMI is due to a decreased cardiac production of BNP in obese patients rather than from increased peripheral metabolism.

Kinodynamic-RRT* provides a sampling based asymptotically-optimal solution for motion planning of kinematically- and dynamically-constrained robots. For nonlinear systems, normally, the time- and energy-clamped steering function solutions needed within the RRT* use numerical iterative schemes such as shooting methods, which are computationally cumbersome. The number of calls to these solvers increases with the size of the tree. Hence, the time complexity of finding feasible steering functions prevents kinodynamic-RRT* for non-linear systems from being utilized in realtime or in situations where fast planning and re-planning are needed. Kinematic/dynamic constraints reduction to make the steering functions solvable in real time has been proposed in literature, however, these methods would affect the optimality of the solution. In this paper, we propose a lazy-steering kinodynmaic RRT* in which, machine learning techniques are used to (1) predict if a randomly-selected node is steerable to, and (2) if the steering is deemed feasible, what would be the estimated energy cost associated, when executing it. This provides a promising framework for implementing Kinodynamic-RRT* in which the use of numerical methods is delayed (hence the name lazy steering) until a potential collision free path has been found, and only then the numerical techniques are invoked. This results in a huge improvement in the run time with little trade off on optimality. Our proposed method was tested via simulation for motion planning of an under-actuated, non-holonomic, quadcopter with nonlinear dynamics in an environment cluttered with obstacles. The lazy-steering RRT* was faster than its counterpart (which was based on some recent works) by two orders of magnitude.

We use multi-wavelength data from the Galaxy and Mass Assembly (GAMA) survey to explore the cause of red optical colours in nearby (0.002= 47% of all spirals in our sample. Furthermore, for a small subsample of our spiral galaxies which are detected in HI, we find that the SFR of gas-rich red spiral galaxies is lower by ~1 dex than their blue counterparts., Comment: Accepted for publication in the MNRAS; 11 pages; 12 figures

Summary: Background: Fibromuscular dysplasia (FMD) primarily involves medium-sized arteries, though the entire spectrum of vascular involvement is not fully understood. We hypothesized that larger arteries may also be affected, albeit sub-clinically. Patients and methods: We measured the cross-sectional diameter of the thoracic aorta, abdominal aorta, common iliac arteries (CIA) and common carotid arteries (CCA) in FMD subjects and compared them to matched controls. We retrospectively analyzed records of FMD subjects (n = 74) and of age- and sex- matched controls (n = 74) that underwent computed tomography of the neck, chest or abdomen. Cross-sectional diameters of the thoracic and abdominal aorta, CIA and CCA were measured in a standardized manner by two trained physicians. Results: The FMD group had a significantly greater diameter of the CIA and CCA bilaterally. The measurements (mm) in FMD and control groups were as follows: Right CIA: 10.85 + 1.75 vs. 10.23 + 1.36, p = 0.04, left CIA: 11.01 + 1.93 vs. 10.15 + 1.38, p = 0.007, right CCA: 7.70 + 0.81 vs. 6.80 + 1.10, p

The effect of normalization of serum testosterone levels with testosterone replacement therapy (TRT) in patients with a history of myocardial infarction (MI) is unknown. The objective of this study was to determine the incidence of recurrent MI and all-cause mortality in subjects with a history of MI and low total testosterone (TT) with and without TRT. We retrospectively examined 1,470 men with documented low TT levels and previous MI, categorized into Gp1: TRT with normalization of TT levels (n = 755) Gp2: TRT without normalization of TT levels (n = 542), and Gp3: no TRT (n = 173). The association of TRT with all-cause mortality and recurrent MI was compared using propensity score-weighted Cox proportional hazard models. All-cause mortality was lower in Gp1 versus Gp2 (hazard ratio [HR] 0.76, confidence interval [CI] 0.64 to 0.90, p = 0.002), and Gp1 versus Gp3 (HR 0.76, CI 0.60 to 0.98, p = 0.031). There was no significant difference in the risk of death between Gp2 versus Gp3 (HR 0.97, CI 0.76 to 1.24, p = 0.81). Adjusted regression analyses showed no significant differences in the risk of recurrent MI between groups (Gp1 vs Gp3, HR 0.79, CI 0.12 to 5.27, p = 0.8; Gp1 vs Gp2 HR 1.10, CI 0.25 to 4.77, p = 0.90; Gp2 vs Gp3 HR 0.58, CI 0.08 to 4.06, p = 0.58). In conclusion, in a large observational cohort of male veterans with previous MI, normalization of TT levels with TRT was associated with decreased all-cause mortality compared with those with non-normalized TT levels and the untreated group. Furthermore, in this high-risk population, TRT was not associated with an increased risk of recurrent MI.

