A Study on Post Myocardial Infarction Ventricular Septal Rupture

INTRODUCTION: Post infarction ventricular septal is a perforation of the muscular ventricular septum occurring in an area of acutely infarcted myocardium. Rupture of the ventricular septum following myocardiam infarction is a relatively infrequent condition, which results in variable amounts of left-to-right shunting at the ventricular level and causes heart failure. The Clinical presentation ranges from an asymptomatic murmur to cardiogenic shock. the first step in the evolution of surgical techniques to repair an acute Post infarction ventricular septal rupture involved differentiating the surgical treatment of these acquired lesions from the surgical approaches used to repair congenital ventricular septal defects, which are, for the most part, not applicable. Next, understanding the significance of differing anatomic locations of Post infarction ventricular septal defects led to innovations in terms of the location of the cardiotomy and the type of repair necessary to achieve a successful result in any given patient. Then, the gradual appreciation of different clinical courses pursued by patients after Post infarction ventricular septal rupture, both in terms of location of the defect and the degree of right ventricular functional impairment, led to an increased urgency relative to the timing of surgical repair. More recently, improved results have been reported using the technique of endocardial patching with infarct exclusion, which may signify progress in the evolution of the surgical management of Post infarction ventricular septal defects. The incorporation of specific anatomic concepts of surgical repair and a better understanding of the physiologic basis of the disease has led to an integrated approach to the patient that has improved salvage of patients suffering this catastrophic complication of acute myocardial infarction. AIMS AND OBJECTIVES: To study incidence and demographics of Post infarction ventricular septal rupture. * To study of Coronary Artery Disease in Post Myocardial Infarction Ventricular Septal Rupture. * To analyse morphology of Post Myocardial Infarction Ventricular Septal Rupture. To discuss current surgical principles of Ventricular Septal Rupture closure. To analyse factors influencing outcome after surgical treatment. MATERIAL AND METHODS; Between June 2002 to April 2007, 4247 patients with Acute Myocardial Infarction were treated at Caronary Care Unit at Government General Hospital, Chennai. 33 patients developed Post Myocardial Infarction Ventricular Septal Rupture, 19 patients died during initial medical stabilization, 14 patients who survived and underwent surgical treatment were taken up for analytical study. Incidence, Demographics, Risk factors, Clinical Presentation, Angiographic patterns, Ventricular Septal Defect Morphology, Surgical Techniques, and Outcome were analysed. CONCLUSION: VSR complicates 0.8% of acute myocardial infarction. Its is more common in males between 50 to 60 years age, Hypertensive and Smoker, Experiencing First Heart Attack. Most have anterior wall infarction with single vessel disease and completely occluded coronary artri and poor colletrals. VSD is more common in anterior location, single, simple type and moderate size. Preoperative condition, smoking history, posterior location of VSR, early surgery within 3 weeks, associated multi vessels CAD, are associated with increased postoperative mortality. Delayed surgery after 3 weeks of medical stabilization increases success rate. Concomitant CABG and aneurysm repair improved postoperative outcome

Identification of genes controlling the action of 9-lox oxylipins in plant defense

Tesis doctoral inédita. Universidad Autónoma de Madrid, Facultad de Ciencias, Departamento de Biología Molecular. Fecha de lectura: 23-10-201

Polyurethane aqueous systems

This article does not have an abstract

Adaptive Super-Candidate Based Approach for Detection and Classification of Drusen on Retinal Fundus Images

Identification and characterization of drusen is essential for the severity assessment of age-related macular degeneration (AMD). Presented here is a novel super-candidate based approach, combined with robust preprocessing and adaptive thresholding for detection of drusen, resulting in accurate segmentation with the mean lesion-level overlap of 0.75, even in cases with non-uniform illumination, poor contrast and con- founding anatomical structures. We also present a feature based lesion- level discrimination analysis between hard and soft drusen. Our method gives sensitivity of 80% for high specificity above 90% and high sensitivity of 95% for specificity of 70% on representative pathological databases (STARE and ARIA) for both detection and discrimination

Secure Ad Hoc Routing Protocols With Detection, Identification And Self-Healing Capabilities

Devices taking part in mobile ad hoc networks (MANET) co-operate with each other to route packets by strictly adhering to the ad hoc routing protocol in use. Malicious nodes taking part in co-operative routing can launch a wide variety of attacks to reduce the utility of MANETs. The aim of secure routing protocols is to ensure that MANETs can continue to function even in the face of malicious nodes. Secure routing protocols should have measures to dissuade attackers by detecting inconsistencies, identifying the perpetrator responsible for the inconsistency, and provide means to inhibit the role of misbehaving nodes. Most existing secure routing protocols try to achieve only first step, viz., detection of inconsistencies. This dissertation research investigates and proposes efficient strategies that substantially enhance the scope of assurances provided by secure MANET routing protocols while keeping the overhead low

Evaluation of smoking-specific and generic quality of life measures in current and former smokers in Germany and the United States

BACKGROUND: Health-related quality of life (QOL) surveys include generic measures that enable comparisons across conditions and measures that focus more specifically on one disease or condition. We evaluated the psychometric properties of German- and English-language versions of survey scales representing both types of measures in samples of current and former smokers. METHODS: TQOLITv1 integrates new measures of smoking-specific symptoms and QOL impact attributed to smoking with generic SF-36 Health Survey measures. For purposes of evaluation, cross-sectional data were analyzed for two independent samples. Disease-free (otherwise healthy) adults ages 23-55 used a tablet to complete surveys in a clinical trial in Germany (125 current and 54 former smokers). Online general population surveys were completed in the US by otherwise healthy current and former smokers (N = 149 and 110, respectively). Evaluations included psychometric tests of assumptions underlying scale construction and scoring, score distributions, and reliability. Tests of validity included cross-sectional correlations and analyses of variance based on a conceptual framework and hypotheses for groups differing in self-reported smoking behavior (current versus former smoker, cigarettes per day (CPD)) and severity of smoking symptoms in both samples and, in the German trial only, clinical parameters of biomarkers of exposure. RESULTS: Tests of scaling assumptions and internal consistency reliability (alpha = 0.71-0.79) of the smoking-specific measures were satisfactory, although ceiling effects attenuated correlations for former smokers in both samples. Correlational evidence supporting validity of smoking-specific symptom and impact measures included their substantial inter-correlation and higher correlations (than generic measures) with smoking behavior (favoring former over current groups) and CPD in both samples. In the German trial, both smoking-specific measures correlated significantly (p \u3c 0.05) with all four biomarkers. QOL impact attributed to smoking correlated with the SF-36 mental but not physical summary measures in both samples. CONCLUSIONS: German- and English-language TQOLITv1 surveys have comparable and satisfactory psychometric properties. Cross-sectional tests, including correlations with four biomarkers, support the validity of the new smoking-specific measures for use in studies of otherwise healthy smokers. Smoking-specific measures consistently performed better than generic QOL measures in all tests of validity

Towards Accelerated Transient Solvers for Full System Power Integrity Verification

This paper proposes a novel framework for power integrity verification of multicore systems, including voltage stabilization provided by multiple integrated voltage regulators at the core interfaces. The proposed framework adopts a two-stage macromodeling strategy to derive a compact representation of the full system dynamics as observed from each core. These dynamics are parameterized by the time-varying duty cycle provided by dedicated feedback controllers to each voltage regulator, here implemented through an averaged model. We show that the proposed simulation framework has the potential to outperform direct transient analysis based on SPICE engines

Pregnancy and Congenital Heart Disease: Moving Beyond the Current Risk Stratification Tools

Women with congenital heart disease have increased risks of complications during pregnancy. Several risk scoring tools have been developed to quantify the likelihood of adverse cardiac outcomes during pregnancy. This article describes how comprehensive pre-pregnancy or early pregnancy counseling needs to go well beyond these risk scores. Non-cardiac risk factors and adverse obstetric and fetal outcomes are vital components of the dialogue between the multidisciplinary team and the patient embarking on, or contemplating, pregnancy

A Structured Krylov Subspace Projection Framework for Fast Power Integrity Verification

This paper presents a model order reduction approach, specifically designed for the generation of compact and efficient transient simulation models of system-level power distribution networks (PDN) of multicore processor systems. The proposed approach applies a Krylov subspace projection, with a structure that is adapted to a block-coupled state-space description of individual PDN subsystems. The latter include board-package, averaged models of integrated voltage regulators switching circuitry, and individual models of all cores including regulator inductors and capacitors. Numerical results from pro-posed reduced-order models provide major speedup with respect to SPICE with negligible loss of accuracy