Current state-of-the-art of device therapy for advanced heart failure

Heart failure remains one of the most common causes of morbidity and mortality worldwide. The advent of mechanical circulatory support devices has allowed significant improvements in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of past and current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support

Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively : a case control study

Introduction: Acute kidney injury (AKI) after cardiac surgery increases length of hospital stay and in-hospital mortality. A significant number of patients undergoing cardiac surgical procedures require perioperative intra-aortic balloon pump (IABP) support. Use of an IABP has been linked to an increased incidence of perioperative renal dysfunction and death. This might be due to dislodgement of atherosclerotic material in the descending thoracic aorta (DTA). Therefore, we retrospectively studied the correlation between DTA atheroma, AKI and in-hospital mortality. Methods: A total of 454 patients were retrospectively matched to one of four groups: -IABP/-DTA atheroma, +IABP/-DTA atheroma, -IABP/+DTA atheroma, +IABP/+DTA atheroma. Patients were then matched according to presence/absence of DTA atheroma, presence/absence of IABP, performed surgical procedure, age, gender and left ventricular ejection fraction (LVEF). DTA atheroma was assessed through standard transesophageal echocardiography (TEE) imaging studies of the descending thoracic aorta. Results: Basic patient characteristics, except for age and gender, did not differ between groups. Perioperative AKI in patients with -DTA atheroma/+IABP was 5.1% versus 1.7% in patients with -DTA atheroma/-IABP. In patients with +DTA atheroma/+IABP the incidence of AKI was 12.6% versus 5.1% in patients with +DTA atheroma/-IABP. In-hospital mortality in patients with +DTA atheroma/-IABP was 3.4% versus 8.4% with +DTA atheroma/+IABP. In patients with +DTA atheroma/+IABP in hospital mortality was 20.2% versus 6.4% with +DTA atheroma/-IABP. Multivariate logistic regression identified DTA atheroma > 1 mm (P = *0.002, odds ratio (OR) = 4.13, confidence interval (CI) = 1.66 to 10.30), as well as IABP support (P = *0.015, OR = 3.04, CI = 1.24 to 7.45) as independent predictors of perioperative AKI and increased in-hospital mortality. DTA atheroma in conjunction with IABP significantly increased the risk of developing acute kidney injury (P = 0.0016) and in-hospital mortality (P = 0.0001) when compared to control subjects without IABP and without DTA atheroma. Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma

Tropospheric distribution of sulphate aerosols mass and number concentration during INDOEX-IFP and its transport over the Indian Ocean: A GCM study

International audienceThe sulphate aerosols mass and number concentration during the Indian Ocean Experiment (INDOEX) Intensive Field Phase-1999 (INDOEX-IFP) has been simulated using an interactive chemistry GCM. The model considers an interactive scheme for feedback from chemistry to meteorology with internally resolving microphysical properties of aerosols. In particular, the interactive scheme has the ability to predict both particle mass and number concentration for the Aitken and accumulation modes as prognostic variables. On the basis of size distribution retrieved from the observations made along the cruise route during IFP-1999, the model successfully simulates the order of magnitude of aerosol number concentration. The results show the southward migration of minimum concentrations, which follows ITCZ (Inter Tropical Convergence Zone) migration. Sulphate surface concentration during INDOEX-IFP at Kaashidhoo (73.46° E, 4.96° N) gives an agreement within a factor of 2 to 3. The measured aerosol optical depth (AOD) from all aerosol species at KCO was 0.37 ± 0.11 while the model simulated sulphate AOD ranged from 0.05 to 0.11. As sulphate constitutes 29% of the observed AOD, the model predicted values of sulphate AOD are hence fairly close to the measured values. The model thus has capability to predict the vertically integrated column sulphate burden. Furthermore, the model results indicate that Indian contribution to the estimated sulphate burden over India is more than 60% with values upto 40% over the Arabian Sea. © 2012 Author(s)

Sub-microsecond temporal evolution of edge density during edge localized modes in KSTAR tokamak plasmas inferred from ion cyclotron emission

