Citations

Background and Purpose— Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods— Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results— During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses ( P =0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions— In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.

It has previously been shown that acoustic ray paths in range-dependent ocean models exhibit chaotic behavior. Most of the investigations into the ray chaos phenomenon have been primarily numerical in nature. The objective of this report is to study theoretically the existence of ray chaos in a parabolic ray system with an analytically prescribed sound-speed model consisting of a double-channel profile perturbed by a typical periodic range-dependent disturbance. The perturbed Hamiltonian ray system is studied analytically via Melnikov’s method. It is shown that, under certain conditions, ray trajectories in some regions of the Poincaré section are equivalent to trajectories of the horseshoe map no matter how small the corresponding perturbation is. These conditions are sufficient for ray chaos and easily satisfied, thus explaining why double-channel propagation is very likely to exhibit chaotic behavior. [Work supported by CA43920 NIH.]

Earlier studies [P. J. Westervelt, J. Acoust. Soc. Am. 29, 199–203, 934–935 (1957)] of the mutual nonlinear interaction of two plane waves of sound with each other are extended to include the viscous effect. The viscous effect is considered both from the equations of motion and the equation of state of the medium. An analytical solution to the lowest order scattering process is obtained if the viscous effect of second order and higher can be neglected. In fact, it is shown that the scattered density ρs of two interacting plane waves having the frequencies ω1 and ω2, respectively, satisfies the following equation: ⧠2vρs=⧠2v{c0−2E12+[(2cosθ +B/A)/2ω1ω2 (1−cosθ)]∇2W12 +[DB(c20ω1ω2)−1 / 4A ×(1−cosθ)2]∇2(∂W12/∂t)+[DB(3+cosθ)/2Ac40 (1−cosθ)](∂V12/∂t)}, where E12, V12, and W12 are, respectively, the total, potential, and special defined energy densities, D is the sound diffusivity, B and A are nonlinearity parameters, θ is the intersecting angle, and ⧠2v is a modified d’Alembertian operator. [Work supported by CA43920 NIH.]

Purpose To review the current utilization of diagnostic tests prescribed by the International Federation of Gynecology and Obstetrics (FIGO) clinical staging guidelines in the pretreatment work-up of invasive cervical cancer, and to compare the data with those of previous patterns of care studies. Patients and Methods This interdisciplinary American College of Radiology Imaging Network/Gynecologic Oncology Group prospective clinical trial was conducted between March 1, 2000, and November 11, 2002. Twenty-five participating institutions, all from the United States, enrolled a total of 208 patients. Only patients scheduled for surgery with biopsy-confirmed cervical cancer of clinical FIGO stage IB or higher were eligible. The patterns of care data analysis was based on 197 patients who met all inclusion criteria. The conventional FIGO-recommended tests used for pre-enrollment FIGO clinical stage classification were at the discretion of the treating physician; overall frequency of use was tabulated for each test. Results Use of cystoscopy (8.1%) and sigmoidoscopy or proctoscopy (8.6%) was significantly lower than in 1988 to 1989 (P < .0001 in each instance). Intravenous urography was used in only 1% of patients as compared with 42% in 1988 to 1989 and 91% in 1983. No patient included in the data analysis had barium enema or lymphangiography. Only 26.9% of patients had examination under anesthesia for FIGO clinical staging. Conclusion There is a large discrepancy between the diagnostic tests recommended by FIGO and the actual tests used for cervical cancer staging, suggesting a need to reassess the relevance of the FIGO guidelines to current clinical practice in the United States.

This paper presents a new method of inducing localized low-frequency acoustic energy in an object by remote sources. In this method two interacting high-power, high-frequency, ultrasound beams at two different frequencies are used. These beams are positioned to interact at the object’s surface (or any other impedance discontinuity inside the object). The result is a radiation force at the difference frequency, df, exerted in a small area defined by the beamwidths. Experiments are performed on a small steel needle and blocks of gelatin. To monitor the vibration, a high-frequency probing transducer is used in pulse echo mode with the beam aimed at the vibrating part of the object. This transducer shoots tone bursts at a rate much higher than df. Echoes are quadrature detected and the resulting in-phase and quadrature signals are recorded. These signals are used to calculate the phase of the returned echo which is shown to be proportional to the target displacement. In the experiments, the power beams were driven at 20 W each and df=10 Hz. Amplitude of the resulting vibrations were 5 μm for the gelatin block and 1.2 μm for the needle.

Log compression of A lines to produce B-scan images in clinical ultrasound imaging systems is a standard procedure to control the dynamic range of the images. The statistics of such compressed images in terms of underlying scatterer statistics have not been derived. The statistics are analyzed for partially formed speckle using a general K distribution model of envelope statistics to derive the density function for the log-compressed envelope. This density function is used to elucidate the relation between the moments of the compressed envelope, the compression parameters, and the statistics of the scatterers. The analysis shows that the mean of the log-compressed envelope is an increasing function of both the backscattered energy and the effective scatterer density. The variance of the log-compressed envelope is a decreasing function of the effective scatterer density and is independent of the backscattered energy.

Earlier studies [P. J. Westervelt, J. Acoust. Soc. Am. 29, 199–203, 934–935 (1957)] of the mutual nonlinear interaction of two plane waves of sound with each other are extended to include the viscous effect. The viscous effect is considered both from the equations of motion and the equation of state of the medium. An analytical solution to the lowest-order scattering process is obtained if the viscous effect of second order and higher can be neglected.

Acoustic radiation pressure exerted by an arbitrary acoustic wave in a three-dimensional lossy medium is calculated by extending an indirect approach developed by Chu and Apfel [B-T. Chu and R. E. Apfel, ‘‘Acoustic radiation pressure produced by a beam of sound,’’ J. Acoust. Soc. Am. 72, 1673–1687 (1982)]. Without appealing to the detailed solutions of equations governing fluid motion, a general analytic expression for the radiation pressure in lossy media with arbitrary waves is obtained. When an infinite lossy medium is considered, the expression states that the radiation pressure, to the lowest order of approximation (i.e., second order), is equal to corresponding total energy density. For a special class of confined spaces, the expression leads to a rather general formula for the radiation pressure, in which the radiation pressure is given in terms of various energy densities in the field. Furthermore, a relationship among these energy densities is generalized to the case of lossy media, which enables one to compute the radiation pressure in the class of spaces with the knowledge of the first-order perturbation solution only.

Modern commercial medical ultrasound instruments are capable of obtaining up to 40 real-time, two-dimensional images per second. One of the most difficult organs to evaluate with ultrasound is the heart. The heart is a complex organ that achieves its pumping function through cyclic motion of its chambers and valves. Computerized visualization of the heart is being developed to aid in training and to provide comprehensible images of this complex organ to the patient, the surgeon, and the researcher. To obtain the required data, the two-dimensional imaging plane of an ultrasound instrument is scanned through the heart from the surface of the chest, or more commonly, from within the esophagus. Sequences of digitized two-dimensional images taken at incremental positions through the heart are gated with the cardiac cycle and assembled by computer programs into volumetric images. Visualization methods of filtering, segmentation, and rendering are used to produce comprehensible, data dense, three-dimensional images of the heart. Sequences of the three-dimensional images obtained at sequential points through the cardiac cycle produce what are called ‘‘four’’-dimensional images. Mathematical projections of elements of these images onto selected two-dimensional planes can be recorded on videotape to produce movies of the structure or function of interest at various angles of view. Metrics such as distance, area, volume, or speed can be used on these data to produce quantitative measurements.