Influence of coronary artery bypass grafting on ventricular late potentials as a predictive factor for ventricular arrhythmias during short- and long-term follow-up

Ventricular late potentials have been identified as a prognostic factor in the prediction of ventricular arrhythmias in patients after myocardial infarction. In this prospective study the possible impact of late potentials on the prediction of ventricular arrhythmias in the short- and long-term follow-up after coronary artery bypass grafting was evaluated. In 188 patients (165 men, 23 women, age 57 ±8 years) with chronic coronary heart disease 48 (26%) had late potentials before bypass grafting; after the procedure this was reduced to 39 (21%) (ns). In 16 (33%) of the 48 patients with late potentials before bypass grafting, late potentials were no longer present in the short-term follow-up (9 ±6 days). Conversely, seven (5%) of the 140 patients without late potentials before bypass grafting had late potentials in the short-term follow-up after grafting. Nine (19%) of the 48 patients with late potentials before bypass grafting had ventricular arrhythmias in the peri-operative phase, which had to be treated with antiarrhythmic agents. In contrast, only three (2%>) of the 140 patients without late potentials before bypass grafting had to be treated for ventricular arrhythmias (P<0.001). In the long-term follow-up of 29 ± 3 months, there were no events in the group of 149 patients without late potentials after grafting. In the 39 patients with late potentials after grafting, there were two (5%) events (two patients with arrhythmic syncope). Conclusions (1) Patients with late potentials before bypass grafting have a markedly higher risk of developing serious ventricular arrhythmias in the peri-operative period than patients without late potentials. (2) Patients without late potentials have a very low risk of developing serious ventricular arrhythmias in the peri-operative period. (3) During long-term follow-up there was only a low probability of developing symptomatic ventricular arrhythmias in patients with or without late potential

Subduction Duration and Slab Dip

The dip angles of slabs are among the clearest characteristics of subduction zones, but the factors that control them remain obscure. Here, slab dip angles and subduction parameters, including subduction duration, the nature of the overriding plate, slab age, and convergence rate, are determined for 153 transects along subduction zones for the present day. We present a comprehensive tabulation of subduction duration based on isotopic ages of arc initiation and stratigraphic, structural, plate tectonic and seismic indicators of subduction initiation. We present two ages for subduction zones, a long‐term age and a reinitiation age. Using cross correlation and multivariate regression, we find that (1) subduction duration is the primary parameter controlling slab dips with slabs tending to have shallower dips at subduction zones that have been in existence longer; (2) the long‐term age of subduction duration better explains variation of shallow dip than reinitiation age; (3) overriding plate nature could influence shallow dip angle, where slabs below continents tend to have shallower dips; (4) slab age contributes to slab dip, with younger slabs having steeper shallow dips; and (5) the relations between slab dip and subduction parameters are depth dependent, where the ability of subduction duration and overriding plate nature to explain observed variation decreases with depth. The analysis emphasizes the importance of subduction history and the long‐term regional state of a subduction zone in determining slab dip and is consistent with mechanical models of subduction

Monitoring the wild black bear's reaction to human and environmental stressors

<p>Abstract</p> <p>Background</p> <p>Bears are among the most physiologically remarkable mammals. They spend half their life in an active state and the other half in a state of dormancy without food or water, and without urinating, defecating, or physical activity, yet can rouse and defend themselves when disturbed. Although important data have been obtained in both captive and wild bears, long-term physiological monitoring of bears has not been possible until the recent advancement of implantable devices.</p> <p>Results</p> <p>Insertable cardiac monitors that were developed for use in human heart patients (Reveal® XT, Medtronic, Inc) were implanted in 15 hibernating bears. Data were recovered from 8, including 2 that were legally shot by hunters. Devices recorded low heart rates (pauses of over 14 seconds) and low respiration rates (1.5 breaths/min) during hibernation, dramatic respiratory sinus arrhythmias in the fall and winter months, and elevated heart rates in summer (up to 214 beats/min (bpm)) and during interactions with hunters (exceeding 250 bpm). The devices documented the first and last day of denning, a period of quiescence in two parturient females after birthing, and extraordinary variation in the amount of activity/day, ranging from 0 (winter) to 1084 minutes (summer). Data showed a transition toward greater nocturnal activity in the fall, preceding hibernation. The data-loggers also provided evidence of the physiological and behavioral responses of bears to our den visits to retrieve the data.</p> <p>Conclusions</p> <p>Annual variations in heart rate and activity have been documented for the first time in wild black bears. This technique has broad applications to wildlife management and physiological research, enabling the impact of environmental stressors from humans, changing seasons, climate change, social interactions and predation to be directly monitored over multiple years.</p

Mitral leaflet anatomy revisited

ObjectiveThe aims of this work were to employ functional imaging capabilities of the Visible Heart laboratory and endoscopic visualization of mitral valves in perfusion-fixed specimens to better characterize variability in mitral valve leaflet anatomy and to provide a method to classify mitral leaflets that varies from the current nomenclature.MethodsWe gathered functional endoscopic video footage (11 isolated reanimated human hearts) and static endoscopic anatomical images (38 perfusion-fixed specimens) of mitral leaflets. Commissure and cleft locations were charted using Carpentier's accepted description.ResultsAll hearts had 2 commissures separating anterior and posterior leaflets. “Standard” clefts separating P1/P2 were found in 66% of hearts (n = 25), and standard clefts separating P2/P3 were present in 71% of hearts (n = 27). “Deviant” clefts occurred in each region of the anterior leaflet (A1, A2, A3), and their relative occurrences were 5%, 8%, and 13% (n = 2, 3, 5), respectively. Deviant clefts were found in posterior leaflets: 13.2% in P1 (n = 5), 32% in P2 (n = 12), and 21% in P3 (n = 8).ConclusionsHumans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3)

