Berry's conjecture and information theory

It is shown that, by applying a principle of information theory, one obtains Berry's conjecture regarding the high-lying quantal energy eigenstates of classically chaotic systems.Comment: 8 pages, no figure

Open repair of type Ia endoleak in the aortic arch: three tailored approaches

Endoleaks are an important complication following hybrid thoracic endovascular aortic repair (TEVAR) with an incidence ranging from 20% to 25%. There are five different types of endoleaks, which are classified based on the source of vessels that cause the inflow into the aneurysm sac. Type I endoleaks (EL-I) occur at either the proximal (Ia) or distal (Ib) attachment sites and can be seen during insertion of the initial stent graft or during a follow-up surveillance imaging exam. EL-I may be secondary to incomplete dilatation or inaccurate sizing of the stent graft, diseased aortic wall or aortic tortuosity with angulations, leading to higher chances of rupture. However, EL-I represent a technical failure of endovascular repair that should be corrected promptly. However, endovascular EL-I repair at the level of aortic arch is not always possible due to an improper landing zone in the ascending aorta making it technically challenging. In the present paper, we describe three cases of EL-Ia following TEVAR and we address different repair techniques. Written informed consents were obtained from the patients for publication of the article and any accompanying images

Aorto-atrial fistula formation and closure: a systematic review

Blood flow between the aorta and atrium is a rare but complex pathological condition, also known as aorto-atrial fistula (AAF). The exact incidence of this condition is unknown, as are the major precipitating factors and best treatment options. We carried out a systematic review of the available case report literature reporting AAF. We systematically reviewed literature on AAF formation and closure. Separate Medline (PubMed), EMBASE, and Cochrane database queries were performed. The following MESH headings were used: atrium, ventricle, fistula, cardiac, shunts, aortic, aorto-atrial tunnels and coronary cameral fistula. All papers were considered for analysis irrespective of their quality, or the journal in which they were published. Fistula formation from the ascending aorta to the atria occurred more often in the right atrium compared to the left. Endocarditis was the major cause of AAF formation, whilst congenital causes were responsible for nearly 12%. In a number of cases fistula formation occurred secondary to cardiac surgery, whilst chest traumas were a relatively rare cause of AAF. Correction via an open surgical approach occurred in 73.5% of cases, whilst percutaneous intervention was utilised in 10% of patients. In 74.3% of all studied cases the fistula repair was successful and patients survived the procedures. In 14.7% of the cases patients did not survive. Similar outcomes were observed between percutaneous and surgical interventions. Data from larger populations with AAF is lacking, meaning that specific data regarding incidence and prevalence does currently not exist

Age-related variations in corneal biomechanical properties

Purpose To determine age-related changes in corneal viscoelastic properties in healthy individuals. Methods This observational cross-sectional study was performed at the Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz, Iran and included 302 healthy individuals in 6 age decades (range: 10�69 years). After complete ocular examination, corneal viscoelastic properties were measured by ocular response analyzer and central corneal thickness (CCT) by an ultrasonic pachymeter. Our main outcome measures were corneal viscoelastic properties in different age groups. Results Corneal hysteresis (CH) and corneal resistance factor (CRF) showed a significant negative correlation with age (P < 0.001 for both, r = �0.353 and r = �0.246, respectively). Female gender had significantly higher CH (P = 0.017) and CRF (P = 0.019). CH and CRF were significantly correlated (P < 0.001, r = 0.821). CCT showed a biphasic pattern with significantly higher thicknesses before 20 and after 50 years of age. CH and CRF were significantly correlated with CCT (P < 0.001 for both, r = 0.21 and r = 0.26, respectively) and intraocular pressure (IOP) (P < 0.001 for both, r = �0.474 and r = 0.598, respectively). Corneal-compensated IOP (IOPcc) was significantly higher after age 40 compared to age group <20 (p < 0.045). Goldmann-correlated IOP (IOPg) was significantly correlated with CCT (P = 0.001, r = 0.193), while IOPcc showed no correlation with CCT (P = 0.265, r = 0.062). CH was significantly higher in hyperopic eyes compared to emmetropic eyes (P = 0.009) and myopic eye (P < 0.001). Conclusions In this study, there was a decrease in CH and CRF with an increase in age. Hyperopia and female gender are associated with higher CH and CRF. CCT is higher toward the extremes of life and is significantly correlated with CH and CRF. © 2016 Iranian Society of Ophthalmolog

