Clinical Utility of Echocardiography in Former Preterm Infants with Bronchopulmonary Dysplasia.

BackgroundThe clinical utility of echocardiography for the diagnosis of pulmonary vascular disease (PVD) in former preterm infants with bronchopulmonary dysplasia (BPD) is not established. Elevated pulmonary vascular resistance (PVR) rather than pulmonary artery pressure (PAP) is the hallmark of PVD. We evaluated the utility of echocardiography in infants with BPD in diagnosing pulmonary hypertension and PVD (PVR >3 Wood units × m2) assessed by cardiac catheterization.MethodsA retrospective single center study of 29 infants born ≤29 weeks of gestational age with BPD who underwent cardiac catheterization and echocardiography was performed. PVD was considered present by echocardiography if the tricuspid valve regurgitation jet peak velocity was >2.9 m/sec, post-tricuspid valve shunt systolic flow velocity estimated a right ventricular systolic pressure >35 mm Hg, or systolic septal flattening was present. The utility (accuracy, sensitivity, and positive predictive value [PPV]) of echocardiography in the diagnosis of PVD was tested. Subgroup analysis in patients without post-tricuspid valve shunts was performed. Echocardiographic estimations of right ventricular pressure, dimensions, function, and pulmonary flow measurements were evaluated for correlation with PVR.ResultsThe duration between echocardiography and cardiac catheterization was a median of 1 day (interquartile range, 1-4 days). Accuracy, sensitivity, and PPV of echocardiography in diagnosing PVD were 72%, 90.5%, and 76%, respectively. Accuracy, sensitivity, and PPV increased to 93%, 91.7%, and 100%, respectively, when infants with post-tricuspid valve shunts were excluded. Echocardiography had poor accuracy in estimating the degree of PAP elevation by cardiac catheterization. In infants without post-tricuspid valve shunts, there was moderate to good correlation between indexed PVR and right ventricular myocardial performance index (rho = 0.89, P = .005), systolic to diastolic time index (0.84, P < .001), right to left ventricular diameter ratio at end systole (0.66, P = .003), and pulmonary artery acceleration time (0.48, P = .05).ConclusionsEchocardiography performs well in screening for PVD in infants with BPD and may be diagnostic in the absence of a post-tricuspid valve shunt. However, cardiac catheterization is needed to assess the degree of PAP elevation and PVR. The diagnostic utility of echocardiographic measurements that correlate with PVR should be evaluated prospectively in this patient population

Boundary effects on the scaling of the superfluid density

We study numerically the influence of the substrate (boundary conditions) on the finite--size scaling properties of the superfluid density $\rho_s$ in superfluid films of thickness $H$ within the XY model employing the Monte Carlo method. Our results suggest that the jump $\rho_s H/T_c$ at the Kosterlitz--Thouless transition temperature $T_c$ depends on the boundary conditions.Comment: 2 pages, 1 Latex file, 1 postscript figure, 2 style file

Possible Glassiness in a Periodic Long-Range Josephson Array

We present an analytic study of a periodic Josephson array with long-range interactions in a transverse magnetic field. We find that this system exhibits a first-order transition into a phase characterized by an extensive number of states separated by barriers that scale with the system size; the associated discontinuity is small in the limit of weak applied field, thus permitting an explicit analysis in this regime.Comment: 4 pages, 2 Postscript figures in a separate file

Critical Currents of Josephson-Coupled Wire Arrays

We calculate the current-voltage characteristics and critical current I_c^{array} of an array of Josephson-coupled superconducting wires. The array has two layers, each consisting of a set of parallel wires, arranged at right angles, such that an overdamped resistively-shunted junction forms wherever two wires cross. A uniform magnetic field equal to f flux quanta per plaquette is applied perpendicular to the layers. If f = p/q, where p and q are mutually prime integers, I_c^{array}(f) is found to have sharp peaks when q is a small integer. To an excellent approximation, it is found in a square array of n^2 plaquettes, that I_c^{array}(f) \propto (n/q)^{1/2} for sufficiently large n. This result is interpreted in terms of the commensurability between the array and the assumed q \times q unit cell of the ground state vortex lattice.Comment: 4 pages, 4 figure

Patterns of Striped order in the Classical Lattice Coulomb Gas

We obtain via Monte Carlo simulations the low temperature charge configurations in the lattice Coulomb gas on square lattices for charge filling ratio $f$ in the range $1/3 < f < 1/2$. We find a simple regularity in the low temperature charge configurations which consist of a suitable periodic combination of a few basic striped patterns characterized by the existence of partially filled diagonal channels. In general there exist two separate transitions where the lower temperature transition ($T_p$) corresponds to the freezing of charges within the partially filled channels. $T_p$ is found to be sensitively dependent on $f$ through the charge number density $\nu = p_{1}/q_{1}$ within the channels.Comment: 4 pages, 8 figure