Asymmetric shallow mantle structure beneath the Hawaiian Swell—evidence from Rayleigh waves recorded by the PLUME network

Author Posting. © The Author(s), 2011. This article is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Geophysical Journal International 187 (2011): 1725–1742, doi:10.1111/j.1365-246X.2011.05238.x.We present models of the 3-D shear velocity structure of the lithosphere and asthenosphere beneath the Hawaiian hotspot and surrounding region. The models are derived from long-period Rayleigh-wave phase velocities that were obtained from the analysis of seismic recordings collected during two year-long deployments for the Hawaiian Plume-Lithosphere Undersea Mantle Experiment. For this experiment, broad-band seismic sensors were deployed at nearly 70 seafloor sites as well as 10 sites on the Hawaiian Islands. Our seismic images result from a two-step inversion of path-averaged dispersion curves using the two-station method. The images reveal an asymmetry in shear velocity structure with respect to the island chain, most notably in the lower lithosphere at depths of 60 km and greater, and in the asthenosphere. An elongated, 100-km-wide and 300-km-long low-velocity anomaly reaches to depths of at least 140 km. At depths of 60 km and shallower, the lowest velocities are found near the northern end of the island of Hawaii. No major velocity anomalies are found to the south or southeast of Hawaii, at any depth. The low-velocity anomaly in the asthenosphere is consistent with an excess temperature of 200–250 °C and partial melt at the level of a few percent by volume, if we assume that compositional variations as a result of melt extraction play a minor role. We also image small-scale low-velocity anomalies within the lithosphere that may be associated with the volcanic fields surrounding the Hawaiian Islands.This research was financed by the National Science Foundation under grants OCE-00-02470 and OCE-00-02819. Markee was partly sponsored by a SIO graduate student fellowship

Near Infrared Investigation of Polypropylene-Clay Nanocomposites for Further Quality Control Purposes-Opportunities and Limitations

YesPolymer nanocomposites are usually characterized using various methods, such as small angle X-ray diffraction (XRD) or transmission electron microscopy, to gain insights into the morphology of the material. The disadvantages of these common characterization methods are that they are expensive and time consuming in terms of sample preparation and testing. In this work, near infrared spectroscopy (NIR) spectroscopy is used to characterize nanocomposites produced using a unique twin-screw mini-mixer, which is able to replicate, at ~25 g scale, the same mixing quality as in larger scale twin screw extruders. We correlated the results of X-ray diffraction, transmission electron microscopy, G′ and G″ from rotational rheology, Young’s modulus, and tensile strength with those of NIR spectroscopy. Our work has demonstrated that NIR-technology is suitable for quantitative characterization of such properties. Furthermore, the results are very promising regarding the fact that the NIR probe can be installed in a nanocomposite-processing twin screw extruder to measure inline and in real time, and could be used to help optimize the compounding process for increased quality, consistency, and enhanced product propertie

Valve replacement in octogenarians: increased early mortality but good long-term result

Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 ± 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective, two urgent, and three emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. Six patients (30%) had an uneventful hospital stay, and the other 14 (70%) experienced several post-operative complications. The operative mortality rate was 15± (three patients). All patients before operation were in NYHA (New York Heart Association) class III and IV and all survivors remained in NYHA class I or II. The survivors have been followed from 6 to 70 months (mean 20 ± 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement in octogenarians can be performed, despite the high rate of post-operative complications, with increased but acceptable mortality. Long-term results are goo

Finite-frequency effects in global surface-wave tomography

We compare traditional ray-theoretical surface-wave tomography with finite-frequency tomography, using 3-D Born sensitivity kernels for long-period, fundamental-mode dispersion measurements. The 3-D kernels preserve sidelobes beyond the first Fresnel zone, and fully account for the directional dependence of surface-wave scattering, and the effects of time-domain tapering and seismic source radiation. Tomographic inversions of Love and Rayleigh phase-delay measurements and synthetic checkerboard tests show that (1) small-scale S-wave velocity anomalies are better resolved using finite-frequency sensitivity kernels, especially in the lowermost upper mantle; (2) the resulting upper-mantle heterogeneities are generally stronger in amplitude than those recovered using ray theory and (3) finite-frequency tomographic models fit long-period dispersion data better than ray-theoretical models of comparable roughness. We also examine the reliability of 2-D, phase-velocity sensitivity kernels in global surface-wave tomography, and show that phase-velocity kernels based upon a forward-scattering approximation or previously adopted geometrical simplifications do not reliably account for finite-frequency wave-propagation effects. 3-D sensitivity kernels with full consideration of directional-dependent seismic scattering are the preferred method of inverting long-period dispersion data. Finally, we derive 2-D boundary sensitivity kernels for lateral variations in crustal thickness, and show that finite-frequency crustal effects are not negligible in long-period surface-wave dispersion studies, especially for paths along continent-ocean boundaries. Unfortunately, we also show that, in global studies, linear perturbation theory is not sufficiently accurate to make reliable crustal corrections, due to the large difference in thickness between oceanic and continental crust