Dysfunction of Mitral Ball Valve Prosthesis

Three case histories of patients with malfunctions of Smeloff-Cutter mitral ball valve prostheses are presented here - one underwent successful replacement. The clinical diagnosis was made by observing a marked variation in the A2OC interval and intermittent absence of the opening click. Phonocardiograms were diagnostic in all three cases. while echocardiograms and even angiograms did not uniformly diagnose prosthetic valve dysfunction. Periodic phonocardiographic evaluations may be helpful in early detection of the prosthetic valve dysfunction. Once the diagnosis is established, immediate surgical treatment is imperative to prevent sudden death

The prognosis of allocentric and egocentric neglect : evidence from clinical scans

We contrasted the neuroanatomical substrates of sub-acute and chronic visuospatial deficits associated with different aspects of unilateral neglect using computed tomography scans acquired as part of routine clinical diagnosis. Voxel-wise statistical analyses were conducted on a group of 160 stroke patients scanned at a sub-acute stage. Lesion-deficit relationships were assessed across the whole brain, separately for grey and white matter. We assessed lesions that were associated with behavioural performance (i) at a sub-acute stage (within 3 months of the stroke) and (ii) at a chronic stage (after 9 months post stroke). Allocentric and egocentric neglect symptoms at the sub-acute stage were associated with lesions to dissociated regions within the frontal lobe, amongst other regions. However the frontal lesions were not associated with neglect at the chronic stage. On the other hand, lesions in the angular gyrus were associated with persistent allocentric neglect. In contrast, lesions within the superior temporal gyrus extending into the supramarginal gyrus, as well as lesions within the basal ganglia and insula, were associated with persistent egocentric neglect. Damage within the temporo-parietal junction was associated with both types of neglect at the sub-acute stage and 9 months later. Furthermore, white matter disconnections resulting from damage along the superior longitudinal fasciculus were associated with both types of neglect and critically related to both sub-acute and chronic deficits. Finally, there was a significant difference in the lesion volume between patients who recovered from neglect and patients with chronic deficits. The findings presented provide evidence that (i) the lesion location and lesion size can be used to successfully predict the outcome of neglect based on clinical CT scans, (ii) lesion location alone can serve as a critical predictor for persistent neglect symptoms, (iii) wide spread lesions are associated with neglect symptoms at the sub-acute stage but only some of these are critical for predicting whether neglect will become a chronic disorder and (iv) the severity of behavioural symptoms can be a useful predictor of recovery in the absence of neuroimaging findings on clinical scans. We discuss the implications for understanding the symptoms of the neglect syndrome, the recovery of function and the use of clinical scans to predict outcome

Oval Domes. The Case of the Basílica de la Virgen de los Desamparados of Valencia