During edge localised mode (ELM) crashes in KSTAR deuterium plasmas, bursts of spectrally structured ion cyclotron emission (ICE) are detected. Usually the ICE spectrum chirps downwards during an ELM crash, on sub-microsecond timescales. For KSTAR ICE where the separation of spectral peak frequencies is close to the proton cyclotron frequency Ω<sub>cp</sub> at the outer plasma edge, we show that the driving population of energetic ions is likely to be a subset of the 3MeV fusion protons, born centrally on deeply passing orbits which drift from the core to the edge plasma. We report first principles modelling of this scenario using a particle-in-cell code, which evolves the full orbit dynamics of large numbers of energetic protons, thermal deuterons, and electrons self-consistently with the electric and magnetic fields. The Fourier transform of the excited fields in the nonlinear saturated regime of the simulations is the theoretical counterpart to the measured ICE spectra. Multiple simulation runs for different, adjacent, values of the plasma density under KSTAR edge conditions enable us to infer the theoretical dependence of ICE spectral structure on the local electron number density. By matching this density dependence to the observed time-dependence of chirping ICE spectra in KSTAR, we obtain sub-microsecond time resolution of the evolving local electron number density during the ELM crash

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage.

BACKGROUND\ud \ud Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania\ud \ud METHODS\ud \ud We investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1) during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999); and (2) three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002). A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked.\ud \ud RESULTS\ud \ud Coverage of vitamin A supplementation among 1-2 year old children increased from 13% [95% CI 10-18%] in 1999 to 76% [95%CI 72-81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70%) (p = 0.04). Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations.\ud \ud CONCLUSION\ud \ud Change in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a need to monitor the effect of such campaigns on the routine health system and on equity of coverage. Documentation of vitamin A supplementation campaign contacts on routine maternal and child health cards would be a simple step to facilitate this monitoring

Vacuum Stability Higgs Mass Bound Revisited with Implications for Extra Dimension Theories

We take the standard model to be an effective theory including higher dimensional operators suppressed by scale $\Lambda$ and re-examine the higgs mass bounds from the requirements of vacuum stability. Our results show that the effects of the higher dimensional operators on the higgs mass limits are significant. As an implication of our results, we study the vacuum stability higgs mass bounds in theories with extra dimensions.Comment: Latex, 14 pages, 1 figure. Added references. To appear in Phys. Rev.

Plexiform Neurofibroma: A Rare Tumor of Submandibular Salivary Gland

A 15-year-old boy presented with swelling in the submandibular region. X-ray of the swollen part showed faint radio opaque shadow. A provisional diagnosis of sialadenitis with sialolithiasis was made. Excised mass was reported histopathologically as plexiform neurofibroma of submandibular salivary gland. Plexiform neurofibroma of the salivary gland is a rare benign tumor often present in the parotid gland. It is very rare in submandibular salivary gland. It is a slow growing, locally infiltrating tumor. Key words: Plexiform neurofibroma, sialadenitis, sialolithiasis, submandibular salivary glan

A transient current based micro-grid connected power system protection scheme using wavelet approach

Micro-grids comprise Distributed Energy Resources (DER’s) with low voltage distribution networks having controllable loads those can operate with different voltage levels are connected to the micro-grid and operated in grid mode or islanding mode in a coordinated way of control. DER’s provides clear environment-economical benefits for society and consumer utilities. But their development poses great technical challenges mainly protection of main and micro grid. Protection scheme must have to respond to both the main grid and micro-grid faults. If the fault is occurs on main grid, the response must isolate the DER’s from the main grid rapidly to protect the system loads. If the fault ocuurs within the micro-grid, the protection scheme must coordinate and isolates the least priority possible part of the grid to eliminate the fault. In order to deal with the bidirectional energy flow due to large numbers of micro sources new protection schemes are required. The system is simulated using MATLAB Wavelet Tool box and Wavelet based Multi-resolution Analysis is considered. Wavelet based Multi-resolution Analysis is used for detection, discrimination and location of faults on transmission network.  This paper is discussed a transient current based micro-grid connected power system protection scheme using Wavelet Approach described on wavelet detailed-coefficients of Mother Biorthogonal 1.5 wavelet. The proposed algorithm is tested in micro-grid connected power systems environment and proved for the detection, discrimination and location of faults which is almost independent of fault impedance, fault inception angle (FIA) and fault distance of feeder line

A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI." Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients

A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (<= 24 hours versus > 24 hours) of decompressive surgery

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest." Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions