On the spectrum of operator families on discrete groups over minimal dynamical systems

It is well known that, given an equivariant and continuous (in a suitable sense) family of selfadjoint operators in a Hilbert space over a minimal dynamical system, the spectrum of all operators from that family coincides. As shown recently similar results also hold for suitable families of non-selfadjoint operators in \ell^p (\ZM). Here, we generalize this to a large class of bounded linear operator families on Banach-space valued $\ell^p$-spaces over countable discrete groups. We also provide equality of the pseudospectra for operators in such a family. A main tool for our analysis are techniques from limit operator theory.Comment: minor revisio

Importance of Oral Hygiene and Maintaining Oral Health in Persons With Disabilities

This paper aims to approximate and facilitate the routine of daily oral hygiene for persons with disabilities, as well as to emphasize the importance of educating persons with disabilities and their caregivers about oral health as an essential part of overall health. Desk research of electronic databases was conducted with the aim of writing this paper, using the following keywords: ‘oral hygiene’, ‘dental plaque’, ‘oral health’ and ‘persons with disabilities’. Literature research has shown that persons with disabilities have poor oral hygiene, as well as that there is a lack of education among them and their caregivers about the importance of oral health and proper oral hygiene. Poor oral hygiene can affect a person’s quality of life due to discomfort during eating, bad breath, poor self-esteem, pain, and disturbed sleep, which is a result of caries or other diseases of the oral cavity. Maintaining oral health is an essential part of overall health

Chronic β-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection

Objectives: To compare the medical treatment of chronic type B aortic dissection with β-blockers versus other antihypertensive treatments in terms of their requirement for surgical intervention and treatment costs. Methods: Case records of the 130 patients treated for aortic dissection type B in this unit between 1988 and 1997 were reviewed. Seventy-eight of 130 patients with chronic dissection have received isolated medical treatment. Seventy-one of 78 patients were discharged alive. Fifty-one of 71 received β-blocker treatment, 20/71 were treated with other antihypertensive drugs. Results: Surgery for aortic dissection became necessary in 20/71 patients (28%) during follow-up (mean, 4.2 years): 10/51 in the β-blocker group and 9/20 in the other antihypertensive drug group. The freedom from subsequent aortic operation was 80 and 47%, respectively (P=0.001). Indications for emergency surgery were increased aortic diameter (79%), symptomatic aortic aneurysm (11%), and renal artery hypoperfusion (5%). The median hospitalization time during follow-up (dissection-related) was 2 days for patients who received β-blockers and 16 days for patients who received other antihypertensive drug treatments (P=0.001). The cost of treatment/patient per year amounted to 644 and 12 748 euros, respectively. Conclusions: A substantial proportion of patients with chronic type B dissection who receive initial medical management will later need surgery. Long-term treatment with β-blockers reduces the progression of aortic dilatation, the incidence of subsequent hospital admissions, as well as the incidence of late dissection-related aortic procedures and the cost of treatment. Patients with chronic type B dissection need, in addition to frequent follow-up of aortic diameter, continuous treatment with β-blocking agent

Surgery for acute type a aortic dissection: comparison of techniques

Objective: In order to determine the optimal surgical strategy for acute ascending aortic dissection, the graft inclusion technique was compared with the open resection technique. Methods: Between 1985 and 1995 a consecutive series of 193 patients (77% male, mean age 58 years) had emergency surgery during a mean interval of 13.2 h after onset of symptoms. Graft replacement of the ascending aorta was performed in all patients (supracoronary graft 143/193=74%, aortic root replacement 50/193=26%, aortic valve replacement 73/193=38%, arch replacement 44/193=20%) The open resection technique was applied in 93 patients and the inclusion technique in 100 patients with a Cabrol-shunt in 26%. Preoperative risk factors were equally distributed between groups (inclusion technique vs. open technique): left ventricular ejection fraction≪45% (13 vs. 2%, not significant (n.s.)), neurological deficit (31 vs. 25%; n.s.), systolic blood pressure≪90 mmHg (20 vs. 15%, n.s.) pericardial tamponade (25 vs. 9%, n.s.), renal failure (6 vs. 4%; n.s.). Results: The overall early mortality was 24%. Following graft inclusion it was 31% compared with 16% in the open technique group (P=0.0154). Postoperative complications (graft inclusion vs. open technique): myocardial infarction (9 vs. 12%, n.s.), low cardiac output (40 vs. 32%, n.s.), reexploration for hemorrhage (23 vs. 25%, n.s.). Survival at 8 years was significantly increased in the open technique group (P=0.0300). Pseudoaneurysm formation occurred in 3% of patients and only after graft inclusion. Freedom from reoperation was 80% at 8 years and did not differ between groups. Graft inclusion was an independent significant predictor of early (P=0.0069; relative risk=2.3673) and late mortality (P=0.0119; relative risk=2.0981). Conclusions: Surgery of acute ascending aortic dissection still carries a considerable early mortality whereas the late outcome is satisfactory. The open resection technique is the method of choice showing superior early and late results and avoiding pseudoaneurysm formation. The inclusion technique may be indicated in situations with increased risk of bleeding. A consequent decompression of the perigraft-space could reduce the rate of pseudoaneurysm

