Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation

ObjectiveA nonresectional technique has been developed for repair of mitral leaflet prolapse causing mitral regurgitation. Polytetrafluoroethylene chordae are used for correction of edge misalignment of the prolapsed mitral leaflet. New chordal length is adjusted during progressive left ventricular inflation to systolic pressure. Annular sizing is determined dynamically after leaflet edge alignment is accomplished to produce an optimal zone of predefined leaflet apposition. The aim of this study was to document the 8- to 10-year durability of this nonresectional approach.MethodsFrom 1983 through 2008, 1121 consecutive patients had mitral valve repair on one service. Of these, 662 had repair of mitral leaflet prolapse. From 1983 until 1998, standard quadratic leaflet resection/plication was used in 72 (11.1%) patients, similar but smaller resection in 93 (14.1%) patients, and then smaller resection and polytetrafluoroethylene chordae in 24 (3.7%) patients. All received Puig–Massana fully flexible rings (Shiley, Inc, Irvine, Calif). After 1998, no leaflet resections or valve replacements have been performed regardless of leaflet size in 566 consecutive patients. Of the 662 patients, the mean age was 62.6 ± 14.1 years, and 424 (64.1%) patients were male. Coronary artery disease was present in 147 (22.2%) patients and 33 (5.0%) had prior coronary artery bypass. Leaflets corrected were as follows: anterior, 152 (23.0%) patients; posterior, 427 (64.5%); and both, 83 (12.5%) Common pathologic characteristics of prolapsing valves were as follows: myxomatous, 332 (50.2%) patients, degenerative, 83 (12.5%), ischemic, 31 (4.7%), and rheumatic, 29 (4.4%).ResultsPerioperative mortality was 2.9% (19/662) overall and 0.49% (2/414) for isolated repair. Freedom from reoperation at 10 years (Kaplan–Meier) was 90.1% and freedom from significant mitral regurgitation (echocardiography) was 93.9%.ConclusionsThis study confirms that mitral regurgitation from mitral leaflet prolapse can be repaired in all cases by a nonresectional technique provided that accurate dynamic evaluation of chordal length and annular sizing is achieved. The intermediate-term results are durable

Homotopy types of stabilizers and orbits of Morse functions on surfaces

Let $M$ be a smooth compact surface, orientable or not, with boundary or without it, $P$ either the real line $R^1$ or the circle $S^1$, and $Diff(M)$ the group of diffeomorphisms of $M$ acting on $C^{\infty}(M,P)$ by the rule $h\cdot f\mapsto f \circ h^{-1}$, where $h\in Diff(M)$ and $f \in C^{\infty}(M,P)$. Let $f:M \to P$ be a Morse function and $O(f)$ be the orbit of $f$ under this action. We prove that $\pi_k O(f)=\pi_k M$ for $k\geq 3$, and $\pi_2 O(f)=0$ except for few cases. In particular, $O(f)$ is aspherical, provided so is $M$. Moreover, $\pi_1 O(f)$ is an extension of a finitely generated free abelian group with a (finite) subgroup of the group of automorphisms of the Reeb graph of $f$. We also give a complete proof of the fact that the orbit $O(f)$ is tame Frechet submanifold of $C^{\infty}(M,P)$ of finite codimension, and that the projection $Diff(M) \to O(f)$ is a principal locally trivial $S(f)$-fibration.Comment: 49 pages, 8 figures. This version includes the proof of the fact that the orbits of a finite codimension of tame action of tame Lie group on tame Frechet manifold is a tame Frechet manifold itsel

Size dependence of volume and surface nucleation rates for homogeneous freezing of supercooled water droplets

The relative roles of volume and surface nucleation were investigated for the homogeneous freezing of pure water droplets. Experiments were carried out in a cryogenic laminar aerosol flow tube using supercooled water aerosols with maximum volume densities at radii between 1 and 3 μm. Temperature- and size-dependent values of volume- and surface-based homogeneous nucleation rates between 234.8 and 236.2 K were derived using a microphysical model and aerosol phase compositions and size distributions determined from infrared extinction measurements in the flow tube. The results show that the contribution from nucleation at the droplet surface increases with decreasing droplet radius and dominates over nucleation in the bulk droplet volume for droplets with radii smaller than approximately 5 μm. This is interpreted in terms of a lowered free energy of ice germ formation in the surface-based process. The implications of surface nucleation for the parameterization of homogeneous ice nucleation in numerical models are considered

Multipurpose High Frequency Electron Spin Resonance Spectrometer for Condensed Matter Research

