Hemodynamic benefits of the Toronto stentless valve

AbstractWe report on 254 consecutive patients (170 male, 84 female) undergoing aortic valve replacement with the Toronto SPV Stentless Valve (St. Jude Medical, Inc., St. Paul, Minn.). Mean age (± standard deviation) was 62.1 ± 11.6 years. Three patients (1%) received sizes 21 or 22 mm, 24 (9%) received size 23 mm, and 227 patients (89%) received sizes 25, 27, or 29 mm. Serial echocardiography was used to assess valve performance during a 3-year follow-up. Mean gradient decreased by 35.8% ( p < 0.0001; 95% confidence interval -39.6%, -31.7%) from postoperative values to the 3- to 6-month follow-up and by 6.1% ( p = 0.004; 95% confidence interval -10.1%, -2%) at each subsequent interval; effective orifice area increased by 17.2% ( p = 0.0001; 95% confidence interval 12.0%, 22.6%) initially and by 4.4% ( p < 0.001; 95% confidence interval 1.8%, 7.0%) thereafter. At 2 years of follow-up, mean gradient was 3.3 ± 2.1 mm Hg and mean effective orifice area was 2.2 ± 0.8 cm 2 . Studies on left ventricular mass were carried out on 84 patients. Left ventricular mass decreased by 14.3% (37.8 ± 57.9 gm; p < 0.0001; 95% confidence interval -53.7, -21.9 gm) and left ventricular mass index decreased by 15.2% (21.1 ± 30.5 gm/m 2; p < 0.0001; 95% confidence interval -29.5, -12.7 gm/m 2) from postoperative values to the 3- to 6-month follow-up interval. The reduction in residual gradient and potential regression in left ventricular hypertrophy may have a beneficial prognostic implication. We believe that the unique stentless design of the Toronto SPV Stentless Valve allows this to occur. (J T horac C ardiovasc S urg 1996;112:431-46

ATLAST detector needs for direct spectroscopic biosignature characterization in the visible and near-IR

Are we alone? Answering this ageless question will be a major focus for astrophysics in coming decades. Our tools will include unprecedentedly large UV-Optical-IR space telescopes working with advanced coronagraphs and starshades. Yet, these facilities will not live up to their full potential without better detectors than we have today. To inform detector development, this paper provides an overview of visible and near-IR (VISIR; $\lambda=0.4-1.8~\mu\textrm{m}$) detector needs for the Advanced Technology Large Aperture Space Telescope (ATLAST), specifically for spectroscopic characterization of atmospheric biosignature gasses. We also provide a brief status update on some promising detector technologies for meeting these needs in the context of a passively cooled ATLAST.Comment: 8 pages, Presented 9 August 2015 at SPIE Optics + Photonics, San Diego, C

BUMC Annual Report

Annual report of the Boston University Medical Center

Hydrogen atom in a spherical well: linear approximation

We discuss the boundary effects on a quantum system by examining the problem of a hydrogen atom in a spherical well. By using an approximation method which is linear in energy we calculate the boundary corrections to the ground-state energy and wave function. We obtain the asymptotic dependence of the ground-state energy on the radius of the well.Comment: Revised version to appear in European Journal of Physic

Persistent spins in the linear diffusion approximation of phase ordering and zeros of stationary gaussian processes

The fraction r(t) of spins which have never flipped up to time t is studied within a linear diffusion approximation to phase ordering. Numerical simulations show that, even in this simple context, r(t) decays with time like a power-law with a non-trival exponent $\theta$ which depends on the space dimension. The local dynamics at a given point is a special case of a stationary gaussian process of known correlation function and the exponent $\theta$ is shown to be determined by the asymptotic behavior of the probability distribution of intervals between consecutive zero-crossings of this process. An approximate way of computing this distribution is proposed, by taking the lengths of the intervals between successive zero-crossings as independent random variables. The approximation gives values of the exponent $\theta$ in close agreement with the results of simulations.Comment: 10 pages, 2 postscript files. Submitted to PRL. Reference screwup correcte

Are stentless valves hemodynamically superior to stented valves? Long-term follow-up of a randomized trial comparing Carpentier–Edwards pericardial valve with the Toronto Stentless Porcine Valve

ObjectiveThe benefit of stentless valves remains in question. In 1999, a randomized trial comparing stentless and stented valves was unable to demonstrate any hemodynamic or clinical benefits at 1 year after implantation. This study reviews long-term outcomes of patients randomized in the aforementioned trial.MethodsBetween 1996 and 1999, 99 patients undergoing aortic valve replacement were randomized to receive either a stented Carpentier–Edwards pericardial valve (CE) (Edwards Lifesciences, Irvine, Calif) or a Toronto Stentless Porcine Valve (SPV) (St Jude Medical, Minneapolis, Minn). Among these, 38 patients were available for late echocardiographic follow-up (CE, n = 17; SPV, n = 21). Echocardiographic analysis was undertaken both at rest and with dobutamine stress, and functional status (Duke Activity Status Index) was compared at a mean of 9.3 years postoperatively (range, 7.5–11.1 years). Clinical follow-up was 82% complete at a mean of 10.3 years postoperatively (range, 7.5–12.2 years).ResultsPreoperative characteristics were similar between groups. Effective orifice areas increased in both groups over time. Although there were no differences in effective orifice areas at 1 year, at 9 years, effective orifice areas were significantly greater in the SPV group (CE, 1.49 ± 0.59 cm2; SPV, 2.00 ± 0.53 cm2; P = .011). Similarly, mean and peak gradients decreased in both groups over time; however, at 9 years, gradients were lower in the SPV group (mean: CE, 10.8 ± 3.8 mm Hg; SPV, 7.8 ± 4.8 mm Hg; P = .011; peak: CE, 20.4 ± 6.5 mm Hg; SPV, 14.6 ± 7.1 mm Hg; P = .022). Such differences were magnified with dobutamine stress (mean: CE, 22.7 ± 6.1 mm Hg; SPV, 15.3 ± 8.4 mm Hg; P = .008; peak: CE, 48.1 ± 11.8 mm Hg; SPV, 30.8 ± 17.7 mm Hg; P = .001). Ventricular mass regression occurred in both groups; however, no differences were demonstrated between groups either on echocardiographic, magnetic resonance imaging, or biochemical (plasma B-type [brain] natriuretic peptide) assessment (P = .74). Similarly, Duke Activity Status Index scores of functional status improved in both groups over time; however, no differences were noted between groups (CE, 27.5 ± 19.1; SPV, 19.9 ± 12.0; P = .69). Freedom from reoperation at 12 years was 92% ± 5% in patients with CEs and 75% ± 5% in patients with SPVs (P = .65). Freedom from valve-related morbidity at 12 years was 82% ± 7% in patients with CEs and 55% ± 7% in patients with SPVs (P = .05). Finally, 12-year actuarial survival was 35% ± 7% in patients with CEs and 52% ± 7% in patients with SPVs (P = .37).ConclusionAlthough offering improved hemodynamic outcomes, the SPV did not afford superior mass regression or improved clinical outcomes up to 12 years after implantation

NN Core Interactions and Differential Cross Sections from One Gluon Exchange

We derive nonstrange baryon-baryon scattering amplitudes in the nonrelativistic quark model using the ``quark Born diagram" formalism. This approach describes the scattering as a single interaction, here the one-gluon-exchange (OGE) spin-spin term followed by constituent interchange, with external nonrelativistic baryon wavefunctions attached to the scattering diagrams to incorporate higher-twist wavefunction effects. The short-range repulsive core in the NN interaction has previously been attributed to this spin-spin interaction in the literature; we find that these perturbative constituent-interchange diagrams do indeed predict repulsive interactions in all I,S channels of the nucleon-nucleon system, and we compare our results for the equivalent short-range potentials to the core potentials found by other authors using nonperturbative methods. We also apply our perturbative techniques to the N$\Delta$ and $\Delta\Delta$ systems: Some $\Delta\Delta$ channels are found to have attractive core potentials and may accommodate ``molecular" bound states near threshold. Finally we use our Born formalism to calculate the NN differential cross section, which we compare with experimental results for unpolarised proton-proton elastic scattering. We find that several familiar features of the experimental differential cross section are reproduced by our Born-order result.Comment: 27 pages, figures available from the authors, revtex, CEBAF-TH-93-04, MIT-CTP-2187, ORNL-CCIP-93-0

Metabolic balance of coastal Antarctic waters revealed by autonomous pCO2 and ΔO2/Ar measurements

Author Posting. © American Geophysical Union, 2014. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 41 (2014): 6803–6810, doi:10.1002/2014GL061266.We use autonomous gas measurements to examine the metabolic balance (photosynthesis minus respiration) of coastal Antarctic waters during the spring/summer growth season. Our observations capture the development of a massive phytoplankton bloom and reveal striking variability in pCO2 and biological oxygen saturation (ΔO2/Ar) resulting from large shifts in community metabolism on time scales ranging from hours to weeks. Diel oscillations in surface gases are used to derive a high-resolution time series of net community production (NCP) that is consistent with 14C-based primary productivity estimates and with the observed seasonal evolution of phytoplankton biomass. A combination of physical mixing, grazing, and light availability appears to drive variability in coastal Antarctic NCP, leading to strong shifts between net autotrophy and heterotrophy on various time scales. Our approach provides insight into the metabolic responses of polar ocean ecosystems to environmental forcing and could be employed to autonomously detect climate-dependent changes in marine primary productivity.This study was supported by funds from the U.S. National Science Foundation (OPP awards ANT-0823101, ANT-1043559, ANT-1043593, and ANT-1043532) as well as support for PDT and ECA from the National Science and Engineering Research Council of Canada.2015-04-0

BUMC Annual Report

Annual report of the Boston University Medical Center