The left ventricular outflow tract in atrioventricular septal defect revisited: surgical considerations regarding preservation of aortic valve integrity in the perspective of anatomic observations

AbstractObjective: The anatomy of the left ventricular outflow tract in hearts with atrioventricular septal defect has been widely investigated, but controversies remain regarding detailed aspects of left ventricular outflow tract anatomy in the perspective of operative techniques to either prevent or relieve outflow tract obstruction. Methods: We investigated 29 postmortem hearts with an atrioventricular septal defect. Measurements were taken of the circumferences and of the widths of the components that make up the outflow tract, that is, the interventricular septum, the superior bridging leaflet, the left ventricular free wall, and the length of the tendinous cords. Results: The circumference of the left ventricular outflow tract immediately underneath the aortic valve was not different from that at the middle part of the outflow tract. Hearts with the partial type defect, characterized by separate atrioventricular orifices, had a smaller outflow tract than those with the complete variety. Although the anatomic constituents that contribute to left ventricular outflow tract obstruction are complex, this study showed that a reduced width of the interventricular septum was most intimately related to narrowing immediately underneath the aortic valve. Obstruction at the middle part of the left ventricular outflow tract was largely caused by reduced width of the interventricular septum together with short tendinous cords. Conclusions: On the basis of these observations, we recommend detailed investigation of the anatomy of the left ventricular outflow tract immediately underneath the aortic valve, before surgical attempts to relieve outflow tract obstruction, because in some procedures the integrity of the aortic valve will be at stake. (J Thorac Cardiovasc Surg 1997;114:586-9

A new optical set-up for on-line following up the crystallization of polymers at high cooling rates

International audienceA new experimental procedure, named " Polymer High Cooling - Optics " and whose performance has been improved, is presented. It allows us to monitor on-line the quiescent crystallization of a polymer film under high and constant cooling rates. With such a set-up, two cooling control modes are available resulting into a range of relatively moderate (from 30 to 500°C/min) and a range of high (from 500 to 1600°C/min) constant cooling rates. The crystallization experiments are observed by polarized light microscopy. Preliminary results are presented. They are obtained on the α-modification of one industrial grade of isotactic polypropylene, under relatively moderate constant cooling rates. Two relevant crystallization parameters are captured, the temperature of crystallization together with the spherulitic growth kinetics versus cooling rate. Accurate data are obtained. As well, they are in good agreement with comparable literature results compiled by Janeschitz-Kriegl [Macromolecules, 2006]. The obtained results seem to match the Hoffman and Lauritzen theory. These discussions validate our " Polymer High Cooling - Optics " set-up in relatively moderate constant cooling rates. Next step is to demonstrate the suitability of this first generation set-up for higher constant cooling rates

Quantum correlations and fluctuations in the pulsed light produced by a synchronously pumped optical parametric oscillator below its oscillation threshold

We present a simple quantum theory for the pulsed light generated by a synchronously pumped optical parametric oscillator (SPOPO) in the degenerate case where the signal and idler trains of pulses coincide, below threshold and neglecting all dispersion effects. Our main goal is to precise in the obtained quantum effects, which ones are identical to the c.w. case and which ones are specific to the SPOPO. We demonstrate in particular that the temporal correlations have interesting peculiarities: the quantum fluctuations at different times within the same pulse turn out to be totally not correlated, whereas they are correlated between nearby pulses at times that are placed in the same position relative to the centre of the pulses. The number of significantly correlated pulses is of the order of cavity finesse. We show also that there is perfect squeezing at noise frequencies multiple of the pulse repetition frequency when one approaches the threshold from below on the signal field quadrature measured by a balanced homodyne detection with a local oscillator of very short duration compared to the SPOPO pulse length.Comment: 12 pages, 3 figure

Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial

BACKGROUND: Elevated levels of osteoprotegerin, a secreted tumor necrosis factor-related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial. METHODS AND RESULTS: The associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non-coronary artery bypass grafting major bleeding during 1 year of follow-up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.21-1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C-reactive protein, troponin T, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and growth differentiation factor-15). The corresponding rates of non-coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted HR of 1.52 (95% CI, 1.36-1.69), and a fully adjusted HR of 1.26 (95% CI, 1.09-1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an HR of 1.09 (95% CI, 0.89-1.33); for major bleeding after 1 month, the HR was 1.33 (95% CI, 0.91-1.96). CONCLUSIONS: In patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving antithrombotic therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872

Airborne observations of Arctic air mass transformations during the HALO-(AC)3 campaign

The HALO-(AC)3 campaign was conducted in March and April 2022 to investigate warm air intrusions into the Arctic and marine cold air outbreaks. In coordinated flights over the Arctic, the High Altitude and Long Range Research Aircraft (HALO), equipped with a remote sensing payload and dropsondes, investigated these air mass transformations together with the research aircraft Polar 5 and Polar 6. In this report, we give an overview about the research flights and preliminary results from projects, which are carried out by employees of the Leipzig Institute for Meteorology (LIM).Die HALO-(AC)3 Kampagne wurde im März und April 2022 durchgeführt, umWarmlufteinbrüche in die Arktis und marine Kaltluftausbrüche zu untersuchen. Das 'High Altitude and Long Range Research Aircraft' (HALO), ausgestattet mit Instrumenten zur Fernerkundung und Standardmeteorologiesonden, untersuchte zusammen mit den Forschungsflugzeugen Polar 5 und Polar 6, in koordinierten Flügen über der Arktis, diese Veränderungen der Luftmassen. In diesem Bericht wird eine Übersicht über die durchgeführten Forschungsflüge gegeben und Forschungsprojekte werden vorgestellt, welche von Mitarbeitern des Leipziger Instituts für Meteorologie (LIM) durchgeführt werden

Legumain in acute coronary syndromes: A substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial

Background The cysteine protease legumain is increased in patients with atherosclerosis, but its causal role in atherogenesis and cardiovascular disease is still unclear. The aim of the study was to investigate the association of legumain with clinical outcome in a large cohort of patients with acute coronary syndrome. Methods and Results Serum levels of legumain were analyzed in 4883 patients with acute coronary syndrome from a substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial. Levels were analyzed at admission and after 1 month follow‐up. Associations between legumain and a composite of cardiovascular death, spontaneous myocardial infarction or stroke, and its individual components were assessed by multivariable Cox regression analyses. At baseline, a 50% increase in legumain level was associated with a hazard ratio (HR) of 1.13 (95% CI, 1.04–1.21), P=0.0018, for the primary composite end point, adjusted for randomized treatment. The association remained significant after adjustment for important clinical and demographic variables (HR, 1.10; 95% CI, 1.02–1.19; P=0.013) but not in the fully adjusted model. Legumain levels at 1 month were not associated with the composite end point but were negatively associated with stroke (HR, 0.62; 95% CI, 0.44–0.88; P=0.0069), including in the fully adjusted model (HR, 0.57; 95% CI, 0.37–0.88; P=0.0114). Conclusions Baseline legumain was associated with the primary outcome in patients with acute coronary syndrome, but not in the fully adjusted model. The association between high levels of legumain at 1 month and decreased occurrence of stroke could be of interest from a mechanistic point of view, illustrating the potential dual role of legumain during atherogenesis and acute coronary syndrome. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT00391872

Charged-Particle Thermonuclear Reaction Rates: III. Nuclear Physics Input

The nuclear physics input used to compute the Monte Carlo reaction rates and probability density functions that are tabulated in the second paper of this series (Paper II) is presented. Specifically, we publish the input files to the Monte Carlo reaction rate code RatesMC, which is based on the formalism presented in the first paper of this series (Paper I). This data base contains overwhelmingly experimental nuclear physics information. The survey of literature for this review was concluded in November 2009.Comment: 132 page

Current and novel biomarkers of thrombotic risk in COVID-19: a Consensus Statement from the International COVID-19 Thrombosis Biomarkers Colloquium

© Springer Nature Limited 2022. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1038/s41569-021-00665-7Coronavirus disease 2019 (COVID-19) predisposes patients to thrombotic and thromboembolic events, owing to excessive inflammation, endothelial cell activation and injury, platelet activation and hypercoagulability. Patients with COVID-19 have a prothrombotic or thrombophilic state, with elevations in the levels of several biomarkers of thrombosis, which are associated with disease severity and prognosis. Although some biomarkers of COVID-19-associated coagulopathy, including high levels of fibrinogen and d-dimer, were recognized early during the pandemic, many new biomarkers of thrombotic risk in COVID-19 have emerged. In this Consensus Statement, we delineate the thrombotic signature of COVID-19 and present the latest biomarkers and platforms to assess the risk of thrombosis in these patients, including markers of platelet activation, platelet aggregation, endothelial cell activation or injury, coagulation and fibrinolysis as well as biomarkers of the newly recognized post-vaccine thrombosis with thrombocytopenia syndrome. We then make consensus recommendations for the clinical use of these biomarkers to inform prognosis, assess disease acuity, and predict thrombotic risk and in-hospital mortality. A thorough understanding of these biomarkers might aid risk stratification and prognostication, guide interventions and provide a platform for future research.Peer reviewe