Chiari's network: Normal anatomic variant or risk factor for arterial embolic events?

Objectives.This study was performed to assess the prevalence of Chiari's network in patients undergoing transesophageal echocardiography and to determine whether this anomaly is associated with other cardiac lesions or is characterized by typical clinical findings.Background.Chiari's network is a congenital remnant of the right valve of the sinus venosus. It has been found in 1.3% to 4% of autopsy studies and is believed to be of little clinical consequence.Methods.Video recordings of 1,436 consecutive adult patients evaluated by transesophageal echocardiography over a 30-month period were reviewed for the presence of Chiari's network. Echocardiographic contrast studies had been performed in all patients with Chiari's network and were compared with those of 160 consecutive patients without a Chiari net, serving as a control group.Results.Chiari's network was present in 29 of 1,436 patients (prevalence 2%). A frequently associated finding was a patent foramen ovale in 24 (83%) of the 29 patients with Chiari's network versus 44 (28%) of 160 control patients (p < 0.001). Intense right-to-left shunting occurred significantly more often in patients with Chiari's network than in control patients (16 [55%] of 29 patients vs. 19 [12%] of 160 control patients, p < 0.001). Another frequent association was an atrial septal aneurysm in 7 (24%) of 29 patients. The indication for transesophageal echocardiography was a suspected cardiac source of arterial embolism in 24 (83%) of 29 patients with a Chiari net, 13 of whom (54%) had recurrent embolic events. Chiari's network was significantly more common in patients with unexplained arterial embolism than in patients evaluated for other indications (24 [4.6%] of 522 patients vs. 5 [0.5%] of 914 patients, p < 0.001). Potential causes for arterial embolism were present in 9 of the 24 patients with a Chiari net and embolic events (atrial septal aneurysm in 7, cerebrovascular lesion in 2). In 15 (62%) of 24 patients only a patent foramen ovale could be identified. Three patients had deep venous thrombosis and pulmonary embolism at the time of arterial embolism; none had a thrombus detected within the network.Conclusions.In patients undergoing transesophageal echocardiography, the prevalence of Chiari's network was 2%, which is consistent with autopsy studies. By maintaining an embryonic right atrial flow pattern into adult life and directing the blood from the inferior vena cava preferentially toward the interatrial septum, Chiari's network may favor persistence of a patent foramen ovale and formation of an atrial septal aneurysm and facilitate paradoxic embolism

Max Schottelius : Pioneer in Pheochromocytoma

First descriptions of diseases attract tremendous interest because they reveal scientific insight even in retrospect. Max Schottelius, the pathologist contributing the first histological description of pheochromocytoma, remains anonymous. We reviewed the description by Schottelius and weighed the report in modern context. Schottelius described the classical diagnostic elements of pheochromocytoma, including the brown appearance after exposure to chromate-containing Mueller's fixative. This color change, known as chromaffin reaction, results fromoxidation of catecholamines and is reflected in the name pheochromocytoma, meaning dusky-colored chromate-positive tumor. Thus Schottelius performed the first known histochemical contribution to diagnosis, which is today standard with immunohistochemistry for chromogranin. Copyright (c) 2017 Endocrine Society This article has been published under the terms of the Creative Commons Attribution NonCommercial, No-Derivatives License (CC BY-NC-ND).Peer reviewe

Guest Editorial: Special section on embracing artificial intelligence for network and service management

Artificial Intelligence (AI) has the potential to leverage the immense amount of operational data of clouds, services, and social and communication networks. As a concrete example, AI techniques have been adopted by telcom operators to develop virtual assistants based on advances in natural language processing (NLP) for interaction with customers and machine learning (ML) to enhance the customer experience by improving customer flow. Machine learning has also been applied to finding fraud patterns which enables operators to focus on dealing with the activity as opposed to the previous focus on detecting fraud

Ethics, space, and somatic sensibilities: comparing relationships between scientific researchers and their human and animal experimental subjects

Drawing on geographies of affect and nature-society relations, we propose a radical rethinking of how scientists, social scientists, and regulatory agencies conceptualise human and animal participants in scientif ic research. The scientific rationale for using animal bodies to simulate what could be done in human bodies emphasises shared somatic capacities that generate comparable responses to clinical interventions. At the same time, regulatory guidelines and care practices stress the differences between human and animal subjects. In this paper we consider the implications of this differentiation between human and animal bodies in ethical and welfare protocols and practices. We show how the bioethical debates around the use of human subjects tend to focus on issues of consent and language, while recent work in animal welfare reflects an increasing focus on the affectual dimensions of ethical practice. We argue that this attention to the more-than-representational dimensions of ethics and welfare might be equally important for human subjects. We assert that paying attention to these somatic sensibilities can offer insights into how experimental environments can both facilitate and restrict the development of more care-full and response-able relations between researchers and their experimental subjects. <br/

Coulomb-gas formulation of SU(2) branes and chiral blocks

We construct boundary states in $SU(2)_k$ WZNW models using the bosonized Wakimoto free-field representation and study their properties. We introduce a Fock space representation of Ishibashi states which are coherent states of bosons with zero-mode momenta (boundary Coulomb-gas charges) summed over certain lattices according to Fock space resolution of $SU(2)_k$. The Virasoro invariance of the coherent states leads to families of boundary states including the B-type D-branes found by Maldacena, Moore and Seiberg, as well as the A-type corresponding to trivial current gluing conditions. We then use the Coulomb-gas technique to compute exact correlation functions of WZNW primary fields on the disk topology with A- and B-type Cardy states on the boundary. We check that the obtained chiral blocks for A-branes are solutions of the Knizhnik-Zamolodchikov equations.Comment: 14 pages, 3 figures, revtex4. Essentially the published versio

Quantization of Wilson loops in Wess-Zumino-Witten models

We describe a non-perturbative quantization of classical Wilson loops in the WZW model. The quantized Wilson loop is an operator acting on the Hilbert space of closed strings and commuting either with the full Kac-Moody chiral algebra or with one of its subalgebras. We prove that under open/closed string duality, it is dual to a boundary perturbation of the open string theory. As an application, we show that such operators are useful tools for identifying fixed points of the boundary renormalization group flow.Comment: 24 pages. Version published in JHE

Twisted boundary states in c=1 coset conformal field theories

We study the mutual consistency of twisted boundary conditions in the coset conformal field theory G/H. We calculate the overlap of the twisted boundary states of G/H with the untwisted ones, and show that the twisted boundary states are consistently defined in the diagonal modular invariant. The overlap of the twisted boundary states is expressed by the branching functions of a twisted affine Lie algebra. As a check of our argument, we study the diagonal coset theory so(2n)_1 \oplus so(2n)_1/so(2n)_2, which is equivalent with the orbifold S^1/\Z_2. We construct the boundary states twisted by the automorphisms of the unextended Dynkin diagram of so(2n), and show their mutual consistency by identifying their counterpart in the orbifold. For the triality of so(8), the twisted states of the coset theory correspond to neither the Neumann nor the Dirichlet boundary states of the orbifold and yield the conformal boundary states that preserve only the Virasoro algebra.Comment: 44 pages, 1 figure; (v2) minor change in section 2.3, references adde