Abnormal wave reflections and left ventricular hypertrophy late after coarctation of the aorta repair

Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (P≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, P=0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m(2), P<0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (P=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM

Export-led or household consumption-led growth in China: An empirical analysis

Abstract. GDP growth dependence on various factors of the country during (1980-2013) 34 years has been estimated. Ordinary Least Squares Technique of regression is applied here. The results are indicative of incidence of devaluation in the Yuan taking real effective and nominal exchange rate. Further, incidence of systematic impact of capital formation on GDP growth is greater than that of the international trade and domestic household consumption expenditure. That signifies the importance of domestic economy in contrast to the general belief of external sector dependence of the Chinese growth.Keywords. Currency devaluation, GDP growth, Regression.JEL. F13, F43, O47, E21

Vortical Flow Topology on Windward and Leeward side of Delta Wing at Supersonic Speed

area of interest for flow control due to coherent vortical structures existing on the leeward side of wing. In the present research, a numerical study was carried out by using two different turbulence models at Mach No. 1.6, to identify the influence of turbulence modeling and wing on overall pressure distribution and onset of flow separation. Fully structured multi-block grid was used with the grid refinement near the wall to resolve the vortical flow structures accurately. Different turbulence models used were SA (Spalart-Allmaras) and kω-SST (Shear-stress Transport). An under prediction in pressure distribution was observed by using SA Turbulence model, in comparison with known experimental data at fixed Mach No. The analysis of results presented showed that the height of primary vortex increases by increasing the angle of attack and by keeping the Mach No. as fixed. Moreover, the vortex formation on cambered wing seems less pronounced as compared with that of sharp wing at high angle of attack

Theoretical and experimental analysis of multifunctional high performance cement mortar matrices reinforced with varying lengths of carbon fibers

An effective scheme to formulate high performance and multifunctional cement based mortar composites reinforced with varying lengths of carbon fibers has been devised. The detailed investigations pertaining to the fracture response of composites in cracks initiation and progression phases, their conducting mechanism and volumetric stability were performed with varying loads of 6mm and 12mm long carbon fibers at two different w/c ratios i.e. 0.45 and 0.50. The experiments concluded that an optimum addition of carbon fibers results in substantial improvement of fracture properties alongside significant reduction in electrical resistivity and total plastic shrinkage. The field emission scanning electron microscopy of the cryofractured specimen revealed crack arresting actions of uniformly distributed carbon fibers through successful crack bridging and branching phenomenon

Photochemistry of [Ru(pytz)(btz)2]2+and Characterization of a κ1-btz Ligand-Loss Intermediate

We report the synthesis, characterisation and photochemical reactivity of the triazole-containing complex [Ru(pytz)(btz)2]2+ (1, pytz = 1-benzyl-4-(pyrid-2-yl)-1,2,3-triazole, btz = 1,1’-dibenzyl-4,4’-bi-1,2,3-triazolyl). The UV-visible absorption spectrum of 1 exhibits pytz- and btz-centred 1MLCT bands at 365 and 300 nm respectively. Upon photo-excitation, acetonitrile solutions of 1 undergo conversion to the ligand loss intermediate, trans-[Ru(pytz)(2-btz)(1-btz)(NCMe)]2+ (2, 363 = 0.013) and ultimately to the ligand loss product trans-[Ru(pytz)(btz)(NCMe)2]2+ (3), both of which are observed and characterised by 1H NMR spectroscopy. Time-dependent density functional theory calculations reveal that the S1 state of the complex has primarily HOMOLUMO pytz-based 1MLCT character. Data show that the 3MLCT and 3MC states are in close energetic proximity ( 0.11 eV to 2 d.p.) and that the T1 state from a single point triplet state calculation at the S0 geometry suggests 3MC character. Optimisation of the T1 state of the complex starting from the ground state geometry leads to elongation of the two Ru-N(btz) bonds cis to the pytz ligand to 2.539 and 2.544 Å leading to a psuedo 4-coordinate 3MC state rather than the 3MLCT state. The work therefore provides additional insights into the photophysical and photochemical properties of ruthenium triazole-containing complexes and their excited state dynamics

Detecting Clinically Meaningful Shape Clusters in Medical Image Data: Metrics Analysis for Hierarchical Clustering applied to Healthy and Pathological Aortic Arches

