Pulmonary hypertension caused by pulmonary venous hypertension

Abstract The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility

Nanoscale spatially resolved infrared spectra from single microdroplets

Droplet microfluidics has emerged as a powerful platform allowing a large number of individual reactions to be carried out in spatially distinct microcompartments. Due to their small size, however, the spectroscopic characterisation of species encapsulated in such systems remains challenging. In this paper, we demonstrate the acquisition of infrared spectra from single microdroplets containing aggregation-prone proteins. To this effect, droplets are generated in a microfluidic flow-focussing device and subsequently deposited in a square array onto a ZnSe prism using a micro stamp. After drying, the solutes present in the droplets are illuminated locally by an infrared laser through the prism, and their thermal expansion upon absorption of infrared radiation is measured with an atomic force microscopy tip, granting nanoscale resolution. Using this approach, we resolve structural differences in the amide bands of the spectra of monomeric and aggregated lysozyme from single microdroplets with picolitre volume.Comment: 5 pages, 3 Figure

Nucleation and Growth of the Superconducting Phase in the Presence of a Current

We study the localized stationary solutions of the one-dimensional time-dependent Ginzburg-Landau equations in the presence of a current. These threshold perturbations separate undercritical perturbations which return to the normal phase from overcritical perturbations which lead to the superconducting phase. Careful numerical work in the small-current limit shows that the amplitude of these solutions is exponentially small in the current; we provide an approximate analysis which captures this behavior. As the current is increased toward the stall current J*, the width of these solutions diverges resulting in widely separated normal-superconducting interfaces. We map out numerically the dependence of J* on u (a parameter characterizing the material) and use asymptotic analysis to derive the behaviors for large u (J* ~ u^-1/4) and small u (J -> J_c, the critical deparing current), which agree with the numerical work in these regimes. For currents other than J* the interface moves, and in this case we study the interface velocity as a function of u and J. We find that the velocities are bounded both as J -> 0 and as J -> J_c, contrary to previous claims.Comment: 13 pages, 10 figures, Revte

Gifted and talented education: The English policy highway at a crossroads?

Copyright © 2013 by Sage Publications. This is the author's accepted manuscript. The final published article is available from the link below.In 1999, the British government launched an education program for gifted and talented pupils as part of its Excellence in Cities initiative (EiC) that was initially designed to raise the educational achievement of very able pupils in state-maintained secondary schools in inner-city areas. Although some activities targeting gifted children had already been initiated by various voluntary organizations over several previous decades, this was the first time that the topic of improved provision for these pupils had been placed firmly within the national agenda. This article provides the background to the English gifted and talented policy “highway” and an overview of what was expected of schools. How practitioners responded to the policy, their beliefs and attitudes toward identifying gifted and talented pupils, and the opportunities and challenges that arose along the way to the current crossroads are explored. The need to empower teachers to feel more confident in classroom provisions for gifted and talented pupils is identified along with the potentially pivotal role of action research and “pupil voice” in the process of continued professional development and support

Pressure-Regulated Volume Control vs Volume Control Ventilation in Infants After Surgery for Congenital Heart Disease

The objective of this investigation was to compare how two modes of positive pressure ventilation affect cardiac output, airway pressures, oxygenation, and carbon dioxide removal in children with congenital heart disease in the immediate postoperative period. The investigation used a one group pretest–post-test study design and was performed in the pediatric cardiac intensive care unit in a university-affiliated children's hospital. Nine infants were enrolled immediately after repair of tetralogy of Fallot (2) or atrioventricular septal defects (7) with mean weight = 5.5 kg (4.2–7.3 kg). Children were admitted to the pediatric cardiothoracic intensive care unit after complete surgical repair of their cardiac defect and stabilized on a Siemen's Servo 300 ventilator in volume control mode (VCV1) (volume-targeted ventilation with a square flow wave pattern). Tidal volume was set at 15 cc/kg (total). Hemodynamic parameters, airway pressures and ventilator settings, and an arterial blood gas were measured. Patients were then changed to pressure-regulated volume control mode (PRVC) (volume-targeted ventilation with decelerating flow wave pattern) with the tidal volume set as before. Measurements were repeated after 30 minutes. Patients were then returned to volume control mode (VCV2) and final measurements made after 30 minutes. The measurements and results are as follows:Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42385/1/246-22-3-233_10220233.pd

Pulmonary-to-Systemic Arterial Shunt to Treat Children With Severe Pulmonary Hypertension

