Initial clinical experience with Myxo-ETlogix∗∗Myxo-ETlogix is a trade name of Edwards Lifesciences LLC, Irvine, Calif. mitral valve repair ring

ObjectiveComplexity of mitral valve repair for myxomatous disease has led to low adoption. We report initial experience with a new ring designed specifically for myxomatous disease, the Myxo-ETlogix (Edwards Lifesciences LLC, Irvine, Calif).MethodsFrom March 15, 2006, through November 19, 2007, 129 patients underwent mitral valve surgery for pure myxomatous disease, and 124 valves (96.1%) were repaired. The Myxo-ETlogix ring was used in 100 cases and the Physio ring (Edwards) in 24. The Myxo-ETlogix design includes a 3-dimensional shape to reduce systolic anterior motion and a larger orifice to accommodate elongated leaflets and decrease need for sliding plasty. Direct mitral valve measurements were made. Sizing was based on A2 height, and choice of ring type was based on unresected leaflet heights.ResultsThere was no operative mortality or lasting perioperative morbidity. The Myxo-ETlogix group had taller A2, P1, P2, and P3 leaflet segments than the Physio group (P ≤ .003). Only 1 sliding plasty was performed for asymmetry in the Myxo-ETlogix group. Predischarge and follow-up echocardiograms (n = 338 in 124 patients) disclosed transient nonobstructive chordal systolic anterior motion in 3 echocardiograms in 3 patients. No patients had 2+ or greater mitral regurgitation. At discharge, 5.7% had 1+ mitral regurgitation; this proportion was 17.3% at last follow-up (mean 6.1 ± 4.4 months).ConclusionIn initial experience with the Myxo-ETlogix ring, nonobstructive systolic anterior motion has been rare and obstructive systolic anterior motion not observed. Ongoing prospective echocardiographic and clinical studies will elucidate the role of this etiology-specific ring

Sensibilidade de acessos de capim-arroz ao herbicida Kifix® coletados em áreas de arroz cultivadas no sistema Clearfield®.

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Estimativa da variabilidade genética,baseada no coeficiente de parentesco e na divergência genética de caracteres,para compor mini-coleção nuclear de trigo.

Em um programa de melhoramento,um dos principais desafios é a identificação de cultivares parentais com alta capacidade de combinação para principais características de interesse agronômico. Aumentando o número de loci heterozigotos, por cruzamento entre linhagens não correlacionadas,é esperado que o nível de heterose seja aumentado, elevando assim as chances de encontrar genótipos que combinam favoravelmente as características desejadas

Estimativa da variabilidade genética, baseada no coeficiente de parentesco e na divergência genética de caracteres, para compor mini-coleção nuclear de trigo.

Em um programa de melhoramento, um dos principais desafios é a identificação de cultivares parentais com alta capacidade de combinação para principais características de interesse agronômico. Aumentando o número de loci heterozigotos, por cruzamento entre linhagens não correlacionadas, é esperado que o nível de heterose seja aumentado, elevando assim as chances de encontrar genótipos que combinam favoravelmente as características desejadas

Quantitative trait loci affecting pathogen resistance and ripening of grapevines

Grapevines (Vitis vinifera L.) form the basis of viticulture, and are susceptible to diseases such as downy mildew (Plasmopara viticola) and powdery mildew (Erysiphe necator). Therefore, successful viticulture programs require the use of pesticides. Breeding for resistance is the only eco-friendly solution. Marker-assisted selection is currently widely used for grapevine breeding. Consequently, traits of interest must be tagged with molecular markers linked to quantitative trait loci (QTL). We herein present our findings regarding genetic mapping and QTL analysis of resistance to downy and powdery mildew diseases in the progenies of the GF.GA-47-42 (‘Bacchus’ × ‘Seyval’) × ‘Villard blanc’ cross. Simple sequence repeats and single nucleotide polymorphisms of 151 individuals were analyzed. A map consisting of 543 loci was screened for QTL analyses based on phenotypic variations observed in plants grown in the field or under controlled conditions. A major QTL for downy mildew resistance was detected on chromosome 18. For powdery mildew resistance, a QTL was identified on chromosome 15. This QTL was replaced by a novel QTL on chromosome 18 in 2003 (abnormally high temperatures) and 2004. Subsequently, both QTLs functioned together. Additionally, variations in the timing of the onset of veraison, which is a crucial step during grape ripening, were studied to identify genomic regions affecting this trait. A major QTL was detected on linkage group 16, which was supplemented by a minor QTL on linkage group 18. This study provides useful information regarding novel QTL-linked markers relevant for the breeding of disease-resistant grapevines adapted to current climatic conditions