The Effect of Columnar Disorder on the Superconducting Transition of a Type-II Superconductor in Zero Applied Magnetic Field

We investigate the effect of random columnar disorder on the superconducting phase transition of a type-II superconductor in zero applied magnetic field using numerical simulations of three dimensional XY and vortex loop models. We consider both an unscreened model, in which the bare magnetic penetration length is approximated as infinite, and a strongly screened model, in which the magnetic penetration length is of order the vortex core radius. We consider both equilibrium and dynamic critical exponents. We show that, as in the disorder free case, the equilibrium transitions of the unscreened and strongly screened models lie in the same universality class, however scaling is now anisotropic. We find for the correlation length exponent $\nu=1.2\pm 0.1$, and for the anisotropy exponent $\zeta=1.3\pm 0.1$. We find different dynamic critical exponents for the unscreened and strongly screened models.Comment: 30 pages 12 ps figure

Vortex lattce melting in 2D superconductors and Josephson arrays

Monte Carlo simulations of 2D vortex lattice melting in a thin superconducting film (or alternatively an array of Josephson junctions) are performed in the London limit. Finite size scaling analyses are used to make a detailed test of the dislocation mediated melting theory of KTNHY. We find that the melting transition is weakly first order, with a jump in the shear modulus very close to that predicted by the KTNHY theory. No hexatic liquid phase is found.Comment: 12 pages, 4 figures (available on request from [email protected]), REVTEX [we revise our conclusion on the order of the melting transition from second to first order - new figure 4 added

Heterogeneous Dynamics, Marginal Stability and Soft Modes in Hard Sphere Glasses

In a recent publication we established an analogy between the free energy of a hard sphere system and the energy of an elastic network [1]. This result enables one to study the free energy landscape of hard spheres, in particular to define normal modes. In this Letter we use these tools to analyze the activated transitions between meta-bassins, both in the aging regime deep in the glass phase and near the glass transition. We observe numerically that structural relaxation occurs mostly along a very small number of nearly-unstable extended modes. This number decays for denser packing and is significantly lowered as the system undergoes the glass transition. This observation supports that structural relaxation and marginal modes share common properties. In particular theoretical results [2, 3] show that these modes extend at least on some length scale $l^*\sim (\phi_c-\phi)^{-1/2}$ where $\phi_c$ corresponds to the maximum packing fraction, i.e. the jamming transition. This prediction is consistent with very recent numerical observations of sheared systems near the jamming threshold [4], where a similar exponent is found, and with the commonly observed growth of the rearranging regions with compression near the glass transition.Comment: 6 pages, improved versio

Positional Disorder (Random Gaussian Phase Shifts) in the Fully Frustrated Josephson Junction Array (2D XY Model)

We consider the effect of positional disorder on a Josephson junction array with an applied magnetic field of f=1/2 flux quantum per unit cell. This is equivalent to the problem of random Gaussian phase shifts in the fully frustrated 2D XY model. Using simple analytical arguments and numerical simulations, we present evidence that the ground state vortex lattice of the pure model becomes disordered, in the thermodynamic limit, by any amount of positional disorder.Comment: 4 pages, 4 eps figures embedde

Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams

AbstractBackground: Published data suggest that low birth weight is a risk factor for poor outcome in corrective surgery for many cardiac defects. Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative operations, with definitive repair delayed. The morbidity associated with such approaches is high. Methods: Since 1990 complete repair of congenital heart defects (other than patent ductus arteriosus) has been performed in 102 infants no larger than 2500 g (median 2100 g, range 700-2500 g), including 16 no larger than 1500 g. Defects included ventricular septal defect (n = 22), tetralogy of Fallot complexes (n = 20), transposition complexes (n = 13), aortic coarctation (n = 12), interrupted arch (n = 10), truncus arteriosus (n = 8), atrioventricular septal defect (n = 6), total anomalous pulmonary venous return (n = 5), and other (n = 6). Results: Preoperative morbidity was more common among patients referred late for surgical correction. There were 10 early deaths (10%) attributable to cardiac failure (n = 4), arrhythmia (n = 1), multiorgan failure (n = 1), sepsis (n = 1), idiopathic coronary artery intimal necrosis (n = 1), foot gangrene (n = 1), and pulmonary hemorrhage (n = 1). No patient had postbypass intracerebral hemorrhage. At follow-up (median 36 months) there were 8 late deaths, and 8 patients underwent 10 reinterventions. There was no evidence of neurologic sequelae attributable to the operation. Conclusions: In general, delaying repair of congenital heart defects in low birth weight infants does not confer a benefit and is associated with higher preoperative morbidity. Complete repair of both simple and complex lesions can be achieved in such cases with good results. Growth after repair approximates the normal curve for low birth weight infants without heart disease. It is recommended that such infants, especially when they have symptoms, undergo early surgical repair rather than prolonged medical management or other forms of palliation. (J Thorac Cardiovasc Surg 1999;117:324-31