Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review

BACKGROUND: Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world.OBJECTIVE:The aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans. METHODS: We performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013. RESULTS: Reference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents. CONCLUSION: Reliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans

Achieving the Minimum Roughness of Laser Milled Micro-Impressions on Ti 6Al 4V, Inconel 718, and Duralumin

Titanium-aluminium-vanadium (Ti 6Al 4V) alloys, nickel alloys (Inconel 718), and duraluminum alloys (AA 2000 series) are widely used materials in numerous engineering applications wherein machined features are required to having good surface finish. In this research, micro-impressions of 12 µm depth are milled on these materials though laser milling. Response surface methodology based design of experiment is followed resulting in 54 experiments per work material. Five laser parameters are considered naming lamp current intensity (I), pulse frequency (f), scanning speed (V), layer thickness (LT), and track displacement (TD). Process performance is evaluated and compared in terms of surface roughness through several statistical and microscopic analysis. The significance, strength, and direction of each of the five laser parametric effects are deeply investigated for the said alloys. Optimized laser parameters are proposed to achieve minimum surface roughness. For the optimized combination of laser parameters to achieve minimum surface roughness (Ra) in the titanium alloy, the said alloy consists of I = 85%, f = 20 kHz, V = 250 mm/s, TD = 11 µm, and LT = 3 µm. Similarly, optimized parameters for nickel alloy are as follows: I = 85%, f = 20 kHz, V = 256 mm/s, TD = 8 µm, and LT = 1 µm. Minimum roughness (Ra) on the surface of aluminum alloys can be achieved under the following optimized parameters: I = 75%, f = 20 kHz, V = 200 mm/s, TD = 12 µm, and LT = 3 µm. Micro-impressions produced under optimized parameters have surface roughness of 0.56 µm, 2.46 µm, and 0.54 µm on titanium alloy, nickel alloy, and duralumin, respectively. Some engineering applications need to have high surface roughness (e.g., in case of biomedical implants) or some desired level of roughness. Therefore, validated statistical models are presented to estimate the desired level of roughness against any laser parametric settings