Immersed boundary-finite element model of fluid-structure interaction in the aortic root

It has long been recognized that aortic root elasticity helps to ensure efficient aortic valve closure, but our understanding of the functional importance of the elasticity and geometry of the aortic root continues to evolve as increasingly detailed in vivo imaging data become available. Herein, we describe fluid-structure interaction models of the aortic root, including the aortic valve leaflets, the sinuses of Valsalva, the aortic annulus, and the sinotubular junction, that employ a version of Peskin's immersed boundary (IB) method with a finite element (FE) description of the structural elasticity. We develop both an idealized model of the root with three-fold symmetry of the aortic sinuses and valve leaflets, and a more realistic model that accounts for the differences in the sizes of the left, right, and noncoronary sinuses and corresponding valve cusps. As in earlier work, we use fiber-based models of the valve leaflets, but this study extends earlier IB models of the aortic root by employing incompressible hyperelastic models of the mechanics of the sinuses and ascending aorta using a constitutive law fit to experimental data from human aortic root tissue. In vivo pressure loading is accounted for by a backwards displacement method that determines the unloaded configurations of the root models. Our models yield realistic cardiac output at physiological pressures, with low transvalvular pressure differences during forward flow, minimal regurgitation during valve closure, and realistic pressure loads when the valve is closed during diastole. Further, results from high-resolution computations demonstrate that IB models of the aortic valve are able to produce essentially grid-converged dynamics at practical grid spacings for the high-Reynolds number flows of the aortic root

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

Impact of concomitant aortic regurgitation on long-term outcome after surgical aortic valve replacement in patients with severe aortic stenosis

<p>Abstract</p> <p>Background</p> <p>Prognostic value of concomitant aprtic regurgitation (AR) in patients operated for severe aortic stenosis (AS) is not clarified. The aim of this study was to prospectively examine the impact of presence and severity of concomitant AR in patients operated for severe AS on long-term functional capacity, left ventricular (LV) function and mortality.</p> <p>Methods</p> <p>Study group consisted of 110 consecutive patients operated due to severe AS. The patients were divided into AS group (56 patients with AS without AR or with mild AR) and AS+AR group (54 patients with AS and moderate, severe or very severe AR). Follow-up included clinical examination, six minutes walk test (6MWT) and echocardiography 12 and 104 months after AVR.</p> <p>Results</p> <p>Patients in AS group had lower LV volume indices throughout the study than patients in AS+AR group. Patients in AS group did not have postoperative decrease in LV volume indices, whereas patients in AS+AR group experienced decrease in LV volume indices at 12 and 104 months. Unlike LV volume indices, LV mass index was significantly lower in both groups after 12 and 104 months as compared to preoperative values. Mean LVEF remained unchanged in both groups throughout the study. NYHA class was improved in both groups at 12 months, but at 104 months remained improved only in patients with AS. On the other hand, distance covered during 6MWT was longer at 104 months as compared to 12 months only in AS+AR group (p = 0,013), but patients in AS group walked longer at 12 months than patients in AS+AR group (p = 0,002). There were 30 deaths during study period, of which 13 (10 due to cardiovascular causes) in AS group and 17 (12 due to cardiovascular causes) in AS+AR group. Kaplan-Meier analysis showed that the survival probability was similar between the groups. Multivariate analysis identified diabetes mellitus (beta 1.78, p = 0.038) and LVEF < 45% (beta 1.92, p = 0.049) as the only independent predictor of long-term mortality.</p> <p>Conclusion</p> <p>Our data indicate that the preoperative presence and severity of concomitant AR has no influence on long-term postoperative outcome, LV function and functional capacity in patients undergoing AVR for severe AS.</p

Nitrogen fertilization of self-seeding Italian ryegrass: effects on plant structure, forage and seed yield.

