Transcatheter closure of iatrogenic Gerbode defect with an Amplatzer duct occluder in a 23-year-old patient

A 23-year-old man was referred to our center with hematuria and hemolysis. The patient had undergone mitral and tricuspid valve replacement 3 months previously. Echocardiography and catheterization revealed a Gerbode-type ventricular septal defect. A decision was made to occlude the defect interventionally. The patient's hematuria ceased immediately safter the occlusion of the defect. © 2015 Japanese College of Cardiology

D’une dramaturgie circulaire à l’image de la conception orientale du Temps : Cas d’un drame historique persan

The present study invites us to discover a new narrative strategy in the way a Persian dramatist chooses to recount his historical drama. By creating holes or  narrative obstacles over the moments of traditional topoi, he explodes the linear narrative and chooses a cyclical, even helical form to complete the fault of the  initial narrative. The narrative form adopted broadly resembles a temporal and philosophical vision of history in its oriental approach, which is similarly  considered cyclical.The present study invites us to discover a new narrative strategy in the way a Persian dramatist chooses to recount his historical drama. By creating holes or  narrative obstacles over the moments of traditional topoi, he explodes the linear narrative and chooses a cyclical, even helical form to complete the fault of the  initial narrative. The narrative form adopted broadly resembles a temporal and philosophical vision of history in its oriental approach, which is similarly  considered cyclical

Global and regional left ventricular function improvement following successful percutaneous coronary intervention in patients with ischemic left ventricular dysfunction

This study assessed changes in global and regional systolic left ventricular function after successful percutaneous recanalization of coronary artery occlusions. A consecutive series of 110 patients with mean ± SD age of 53.6 ± 9.1 years, in whom a complete angiographic evaluation was available before angioplasty, underwent successful percutaneous recanalization of significant occlusions of coronary arteries. Left ventricular ejection fraction and wall motion score index were assessed by echocardiography at baseline, and 1, and 6 months after recanalization. Left ventricular ejection fraction increased from a mean ± SD of 40.7 ± 4.52 at baseline to 50 ± 8.3 after one month (P < 0.001) and to 50.9 ± 8.5 after 6 months. There was no significant difference between left ventricular ejection fraction at the end of the first and the sixth month of treatment (P = NS). The wall motion score index decreased from 1.3 ± 0.2 at baseline to 1.1 ± 0.2 after one month (P < 0.01). There was no significant difference between 1 and 6 months results. Six-month follow-up of all patients showed significant improvement in both angina severity and NYHA class. The restoration of coronary potency of occluded coronary arteries by successful percutaneous recanalization is associated with significant improvement in regional and global left ventricular function and clinical outcome

Sarilumab for the treatment of ankylosing spondylitis: results of a Phase II, randomised, double-blind, placebo-controlled study (ALIGN)

OBJECTIVES: The ALIGN study (NCT01061723) evaluated the efficacy and safety of sarilumab, the first fully human monoclonal antibody against interleukin-6 receptor-alpha (IL-6Ralpha), in patients with ankylosing spondylitis (AS). METHODS: Patients with active AS despite conventional treatment were randomised to placebo, or one of five subcutaneous dose regimens of sarilumab (100, 150 or 200 mg every other week, or 100 or 150 mg every week), for 12 weeks. The primary efficacy end point was the percentage of patients achieving the Axial SpondyloArthritis international Society (ASAS) 20 response criteria at week 12. Secondary endpoints included ASAS40 response, ASAS partial remission, AS Disease Activity Score, high-sensitivity C-reactive protein (hs-CRP) value, and safety. RESULTS: Baseline demographic and disease characteristics of the 301 patients enrolled were similar across treatment groups. At week 12, there was no statistically significant difference in ASAS20 response rate between placebo (ASAS20 = 24.0%) and any sarilumab dose group. A significantly greater reduction in hs-CRP value was achieved with the higher sarilumab doses versus placebo. No other statistically significant differences were evident for secondary efficacy endpoints.The most common treatment-emergent adverse events reported for sarilumab included infections (non-serious), neutropenia, and increase in alanine aminotransferase. No cases of tuberculosis, opportunistic, or fungal infections, or bowel perforations were reported. Seven patients experienced a treatment-emergent serious adverse event (all in sarilumab treatment groups). No deaths occurred. CONCLUSIONS: The ALIGN study shows that IL-6Ralpha blockade with sarilumab was not an effective treatment for AS. Sarilumab was generally well tolerated with a manageable safety profile

Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

Background Valvular heart diseases and mainly rheumatic heart diseases complicate about 1% of pregnancies. During pregnancy physiological hemodynamic changes of the circulation are the main cause of mitral stenosis (MS) decompensation. Prior to introduction of percutaneous mitral balloon commissuroplasty (PTMC), surgical comissurotomy was the preferred method of treatment in patients with refractory symptoms. PTMC is an established non-surgical treatment of rheumatic mitral stenosis. The study aimed to assess the safety and efficacy of PTMC in pregnant women with severs mitral stenosis. Material and Method Thirty three consecutive patients undergoing PTMC during pregnancy enrolled in this prospective study. Mitral valve area (MVA), transmitral valve gradient (MVG), and severity of mitral regurgitation (MR) were assessed before and 24 hour after the procedure by transthoracic and transesophageal echocardiography. Mitral valve morphology was evaluated before the procedure using Wilkin's criteria. Patient followed for one month and neonates monitored for weight and height and adverse effect of radiation. Result Mitral valve area increased from 0.83 ± 0.13 cm 2 to 1.38 ± 0.29 cm 2 ( P = 0.007). Mean gradient of mitral valve decreased from 15.5 ± 7.4 mmHg to 2.3 ± 2.3 mmHg ( P = <0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 ( P = 0.012). No maternal death, abortion, intrauterine growth restriction was observed and only one stillbirth occurred. Conclusion PTMC in pregnant women has favorable outcome and no harmful effect on children noted

Percutaneous device closure for secundum-type atrial septal defect: Short and intermediate-term results

BACKGROUND: Device closure of an isolated secundum type atrial septal defect (ASD) has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an Amplatzer�Septal Occluder(ASO) device or a Figula ASD occluder device. METHODS: From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography (TEE).The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 ±4 months. RESULTS: The median stretched diameter of the defect was 20.7±4.8 mm (range: 8 - 30 mm).A total of 73 devices were used in this study. Device closure was successful in 72 (97.2) out of 74 patients. Repositioning of the device was required in one patient. Major complications(including significant residual shunt and device embolization) occurred in 3 (4) patients.There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 (13.7) patients immediately following the procedure and in 5 (6.7) patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. CONCLUSION: Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results

Assessment of evolutionary algorithms for optimal operating rules design in real Water Resource Systems

Two evolutionary algorithms (EAs) are assessed in this paper to design optimal operating rules (ORs) for Water Resource Systems (WRS). The assessment is established through a parameter analysis of both algorithms in a theoretical case, and the methodology described in this paper is applied to a complex, real case. These two applications allow us to analyse an algorithm's properties and performance by defining ORs, how an algorithm's termination/convergence criteria affect the results and the importance of decision-makers participating in the optimisation process. The former analysis reflects the need for correctly defining the important algorithm parameters to ensure an optimal result and how the greater number of termination conditions makes the algorithm an efficient tool for obtaining optimal ORs in less time. Finally, in the complex real case application, we discuss the participation value of decision-makers toward correctly defining the objectives and making decisions in the post-process. (C) 2014 Elsevier Ltd. All rights reserved.[EN]The authors wish to thank the University of Cagliari (Sardinia) and the Basin Agency of Sardinia for the data provided in the development of this study, as well as the Autonomous Region of Sardinia for funding the research project CRP 2_716. Thanks are also due to the Spanish Ministry of Science and Innovation (Comision Interministerial de Ciencia y Tecnologia, CICYT) for funding the projects NUTEGES (VI Plan Nacional de I+D-Ei 2008-2011, CGL2012-34978) and SCARCE (program Consolider-Ingenio 2010, project CSD2009-00065). The authors also thank the European Commission (Directorate-General for Research and Innovation) for funding the projects DROUGHT-R&SPI (program FP7-ENV-2011, project 282769), SIRIUS (FP7-SPACE-2010-1, project 262902), LIFE ALBUFERA project (LIFE12 ENV/ES/000685) and WAMCD project (EC-DG Environment No. 07.0329/2013/671291/SUB/ENV.C.1).Lerma Elvira, N.; Paredes Arquiola, J.; Andreu Álvarez, J.; Solera Solera, A.; Sechi, GM. (2015). Assessment of evolutionary algorithms for optimal operating rules design in real Water Resource Systems. Environmental Modelling and Software. 69:425-436. https://doi.org/10.1016/j.envsoft.2014.09.024S4254366