[EN] The dome of the Basilica de la Virgen de los Desamparados of Valencia is an emblematic example of Valencian baroque architecture and painting. Its shape, oval or elliptical, has been the subject of controversy in various studies. The study of oval domes throughout history is a very interesting field of research because, among other things, the determination of the exact shape is important in order to conclude how it was built. We approach the problem from a new mathematical point of view, calculating the distances between the points that make up the real data cloud and the hypothetical form considered, oval or ellipse. The use of modern graphic surveying techniques, carried out with a 3D laser scanner, and computation with the powerful symbolic and numerical mathematical solver, Mathematica, has allowed us to accurately determine the shape of the dome and determine that its sections are not well-described by ellipses. A better fit is obtained assuming that sections are ovals. The programming and generalization of the mathematical method employed in this work will allow it to be applied to determine the exact geometry of other oval or ellipsoidal vaults.Calvo Roselló, V.; Capilla Tamborero, E.; Navarro Fajardo, JC. (2020). Oval Domes. The Case of the Basílica de la Virgen de los Desamparados of Valencia. Nexus Network Journal. 22(2):393-409. https://doi.org/10.1007/s00004-019-00465-0S393409222Arphe i Villafañe, Juan de. 1585. Tratado De varia conmmensuracion para la Escultura y Architectura. Sevilla: imprenta de Andrea Pescioni i Juan de León.Barrallo J. 2011. Ovals and Ellipses in Architecture. Proceedings of ISAMA 2011, Columbia College, Chicago, Illinois; p. 9–18.Bérchez Gómez, J. 1995. Basílica de Nuestra Señora de los Desamparados (Valencia). In: Monumentos de la Comunidad Valenciana. Catálogo de Monumentos declarados y conjuntos históricos incoados. Tomo X. Valencia. Arquitectura Religiosa. Valencia: Conselleria de Cultura, Educació i Ciència—Generalitat Valenciana, 204–217.Borngässer, B. 1997a. Arquitectura barroca en España y Portugal. In Toman R. (ed.) El barroco. Arquitectura-escultura-pintura. Köln: Könemann, 78–119.Borngässer, B. 1997b. Arquitectura barroca en Francia. In Toman R. (ed.) El barroco. Arquitectura-escultura-pintura. Köln: Könemann, 122–151.Bosch Reig, I., Roig Picazo, P. 1999. El proyecto de restauración arquitectónica de las cúpulas, tambor y linterna de la Basílica de la Virgen de los Desamparados de Valencia. In: Restauración de Pintura Mural aplicada a la Basílica de la Virgen de los Desamparados de Valencia, Roig Picazo, P. y Bosch Reig, I. Valencia: Servicio de Publicaciones de la U.P.V., 21–74.Calvo López, J., Alonso Rodríguez, M.A., Rabasa Díaz, E.; López Mozo, A. 2005. Cantería Renacentista en la Catedral de Murcia. Murcia: Colegio Oficial de Arquitectos.Capilla Tamborero E., Calvo Roselló, V. 2014. Chapter 8: La cúpula interior de la Basílica de la Virgen de los Desamparados de Valencia. Análisis geométrico y matemático. In: J. C. Navarro (ed.) Bóvedas Valencianas. Arquitecturas ideales, reales y virtuales en época medieval y moderna. Valencia: ed. UPV (Scientia), 196–237. ISBN: 978-84-9048-188-2.Connors, J. 1999. Un teorema sacro: San Carlo alle Quattro Fontane. In Il giovane Borromini. Dagli esordi a San Carlo alle Quattro Fontane. Milano: Skira, 459–512.Dotto, E. 2001. Note sulle costruzioni degli ovali a quattro centri. Vecchie e nuove costruzioni dell’ovale. Disegnare Idee Immagini; XII 23: 7–14.Duvernoy, Sylvie. 2015. Baroque Oval Churches: Innovative Geometrical Patterns in Early Modern Sacred Architecture. Nexus Network Journal 17 (2): 425–456.Fernández Gómez M. 1996. La planta oval. Traza y símbolo. Loggia. Arquitectura & Restauración 3: 16–21.García Jara F. 2008. Las cúpulas de la arquitectura religiosa de la provincia de Alicante: del Renacimiento al siglo XIX. Ph.D. Thesis.García Jara F. 2010. La estereotomía de las cúpulas sobre base oval. In: X Congreso Internacional de Expresión Gráfica aplicada a la Edificación, APEGA 2010, Alicante: 767–780.Gentil Baldrich, J. M. 1994. Planta oval y traza elíptica en la arquitectura: Consideraciones geométricas y un ejemplo español. Valladolid.Gentil Baldrich J.M. 1996. La traza oval y la Sala Capitular de la catedral de Sevilla. Una aproximación geométrica. In: J. A. Ruiz de la Rosa et al. Quatro edificios sevillanos. Sevilla: Colegio Oficial de Arquitectos de Andalucía, Demarcación Occidental, 73–147.Gómez-Collado, M.C.; Calvo Roselló, V; Capilla Tamborero, E. 2018. Mathematical modeling of oval arches. A study of the George V and Neuilly Bridges. Journal of Cultural Heritage Vol. 32: 144–155; https://doi.org/10.1016/j.culher.2018.01.012Hatch, John G. 2015. The Science Behind Francesco Borromini’s Divine Geometry. In: Architecture and Mathematics from Antiquity to the Future, eds. Kim Williams and Michael J. Oswald, vol. II, ch. 61, 217–228. Basel: Birkhäuser.Hill, Michael. 