316: Diuretic is safe and superior to volume expansion in normotensive patients with acute pulmonary embolism and right ventricular dilatation

BackgroundThe rational and the benefit of load expansion is controversial in acute pulmonary embolism (PE). Diuretic may reduce RV preload and improve hemodynamic status. The present study reported the safety of furosemide in normotensive acute PE with oligo-anuria.Methods and ResultsWe prospectively included 68 consecutive normotensive patients (systolic blood pressure ≥90mmHg) admitted for acute PE with oligoanuria and RV dilation. RV dilation was defined by a right and left ventricular diameter ratio >0.6. Overall, 29 patients were treated by a repeated bolus of furosemide (83±84mg, range 40 to 160mg), while 39 patients received isotonic saline solution (1.6±0.8 L, range, 0.5 to 4,0L). Patients treated by furosemide and fluid expansion had similar severity of hypoxemia but the furosemide group had lower admission blood pressure (119±21mmHg vs. 132±18mmHg, P=0.007) and greater shock index defined as heart rate and blood pressure ratio (0.81±0.23 vs. 0.69±0.18, P=0.02). Despite these differences, only the furosemide group had decrease shock index (0.81±0.23 vs. 0.62±0.17, P<0.0001) with improved systolic blood pressure (119±21mmHg vs. 133 ±18mmHg, P<0.001), heart rate (93±19bpm vs. 81±18bpm, P<0.001), and creatinin level. Finally, more patients were weaned in oxygen at 24 hours (39% vs. 19%) and in-hospital survival without death and PE-related shock was similar between the two groups (93% vs. 95%).ConclusionsIn normotensive PE with oligoanuria and RV dilatation, diuretic can be safely delivered to improve systolic blood pressure and oxygenation

Tunable Kondo effect in double quantum dots coupled to ferromagnetic contacts

We investigate the effects induced by spin polarization in the contacts attached to a serial double quantum dot. The polarization generates effective magnetic fields and suppresses the Kondo effect in each dot. The super-exchange interaction ($J_{\mathrm{AFM}}$), tuned by the inter-dot tunnelling rate $t$, can be used to compensate the effective fields and restore the Kondo resonance when the contact polarizations are aligned. As a consequence, the direction of the spin conductance can be controlled and even reversed using electrostatic gates alone. Furthermore, we study the associated two-impurity Kondo model and show that a ferromagnetic exchange coupling ($J_{\mathrm{FM}}$) leads to an effective spin-1 exchange-anisotropic Kondo model which exhibits a quantum phase transition in the presence of partially polarized contacts.Comment: 5 pages, 4 figure

Transport properties of a molecule embedded in an Aharonov-Bohm interferometer

We theoretically investigate the transport properties of a molecule embedded in one arm of a mesoscopic Aharonov-Bohm interferometer. Due to the presence of phonons the molecule level position ($\epsilon_d$) and the electron-electron interaction ($U$) undergo a \emph{polaronic shift} which affects dramatically the electronic transport through the molecular junction. When the electron-phonon interaction is weak the linear conductance presents Fano-line shapes as long as the direct channel between the electrodes is opened. The observed Fano resonances in the linear conductance are originated from the interference between the spin Kondo state and the direct path. For strong enough electron-phonon interaction, the electron-electron interaction is renormalized towards negative values, {\it i.e.} becomes effectively attractive. This scenario favors fluctuations between the empty and doubly occupied charge states and therefore promotes a charge Kondo effect. However, the direct path between the contacts breaks the electron-hole symmetry which can efficiently suppress this charge Kondo effect. Nevertheless, we show that a proper tuning of the gate voltage is able to revive the Kondo resonance. Our results are obtained by using the Numerical Renormalization approximation to compute the electronic spectral function and the linear conductance.Comment: 17 pages, 12 figure

120 Superiority of CT scan over transthoracic echocardiography in predicting aortic regurgitation after TAVI

BackgroundParavalvular aortic regurgitation (AR) occurs in up to 86% of patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Its prevalence remains unchanged after one year follow-up but its determinants are unclear. We sought to evaluate the impact of annulus measurement by transthoracic echocardiography (TTE) and by CT scan on the occurrence of AR.MethodsThe study included 43 symptomatic patients (83±8 years, 72% in NYHA≥III) with severe aortic stenosis [0.76±0.19cm2, mean gradient 42±14mmHg] who underwent TAVI using CoreValve® LLC Percutaneous Aortic Valve Implantation System, Medtronic, Minneapolis USA. Left ventricular outflow tract (LVOT) area was computed from LVOT diameter (21±2mm) by TTE using a spherical model and from CT using an ellipsoidal model according to the larger (25±3mm) and the smaller outflow tract diameters (22±3mm). These data were compared to the prosthesis area and the occurrence of AR after TAVI.ResultsIn patients with AR greater or equal to 2/4 (32%), LVOT area measured by CT was significantly greater as compared to patients with no or mild AR (478±65mm 2 vs. 411±85mm2, p=0.009). Furthermore, the difference between actual prosthesis area and LVOT area measured by CT scan was significantly smaller (113±55 vs. 171±67, p=0.009) in patients with significant AR (≥2/4) after TAVI. In contrast, LVOT area from TTE did not correlate with AR severity.ConclusionCT scan is more accurate than TTE for calculating LVOT area for prosthesis sizing before TAVI in order to avoid post-implantation AR

Triplicity and Physical Characteristics of Asteroid (216) Kleopatra

To take full advantage of the September 2008 opposition passage of the M-type asteroid (216) Kleopatra, we have used near-infrared adaptive optics (AO) imaging with the W.M. Keck II telescope to capture unprecedented high resolution images of this unusual asteroid. Our AO observations with the W.M. Keck II telescope, combined with Spitzer/IRS spectroscopic observations and past stellar occultations, confirm the value of its IRAS radiometric radius of 67.5 km as well as its dog-bone shape suggested by earlier radar observations. Our Keck AO observations revealed the presence of two small satellites in orbit about Kleopatra (see Marchis et al., 2008). Accurate measurements of the satellite orbits over a full month enabled us to determine the total mass of the system to be 4.64+/-0.02 10^18 Kg. This translates into a bulk density of 3.6 +/-0.4 g/cm3, which implies a macroscopic porosity for Kleopatra of ~ 30-50%, typical of a rubble-pile asteroid. From these physical characteristics we measured its specific angular momentum, very close to that of a spinning equilibrium dumbbell.Comment: 35 pages, 3 Tables, 9 Figures. In press to Icaru