Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: Incidence and significance of systolic anterior motion

AbstractObjectives. This study was designed to delineate the utility and results of intraoperative transesophageal echocardiography in the evaluation of patients undergoing mural valve repair for mitral regurgitation.Background. Mitral valve reconstruction offers many advantages over prosthetic valve replacement. Intraoperative assessment of valve competence after repair is vital to the effectiveness of this procedure.Methods. Intraoperative transesophageal echocardiography was performed in 143 patients undergoing mitral valve repair over a period of 23 months, Before and after repair, the functional morphology of the mitral apparatus was defined by twodimensional echocardiography; Doppler color flow imaging was used to clarify the mechanism of mitral regurgitation and to semiquantitate its severity.Results. There was significant improvement in the mean mitral regurgitation grade by composite intraoperative transesophageal echocardiography after valve repair (3.6 ± 0.8 to 0.7 ± 0.7; p < 0.00001). Excellent results from initial repair with grade ≤ 1 residual mitral regurgitation were observed in 88.1% of patients. Significant residual mitral regurgitation (grade ≥ 3) was identified in 11 patients (7.7%); 5 underwent prosthetic valve replacement, 5 had revision of the initial repair and 1 patient had observation only. Of the 100 patients with a myxomatous mitral valve, the risk of grade ≥ 3 mitral regurgitation after initial repair was 1.7% in patients with isolated posterior leaflet disease compared with 22.5% in patients with anterior or bileaflet disease.Severe systolic anterior motion of the mitral apparatus causing grade 2 to 4 mitral regurgitation was present in 13 patients (9.1%) after cardiopulmonary bypass. In 8 patients (5.6%), systolic anterior motion resolved immediately with correction of hyperdynamic hemodynamic status, resulting in grade ≤ 1 residual mitral regurgitation without further operative intervention.Transthoracic echocardiography before hospital discharge demonstrated grade ≤ 1 residual mitral regurgitation in 86.4% of 132 patients studied. A significant discrepancy (> 1 grade) in residual mitral regurgitation by predischarge transthoracic versus intraoperative transesophageal echocardiography was noted in 17 patients (12.9%).Conclusions. Transesophageal echocardiography is a valuable adjunct in the intraoperative assessment of mitral valve repair

Value-based decision-making of cigarette and nondrug rewards in dependent and occasional cigarette smokers:An FMRI study

Little is known about the neural functioning that underpins drug valuation and choice in addiction, including nicotine dependence. Following ad libitum smoking, 19 dependent smokers (smoked≥10/day) and 19 occasional smokers (smoked 0.5‐5/week) completed a decision‐making task. First, participants stated how much they were willing‐to‐pay for various amounts of cigarettes and shop vouchers. Second, during functional magnetic resonance imaging, participants decided if they wanted to buy these cigarettes and vouchers for a set amount of money. We examined decision‐making behaviour and brain activity when faced with cigarette and voucher decisions, purchasing (vs not purchasing) cigarettes and vouchers, and “value signals” where brain activity correlated with cigarette and voucher value. Dependent smokers had a higher willingness‐to‐pay for cigarettes and greater activity in the bilateral middle temporal gyrus when faced with cigarette decisions than occasional smokers. Across both groups, the decision to buy cigarettes was associated with activity in the left paracingulate gyrus, right nucleus accumbens, and left amygdala. The decision to buy vouchers was associated with activity in the left superior frontal gyrus, but dependent smokers showed weaker activity in the left posterior cingulate gyrus than occasional smokers. Across both groups, cigarette value signals were observed in the left striatum and ventromedial prefrontal cortex. To summarise, nicotine dependence was associated with greater behavioural valuation of cigarettes and brain activity during cigarette decisions. When purchasing cigarettes and vouchers, reward and decision‐related brain regions were activated in both groups. For the first time, we identified value signals for cigarettes in the brain

Cytogenetic analysis of 130 renal oncocytomas identify three distinct and mutually exclusive diagnostic classes of chromosome aberrations

The cytogenetic alterations in renal oncocytoma (RO) are poorly understood. We analyzed 130 consecutive RO for karyotypic alterations. Clonal chromosome abnormalities were identified in 63 (49%) cases, which could be categorized into three classes of mutually exclusive cytogenetic categories. Class 1 (N = 20) RO had diploid karyotypes with characteristic 11q13 rearrangement in balanced translocations with 10 or more different chromosome partners in all cases. We identified recurrent translocation partners at 5q35, 6p21, 9p24, 11p13-14, and 11q23, and confirmed that CCND1 gene rearrangement at 11q13 utilizing fluorescence in situ hybridization (FISH). Class 2 RO (N = 25) exhibited hypodiploid karyotypes with loss of chromosome 1 and/or losses of Y in males and X in females in all cases. The class 3 tumors comprising of 18 cases showed diverse types of abnormalities with the involvement of two or more chromosomes exclusive of abnormalities seen in classes 1 and 2 tumors. Furthermore, karyotypically uninformative cases were subjected to FISH analysis to identify classes 1 and 2 abnormalities. In this group, we found similar frequencies of CCND1 rearrangement, loss of chromosome 1 or Y as with karyotypically abnormal cases. We validated our results against 91 tumors from the Mitelman database. Correlation of clinical data with all the three classes of ROs showed no clear evidence of overall patient survival. Our findings support the hypothesis that RO exhibit three principal cytogenetic categories, which may have different roles in initiation and/or progression. These cytogenetic markers provide a key tool in the diagnostic evaluation of RO