Patient: Female, 29 Final Diagnosis: Renal arteriovenous malformation Symptoms: Hypertension Medication: — Clinical Procedure: Angiography Specialty: Cardiology Objective: Rare disease Background: Congenital renal vascular anomalies have been classified into 3 categories: cirsoid, angiomatous, and aneurysmal. These classifications are based on the size, location, and number of vessels involved. Aneurysmal malformations, such as the one reported here, have a single (and dilated) feeding and draining vessel. The prevalence of renal AVMs is estimated at less than 0.04%, making them rare causes of secondary hypertension. Case Report: A 29-year-old white woman was seen in the hypertension clinic as a referral from high-risk obstetric clinic for management of hypertension (HTN). A secondary hypertension workup with Doppler waveforms of the renal arteries revealed prominent diastolic flow in the left compared to the right. For confirmation, an MRA was done, which showed a large left renal upper-pole arteriovenous malformation (AVM) with associated vascular shunting and early opacification of the left renal vein. This congenital AVM was identified as the cause of her hypertension. Angiography and coil embolization were performed. The patient’s BP normalized within a few days and she was taken off her antihypertensive medications. Conclusions: This case illustrates that a careful review of duplex waveforms beyond just peak velocity and ratios is important to identify uncommon pathologies. This is important, as renal AVMs respond well to embolization, with resolution of hypertension in 59% of patients treated.

Background Testosterone replacement therapy (TRT) prescriptions have increased several-fold in the last decade. There have been concerns regarding a possible increased incidence of DVT and pulmonary embolism (PE) with TRT. Few data support the association between TRT and DVT/PE. We evaluated the incidence of DVT and PE in men who were prescribed TRT for low serum total testosterone (sTT) levels. Methods This is a retrospective cohort study, conducted using data obtained from the Veterans Affairs Informatics and Computing Infrastructure. We compared the incidence of DVT/PE between those who received TRT and subsequently had normal on-treatment sTT levels (Gp1), those who received TRT but continued to have low on-treatment sTT (Gp2), and those who did not receive TRT (Gp3). Those with prior history of DVT/PE, cancer, hypercoagulable state, and chronic anticoagulation were excluded. Results The final cohort consisted of 71,407 subjects with low baseline sTT. Of these, 10,854 did not receive TRT (Gp3) and 60,553 received TRT. Of those who received TRT, 38,362 achieved normal sTT (Gp1) while 22,191 continued to have low sTT (Gp2). The incidence of DVT/PE was 0.5%, 0.4%, and 0.4% in Gp1, Gp2, and Gp3, respectively. Univariate, multivariate, and stabilized inverse probability of treatment weights analyses showed no statistically significant difference in DVT/PE-free survival between the various groups. Conclusions This study did not detect a significant association between testosterone replacement therapy and risk of DVT/PE in adult men with low sTT who were at low to moderate baseline risk of DVT/PE.

Background Benefits of temporary mechanical circulatory support has not been demonstrated successfully in clinical trials despite their increased widespread use in the real-world management of patients with cardiogenic shock (CS). Methods Using the Nationwide Readmissions Database from Jan 2016 to Nov 2017, we identified all patients admitted with CS requiring either only intra-aortic balloon pump (IABP) or Impella device implantation (IM) with 30-day follow up. Patients with combined devices or undergoing medical management only were excluded. Propensity matched (1:1) was performed based on demographics and comorbidities to compare the survival, complications, and use of advanced heart failure therapies. Results Out of a total of 236156 patients, 32850(13.9%) had IABP and 8389(3.5%; unweighted n= 4504) patients had IM implantation. Well-matched 4411-pairs of matched IABP vs IM patients had mean similar age (65 vs 64.9 years), women (29.2% vs 28.6%), and acute myocardial infarction (75.7% vs 75.8%). In terms of therapy, no differences in use of right heart catheterization/pulmonary catheter placement or vasopressor use(p>0.05 for all). IM group had higher mortality (45.8% vs. 28.6%, p Conclusion Significant number of CS patients undergo IM implantations with widely different survival as well as candidacy for a heart transplant. The underlying patient- and physician-related differences need to further be explored prior to widespread use of this powerful technology.