2013. Practical and Symbolic Geometry in Borromini’s San Carlo alle Quattro Fontane. Journal of the Society of Architectural Historians 72 (4): 555–583.Huerta Fernández, S. 2002. Informe sobre la estabilidad de la cúpula interior de la Basílica de la Virgen de los Desamparados de Valencia. Valencia. Conselleria Cultura, Educació y Ciència de la Generalitat Valenciana, 20 páginas.Huerta Fernández, S. 2007. Oval domes, geometry and mechanics. Nexus Network Journal 9(2), 211–248.Huerta Fernández, S. 2012a. Análisis estructural de cúpulas tabicadas: la cúpula interior de la Basílica de la Virgen de los Desamparados en Valencia. Construyendo Bóvedas Tabicadas. In: Actas del Simposio Internacional sobre bóvedas tabicadas. Valencia, 26 y 27 de mayo de 2011. Valencia: Editorial Universitat Politècnica de València, 318–335.Huerta Fernández, S. 2012b. Structural Analysis of Thin Tile Vaults and Domes: The Inner Oval Dome of the Basílica de la Virgen de los Desamparados in Valencia. In: Carvais et al (ed.) Nuts and Bolts of construction history. Culture, technology and society. Vol. 1. Paris: Picard, 375–383.Jung, W. 1997.) Arquitectura y ciudad en Italia. In Toman R. (ed.) El barroco. Arquitectura-escultura-pintura. Köln: Könemann, 12–75.Kluckert, E. 1997. Arquitectura barroca en Alemania, Suiza, Austria y Europa oriental. In Toman R. (ed.) El barroco. Arquitectura-escultura-pintura. Köln: Könemann, 184–273.López Manzanares, G. 2005. La contribución de R. G. Boscovich al desarrollo de la teoría de cúpulas: el informe sobre la Biblioteca Cesarea de Viena. In: Huerta, S. (ed.) Actas del Cuarto Congreso Nacional de Historia de la Construcción. Cádiz, 27–29 January 2005. Madrid: Instituto Juan de Herrera, 655–665.López Mozo A. 2011. Ovals for Any Given Proportion in Architecture: A Layout Possibly Known in the Sixteenth Century. Nexus Network Journal Vol. 13: 569–597.Mazzotti, A. 2014a. A Euclidean Approach to Eggs and Polycentric Curves. Nexus Network Journal, 16, 345–387. DOI https://doi.org/10.1007/s00004-014-0189-5Mazzotti, A. 2014b. What Borromini Might Have Known About Ovals. Ruler and Compass Constructions. Nexus Network Journal. https://doi.org/10.1007/s00004-014-0190-z .Mazzotti, A. 2017. All sides to an oval. Properties, Parameters, and Borromini’s Mysterious Construction. Springer. DOI https://doi.org/10.1007/978-3-319-39375-9Montoliu Soler, V. 2012. La Real Capilla de la Virgen de los Desamparados de Valencia: sus orígenes histórico-artísticos. Valencia: Real Academia de Cultura Valenciana.Navascués Palacio, P. 1974. El libro de arquitectura de Hernán Ruiz el Joven. Estudio y edición crítica por Pedro Navascues Palacio. Madrid: Escuela Técnica Superior de Arquitectura.Petrovic, Maja et al. 2019. A Focal Curve Approximation of a Borromini Oval Contour. Nexus Network Journal 21:19–31 https://doi.org/10.1007/s00004-018-00421-4Rabasa, E. 2009. Soluciones innecesariamente complicadas de la estereotomía clásica. In: AA.VV. El arte de la piedra, teoría y prática de la cantería. Madrid: CEU Ediciones, 50–69.Ragazzo, F. 1995, Geometria delle figure ovoidali, In Disegnare: 11, 17-24.Rosin P. 2001. On Serlio’s construction of ovals. The Mathematical Intelligencer 23(1): 58–69.Serlio S. 1552. Tercero y cuarto libro de Architectura de Sebastiano Serlio Boloñes. Translated by Francisco de Villalpando Architecto. Toledo: Casa de Iván de Ayala, 1552. (Edición facs. Barcelona: Serie Arte y Arquitectura, Editorial Alta Fulla, 1990.) (Edición digitalizada en Huerta, S. 2004. Selección de Tratados españoles de Arquitectura y Construcción de los siglos XVI al XX).Simona, M. 2005. Ovals in Borromini’s Geometry. In: Emmer, M., (ed.) Mathematics and Culture II. Visual Perfection: Mathematics and Creativity. Springer. 45–52. springeronline.comSoler Verdú, R. 1995. La cúpula en la arquitectura moderna valenciana. Siglos XVI a XVIII. Metodologías de estudios previos, para las arquitecturas de sistemas abovedados. Ph.D. Thesis. Universitat Politècnica de València.VV.AA. 2001. Real Basílica de la Virgen de los Desamparados de Valencia. Restauración de los fondos pictóricos y escultóricos. 1998–2001. I. Bosch (ed.) Valencia: Fundación para la Restauración de la Basílica de la Mare de Déu dels Desamparats

