An echocardiographic comparison of sutureless and conventional aortic valve replacement : a matched case-control study

Background: Patients at a high operative risk for conventional aortic valve replacement (AVR) may be offered sutureless valve implantation. Sutureless valves resemble conventional valves but incorporate an anchoring mechanism without using annular sutures. Methods Pre-operative and six month post-operative echocardiography data from our first year, single centre experience of sutureless valves was compared to conventional aortic valve replacements in patients matched for operative risk. Left ventricular ejection fraction, mean and peak AV gradients and inter-ventricular septal thickness, effective orifice area (EOA) and indexed effective orifice area (iEOA) were measured. Results The drops in mean and peak pre- to post-operative gradients were greater in the sutureless group, p=0.039 and p=0.001 respectively. Post-operative EOA was 1.69 cm2 and 1.26 cm2 (p=0.001) in the sutureless and conventional groups. Similarly iEOA was 0.93 cm2 and 0.74 cm2 (p=0.001) in the sutureless and conventional groups. There was also a reduction in patient prosthesis mismatch (PPM) in the sutureless group as compared to the conventional group (Chi square test p=0.026). Post-operative inter-ventricular septal thickness was 1.13 cm2 in the sutureless group and 1.35 cm2 in the conventional group (p=0.011). Conclusions Use of sutureless valves with a stent framework resulted in larger EOA and iEOA and a diminution in PPM; and lead to a statistically significant faster regression in inter-ventricular septal thickness that is a measure of left ventricular mass. The rate and extent of regression in left ventricular hypertrophy after AVR is important since it determines long-term survival including mortality, heart failure and decreased admission rates.peer-reviewe

Atmospheric influences on the anomalous 2016 Antarctic sea ice decay

In contrast to the Arctic, where total sea ice extent (SIE) has been decreasing for the last three decades, Antarctic SIE has shown a small, but significant, increase during the same time period. However, in 2016, an unusually early onset of the melt season was observed; the maximum Antarctic SIE was already reached as early as August rather than the end of September, and was followed by a rapid decrease. The decay was particularly strong in November, when Antarctic SIE exhibited a negative anomaly (compared to the 1979–2015 average) of approximately 2 million km2. ECMWF Interim reanalysis data showed that the early onset of the melt and the rapid decrease in sea ice area (SIA) and SIE were associated with atmospheric flow patterns related to a positive zonal wave number three (ZW3) index, i.e., synoptic situations leading to strong meridional flow and anomalously strong southward heat advection in the regions of strongest sea ice decline. A persistently positive ZW3 index from May to August suggests that SIE decrease was preconditioned by SIA decrease. In particular, in the first third of November northerly flow conditions in the Weddell Sea and the Western Pacific triggered accelerated sea ice decay, which was continued in the following weeks due to positive feedback effects, leading to the unusually low November SIE. In 2016, the monthly mean Southern Annular Mode (SAM) index reached its second lowest November value since the beginning of the satellite observations. A better spatial and temporal coverage of reliable ice thickness data is needed to assess the change in ice mass rather than ice area

A Qualitative Study Investigating Gender Differences in Primary Work Stressors and Levels of Job Satisfaction in Greek Junior Hospital Doctors

Primary work stressors and job satisfaction/dissatisfaction in Greek Junior Hospital Doctors (JHDs) are investigated to identify similarities and differences in the reports obtained from male and female hospital doctors. Participants in the study included 32 male and 28 female Greek hospital doctors who provided information through semi-structured, in-depth interviews. The findings revealed that a majority of Greek JHDs considered their profession very stressful, and that various differences were identified between male and female JHDs, with regard to perceived stress and satisfaction. The study has implications for the possible introduction of in-house stress management training programmes, both at a generic, and gender specific level. Future research aimed at increasing the individuals’ coping mechanism s, and identifying environmental sources of stress are recommended

Pathophysiological mechanism of post-lobectomy air leaks

Background: Air leak post-lobectomy continues to remain a significant clinical problem, with upper lobectomy associated with higher air leak rates. This paper investigated the pathophysiological role of pleural stress in the development of post-lobectomy air leak.Methods: Preoperative characteristics and postoperative data from 367 consecutive video assisted thoracic surgery (VATS) lobectomy resections from one centre were collected prospectively between January 2014 and March 2017. Computer modelling of a lung model using finite element analysis (FEA) was used to calculate pleural stress in differing areas of the lung.Results: Air leak following upper lobectomy was significantly higher than after middle or lower lobectomy (6.3% versus 2.5%, P=0.044), resulting in a significant six-day increase in mean hospital stay, P=0.004. The computer simulation model of the lung showed that an apical bullet shape was subject to eightyfold higher stress than the base of the lung model.Conclusions: After upper lobectomy, the bullet shape of the apex of the exposed lower lobe was associated with high pleural stress, and a reduction in mechanical support by the chest wall to the visceral pleura due to initial post-op lack of chest wall confluence. It is suggested that such higher stress in the lower lobe apex explains the higher parenchymal air leak post-upper lobectomy. The pleural stress model also accounts for the higher incidence of right-sided prolonged air leak post-resection.peer-reviewe