Background: The usefulness of the Right Heart Catherization/Pulmonary Artery Catheterization (RHC/PAC) has been long debated. Previous evidence has shown the lack of additive benefit of RHC/PAC use in various clinical settings. However, current evidence of RHC/PAC utility in the setting of cardiogenic shock (CS) is scarce. Methods: In the Nationwide Readmissions Database (NRD) using International Classification of Diseases, Tenth revision we identified 269,475 patient hospitalizations with cardiogenic shock between 2016-2017. We sought to evaluate the impact of RHC/PAC on in-hospital and readmission outcomes. Results: Approximately 25,840 patients received a RHC/PAC on index admission. The RHC/PAC group had significantly more comorbidities and higher AKI rates (73% vs 60.4%; p

Critical limb ischemia (CLI) is associated with significant morbidity and mortality. However, there is a dearth of data on six-month readmissions for CLI. A secondary analysis of the Nationwide Readmissions Database for 2016 was conducted. Index admissions for CLI in the first six months were

BACKGROUND Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p-LVADs). p-LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock. These large bore percutaneous devices have a higher risk of vascular complications. We examined the vascular complication rates from the use of p-LVAD in a national database. METHODS We conducted a secondary analysis of the National In-patient Sample (NIS) dataset from 2005 till 2015. We used the ICD-9-CM procedure codes 37.68 and 37.62 for p-LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ2 test and t test were used for categorical and continuous variables, respectively for comparison. RESULTS A total of 31,263 p-LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in-hospital mortality (37.77% vs. 29.95%, p

Objective To assess the influence of body-mass index (BMI) on the association of ankle-brachial index (ABI) with mortality. Patients and Methods We conducted a prospective study of National Health and Nutrition Examination Survey participants enrolled from January 1, 1999 to December 31, 2002 with BMI and ABI data available. ABI categories were 1.3 (high). BMI categories were

Objective: To examine the effect of cigarette smoking (CS) status and total testosterone (TT) levels after testosterone replacement therapy (TRT) on all-cause mortality, myocardial infarction (MI), and stroke in male smokers and nonsmokers without history of MI and stroke. Participants and Methods: Data from 18,055 males with known CS status and low TT levels who received TRT at the Veterans Health Administration between December 1, 1999, and May 31, 2014, were grouped into (1) current smokers with normalized TT, (2) current smokers with nonnormalized TT, (3) nonsmokers with normalized TT, and (4) nonsmokers with nonnormalized TT. Combined effect of CS status and TT level normalization after TRT on all-cause mortality, MI, and stroke was compared using propensity score–weighted Cox proportional hazard models. Results: Normalization of serum TT levels in nonsmokers was associated with a significant decrease in all-cause mortality (hazard ratio [HR]=0.526; 95% CI, 0.477-0.581; P

With an expanding and aging heart transplant population, the incidence of acute coronary syndromes (ACS) is expected to increase. Our study aims to report current trends in in-hospital management and outcomes in heart transplant recipients presenting with ACS. We conducted an analysis of the National Inpatient Sample (2007 to 2014) to study the trends in hospitalization, in-hospital management, and outcomes in heart transplant recipients with a primary diagnosis of ACS. We included patients with ST elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and those with unstable angina pectoris (UAP). A total of 1,621 ACS (NSTEMI/UAP-76% vs STEMI-24%) hospitalizations were identified. Despite 1,327 (81%) of patients who underwent left heart catheterization, coronary revascularization was performed in only 576 patients (36%). Mortality was significantly higher in patients presenting with STEMI versus NSTEMI/UAP (28% vs 11%, respectively; p0.05) and those who did not undergo revascularization (19% vs 7%; p0.05). Cardiogenic shock (CS) was diagnosed in 14.5% patients. Mechanical circulatory support utilization was higher in CS group compared with non-CS group (69% vs 2.8%; p0.05), as was in-hospital mortality (39% vs 10%; p0.05). Repeat transplantation during the index hospitalization was done in 4.5% of ACS patients. In conclusion, in heart transplant recipients, ACS is associated with a high incidence of CS and in-hospital mortality. Aggressive treatment strategy that includes revascularization, mechanical circulatory support use (in those developing CS), and urgent retransplantation in suitable candidates seems to lead to better results than a more conservative strategy.

OBJECTIVES To assess the prognostic significance of high vs. low grade coronary artery ectasia (CAE) and the impact of antithrombotic or anticoagulant therapy on adverse cardiac outcomes. BACKGROUND There is paucity of knowledge on the impact of angiographic characteristics in CAE or that of antithrombotic or anticoagulant therapy on outcomes. METHODS AND RESULTS In this retrospective study, we reviewed angiograms and medical records of all cases of confirmed CAE (2001-2011). Extent of CAE was categorized using the Markis classification. Types 1 and 2 were categorized as high-grade and types 3 and 4 as low-grade CAE. Angiographic flow was recorded as normal or sluggish (

Rotary-wing-based Unmanned Aerial Manipulators (UAM) are gaining attention for their in-place hovering capability, holonomy in motion, and safe operation due to their redundancy. Task-oriented optimal control strategies can also further improve the flight time by generating energy-optimal coordinated motions. This paper addresses the dynamic modeling, trajectory tracking and control of an UAM that consists of an under-actuated rotary-wing UAV, with a novel pitch-hover-maneuvering capability, and a 2-DOF robotic arm. A decoupled velocity-based Model Predictive Control (MPC) strategy is proposed for tracking a trajectory in the sagittal plane of the UAM while the UAV base pitch hovers in place. Conventional PD controllers were used to generate set-point velocity screws as the inputs to the MPC. A partitioned (but complete) dynamic model of the UAM was developed and used for implementing the proposed control strategy in a simulated environment. The MPC controller takes the force/torque exerted (by the arm) on the UAV base into account and augments the desired control inputs accordingly. The proposed control strategy provides the following advantages: (1) it can be implemented in real time since a linearized dynamic model of the UAV base is used, (2) it provides a generic control structure that can be applied to different classes of UAMs.

Amazon Aurora is a high-throughput cloud-native relational database offered as part of Amazon Web Services (AWS). One of the more novel differences between Aurora and other relational databases is how it pushes redo processing to a multi-tenant scale-out storage service, purpose-built for Aurora. Doing so reduces networking traffic, avoids checkpoints and crash recovery, enables failovers to replicas without loss of data, and enables fault-tolerant storage that heals without database involvement. Traditional implementations that leverage distributed storage would use distributed consensus algorithms for commits, reads, replication, and membership changes and amplify cost of underlying storage. In this paper, we describe how Aurora avoids distributed consensus under most circumstances by establishing invariants and leveraging local transient state. Doing so improves performance, reduces variability, and lowers costs.

Objective Peripartum cardiomyopathy (PPCM) can present during pregnancy and up to months post-delivery. Most large-scale epidemiologic studies have reported on cases occurring during pregnancy or the first few days postpartum (termPPCM). Limited information is available on PPCM in the later postpartum period (latePPCM). We studied the incidence, predictors, and hospital outcome of peripartum cardiomyopathy (PPCM) in the prepartum and immediate post delivery period versus up to 3 months post-delivery. Methods We performed a secondary analysis of the 2013 Nationwide Readmissions Database, and compared the incidence, patient characteristics and in-hospital outcomes of PPCM during the peripartum and three-month postpartum period. All women with a discharge diagnosis of PPCM during a hospitalization for childbirth were included in the termPPCM group and those re-hospitalized within 3 month post-delivery with a new diagnosis of PPCM comprised the latePPCM group. Results There were 568 cases of PPCM, indicating an incidence of 1 per 2187 deliveries. Two thirds of those were latePPCM, and 75% of latePPCM cases occurred within 10 days of discharge. LatePPCM incidence was 1 per 208 deliveries in the highest risk group (age > 35, gestation diabetes and preeclampsia). Patients with termPPCM were more likely to be co-diagnosed with preeclampsia, to be anemic, and to be delivered by C-section. Conclusions Most cases of PPCM were diagnosed during a readmission, rather than during pregnancy or childbirth-related index hospitalization. It may be possible to identify latePPCM cases by pre-discharge screening in high risk women and institute early management to potentially decrease morbidity/mortality.