We describe a quasi-optical multifrequency ESR spectrometer operating in the 75-225 GHz range and optimized at 210 GHz for general use in condensed matter physics, chemistry and biology. The quasi-optical bridge detects the change of mm wave polarization at the ESR. A controllable reference arm maintains a mm wave bias at the detector. The attained sensitivity of 2x10^10 spin/G/(Hz)1/2, measured on a dilute Mn:MgO sample in a non-resonant probe head at 222.4 GHz and 300 K, is comparable to commercial high sensitive X band spectrometers. The spectrometer has a Fabry-Perot resonator based probe head to measure aqueous solutions, and a probe head to measure magnetic field angular dependence of single crystals. The spectrometer is robust and easy to use and may be operated by undergraduate students. Its performance is demonstrated by examples from various fields of condensed matter physics.Comment: submitted to Journal of Magnetic Resonanc

Automorphisms of graphs of cyclic splittings of free groups

We prove that any isometry of the graph of cyclic splittings of a finitely generated free group $F_N$ of rank $N\ge 3$ is induced by an outer automorphism of $F_N$. The same statement also applies to the graphs of maximally-cyclic splittings, and of very small splittings.Comment: 22 pages, 5 figures. Small modifications. To appear in Geometriae Dedicat

Pluto's global surface composition through pixel-by-pixel Hapke modeling of New Horizons Ralph/LEISA data

On July 14th 2015, NASA's New Horizons mission gave us an unprecedented detailed view of the Pluto system. The complex compositional diversity of Pluto's encounter hemisphere was revealed by the Ralph/LEISA infrared spectrometer on board of New Horizons. We present compositional maps of Pluto defining the spatial distribution of the abundance and textural properties of the volatiles methane and nitrogen ices and non-volatiles water ice and tholin. These results are obtained by applying a pixel-by-pixel Hapke radiative transfer model to the LEISA scans. Our analysis focuses mainly on the large scale latitudinal variations of methane and nitrogen ices and aims at setting observational constraints to volatile transport models. Specifically, we find three latitudinal bands: the first, enriched in methane, extends from the pole to 55deg N, the second dominated by nitrogen, continues south to 35deg N, and the third, composed again mainly of methane, reaches 20deg N. We demonstrate that the distribution of volatiles across these surface units can be explained by differences in insolation over the past few decades. The latitudinal pattern is broken by Sputnik Planitia, a large reservoir of volatiles, with nitrogen playing the most important role. The physical properties of methane and nitrogen in this region are suggestive of the presence of a cold trap or possible volatile stratification. Furthermore our modeling results point to a possible sublimation transport of nitrogen from the northwest edge of Sputnik Planitia toward the south.Comment: 43 pages, 7 figures; accepted for publication in Icaru

Mapping auroral activity with Twitter

Twitter is a popular, publicly-accessible, social media service that has proven useful in mapping large-scale events in real-time. In this study, for the first time, the use of Twitter as a measure of auroral activity is investigated. Peaks in the number of aurora-related tweets are found to frequently coincide with geomagnetic disturbances (detection rate of 91%). Additionally, the number of daily aurora-related tweets is found to strongly correlate with several auroral strength proxies (ravg ≈ 0.7). An examination is made of the bias for location and time of day within Twitter data, and a first order correction of these effects is presented. Overall, the results suggest that Twitter can provide both specific details about an individual aurora and accurate real-time indication of when, and even from where, an aurora is visible

The effect on survival of continuing chemotherapy to near death

<p>Abstract</p> <p>Background</p> <p>Overuse of anti-cancer therapy is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on quality of life and cost, but its effect on survival is not well-defined.</p> <p>Methods</p> <p>Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 7,879 Medicare-enrolled patients aged 65 or older who died after having survived at least 3 months after diagnosis of advanced non-small cell lung cancer (NSCLC) between 1991 and 1999. We used Cox proportional hazards regression analysis, propensity scores, and instrumental variable analysis (IVA) to compare survival among patients who never received chemotherapy (n = 4,345), those who received standard chemotherapy but not within two weeks prior to death (n = 3,235), and those who were still receiving chemotherapy within 14 days of death (n = 299). Geographic variation in the application of chemotherapy was used as the instrument for IVA.</p> <p>Results</p> <p>Receipt of chemotherapy was associated with a 2-month improvement in overall survival. However, based on three different statistical approaches, no additional survival benefit was evident from continuing chemotherapy within 14 days of death. Moreover, patients receiving chemotherapy near the end of life were much less likely to enter hospice (81% versus 51% with no chemotherapy and 52% with standard chemotherapy, P < 0.001), or were more likely to be admitted within only 3 days of death.</p> <p>Conclusions</p> <p>Continuing chemotherapy for advanced NSCLC until very near death is associated with a decreased likelihood of receiving hospice care but not prolonged survival. Oncologists should strive to discontinue chemotherapy as death approaches and encourage patients to enroll in hospice for better end-of-life palliative care.</p