Age-related variations in corneal biomechanical properties

Purpose To determine age-related changes in corneal viscoelastic properties in healthy individuals. Methods This observational cross-sectional study was performed at the Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz, Iran and included 302 healthy individuals in 6 age decades (range: 10�69 years). After complete ocular examination, corneal viscoelastic properties were measured by ocular response analyzer and central corneal thickness (CCT) by an ultrasonic pachymeter. Our main outcome measures were corneal viscoelastic properties in different age groups. Results Corneal hysteresis (CH) and corneal resistance factor (CRF) showed a significant negative correlation with age (P < 0.001 for both, r = �0.353 and r = �0.246, respectively). Female gender had significantly higher CH (P = 0.017) and CRF (P = 0.019). CH and CRF were significantly correlated (P < 0.001, r = 0.821). CCT showed a biphasic pattern with significantly higher thicknesses before 20 and after 50 years of age. CH and CRF were significantly correlated with CCT (P < 0.001 for both, r = 0.21 and r = 0.26, respectively) and intraocular pressure (IOP) (P < 0.001 for both, r = �0.474 and r = 0.598, respectively). Corneal-compensated IOP (IOPcc) was significantly higher after age 40 compared to age group <20 (p < 0.045). Goldmann-correlated IOP (IOPg) was significantly correlated with CCT (P = 0.001, r = 0.193), while IOPcc showed no correlation with CCT (P = 0.265, r = 0.062). CH was significantly higher in hyperopic eyes compared to emmetropic eyes (P = 0.009) and myopic eye (P < 0.001). Conclusions In this study, there was a decrease in CH and CRF with an increase in age. Hyperopia and female gender are associated with higher CH and CRF. CCT is higher toward the extremes of life and is significantly correlated with CH and CRF. © 2016 Iranian Society of Ophthalmolog

Incidence, prevalence, and trajectories of repetitive conduction patterns in human atrial fibrillation

AIMS: Repetitive conduction patterns in atrial fibrillation (AF) may reflect anatomical structures harbouring preferential conduction paths and indicate the presence of stationary sources for AF. Recently, we demonstrated a novel technique to detect repetitive patterns in high-density contact mapping of AF. As a first step towards repetitive pattern mapping to guide AF ablation, we determined the incidence, prevalence, and trajectories of repetitive conduction patterns in epicardial contact mapping of paroxysmal and persistent AF patients. METHODS AND RESULTS: A 256-channel mapping array was used to record epicardial left and right AF electrograms in persistent AF (persAF, n = 9) and paroxysmal AF (pAF, n = 11) patients. Intervals containing repetitive conduction patterns were detected using recurrence plots. Activation movies, preferential conduction direction, and average activation sequence were used to characterize and classify conduction patterns. Repetitive patterns were identified in 33/40 recordings. Repetitive patterns were more prevalent in pAF compared with persAF [pAF: median 59%, inter-quartile range (41-72) vs. persAF: 39% (0-51), P < 0.01], larger [pAF: = 1.54 (1.15-1.96) vs. persAF: 1.16 (0.74-1.56) cm2, P < 0.001), and more stable [normalized preferentiality (0-1) pAF: 0.38 (0.25-0.50) vs. persAF: 0.23 (0-0.33), P < 0.01]. Most repetitive patterns were peripheral waves (87%), often with conduction block (69%), while breakthroughs (9%) and re-entries (2%) occurred less frequently. CONCLUSION: High-density epicardial contact mapping in AF patients reveals frequent repetitive conduction patterns. In persistent AF patients, repetitive patterns were less frequent, smaller, and more variable than in paroxysmal AF patients. Future research should elucidate whether these patterns can help in finding AF ablation targets

Tissue Necrosis Following Diode Laser-assisted Transcanalicular Dacryocystorhinostomy

Advantages of transcanalicular laser-assisted dacryocystorhinostomy (TCDCR) over conventional external and endonasal dacryocystorhinostomy (DCR) have been purported to include decreased operating time, reduced morbidity, enhanced cosmesis, avoidance of general anesthesia, and a shorter recovery time. However, one case of skin necrosis has recently been reported to have occurred following diode laser-assisted TCDCR, and we now report three additional cases that were evaluated by the Ophthalmic Plastic Surgery services at the University of North Carolina and the University of California, San Francisco. Three patients developed full-thickness tissue necrosis over the medial canthus following TCDCR, and two of these patients experienced persistent tissue breakdown at the site following reconstructive repair

Clinical and electrophysiological predictors of device-detected new-onset atrial fibrillation during 3 years after cardiac surgery