Background/objectives Orbital atherectomy (OA) is routinely being used for plaque modification to facilitate percutaneous revascularization in patients with peripheral arterial disease (PAD) and arterial calcification. Guidewire fracture (GWF) during OA, though anecdotally described, has not been studied in a systematic manner. We conducted a review of the Manufacturer and User Facility Device Experience (MAUDE) database to study the reports of wire fracture and its management and consequences. Methods We queried the MAUDE database for all events involving the current generation of the OA device: "Diamondback 360 Peripheral Orbital Atherectomy System", and "Stealth 360° Orbital PAD System". Results We identified 62 reports of GWF during OA for PAD. The superficial femoral artery was the most commonly involved atherectomy site. The wire fractured at the soft tip in a majority of cases (68%). Embolized wire fragments were left in the patient in 36 cases (58%), retrieved percutaneously in 10 cases (16%), and trapped by a stent against the arterial wall in eight cases (13%). Lastly, eight patients (13%) underwent surgery for removal of the wire fragment. Conclusions This is the first published report to study the complication of GWF during peripheral OA. GWF is an uncommon but has significant procedural and clinical consequences. It results in a high rate of ancillary rescue procedures (including surgery) and is associated with a higher risk of arterial thrombosis and complications from wire retrieval attempts. The risk of wire fracture may be avoided with carefully adherence to the IFU.

We present efficient localization aware sampling and connection strategies for incremental sampling-based stochastic motion planners. For sampling, we introduce a new measure of localization ability of a sample, one that is independent of the path taken to reach the sample and depends only on the sensor measurement at the sample. Using this measure, our sampling strategy puts more samples in regions where sensor data is able to achieve higher uncertainty reduction while maintaining adequate samples in regions where uncertainty reduction is poor. This leads to a less dense roadmap and hence results in significant time savings. We also show that a stochastic planner that uses our sampling strategy is probabilistically complete under some reasonable conditions on parameters. We then present a localization aware efficient connection strategy that uses an uncertainty aware approach in connecting the new sample to the neighbouring nodes, i.e., it uses an uncertainty measure (as opposed to distance) to connect the new sample to a neighboring node so that the new sample is reachable with least uncertainty ("the closest"), and furthermore, connections to other neighbouring nodes are made only if the new path to them (via the new sample) helps to reduce the uncertainty at those nodes. This is in contrast to current incremental stochastic motion planners that simply connect the new sample to all of the neighbouring nodes and therefore, take more search queue iterations to update the paths (i.e., uncertainty propagation). Hence, our efficient connection strategy, in addition to eliminating the inefficient edges that do not contribute to better localization, also reduces the number of search queue iterations. We provide simulation results that show that (a) our localization aware sampling strategy places less samples and find a well-localized path in shorter time with little compromise on the quality of path as compared to existing sampling techniques, (b) our localization aware connection strategy finds a well-localized path in shorter time with no compromise on the quality of path as compared to existing connection techniques, and finally (c) combined use of our sampling and connection strategies further reduces the planner run time.