A dominant mutation in β-AMYLASE1 disrupts nighttime control of starch degradation in Arabidopsis leaves

Arabidopsis (Arabidopsis thaliana) leaves possess a mechanism that couples the rate of nighttime starch degradation to the anticipated time of dawn, thus preventing premature exhaustion of starch and nighttime starvation. To shed light on the mechanism, we screened a mutagenized population of a starvation reporter line and isolated a mutant that starved prior to dawn. The mutant had accelerated starch degradation, and the rate was not adjusted to time of dawn. The muta- tion responsible led to a single amino acid change (S132N) in the starch degradation enzyme BETA-AMYLASE1 (BAM1; mutant allele named bam1-2D), resulting in a dominant, gain-of-function phenotype. Complete loss of BAM1 (in bam1-1) did not affect rates of starch degradation, while expression of BAM1(S132N) in bam1-1 recapitulated the accelerated starch degradation phenotype of bam1-2D. In vitro analysis of recombinant BAM1 and BAM1(S132N) proteins revealed no differ- ences in kinetic or stability properties, but in leaf extracts, BAM1(S132N) apparently had a higher affinity than BAM1 for an established binding partner required for normal rates of starch degradation, LIKE SEX FOUR1 (LSF1). Genetic approaches showed that BAM1(S132N) itself is likely responsible for accelerated starch degradation in bam1-2D and that this activity requires LSF1. Analysis of plants expressing BAM1 with alanine or aspartate rather than serine at position 132 indicated that the gain-of-function phenotype is not related to phosphorylation status at this position. Our results strengthen the view that control of starch degradation in wild-type plants involves dynamic physical interactions of degradative enzymes and related proteins with a central role for complexes containing LSF1

Tunable and abrupt thermal quenching of photoluminescence in high-resistivity Zn-doped GaN

Tunable and abrupt thermal quenching of photoluminescence by increasing temperature has been observed for the blue band in high-resistivity Zn-doped GaN. The photoluminescence intensity dropped by several orders of magnitude within a few Kelvins, and the temperature at which that drop occurred could be tuned by changing the incident light intensity. Modeling the system with rate equations for competing electron-hole recombination flows through three defect species, one of which is a nonradiative deep donor, gives results consistent with these observations

A novel method of personnel cooling in an operating theatre environment

Funding obtained from University of Malta.An optimized theatre environment, including personal temperature regulation, can help maintain concentration, extend work times and may improve surgical outcomes. However, devices, such as cooling vests, are bulky and may impair the surgeon's mobility. We describe the use of a low-cost, low-energy 'bladeless fan' as a personal cooling device. The safety profile of this device was investigated by testing air quality using 0.5- and 5-µm particle counts as well as airborne bacterial counts on an operating table simulating a wound in a thoracic operation in a busy theatre environment. Particle and bacterial counts were obtained with both an empty and full theatre, with and without the 'bladeless fan'. The use of the 'bladeless fan' within the operating theatre during the simulated operation led to a minor, not statistically significant, lowering of both the particle and bacterial counts. In conclusion, the 'bladeless fan' is a safe, effective, low-cost and low-energy consumption solution for personnel cooling in a theatre environment that maintains the clean room conditions of the operating theatre.peer-reviewe

Art and the State: The Visual Arts in Comparative Perspective

This book examines the impact of states and their policies on visual art. States shape the role of art and artists in society, influence the development of audiences, support artistic work, and even affect the very nature of artistic production. The book contrasts developments in the United States with art policies in Britain and in the social democratic states of Norway and Sweden. In addition, it analyzes revealing transitions - the changes brought about in East Germany after unification and the experiences of artists who left the Soviet Union for the west. The result is a significant contribution to the sociology and the political economy of art

Extended Red Objects and Stellar Wind Bow Shocks in the Carina Nebula

We report the results of infrared photometry on 39 extended red objects (EROs) in the Carina Nebula, observed with the Spitzer Space Telescope. Most EROs are identified by bright, extended 8.0 um emission, which ranges from 10'' to 40'' in size, but our sample also includes 4 EROs identified by extended 24 um emission. Of particular interest are nine EROs associated with late O or early B-type stars and characterized by arc-shaped morphology, suggesting dusty, stellar-wind bow shocks. These objects are preferentially oriented towards the central regions of the Carina Nebula, suggesting that these bow shocks are generally produced by the interactions of OB winds with the bulk expansion of the H II region rather than high proper motion. We identify preferred regions of mid-infrared color space occupied by our bow shock candidates, which also contain bow shock candidates in M17 and RCW 49 but are well-separated from polycyclic aromatic hydrocarbon emission or circumstellar discs. Color cuts identify an additional 12 marginally-resolved bow shock candidates, 10 of which are also associated with known late O or early B stars. H II region expansion velocities derived from bow shock candidate standoff distances are ~10 km/s, assuming typical H II region gas densities, comparable to expansion velocities derived from bow shocks in M17 and RCW 49. One candidate bow shock provides direct evidence of physical interaction between the massive stellar winds originating in the Trumpler 15 and Trumpler 14 clusters, supporting the conclusion that both clusters are at similar heliocentric distances.Comment: 15 pages, 7 figures, MNRAS accepted (2014 October 10