Postoperative atrial fibrillation (POAF) after cardiac surgery is an independent predictor of stroke and mortality late after discharge. We aimed to determine the burden and predictors of early (up to 5th postoperative day) and late (after 5th postoperative day) new-onset atrial fibrillation (AF) using implantable loop recorders (ILRs) in patients undergoing open chest cardiac surgery Seventy-nine patients without a history of AF undergoing cardiac surgery underwent peri-operative high-resolution mapping of electrically induced AF and were followed 36 months after surgery using an ILR (Reveal XTTM). Clinical and electrophysiological predictors of late POAF were assessed. POAF occurred in 46 patients (58%), with early POAF detected in 27 (34%) and late POAF in 37 patients (47%). Late POAF episodes were short-lasting (mostly between 2 min and 6 h) and showed a circadian rhythm pattern with a peak of episode initiation during daytime. In POAF patients, electrically induced AF showed more complex propagation patterns than in patients without POAF. Early POAF, right atrial (RA) volume, prolonged PR time, and advanced age were independent predictors of late POAF

Impact of Vitamin D Supplementation on Arterial Vasomotion, Stiffness and Endothelial Biomarkers in Chronic Kidney Disease Patients

Background: Cardiovascular events are frequent and vascular endothelial function is abnormal in patients with chronic kidney disease (CKD). We demonstrated endothelial dysfunction with vitamin D deficiency in CKD patients; however the impact of cholecalciferol supplementation on vascular stiffness and vasomotor function, endothelial and bone biomarkers in CKD patients with low 25-hydroxy vitamin D [25(OH)D] is unknown, which this study investigated. Methods: We assessed non-diabetic patients with CKD stage 3/4, age 17–80 years and serum 25(OH)D ,75 nmol/L. Brachial artery Flow Mediated Dilation (FMD), Pulse Wave Velocity (PWV), Augmentation Index (AI) and circulating blood biomarkers were evaluated at baseline and at 16 weeks. Oral 300,000 units cholecalciferol was administered at baseline and 8-weeks. Results: Clinical characteristics of 26 patients were: age 50614 (mean61SD) years, eGFR 41611 ml/min/1.73 m2, males 73%, dyslipidaemia 36%, smokers 23% and hypertensives 87%. At 16-week serum 25(OH)D and calcium increased (43616 to 84629 nmol/L, p,0.001 and 2.3760.09 to 2.4260.09 mmol/L; p = 0.004, respectively) and parathyroid hormone decreased (10.868.6 to 7.464.4; p = 0.001). FMD improved from 3.163.3% to 6.163.7%, p = 0.001. Endothelial biomarker concentrations decreased: E-Selectin from 566662123 to 525662058 pg/mL; p = 0.032, ICAM-1, 3.4560.01 to 3.1061.04 ng/mL; p = 0.038 and VCAM-1, 54633 to 42633 ng/mL; p = 0.006. eGFR, BP, PWV, AI, hsCRP, von Willebrand factor and Fibroblast Growth Factor-23, remained unchanged. Conclusion: This study demonstrates for the first time improvement of endothelial vasomotor and secretory functions with vitamin D in CKD patients without significant adverse effects on arterial stiffness, serum calcium or FGF-23. Trial Registration: ClinicalTrials.gov NCT0200571

Benign Orbital Tumors with Bone Destruction in Children

Purpose: To present rare benign orbital tumors with bone destruction in children who could not be diagnosed presurgically and may simulate malignant ones. Methods: A retrospective review of cases. Clinical, operative and pathological records in all children with a diagnosis of benign orbital tumors who showed remarkable bone destruction at a tertiary Ophthalmic Center in China between Jan 1, 2000 and Dec 31, 2009 were reviewed. All patients had definitive histopathologic diagnosis. Results: Eight patients with benign orbital tumors showed obvious bone destruction, including six cases of eosinophilic granuloma, one case of leiomyoma and one case of primary orbital intraosseous hemangioma. Among them, three patients were females and five patients were males. Tumors were unilateral in all cases, with both the right and left side affected equally. Age ranged from 3 to 7 years (mean 4.1 years). Symptom duration ranged from 1 to 5 weeks (mean 4.8 weeks). Eyelid swelling and palpable mass were the most common complaint. There was no evidence for multifocal involvement in cases with eosinophilic granuloma. Among six patients with eosinophilic granuloma, two were treated with low dose radiation (10 Gy), three received systemic corticosteroid and one was periodically observed only after incisional biopsy or subtotal curettage. There was no postoperative therapeutic intervention in the two patients with leiomyoma and intraosseous hemangioma. All eight patients regained normal vision without local recurrence after a mean follow-up time o