Aims There is a significant uncertainty regarding the effect of testosterone replacement therapy (TRT) on cardiovascular (CV) outcomes including myocardial infarction (MI) and stroke. The aim of this study was to examine the relationship between normalization of total testosterone (TT) after TRT and CV events as well as all-cause mortality in patients without previous history of MI and stroke. Methods and results We retrospectively examined 83 010 male veterans with documented low TT levels. The subjects were categorized into (Gp1: TRT with resulting normalization of TT levels), (Gp2: TRT without normalization of TT levels) and (Gp3: Did not receive TRT). By utilizing propensity score-weighted Cox proportional hazard models, the association of TRT with all-cause mortality, MI, stroke, and a composite endpoint was compared between these groups. The all-cause mortality [hazard ratio (HR): 0.44, confidence interval (CI) 0.42–0.46], risk of MI (HR: 0.76, CI 0.63–0.93), and stroke (HR: 0.64, CI 0.43–0.96) were significantly lower in Gp1 ( n = 43 931, median age = 66 years, mean follow-up = 6.2 years) vs. Gp3 ( n = 13 378, median age = 66 years, mean follow-up = 4.7 years) in propensity-matched cohort. Similarly, the all-cause mortality (HR: 0.53, CI 0.50–0.55), risk of MI (HR: 0.82, CI 0.71–0.95), and stroke (HR: 0.70, CI 0.51–0.96) were significantly lower in Gp1 vs. Gp2 ( n = 25 701, median age = 66 years, mean follow-up = 4.6 years). There was no difference in MI or stroke risk between Gp2 and Gp3. Conclusion In this large observational cohort with extended follow-up, normalization of TT levels after TRT was associated with a significant reduction in all-cause mortality, MI, and stroke.

In this paper, we obtain generating functions involving hyper geometric functions. Rodrigues type formula of Hermite polynomials which is closely related to generalized Hermite polynomials of Dattoli et. al. These results provide useful extensions of the well known results of classical Hermite polynomials Hn(x).

Introduction: Patients undergoing endovascular therapy (EVT) for lower extremity peripheral arterial disease (PAD) are at risk for acute kidney injury (AKI). The purpose of this study was to determine the incidence, risk factors, and outcomes of AKI in the context of EVT from the National Inpatient Sample (NIS). Methods: Patient admissions in the NIS were queried from 2003-2012. The admissions were limited to non-dialysis patients with either critical limb ischemia (CLI) or claudication undergoing either EVT and/or angiography. AKI was defined using a composite of ICD-9 codes which have been previously validated in this context. Available comorbidity data, demographics, and inpatient outcomes (AKI, mortality) were analyzed using multivariable logistic regression models with age expressed in decades. Results: 552,484 admissions for CLI and 441,736 for claudication were included. The incidence of AKI is shown in the figure. The multivariate predictors of AKI in patients with claudication undergoing EVT only included age (OR 1.05, CI [1.02-1.09], P Conclusions: AKI occurs in approximately 3.5% of patients undergoing endovascular procedures for claudication and 10.9% in CLI patients. CKD and heart failure are the strongest risk factors for AKI. AKI is an independent predictor of inpatient mortality.

Dual antiplatelet therapy (DAPT) is associated with an increased risk of gastrointestinal (GI) bleeding and is thought to cause upper gastrointestinal bleeding (UGIB). However, recent reports indicate that the incidence of lower gastrointestinal bleeding (LGIB) in patients on DAPT may be increasing. We aimed to compare the endoscopic findings and etiology of GI bleeding between patients on DAPT compared with those not on DAPT.This was a retrospective, single-center, case-control study. Cases were 114 consecutive patients admitted with a first episode of GI bleeding while on DAPT who underwent detailed GI evaluation. We chose 114 controls who had GIB but were not on DAPT.There was no significant difference in the incidence of UGIB or LGIB between the two groups (UGIB: 53.5% vs 51.3% and LGIB: 46.5% vs 48.7%, P = 0.10) or within groups (DAPT: 53.5% vs 46.5%, P = 0.30 and controls: 51.3% vs 48.7%, P = 0.80). Although the DAPT group had a lower prevalence of the usual UGIB risk factors, it had a higher likelihood of bleeding from varices or upper GI inflammation [odds ratio (OR) 3.54, 95% confidence interval (CI) 0.14-92.3; OR 13.98, 95% CI 1.40-140.36]. No etiology of bleeding was identified in a higher percentage of patients on DAPT than those who were not (22.8% vs 5.3%).In patients with GI bleeding, the incidences of UGIB and LGIB are similar irrespective of their DAPT use.

