An Approach to Overcoming Specific Difficulties with Cardiac Resynchronization Therapy in Children

Cardiac resynchronization therapy (CRT) is now a well established treatment modality for adult patients with drug refractory symptomatic congestive heart failure. Multiple large-scale studies have clearly demonstrated reduction in heart failure-related morbidity with CRT. More recently, a likely independent mortality benefit with CRT has also been shown. Improvement in quality of life, decrease in left ventricular diastolic dimension, improved objective assessment of exercise tolerance, and decreased heart failure-related hospitalizations have all been well demonstrated in the adult population. Whether or not these benefits occur in younger patients is not clear. Since none of the major trials for CRT have included children, much is unknown about the specifics of indication, difficulties with implant, and efficacy in the pediatric populatio

Putting hydrodynamic interactions to work: tagged particle separation

Separation of magnetically tagged cells is performed by attaching markers to a subset of cells in suspension and applying fields to pull from them in a variety of ways. The magnetic force is proportional to the field gradient, and the hydrodynamic interactions play only a passive, adverse role. Here we propose using a homogeneous rotating magnetic field only to make tagged particles rotate, and then performing the actual separation by means of hydrodynamic interactions, which thus play an active role. The method, which we explore here theoretically and by means of numerical simulations, lends itself naturally to sorting on large scales.Comment: Version accepted for publication - Europhysics Letter

Transmission of the Pi<SUP>Z</SUP> allele for &#945;<SUB>1</SUB>-antitrypsin deficiency: population genetic considerations

It is shown that a simple preferential transmission of the PiZ allele by PiZ-heterozygous males for 1-antitrypsin deficiency cannot maintain the observed polymorphism at the locus without invoking any viability or fertility selection against the PiZ gene carriers (heterozygotes or homozygotes). From the data on frequencies of PiZ alleles in Europe, the estimates of such selection coefficients are shown to be of the order of 5-20%, which seems too large for natural populations. Furthermore, an analysis of 26 nuclear families, each ascertained through a heterozygous PiZ or homozygous ZZ child, does not provide statistical evidence for such a hypothesis

Idiopathic hypertrophic pachymeningitis presenting with occipital neuralgia

Background: Although occipital neuralgia is usually caused by degenerative arthropathy, nearly 20 other aetiologies may lead to this condition.Methods: We present the first case report of hypertrophic pachymeningitis revealed by isolated occipital neuralgia.Results and conclusions: Idiopathic hypertrophic pachymeningitis is a plausible cause of occipital neuralgia and may present without cranial-nerve palsy. There is no consensus on the treatment for idiopathic hypertrophic pachymeningitis, but the usual approach is to start corticotherapy and then to add immunosuppressants. When occipital neuralgia is not clinically isolated or when a first-line treatment fails, another disease diagnosis should be considered. However, the cost effectiveness of extended investigations needs to be considered.Keywords: neuralgia/pathology, meningitis, neck pain/aetiology, revie

Phase unwrapping : geometric distortions correction on MRI

Magnetic Resonance Imaging has entered clinical practice about fifteen years ago, and has become one of the most widely used imaging modality. MRI suffers from important geometric distortions, leading to pixel shifts and intensity variations in the acquired images. Correction of these distortions is clearly required in stereotactic surgery using frame-based registrations or neuro-navigation. These distortions can be corrected using the phase of signal or image. However, as in Inverse Synthetic Aperture Radar (ISAR), the phase of the signal is obtained modulo 2 π. The goal of Phase unwrapping is to retrieve the initial phase of the signal. After a brief summary of related works and applications mainly using ISAR data, this paper presents a new algorithm for phase unwrapping. This algorithm is fast, robust to noise and takes into account the discontinuities of the acquired object. It is based upon the notion of homogeneous region. This homogeneity is defined by phase jumps and no parameters have to be determined a priori. Experiments on noisy phantoms exhibit good robustness to noise. An application to the correction of MRI of the head is presented.Les images du corps humain acquises par résonance magnétique sont une des modalités les plus utilisées à des fins cliniques depuis une quinzaine d'années. Elles souffrent cependant de distorsions géométriques importantes sous forme de décalages de pixels et de variations d'intensité. Ces distorsions doivent être corrigées pour utiliser ces imagés dans des applications de neuro-navigation ou de neuro-chirurgie stéréotaxiques. Une des solutions pour la correction exploite les images de phase issues de l'imageur. Cependant, comme en Interférométrie Radar à Ouverture Synthétique (ISAR), cette phase est codée modulo 2 π. Le déroulement de phase a pour objectif de retrouver la phase réelle du signal. Après un rapide bilan des outils existants, principalement dans le domaine ISAR, nous proposons dans cet article un algorithme de déroulement de phase original, rapide, robuste au bruit et qui prend en compte les discontinuités réelles de l'objet imagé. Il est basé sur la notion de région homogène du point de vue des sauts de phase et ne nécessite pas la détermination de paramètres. Les tests sur des fantômes bruités démontrent la bonne robustesse au bruit. Cet algorithme est ensuite utilisé pour la correction d'images IRM et illustre le bon déroulement de la phase

