Aortic regurgitation in athletes: The challenges of echocardiographic interpretation

Background Bicuspid aortic valve (BAV) is the most common congenital cardiac defect and prone to premature degeneration causing aortic regurgitation (AR). The assessment of AR in athletic individuals poses several challenges as the pathological left ventricle (LV) remodelling caused by AR may overlap with the physiological remodelling of intense exercise. The purpose of this study is to highlight these challenges, review the existing literature and discuss how to tackle these conundrums. As a real-world example, we compare the resting transthoracic echocardiographic (TTE) findings in a cohort of individuals with BAV and AR, sub-grouped into “highly active” or “lightly active”. Methods Adult male subjects with an index TTE performed at a tertiary referral centre between 2019 and 2022 were included if the TTE confirmed a BAV and at least moderate AR. Further strict inclusion criteria were applied and parameters of valve disease severity was made in accordance with existing guidelines. Subjects completed a physical activity questionnaire over the telephone, and were classified into either group 1: “highly active” or group 2: “lightly active” based on their answers. Demographics and TTE parameters were compared between the two groups. Results 30 male subjects (mean age 44±13 years) with BAV-AR were included – 17 were highly active, and 13 lightly active. There was no significant difference in age (group 1, 45±12.7yrs vs group 2, 42±17yrs; p=0.49), height (p=0.45), weight (p=0.268) or severity of AR, when quantitative assessment was possible. Group 1 had a significantly higher stroke volume (131±17mls vs 102±13 mls; p=0.027), larger LV volumes, diastolic dimensions and significantly larger bi-atrial and right ventricular size. This LV dilatation in the context of AR and athleticism poses a diagnostic and management conundrum. Despite this, none of these 17 highly active individuals demonstrated any of the traditional criteria used to consider surgery. Conclusion There is significant overlap between the physiological adaptations to exercise and those caused by AR. Multi-modality imaging and stress testing can aid clinicians in diagnostic and management decisions in exercising individuals when there is discordance between AR severity and symptoms

Nodules et carcinomes thyroïdiens

Face à l’augmentation des incidentalomes thyroïdiens, la gestion appropriée des nodules thyroïdiens est primordiale afin de permettre la détection des cancers relevants et d’éviter le surdiagnostic et le surtraitement des microcarcinomes papillaires. Cet article décrit les grandes lignes de la prise en charge en tenant compte des nouvelles recommandations

B and I-band optical micro-variability observations of the BL Lac objects S5 2007+777 and 3C371

We have observed S5 2007+777 and 3C371 in the B and I bands for 13 and 8 nights, respectively, during various observing runs in 2001, 2002 and 2004. The observations resulted in almost evenly sampled light curves, 6-9 hours long. We do not detect any flares within the observed light curves, but we do observe small amplitude, significant variations, in both bands, on time scales of hours and days. The average variability amplitude on time scales of minutes/hours is 2.5% and 1-1.5% in the case of S5 2007+777 and 3C371, respectively. The average amplitudes increase to 5-12% and 4-6%, respectively, on time scales of days. We find that the B and I band variations are highly correlated, on both short and long time scales. During the 2004 observations, which resulted in the longest light curves, we observe two well defined flux-decay and rising trends in the light curves of both objects. When the flux decays, we observe significant delays, with the B band flux decaying faster than the flux in the I band. As a result, we also observe significant, flux related spectral variations as well. The flux-spectral relation is rather complicated, with loop-like structures forming during the flux evolution. The presence of spectral variations imply that the observed variability is not caused by geometric effects. On the other hand, our results are fully consistent with the hypothesis that the observed variations are caused by perturbations which affect different regions in the jet of the sources.Comment: Accepted for publication in Astronomy and Astrophysic