Percutaneous coronary intervention (PCI) followed by transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis (AS) and coronary artery disease (CAD). In many, the coronary arteries are severely calcified and best treated with rotational atherectomy (RA). However, RA is not routinely performed in severe AS patients due to safety concerns. There is a paucity of data on the safety of RA in severe AS patients with calcific CAD.We retrospectively analyzed the medical records of 29 patients with severe AS who underwent elective RA-facilitated PCI at our center between January 1, 2011 and December 31, 2015.Twenty-nine patients (mean age, 79.8 ± 8.8 years) were enrolled. Mean aortic valve area was 0.71 ± 0.20 cm², mean aortic valve gradient was 40.32 ± 9.88 mm Hg. All PCIs were successful (mean diameter stenosis, 86.3 ± 7.6%; mean burr size, 1.62 ± 0.19 mm). Nineteen patients (65.5%) required temporary pacemaker. Eight patients (27.6%) required vasopressors during PCI. There was a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during RA, but without clinical events. No procedure was aborted and there were no deaths or clinical myocardial infarctions.RA-facilitated PCI can be safely performed in elderly patients with severe AS and severely calcified CAD with low risk of complications. There was a significant but transient drop in SBP, DBP, MAP, and HR during RA. However, this was not associated with clinically significant adverse events.

Background Atrial fibrillation ( AF ) is the most common cardiac dysrhythmia associated with significant morbidity and mortality. Several small studies have reported that low serum total testosterone ( TT ) levels were associated with a higher incidence of AF . In contrast, it is also reported that anabolic steroid use is associated with an increase in the risk of AF . To date, no study has explored the effect of testosterone normalization on new incidence of AF after testosterone replacement therapy ( TRT ) in patients with low testosterone. Methods and Results Using data from the Veterans Administrations Corporate Data Warehouse, we identified a national cohort of 76 639 veterans with low TT levels and divided them into 3 groups. Group 1 had TRT resulting in normalization of TT levels (normalized TRT ), group 2 had TRT without normalization of TT levels (nonnormalized TRT ), and group 3 did not receive TRT (no TRT ). Propensity score–weighted stabilized inverse probability of treatment weighting Cox proportional hazard methods were used for analysis of the data from these groups to determine the association between post‐ TRT levels of TT and the incidence of AF . Group 1 (40 856 patients, median age 66 years) had significantly lower risk of AF than group 2 (23 939 patients, median age 65 years; hazard ratio 0.90, 95% CI 0.81–0.99, P =0.0255) and group 3 (11 853 patients, median age 67 years; hazard ratio 0.79, 95% CI 0.70–0.89, P =0.0001). There was no statistical difference between groups 2 and 3 (hazard ratio 0.89, 95% CI 0.78– 1.0009, P =0.0675) in incidence of AF . Conclusions These novel results suggest that normalization of TT levels after TRT is associated with a significant decrease in the incidence of AF .

The CardioMEMSTM heart failure (HF) system is an ambulatory pulmonary artery pressure monitoring system designed to help manage patients with difficult to control HF symptoms and to reduce the need for hospitalizations due to acute HF exacerbations. It is currently approved for use in patients with New York Heart Association class III symptoms and a previous hospitalization for congestive heart failure within the last year, regardless of ejection fraction.1,2 The entire system consists of a small pressure sensor (Figure 1) that is percutaneously placed in a branch pulmonary artery and can be remotely interrogated, in the hospital and at home, using a receiver. Figure 1. CardioMEMSTM Sensor. CardioMEMSTM and St. Jude Medical are trademarks of St. Jude Medical, LLC or its related companies. Reprinted with permission of the publisher. Copyright ©2017, St. Jude Medical. Available evidence within the literature indicates that the device implant is a safe process with no major complications being reported.1–4 The implant procedure is simple and involves a pulling thread that secures the tightly bound sensor to the delivery catheter. Once pulled, the nitinol …