Integrating Design Throughout The Mechanical Engineering Curriculum: A Focus On The Engineering Clinics

At Rowan University, we have infused design into the curriculum through an eight-semester course sequence called the Engineering Clinic. Through this experience students learn the art and science of design in a multidisciplinary team environment. While many engineering programs currently include a Capstone Design course taken near the end of the college career to meet the design needs, Engineering Clinic at Rowan allows students to hone their design skills throughout their four-year career. This paper will describe in further detail the objectives and execution of each year in the design sequence, types of projects and how the Clinics complement traditional core courses in the curriculum. Impacts and benefits of the Clinics on students and faculty are discussed, as well as comparative data of Rowan Mechanical Engineering students and their peers nationally

Comparison of Design Approaches for Low-Cost Sampling Mechanisms in Open-Source Chemical Instrumentation

Robotic positioning systems are used in a variety of chemical instruments, primarily for liquid handling purposes, such as autosamplers from vials or well plates. Here, two approaches to the design of open-source autosampler positioning systems for use with 96-well plates are described and compared. The first system, a 3-axis design similar to many low-cost 3D printers that are available on the market, is constructed using an aluminum frame and stepper motors. The other system relies upon a series of 3D printed parts to achieve movement with a series of linker arms based on Selective Compliance Assembly Robot Arm (SCARA) design principles. Full printer design files, assembly instructions, software, and user directions are included for both samplers. The positioning precision of the 3-axis system is better than the SCARA mechanism due to finer motor control, albeit with a slightly higher cost of materials. Based on the improved precision of this approach, the 3-axis autosampler system was used to demonstrate the generation of a segmented flow droplet stream from adjacent wells within a 96-well plate

Evaluation of machine-learning methods for ligand-based virtual screening

Machine-learning methods can be used for virtual screening by analysing the structural characteristics of molecules of known (in)activity, and we here discuss the use of kernel discrimination and naive Bayesian classifier (NBC) methods for this purpose. We report a kernel method that allows the processing of molecules represented by binary, integer and real-valued descriptors, and show that it is little different in screening performance from a previously described kernel that had been developed specifically for the analysis of binary fingerprint representations of molecular structure. We then evaluate the performance of an NBC when the training-set contains only a very few active molecules. In such cases, a simpler approach based on group fusion would appear to provide superior screening performance, especially when structurally heterogeneous datasets are to be processed

Urgent need to clarify the definition of chronic critical limb ischemia - a position paper from the European Society for Vascular Medicine

Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence. We should thus propose a definition and then validate it in a prospective cohort in order to define the patients at major risk of amputation, and also to define the categories of patients whose prognosis is improved by revascularisation. From today\u27s available data, it seems clear that the patients with a systolic toe pressure (STP) below 30 mmHg must be revascularised whenever possible. However other patients with clinically suspected CLI and STP above 30 mmHg must be evaluated and treated in specialised vascular units and revascularisation has to be discussed on a case by case basis, taking into account other data such as the WiFi classification for ulcers.In conclusion, many useful but at times contradictory definitions of CLI have been suggested. Only a few have taken into account evidence, and none have been validated prospectively. This paper aims to address this and to give notice that a CLI registry within Europe will be set up to prospectively validate, or not, the previous and suggested definitions of CLI