Prognostic utility of sestamibi lung uptake does not require adjustment for stress-related variables: A retrospective cohort study

BACKGROUND: Increased (99m)Tc-sestamibi stress lung-to-heart ratio (sLHR) has been shown to predict cardiac outcomes similar to pulmonary uptake of thallium. Peak heart rate and use of pharmacologic stress affect the interpretation of lung thallium uptake. The current study was performed to determine whether (99m)Tc-sestamibi sLHR measurements are affected by stress-related variables, and whether this in turn affects prognostic utility. METHODS: sLHR was determined in 718 patients undergoing (99m)Tc-sestamibi SPECT stress imaging. sLHR was assessed in relation to demographics, hemodynamic variables and outcomes (mean follow up 5.6 ± 1.1 years). RESULTS: Mean sLHR was slightly greater in males than in females (P < 0.01) and also showed a weak negative correlation with age (P < 0.01) and systolic blood pressure (P < 0.01), but was unrelated to stress method or heart rate at the time of injection. In patients undergoing treadmill exercise, sLHR was also positively correlated with peak workload (P < 0.05) but inversely with double product (P < 0.05). The combined explanatory effect of sex, age and hemodynamic variables on sLHR was less than 10%. The risk of acute myocardial infarction (AMI) or death increased by a factor of 1.7–1.8 for each SD increase in unadjusted sLHR, and was unaffected by adjustment for sex, age and hemodynamic variables (hazard ratios 1.6–1.7). The area under the ROC curve for the unadjusted sLHR was 0.65 (95% CI 0.59–0.71, P < 0.0001) and was unchanged for the adjusted sLHR (0.65, 95% CI 0.61–0.72, P < 0.0001). CONCLUSION: Stress-related variables have only a weak effect on measured sLHR. Unadjusted and adjusted sLHR provide equivalent prognostic information for prediction of AMI or death

Nociception-induced spatial and temporal plasticity of synaptic connection and function in the hippocampal formation of rats: a multi-electrode array recording

<p>Abstract</p> <p>Background</p> <p>Pain is known to be processed by a complex neural network (neuromatrix) in the brain. It is hypothesized that under pathological state, persistent or chronic pain can affect various higher brain functions through ascending pathways, leading to co-morbidities or mental disability of pain. However, so far the influences of pathological pain on the higher brain functions are less clear and this may hinder the advances in pain therapy. In the current study, we studied spatiotemporal plasticity of synaptic connection and function in the hippocampal formation (HF) in response to persistent nociception.</p> <p>Results</p> <p>On the hippocampal slices of rats which had suffered from persistent nociception for 2 h by receiving subcutaneous bee venom (BV) or formalin injection into one hand paw, multisite recordings were performed by an 8 × 8 multi-electrode array probe. The waveform of the field excitatory postsynaptic potential (fEPSP), induced by perforant path electrical stimulation and pharmacologically identified as being activity-dependent and mediated by ionotropic glutamate receptors, was consistently positive-going in the dentate gyrus (DG), while that in the CA1 was negative-going in shape in naïve and saline control groups. For the spatial characteristics of synaptic plasticity, BV- or formalin-induced persistent pain significantly increased the number of detectable fEPSP in both DG and CA1 area, implicating enlargement of the synaptic connection size by the injury or acute inflammation. Moreover, the input-output function of synaptic efficacy was shown to be distinctly enhanced by the injury with the stimulus-response curve being moved leftward compared to the control. For the temporal plasticity, long-term potentiation produced by theta burst stimulation (TBS) conditioning was also remarkably enhanced by pain. Moreover, it is strikingly noted that the shape of fEPSP waveform was drastically deformed or split by a TBS conditioning under the condition of persistent nociception, while that in naïve or saline control state was not affected. All these changes in synaptic connection and function, confirmed by the 2-dimentional current source density imaging, were found to be highly correlated with peripheral persistent nociception since pre-blockade of nociceptive impulses could eliminate all of them. Finally, the initial pharmacological investigation showed that AMPA/KA glutamate receptors might play more important roles in mediation of pain-associated spatiotemporal plasticity than NMDA receptors.</p> <p>Conclusion</p> <p>Peripheral persistent nociception produces great impact upon the higher brain structures that lead to not only temporal plasticity, but also spatial plasticity of synaptic connection and function in the HF. The spatial plasticity of synaptic activities is more complex than the temporal plasticity, comprising of enlargement of synaptic connection size at network level, deformed fEPSP at local circuit level and, increased synaptic efficacy at cellular level. In addition, the multi-synaptic model established in the present investigation may open a new avenue for future studies of pain-related brain dysfunctions at the higher level of the neuromatrix.</p