BACKGROUND: The placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease. OBJECTIVES: The aim of this study was to expand upon these earlier findings using an international registry for children with PH who have undergone a shunt procedure. METHODS: Retrospective data were obtained from 110 children with PH who underwent a shunt procedure collected from 13 institutions in Europe and the United States. RESULTS: Seventeen children died in-hospital postprocedure (15%). Of the 93 children successfully discharged home, 18 subsequently died or underwent lung transplantation (20%); the mean follow-up was 3.1 years (range: 25 days to 17 years). The overall 1- and 5-year freedom from death or transplant rates were 77% and 58%, respectively, and 92% and 68% for those discharged home, respectively. Children discharged home had significantly improved World Health Organization functional class (P < 0.001), 6-minute walk distances (P = 0.047) and lower brain natriuretic peptide levels (P < 0.001). Postprocedure, 59% of children were weaned completely from their prostacyclin infusion (P < 0.001). Preprocedural risk factors for dying in-hospital postprocedure included intensive care unit admission (hazard ratio [HR]: 3.2; P = 0.02), mechanical ventilation (HR: 8.3; P < 0.001) and extracorporeal membrane oxygenation (HR: 10.7; P < 0.001). CONCLUSIONS: A pulmonary-to-systemic arterial shunt can provide a child with severe PH significant clinical improvement that is both durable and potentially free from continuous prostacyclin infusion. Five-year survival is comparable to children undergoing lung transplantation for PH. Children with severely decompensated disease requiring aggressive intensive care are not good candidates for the shunt procedure

A Population Pharmacokinetic Analysis of Milrinone in Pediatric Patients After Cardiac Surgery

The purpose of this study was to ascertain the optimal pharmacokinetic model for milrinone in pediatric patients after cardiac surgery when milrinone was administered as a slow loading dose followed by a constant-rate infusion. The data used for pharmacokinetic analysis were collected in a prospective, randomized, placebo-controlled multi-center trial of milrinone as prophylaxis for the development of low cardiac output syndrome after surgery for repair of complex congenital cardiac defects. Two blood samples were randomly collected from each patient for determination of plasma milrinone concentrations with subsequent population pharmacokinetic modeling. The pharmacokinetics of milrinone in pediatric patients under 6year's age were best described by a weight-normalized one compartment model after a slow loading dose followed by a constant-rate infusion. The volume of distribution was 482mlkg −1 , and was independent of age. Clearance was a linear function of age given by Cl=2.42mlkg −1 min −1 [1+0.0396*age].Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45063/1/10928_2004_Article_485925.pd

Thermodynamic modelling of alkali-activated slag cements

This paper presents a thermodynamic modelling analysis of alkali-activated slag-based cements, which are high performance and potentially low-CO2 binders relative to Portland cement. The thermodynamic database used here contains a calcium (alkali) aluminosilicate hydrate ideal solid solution model (CNASH_ss), alkali carbonate and zeolite phases, and an ideal solid solution model for a hydrotalcite-like Mg-Al layered double hydroxide phase. Simulated phase diagrams for NaOH- and Na2SiO3-activated slag-based cements demonstrate the high stability of zeolites and other solid phases in these materials. Thermodynamic modelling provides a good description of the chemical compositions and types of phases formed in Na2SiO3-activated slag cements over the most relevant bulk chemical composition range for these cements, and the simulated volumetric properties of the cement paste are consistent with previously measured and estimated values. Experimentally determined and simulated solid phase assemblages for Na2CO3-activated slag cements were also found to be in good agreement. These results can be used to design the chemistry of alkali-activated slag-based cements, to further promote the uptake of this technology and valorisation of metallurgical slags

Search for Squarks and Gluinos in Events Containing Jets and a Large Imbalance in Transverse Energy

Using data corresponding to an integrated luminosity of 79 pb-1, D0 has searched for events containing multiple jets and large missing transverse energy in pbar-p collisions at sqrt(s)=1.8 TeV at the Fermilab Tevatron collider. Observing no significant excess beyond what is expected from the standard model, we set limits on the masses of squarks and gluinos and on the model parameters m_0 and m_1/2, in the framework of the minimal low-energy supergravity models of supersymmetry. For tan(beta) = 2 and A_0 = 0, with mu < 0, we exclude all models with m_squark < 250 GeV/c^2. For models with equal squark and gluino masses, we exclude m < 260 GeV/c^2.Comment: 10 pages, 3 figures, Submitted to PRL, Fixed typo on page bottom of p. 6 (QCD multijet background is 35.4 events