Galaxia: a code to generate a synthetic survey of the Milky Way

We present here a fast code for creating a synthetic survey of the Milky Way. Given one or more color-magnitude bounds, a survey size and geometry, the code returns a catalog of stars in accordance with a given model of the Milky Way. The model can be specified by a set of density distributions or as an N-body realization. We provide fast and efficient algorithms for sampling both types of models. As compared to earlier sampling schemes which generate stars at specified locations along a line of sight, our scheme can generate a continuous and smooth distribution of stars over any given volume. The code is quite general and flexible and can accept input in the form of a star formation rate, age metallicity relation, age velocity dispersion relation and analytic density distribution functions. Theoretical isochrones are then used to generate a catalog of stars and support is available for a wide range of photometric bands. As a concrete example we implement the Besancon Milky Way model for the disc. For the stellar halo we employ the simulated stellar halo N-body models of Bullock & Johnston (2005). In order to sample N-body models, we present a scheme that disperses the stars spawned by an N-body particle, in such a way that the phase space density of the spawned stars is consistent with that of the N-body particles. The code is ideally suited to generating synthetic data sets that mimic near future wide area surveys such as GAIA, LSST and HERMES. As an application we study the prospect of identifying structures in the stellar halo with a simulated GAIA survey. We plan to make the code publicly available at http://galaxia.sourceforge.net.Comment: Accepted for publication in Ap

The challenges of ethical research with children

As especificidades da pesquisa com crianças têm ganhado visibilidade nas produções acadêmicas em diversas áreas de conhecimento, com destaque para a Sociologia da Infância, principalmente a partir dos “novos estudos sobre a infância” os quais emergiram ao final da década de 1980. Essa visibilidade acontece devida a questões como: a discussão sobre as imagens da infância, construídas socio-historicamente; o reconhecimento da condição das crianças enquanto atores sociais, portanto, seres competentes, que atribuem significações a suas experiências e contextos; e o reconhecimento das crianças enquanto sujeitos de direitos, reconhecimento este pautado pela Doutrina da Proteção Integral. Permeadas por essas questões, as pesquisas com crianças agregam a questão da Ética nas atividades desenvolvidas na relação pesquisador-criança. No contexto dessa discussão, este trabalho propõe refletir sobre essas questões e os cuidados éticos nesse tipo de pesquisa, considerando a condição da criança enquanto sujeito de direitos. Foi realizado um recorte da produção acadêmica representativa na área da Sociologia da Infância nas duas últimas décadas, identificando quais aspectos aparecem nas preocupações dos autores, quais abordagens norteiam a discussão desses aspectos e, principalmente, que concepção de infância está presente nessa produção.The specificities of research with children have gained visibility in scientific publications in various areas of knowledge, especially in Sociology of Childhood and the “new studies of childhood”, which emerged at the end of the 1980s. This fact is due to discussions about childhood from a socio-historical perspective; the recognition of children as social actors and therefore able to give meaning to their experiences and contexts; and the recognition of children as individuals entitled to rights, according to the Doutrina da Proteção Integral (Full Protection Doctrine). Therefore, research ethics is an essential element of good research governance, especially in terms of activities related to the relationship between the researcher and child. Accordingly, the objective of this study is to examine and explore these issues, considering the child as an individual entitled to rights. A literature review of articles published in the last two decades in the area of Sociology of Childhood was conducted to identify the main issues and topics addressed, the approaches that guided the discussions and, especially, to identify the conception of childhood present in these studies.CIEC - Centro de Investigação em Estudos da Criança, IE, UMinho (UI 317 da FCT), Portuga

An international comparative study of blood pressure in populations of European vs. African descent

Background: The consistent finding of higher prevalence of hypertension in US blacks compared to whites has led to speculation that African-origin populations are particularly susceptible to this condition. Large surveys now provide new information on this issue. Methods: Using a standardized analysis strategy we examined prevalence estimates for 8 white and 3 black populations (N = 85,000 participants). Results: The range in hypertension prevalence was from 27 to 55% for whites and 14 to 44% for blacks. Conclusions: These data demonstrate that not only is there a wide variation in hypertension prevalence among both racial groups, the rates among blacks are not unusually high when viewed internationally. These data suggest that the impact of environmental factors among both populations may have been under-appreciated

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

BACKGROUND: Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. METHODS: A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. RESULTS: 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. CONCLUSIONS: Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority