Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement

ObjectiveThe study objective was to determine whether recurrent or residual mild aortic regurgitation, which occurs after valve-sparing aortic root replacement, progresses over time.MethodsBetween 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid aortic valve, 41% had Marfan syndrome, and 51% underwent aortic valve repair, predominantly cusp free margin shortening.ResultsForty-one patients (43%) had mild aortic regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild aortic regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate aortic regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe aortic regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate aortic regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate aortic regurgitation at 1 year, and both ultimately required reoperation.ConclusionsAlthough mild aortic regurgitation occurs frequently after valve-sparing aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild aortic regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild aortic regurgitation early after valve-sparing aortic root replacement

Diffusion-Weighted MRI: Distinction of Skull Base Chordoma from Chondrosarcoma

BACKGROUND AND PURPOSE: Chordoma and chondrosarcoma of the skull base are rare tumors with overlapping presentations and anatomic imaging features but different prognoses. We hypothesized that these tumors might be distinguished by using diffusion-weighted MR imaging. MATERIALS AND METHODS: We retrospectively reviewed 19 patients with pathologically confirmed chordoma or chondrosarcoma who underwent both conventional and diffusion-weighted MR imaging. Differences in distributions of ADC were assessed by the Kruskal-Wallis test. Associations between histopathologic diagnosis and conventional MR imaging features (T2 signal intensity, contrast enhancement, and tumor location) were assessed with the Fisher exact test. RESULTS: Chondrosarcoma was associated with the highest mean ADC value (2051 ± 261 × 10−6 mm2/s) and was significantly different from classic chordoma (1474 ± 117 × 10−6 mm2/s) and poorly differentiated chordoma (875 ± 100 × 10−6 mm2/s) (P CONCLUSIONS: Diffusion-weighted MR imaging may be useful in assessing clival tumors, particularly in differentiating chordoma from chondrosarcoma. A prospective study of a larger cohort will be required to determine the value of ADC in predicting histopathologic diagnosis

Transverse Electronic Transport through DNA Nucleotides with Functionalized Graphene Electrodes

Graphene nanogaps and nanopores show potential for the purpose of electrical DNA sequencing, in particular because single-base resolution appears to be readily achievable. Here, we evaluated from first principles the advantages of a nanogap setup with functionalized graphene edges. To this end, we employed density functional theory and the non-equilibrium Green's function method to investigate the transverse conductance properties of the four nucleotides occurring in DNA when located between the opposing functionalized graphene electrodes. In particular, we determined the electrical tunneling current variation as a function of the applied bias and the associated differential conductance at a voltage which appears suitable to distinguish between the four nucleotides. Intriguingly, we observe for one of the nucleotides a negative differential resistance effect.Comment: 19 pages, 7 figure

Development of intuitive rules: Evaluating the application of the dual-system framework to understanding children's intuitive reasoning

This is an author-created version of this article. The original source of publication is Psychon Bull Rev. 2006 Dec;13(6):935-53 The final publication is available at www.springerlink.com Published version: http://dx.doi.org/10.3758/BF0321390

Antigen-specific CD4 cells assist CD8 T-effector cells in eliminating keratinocytes

Keratinocytes expressing tumor or viral antigens can be eliminated by antigen-primed CD8 cytotoxic T cells. CD4 T-helper cells help induction of CD8 cytotoxic T cells from naive precursors and generation of CD8 T-cell memory. In this study, we show, unexpectedly, that CD4 cells are also required to assist primed CD8 effector T cells in rejection of skin expressing human growth hormone, a neo-self-antigen, in keratinocytes. The requirement for CD4 cells can be substituted by CD40 costimulation. Rejection of skin expressing ovalbumin (OVA), a non-self-antigen, by primed CD8 cytotoxic T cells can in contrast occur without help from antigen-specific CD4 T cells. However, rejection of OVA expressing keratinocytes is helped by antigen-specific CD4 T cells if only low numbers of primed or naive OVA-specific CD8 T cells are available. Effective immunotherapy directed at antigens expressed in squamous cancer may therefore be facilitated by induction of tumor antigen-specific CD4 helper T cells, as well as cytotoxic CD8 T cells

Simultaneous genetic analysis of longitudinal means and covariance structure in the simplex model using twin data

A longitudinal model based on the simplex model is presented to analyze simultaneously means and covariance structure using univariate longitudinal twin data. The objective of the model is to decompose the mean trend into components which can be attributed to those genetic and environmental factors which give rise to phenotypic individual differences and a component of unknown constitution which does not involve individual differences. Illustrations are given using simulated data and repeatedly measured weight obtained in a sample of 82 female twin pairs on sbc occasions. KEY WORDS: repeated measures; genetic and environmental covariance structure; mean trend; longitudinal twin data; genetic simplex mode; LISREL

Intuitive and Informal Knowledge in Preschoolers’ Development of Probabilistic Thinking

Preschoolers develop a wide range of mathematical informal knowledge and intuitive thinking before they enter formal, goal-oriented education. In their everyday activities young children get engaged with situations that enhance them to develop skills, concepts, strategies, representations, attitudes, constructs and operations concerning a wide range of mathematical notions. Recently there is scientific interest in linking children’s informal and formal knowledge in order to provide them with opportunities to avoid biases aiming at formulating, perceiving, reflecting on and exercising probabilistic notions. The current study investigates preschoolers’ (N=90) intuitive understanding of the likelihood of events in a probabilistic task with spinners. Participants, at the age of 4 to 6, are tested on their predictions of the most probable outcome prior to and after an instructive session of reasoning. The probabilistic task, based on constructivist principles, includes methodological alterations concerning the sample space and the themes of the stimuli. Educational implications are further discussed under the general point of view that in order to link informal to formal mathematical learning in preschool classroom, the subject content and the cognitive capacity of children are important to match

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine