Presence Of A Congenitally Bicuspid Aortic Valve Among Patients Having Combined Mitral And Aortic Valve Replacement

Although bicuspid aortic valve occurs in an estimated 1% of adults and mitral valve prolapse in an estimated 5% of adults, occurrence of the 2 in the same patient is infrequent. During examination of operatively excised aortic and mitral valves because of dysfunction (stenosis and/or regurgitation), we encountered 16 patients who had congenitally bicuspid aortic valves associated with various types of dysfunctioning mitral valves. Eleven of the 16 patients had aortic stenosis (AS): 5 of them also had mitral stenosis, of rheumatic origin in 4 and secondary to mitral annular calcium in 1; the other 6 with aortic stenosis had pure mitral regurgitation (MR) secondary to mitral valve prolapse in 3, to ischemia in 2, and to unclear origin in 1. Of the 5 patients with pure aortic regurgitation, each also had pure mitral regurgitation: in 1 secondary to mitral valve prolapse and in 4 secondary to infective endocarditis. In conclusion, various types of mitral dysfunction severe enough to warrant mitral valve replacement occur in patients with bicuspid aortic valves. A proper search for mitral valve dysfunction in patients with bicuspid aortic valves appears warranted. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:263-271)Integrative Biolog

Clinical Relevance of Baseline TCP in Transcatheter Aortic Valve Replacement

AIMS: To investigate the influence of baseline thrombocytopenia (TCP) on short-term and long-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: A total of 732 consecutive patients with severe, symptomatic aortic stenosis undergoing TAVR from January 2012 to December 2015 were included. Primary outcomes of interest were the relationship of baseline TCP with 30-day and 1-year all-cause mortality. Secondary outcomes of interest were procedural complications and in-hospital mortality in the same subgroups. The prevalence of TCP (defined as platelet count <150 × 109/L) at baseline was 21.9%, of whom 4.0% had moderate/severe TCP (defined as platelet count <100 × 109/L). Compared to no or mild TCP, moderate/severe TCP at baseline was associated with a significantly higher 30-day mortality (23.3% vs 2.3% and 3.1%, respectively; P<.001) and 1-year mortality (40.0% vs 8.3% and 13.4%, respectively; P<.001). In Cox regression analysis, moderate/severe baseline TCP was an independent predictor of 30-day and 1-year mortality (hazard ratio [HR], 13.18; 95% confidence interval [CI], 4.49-38.64; P<.001 and HR, 5.90; 95% CI, 2.68-13.02; P<.001, respectively). CONCLUSIONS: In conclusion, baseline TCP is a strong predictor of mortality in TAVR patients, possibly identifying a specific subgroup of frail patients; therefore, it should be taken into account when addressing TAVR risk

Effect Of Coronary Bypass And Valve Structure On Outcome In Isolated Valve Replacement For Aortic Stenosis

Reports differ regarding the effect of concomitant coronary artery bypass grafting (CABG) in patients who undergo aortic valve replacement (AVR) for aortic stenosis (AS), and no reports have described the effect of aortic valve structure in patients who undergo AVR for AS. A total of 871 patients aged 24 to 94 years (mean 70) whose AVR for AS was their first cardiac operation, with or without first concomitant CABG, were included. Patients who underwent mitral valve procedures were excluded. In comparison with the 443 patients (51%) who did not undergo CABG, the 428 (49%) who underwent concomitant CABG were significantly older, were more often male, had lower transvalvular peak systolic pressure gradients and larger valve areas, had lower frequencies of congenitally malformed aortic valves, had lighter valves by weight, had higher frequencies of systemic hypertension, and had longer stays in the hospital after AVR. Early and late (to 10 years) mortality were similar by propensity-adjusted analysis in patients who did and did not undergo concomitant CABG. Congenitally unicuspid or bicuspid valves occurred in approximately 90% of those aged 21 to 50, in nearly 70% in those aged 51 to 70 years, and in just over 30% in those aged 71 to 95 years. Unadjusted and adjusted survival was significantly higher in patients with unicuspid or bicuspid valves compared to those with tricuspid valves. In conclusion, although concomitant CABG had no effect on the adjusted probability of survival, the type of aortic valve (unicuspid or bicuspid vs tricuspid) significantly affected the unadjusted and adjusted probability of survival. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:1334-1340)Statistic

Dense matter with eXTP

In this White Paper we present the potential of the Enhanced X-ray Timing and Polarimetry (eXTP) mission for determining the nature of dense matter; neutron star cores host an extreme density regime which cannot be replicated in a terrestrial laboratory. The tightest statistical constraints on the dense matter equation of state will come from pulse profile modelling of accretion-powered pulsars, burst oscillation sources, and rotation-powered pulsars. Additional constraints will derive from spin measurements, burst spectra, and properties of the accretion flows in the vicinity of the neutron star. Under development by an international Consortium led by the Institute of High Energy Physics of the Chinese Academy of Science, the eXTP mission is expected to be launched in the mid 2020s.Comment: Accepted for publication on Sci. China Phys. Mech. Astron. (2019

The Service Recovery Paradox: Can Bad Be Good? An Empirical Investigation of the Transformation of Consumer Perceptions of Vacation Home Rental Products and Services Into the Overall Vacation Experience and What It Means for Future Business

This research on the transformation of consumer perceptions of vacation home rental products and services into the overall vacation experience and the role of service recovery in the vacation experience and with future business was inspired by Hirschman’s (1970) theoretical framework of exit, voice, and loyalty. Specifically, Hirschman (1970) provided the basis for understanding the various responses to decline in quality and why voicing complaints is important to companies trying to retain existing consumers and gain new consumers. The research utilized formative measures identified by a panel of vacation home rental company experts. The measures were evaluated through a guest experience survey by over 38,000 guests staying in vacation home rentals from May 2017 to April 2018. Partial Least Squares Structural Equation Modeling (PLS-SEM) was utilized to assess the formative measurement model, the structural models, moderator and mediator analyses, and the presence of the service recovery paradox. The research found that consumer perceptions significantly drive the quality of the overall vacation home rental experience. If consumer perceptions fall below expectations and consumers voice their failed expectations to service staff, a service recovery positively and significantly moderates the overall vacation home rental experience. The overall vacation experience, influenced by service recovery, positively and significantly mediates the guest’s willingness to recommend and willingness to return. Also, the research tested for the service recovery paradox between consumers who did not have failed expectations and no service recovery was necessary with consumers who had failed expectations, voiced their failed expectations, and received service recovery. The research did not find support for the service recovery paradox in vacation home rentals

Family of chiral two- plus three-nucleon interactions for accurate nuclear structure studies

We present a family of nucleon-nucleon (NN) plus three-nucleon (3N) interactions up to N3LO in the chiral expansion that provides an accurate ab initio description of ground-state energies and charge radii up to the medium-mass regime with quantified theory uncertainties. Starting from the NN interactions proposed by Entem, Machleidt and Nosyk, we construct 3N interactions with consistent chiral order, non-local regulator, and cutoff value and explore the dependence of nuclear observables over a range of mass numbers on the 3N low-energy constants. By fixing these constants using the 3-H and 16-O ground-state energies, we obtain interactions that robustly reproduce experimental energies and radii for large range from p-shell nuclei to the nickel isotopic chain and resolve many of the deficiencies of previous interactions. Based on the order-by-order convergence and the cutoff dependence of nuclear observables, we assess the uncertainties due the interaction, which yield a significant contribution to the total theory uncertainty.Comment: 6 pages, 5 figures, 1 tabl

of Thoracic Surgery New-Onset Postoperative Atrial Fibrillation and Long-Term Survival After Aortic Valve Replacement Surgery

Results. Ten-year unadjusted survival was 50.8% for patients with new-onset postoperative AF and 59.4% fo