Testing for Spatial Neglect with Line Bisection and Target Cancellation: Are Both Tasks Really Unrelated?

Damage to the parietal lobe can induce a condition known as spatial neglect, characterized by a lack of awareness of the personal and/or extrapersonal space opposite the damaged brain region. Spatial neglect is commonly assessed clinically using either the line bisection or the target cancellation task. However, it is unclear whether poor performance on each of these two tasks is associated with the same or different lesion locations. To date, methodological limitations and differences have prevented a definitive link between task performance and lesion location to be made. Here we report findings from a voxel-based lesion symptom mapping (VLSM) analysis of an unbiased selection of 44 patients with a recent unifocal stroke. Patients performed both the line bisection and target cancellation task. For each of the two tasks a continuous score was incorporated into the VLSM analysis. Both tasks correlated highly with each other (r = .76) and VLSM analyses indicated that the angular gyrus was the critical lesion site for both tasks. The results suggest that both tasks probe the same underlying cortical deficits and although the cancellation task was more sensitive than the line bisection task, both can be used in a clinical setting to test for spatial neglect

In-hospital complications after invasive strategy for the management of Non STEMI: women fare as well as men

<p>Abstract</p> <p>Background</p> <p>To analyze the in-hospital complication rate in women suffering from non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) compared to men.</p> <p>Methods</p> <p>The files of 479 consecutive patients (133 women and 346 men) suffering from a Non STEMI (Non ST-segment elevation myocardial infarction) between the January 1^st2006 and March 21^st2009 were retrospectively analyzed with special attention to every single complication occurring during hospital stay. Data were analyzed using nonparametric tests and are reported as median unless otherwise specified. A p value < .05 was considered significant.</p> <p>Results</p> <p>As compared to men, women were significantly older (75.8 <it>vs</it>. 65.2 years; p < .005). All cardiovascular risk factors but tobacco and hypertension were similar between the groups: men were noticeably more often smoker (p < .0001) and women more hypertensive (p < .005). No difference was noticed for pre-hospital cardiovascular drug treatment. However women were slightly more severe at entry (more Killip class IV; p = .0023; higher GRACE score for in-hospital death - p = .008 and CRUSADE score for bleeding - p < .0001). All the patients underwent PCI of the infarct-related artery after 24 or 48 hrs post admission without sex-related difference either for timing of PCI or primary success rate. During hospitalization, 130 complications were recorded. Though the event rate was slightly higher in women (30% <it>vs</it>. 26% - p = NS), no single event was significantly gender related. The logistic regression identified age and CRP concentration as the only predictive variables in the whole group. After splitting for genders, these parameters were still predictive of events in men. In women however, CRP was the only one with a borderline p value.</p> <p>Conclusions</p> <p>Our study does not support any gender difference for in-hospital adverse events in patients treated invasively for an acute coronary syndrome without ST-segment elevation and elevated troponin.</p