Detecting Trivial Mutant Equivalences via Compiler Optimisations

Mutation testing realises the idea of fault-based testing, i.e., using artificial defects to guide the testing process. It is used to evaluate the adequacy of test suites and to guide test case generation. It is a potentially powerful form of testing, but it is well-known that its effectiveness is inhibited by the presence of equivalent mutants. We recently studied Trivial Compiler Equivalence (TCE) as a simple, fast and readily applicable technique for identifying equivalent mutants for C programs. In the present work, we augment our findings with further results for the Java programming language. TCE can remove a large portion of all mutants because they are determined to be either equivalent or duplicates of other mutants. In particular, TCE equivalent mutants account for 7.4% and 5.7% of all C and Java mutants, while duplicated mutants account for a further 21% of all C mutants and 5.4% Java mutants, on average. With respect to a benchmark ground truth suite (of known equivalent mutants), approximately 30% (for C) and 54% (for Java) are TCE equivalent. It is unsurprising that results differ between languages, since mutation characteristics are language-dependent. In the case of Java, our new results suggest that TCE may be particularly effective, finding almost half of all equivalent mutants

A Cutoff in the X-ray Fluctuation Power Density Spectrum of the Seyfert 1 Galaxy NGC 3516

During 1997 March-July, XTE observed the bright, strongly variable Seyfert 1 galaxy NGC 3516 once every ~12.8 hr for 4.5 months and nearly continuously (with interruptions due to SAA passage but not Earth occultation) for a 4.2 day period in the middle. These were followed by ongoing monitoring once every ~4.3 days. These data are used to construct the first well-determined X-ray fluctuation power density spectrum (PDS) of an active galaxy to span more than 4 decades of usable temporal frequency. The PDS shows no signs of any strict or quasi-periodicity, but does show a progressive flattening of the power-law slope from -1.74 at short time scales to -0.73 at longer time scales. This is the clearest observation to date of the long-predicted cutoff in the PDS. The characteristic variability time scale corresponding to this cutoff temporal frequency is 1 month. Although it is unclear how this time scale may be interpreted in terms of a physical size or process, there are several promising candidate models. The PDS appears similar to those seen for Galactic black hole candidates such as Cyg X-1, suggesting that these two classes of objects with very different luminosities and putative black hole masses (differing by more than a factor of 10^5) may have similar X-ray generation processes and structures.Comment: 21 pages, incl. 5 figures, AASTe

Highly anisotropic g-factor of two-dimensional hole systems

Coupling the spin degree of freedom to the anisotropic orbital motion of two-dimensional (2D) hole systems gives rise to a highly anisotropic Zeeman splitting with respect to different orientations of an in-plane magnetic field B relative to the crystal axes. This mechanism has no analogue in the bulk band structure. We obtain good, qualitative agreement between theory and experimental data, taken in GaAs 2D hole systems grown on (113) substrates, showing the anisotropic depopulation of the upper spin subband as a function of in-plane B.Comment: 4 pages, 3 figure

The swan song: the disappearance of the nucleus of NGC 4051 and the echo of its past glory

BeppoSAX observed the low-luminous Seyfert 1 Galaxy NGC4051 in a ultra-dim X-ray state. The 2-10 keV flux (1.26 x 10^{-12} erg/cm^2/s) was about 20 times fainter than its historical average value, and remained steady along the whole observation (~2.3 days). The observed flat spectrum (\Gamma ~ 0.8) and intense iron line (EW ~600 eV) are best explained assuming that the active nucleus has switched off, leaving only a residual reflection component visible.Comment: 5 pages, Latex, 3 Postscript figures, accepted for publication in MNRA

A Laterally Modulated 2D Electron System in the Extreme Quantum Limit

We report on magnetotransport of a two-dimensional electron system (2DES), located 32 nm below the surface, with a surface superlattice gate structure of periodicity 39 nm imposing a periodic modulation of its potential. For low Landau level fillings $\nu$, the diagonal resistivity displays a rich pattern of fluctuations, even though the disorder dominates over the periodic modulation. Theoretical arguments based on the combined effects of the long-wavelength, strong disorder and the short-wavelength, weak periodic modulation present in the 2DES qualitatively explain the data.Comment: 4 pages, 5 figures. to appear in Phys. Rev. Let