OBJECTIVE: Today's growing medical image databases call for novel processing tools to structure the bulk of data and extract clinically relevant information. Unsupervised hierarchical clustering may reveal clusters within anatomical shape data of patient populations as required for modern Precision Medicine strategies. Few studies have applied hierarchical clustering techniques to three-dimensional patient shape data and results depend heavily on the chosen clustering distance metrics and linkage functions. In this study, we sought to assess clustering classification performance of various distance/linkage combinations and of different types of input data to obtain clinically meaningful shape clusters. METHODS: We present a processing pipeline combining automatic segmentation, statistical shape modelling and agglomerative hierarchical clustering to automatically subdivide a set of 60 aortic arch anatomical models into healthy controls, two groups affected by congenital heart disease, and their respective subgroups as defined by clinical diagnosis. Results were compared with traditional morphometrics and principal component analysis of shape features. RESULTS: Our pipeline achieved automatic division of input shape data according to primary clinical diagnosis with high F-score (0.902/pm0.042) and Matthews Correlation Coefficient (0.851/pm0.064) using the Correlation/Weighted distance/linkage combination. Meaningful subgroups within the three patient groups were obtained and benchmark scores for automatic segmentation and classification performance are reported. CONCLUSION: Clustering results vary depending on the distance/linkage combination used to divide the data. Yet, clinically relevant shape clusters and subgroups could be found with high specificity and low misclassification rates. SIGNIFICANCE: Detecting disease-specific clusters within medical image data could improve image-based risk assessment, treatment planning and medical device development in complex disease

How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function

OBJECTIVES: Even after successful aortic coarctation repair, there remains a significant incidence of late systemic hypertension and other morbidities. Independently of residual obstruction, aortic arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch 3-dimensional shape features with functional data obtained from cardiac magnetic resonance scans. METHODS: Three-dimensional aortic arch shape models of 53 patients (mean age, 22.3 ± 5.6 years) 12 to 38 years after aortic coarctation repair were reconstructed from cardiac magnetic resonance data. A novel validated statistical shape analysis method computed a 3-dimensional mean anatomic shape of all aortic arches and calculated deformation vectors of the mean shape toward each patient's arch anatomy. From these deformations, 3-dimensional shape features most related to left ventricular ejection fraction, indexed left ventricular end-diastolic volume, indexed left ventricular mass, and resting systolic blood pressure were extracted from the deformation vectors via partial least-squares regression. RESULTS: Distinct arch shape features correlated significantly with left ventricular ejection fraction (r = 0.42, P = .024), indexed left ventricular end-diastolic volume (r = 0.65, P < .001), and indexed left ventricular mass (r = 0.44, P = .014). Lower left ventricular ejection fraction, larger indexed left ventricular end-diastolic volume, and increased indexed left ventricular mass were identified with an aortic arch shape that has an elongated ascending aorta with a high arch height-to-width ratio, a relatively short proximal transverse arch, and a relatively dilated descending aorta. High blood pressure seemed to be linked to gothic arch shape features, but this did not achieve statistical significance. CONCLUSIONS: Independently of hemodynamically important arch obstruction or residual aortic coarctation, specific aortic arch shape features late after successful aortic coarctation repair seem to be associated with worse left ventricular function. Analyzing 3-dimensional shape information via statistical shape modeling can be an adjunct to long-term risk assessment in patients after aortic coarctation repair

Social isolation and incident heart failure hospitalization in older women: Women\u27s health initiative study findings

Background The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potential mediator and age and race and ethnicity as effect modifiers. Methods and Results This study included 44 174 postmenopausal women of diverse race and ethnicity from the WHI (Women\u27s Health Initiative) study who underwent annual assessment for HF adjudication from baseline enrollment (1993-1998) through 2018. We conducted a mediation analysis to examine depressive symptoms as a potential mediator and further examined effect modification by age and race and ethnicity. Incident HF requiring hospitalization was the main outcome. Social isolation was a composite variable based on marital/partner status, religious ties, and community ties. Depressive symptoms were assessed using CES-D (Center for Epidemiology Studies-Depression). Over a median follow-up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08-1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07-1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF. Conclusions Socially isolated older women are at increased risk for developing HF, independent of traditional HF risk factors. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT00000611