ABSTRACT: This study aimed to evaluate the effect of different levels of self-seeding Italian ryegrass (Lolium multiflorum Lam.) and nitrogen rates - applied additionally after two defoliations - on plant structure, in forage and seed yield. Levels of self-seeding were classified as very high (777 kg ha-1), high (736 kg ha-1), intermediate (624 kg ha-1), and low (234 kg ha-1). Populations were fertilized with zero, 20.25, 40.50, and 60.75 kg ha-1 of supplemental nitrogen applied after two defoliations; respectively, in very high, high, intermediate, and low levels. Higher levels of self-seeding promoted greater forage yield and uniformity of vegetation structure. Number of fertile tillers and number of seeds per plant have benefited by the combination of high self-seeding and supplemental nitrogen fertilization. Despite influencing the uniformity and amount of forage obtained in two defoliations, the very high and low self-seeding levels did not differ in Italian ryegrass seed production. However, linear addition for this same variable was obtained with the inclusion of supplemental nitrogen fertilization. In pastures from low and intermediate self-seeding levels, total dry mass increases linearly with the levels of nitrogen fertilization assessed in this research. RESUMO: O objetivo deste estudo foi avaliar o efeito de diferentes níveis de ressemeadura natural de azevém anual (Lolium multiflorum Lam.), bem como, doses suplementares de nitrogênio sobre a estrutura de plantas, produção de forragem e de sementes. Os níveis de ressemeadura foram classificados como: muito elevada (777 kg ha-1); elevada (736 kg ha-1); intermediária (624 kg ha-1) e baixa (234 kg ha-1). Populações oriundas destes níveis foram fertilizadas com zero, 20.25, 40.50, and 60.75 kg ha-1 de nitrogênio, aplicado de forma suplementar após duas desfolhas. Maiores níveis de ressemeadura propiciaram maior colheita de forragem e maior uniformização da estrutura da vegetação. A quantidade de perfilhos férteis e o número de sementes por planta foram beneficiados pela combinação de elevada ressemeadura e aplicação de nitrogênio. Apesar de influenciar a uniformização e a quantidade de forragem obtida em duas desfolhas, os níveis de ressemeadura natural, muito elevada e baixa não diferiram entre si na produção de sementes no ano subsequente. Todavia, acréscimo linear para esta mesma variável foi verificado com avanço suplementar da adubação nitrogenada. Em pastagem de azevém anual proveniente dos níveis baixo e intermediário, a produção de massa seca total é acrescida linearmente com os níveis de fertilização avaliados no presente trabalho

A standardized approach to treat complex aortic valve endocarditis: a case series

Background Surgical treatment of complicated aortic valve endocarditis often is challenging, even for experienced surgeons. We aim at demonstrating a standardized surgical approach by stentless bioprostheses for the treatment of aortic valve endocarditis complicated by paravalvular abscess formation. MethodsSixteen patients presenting with aortic valve endocarditis (4 native and 12 prosthetic valves) and paravalvular abscess formation at various localizations and to different extents were treated by a standardized approach using stentless bioprostheses. The procedure consisted of thorough debridement, root replacement with reimplantation of the coronary arteries and correction of accompanying pathologies (aortoventricular and aortomitral dehiscence, septum derangements, Gerbode defect, total atrioventricular conduction block, mitral and tricuspid valve involvement).ResultsAll highly complex patients included (14 males and 2 females; median age 63 years [range 31–77]) could be successfully treated with stentless bioprostheses as aortic root replacement. Radical surgical debridement of infected tissue with anatomical recontruction was feasible. Although predicted operative mortality was high (median logarithmic EuroSCORE I of 40.7 [range 12.8–68.3]), in-hospital and 30-day mortality rates were favorable (18.8 and 12.5% respectively). ConclusionsRepair of active aortic valve endocarditis complicated by paravalvular abscess formation and destruction of the left ventricular outflow tract with stentless bioprosthesis is a valuable option for both native and prosthetic valves. It presents a standardized approach with a high success rate for complete debridement, is readily available, and yields comparable clinical outcomes to the historical gold standard, repair by homografts. Additionally, use of one type of prosthesis reduces logistical issues and purchasing costs