Implicit Stochastic Optimization for deriving reservoir operating rules in semiarid Brazil

Este artigo investiga a aplicação de Otimização Estocástica Implícita (OEI) para determinar regras de operações mensais em um sistema de reservatórios localizado no nordeste semi-árido brasileiro. OEI emprega um modelo de otimização determinística para encontrar alocações ótimas do reservatório sob vários cenários possíveis de afluências e posteriormente constrói as regras a partir da análise deste conjunto de liberações ótimas. As políticas operacionais fornecem a alocação mensal do reservatório condicionada ao armazenamento no início do mês e a afluência prevista para o mês. Além da clássica análise de regressão, este estudo estabelece as regras por meio de uma estratégia de interpolação bidimensional. Após a sua identificação, as regras são aplicadas para operar o sistema sob novas realizações de afluências e mostram habilidade para produzir políticas semelhantes às obtidas a partir de otimização determinística tendo estas mesmas afluências como previsão perfeita.._________________________________________________________________________________________ ABSTRACT: This paper deals with the application of Implicit Stochastic Optimization (ISO) to determine monthly operating rules for a reservoir system located in the semiarid Northeast of Brazil. ISO employs a deterministic optimization model to find optimal reservoir allocations under several possible inflow scenarios and later constructs the rules by analyzing the ensemble of these optimal releases. The operating policies provide the monthly reservoir release conditioned on the storage at the beginning of the month and the inflow predicted for the month. In addition to the classical regression analysis, this study establishes the rules by a two-dimensional interpolation strategy. After the rules are identified, they are applied to operate the system under new inflow realizations and show ability to produce policies similar to those obtained by deterministic optimization taking the same inflows as perfect forecasts

An Optical Sensory System for Assessment of Residual Cancer Burden in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy

Breast cancer patients undergoing neoadjuvant chemotherapy (NAC) require precise and accurate evaluation of treatment response. Residual cancer burden (RCB) is a prognostic tool widely used to estimate survival outcomes in breast cancer. In this study, we introduced a machine-learning-based optical biosensor called the Opti-scan probe to assess residual cancer burden in breast cancer patients undergoing NAC. The Opti-scan probe data were acquired from 15 patients (mean age: 61.8 years) before and after each cycle of NAC. Using regression analysis with k-fold cross-validation, we calculated the optical properties of healthy and unhealthy breast tissues. The ML predictive model was trained on the optical parameter values and breast cancer imaging features obtained from the Opti-scan probe data to calculate RCB values. The results show that the ML model achieved a high accuracy of 0.98 in predicting RCB number/class based on the changes in optical properties measured by the Opti-scan probe. These findings suggest that our ML-based Opti-scan probe has considerable potential as a valuable tool for the assessment of breast cancer response after NAC and to guide treatment decisions. Therefore, it could be a promising, non-invasive, and accurate method for monitoring breast cancer patient’s response to NAC

Translation Role in Comparative Literature and Contemporary Fiction of Iran and Arab

Considering the fact that translation is the primary tool for passing the boundary of a literature and entering the territory of another literature, it is one of the factors that prevent the isolation of different literary genres of a nation and hence, its fall. The present study intends to show the role of translation on generation and formation of nations' literary relations and show that it plays a significant role even in the comparative literature that is one of the fields related to nations' literature. This paper first points to the types of translation and its position in world literature; then to some of its functions (accuracy and translator's faithfulness in translation, the effect of translated work on the target literature, development of the art of fiction writing in classical and contemporary Persian and Arabic literature, prosperity of translation of realistic and romantic  works, expansion of themes, fascinating the readers of destination language to source literature and introducing famous western  writers to Persian and Arabic authors of contemporary literature). The researcher, following a descriptive and analytical method, has achieved proper solutions for examining the accuracy of the translation of literary works to compare two literary works with one common or different language