Background: Cholesterol management guidelines from the American College of Cardiology/American Heart Association (ACC/AHA-2013) recommend fixed statin dosing (dose depends on age ≤ or >75 years) compared to the earlier adult treatment panel III (ATPIII) guidelines which recommended specific low-density lipoprotein-cholesterol (LDL-C) targets. Clinical implications of this recommendation are not known. Methods: We retrospectively compared cholesterol levels and statin utilization across cohorts with coronary artery disease (CAD) (n = 9563), peripheral arterial disease (PAD) (n = 596) and CAD + PAD (n = 975) by applying both guidelines. The percentage of patients who achieved guideline-specific targets using 2013 ACC/AHA (use of moderate/high intensity statins) or ATPIII guidelines (LDL-C 100 mg/dl. Conclusions: Application of the ACC/AHA guidelines results in a higher percentage of patients considered to be ‘at goal’ when compared to the ATP III guidelines without changes in clinical practice. This is due to patients ≤75 years old on adequate statin doses but still have LDL-C levels >100 mg/dl, thereby raising concerns that physicians may not pursue alternate LDL reduction strategies since they are now considered at goal despite LDL-C >100 mg/dl. Lipid management of PAD patients remains sub-optimal as compared to CAD and CAD + PAD.

Ankle-brachial index (ABI) is conventionally derived as the ratio of higher of the 2 systolic ankle blood pressures to the higher brachial pressure (HABI method). Alternatively, ABI may be derived using the lower of the 2 systolic ankle pressures (LABI method). The objective of this study was to assess the utility and difference between 2 techniques in predicting peripheral artery disease (PAD). Participants who underwent both ABI measurement and arteriography from July 2005 to June 2010 were reviewed. Angiographic disease burden was scored semiquantitatively (0=50%, 1=50% to 75%, and 2=75% stenosis of any lower extremity arterial segment), and PAD by angiography was defined as50% stenosis of any 1 lower extremity arterial segment. A combined PAD disease score was calculated for each leg. A total of 130 patients were enrolled (260 limbs). The ABI was0.9 (abnormal) in 68% of patients by HABI method and in 84% by LABI. LABI method had higher sensitivity and overall accuracy to detect PAD compared with the HABI method. Regression analysis showed that an abnormal ABI detected by LABI method is more likely to predict angiographic PAD and total PAD burden compared with HABI. Moreover, abnormal ABI by LABI method had higher sensitivity and accuracy to detect PAD in patients with diabetes and below knee PAD compared with the HABI method. In conclusion, ABI determined by the LABI method has higher sensitivity and is a better predictor of PAD compared with the conventional (HABI) method.

Aorto-iliac arterial occlusive disease is common and may cause a spectrum of chronic symptoms from intermittent claudication to critical limb ischemia. Treatment is indicated for symptoms that have failed lifestyle and medical therapies or occasionally to facilitate other interventional procedures such as TAVR and/or placement of hemodynamic assist devices. It is widely accepted that TASC A, B, and C lesions are best managed with endovascular intervention. In experienced hands, most TASC D lesions may be treated by endovascular methods, and with the development of chronic total occlusion devices, many aorto-iliac occlusions may be recanalized safely by endovascular means. Interventional cardiologists should be well versed in the anatomy, as well as the treatment of aorto-iliac disease, given their need to traverse these vessels during transfemoral procedures. Overall, aorto-iliac occlusive disease is more commonly being treated with an endovascular-first approach, using open surgery as a secondary option. This document was developed to guide physicians in the clinical decision-making related to the contemporary application of endovascular intervention among patients with aorto-iliac arterial disease.

Background: We are presenting a rare case of an elderly female who had been asymptomatic until the age of 56 years and had successfully completed three pregnancies. She presented with an episode of acute onset chest pain of moderate intensity and was initially suspected to have an evolved inferior wall myocardial infarction on the basis of the electrocardiogram. The echocardiogram performed subsequently surprisingly revealed the presence of a severe form of Ebstein`s anomaly. Methods & Results: Various forms of electrocardiographic abnormalities and conduction defects are reported in Ebstein’s anomaly but the presence of a normal ECG pattern or pseudoinfarct pattern with the absence of any associated conduction blocks or axis deviation is highly unlikely especially in severe forms of the disease. There are three aspects of this cases which make it rare. Firstly, the presentation of a patient with severe form of Ebstein`s anomaly with an isolated evolved inferior wall myocardial infarction pattern on the ECG ,secondly the presence of an extra-ordinarily long asymptomatic period and thirdly the presentation with angina as the presenting symptom with normal epicardial coronaries. Key words : Ebstein`s pseudoinfarct pattern angina inferior wall infarction pattern normal coronaries.