Probing molecular free energy landscapes by periodic loading

Single molecule pulling experiments provide information about interactions in biomolecules that cannot be obtained by any other method. However, the reconstruction of the molecule's free energy profile from the experimental data is still a challenge, in particular for the unstable barrier regions. We propose a new method for obtaining the full profile by introducing a periodic ramp and using Jarzynski's identity for obtaining equilibrium quantities from non-equilibrium data. Our simulated experiments show that this method delivers significant more accurate data than previous methods, under the constraint of equal experimental effort.Comment: 4 pages, 3 figure

Incidence and pathophysiology of atrioventricular block following mitral valve replacement and ring annuloplasty

Background: In this retrospective study we evaluate the causative mechanisms underlying postoperative atrioventricular block (AVB) following mitral valve replacement and mitral valve annuloplasty. Methods: Between January 1990 and December 2003, 391 patients underwent mitral valve replacement or ring annuloplasty and quadrangular resection. Exclusion criteria were preoperative AV block, two or three valvular procedures, reoperations and procedures combined with coronary artery bypass grafting. The presence of the postoperative AVB was compared with preoperative and intraoperative variables. On 55 post-mortem specimens the relationship between the AV node, AV node artery and mitral valve annulus was investigated. Results: The mean age was 59±14 years and 44% of patients were female. Postoperatively AVB occurred in 92 (23.5%) patients. AVB III was found in 17 (4%) patents, in whom a pacemaker was implanted within median interval of 4 days. Second degree AVB occurred and first degree AVB in five (1.3%) and in 70 (18%) patients respectively. In dry dissected human hearts in 23% of investigated cases the AV node artery was discovered to run close to the annulus of the mitral valve. Conclusions: Data collected in this study showed that, sotalol and amiodarone as well as a prolonged cross-clamp time may slightly influence the 23% incidence of postoperative AVB. The morphological investigation showed that the AV node artery runs in close proximity to the annulus in 23% of cases. We speculate that damage of the AV node artery may play a role in development of AV

Conservative treatment of the aortic root in acute type a dissection

Objective: In acute type A dissection long-term results of conservative aortic root surgery were compared with the outcome of primary valve and/or root replacement. Methods: Between 1985 and 1995, 199 patients (mean age 59 years, 154 men) were operated on. The aortic root was involved in the dissection process and valve incompetence of varying degree was present without exception. Replacement of a proximal aortic segment was standard procedure in all patients. The aortic valve was preserved in 126 patients: commissural suture resuspension (12 patients), root reconstruction with GRF-glue (gelatine-resorcin-formaldehyde/glutaraldehyde-glue) (114 patients). Valve replacement was performed in 73 patients (50 composite grafts, 23 valve prostheses with separate supracoronary grafts). Preoperative risk factors (valve replacement vs. preservation): coronary artery disease (11 vs. 8%, NS), tamponade (18 vs. 17%, NS), unstable hemodynamics (22 vs. 15%, NS), renal failure (4 vs. 6%, NS), neurologic disorder (19 vs. 32%, NS). Results: The overall early mortality was 23.6% (47/199 patients) and increased after commissural suture resuspension compared with GRF-glue reconstruction (P=NS). Parameters of the early postoperative period did not differ between conservative treatment and root/valve replacement: low cardiac output, 34 versus 38% (P=NS); myocardial infarction, 10 versus 11% (P=NS); hemorrhage, 25 versus 23% (P=NS); duration of intensive care (P=NS). Survival was 61% after 8 years without difference between the two principal treatment groups (P=NS) and between the two conservative subgroups (P=NS). At 2 years, GRF-glue reconstruction had an increased freedom from reoperation on the aortic root (92 vs. 70%, P=0.0253) and event free survival (77 vs. 41%, P=0.0224) compared with suture resuspension. Commissural suture resuspension was an independent, significant predictor for reoperation (P=0.0221, relative risk=4.7130). Conclusion: Surgery for acute type A dissection still carries a considerable early risk. Preservation of the aortic root is safe in the absence of Marfan or annuloaortic ectasia, but a certain incidence of reoperations on the aortic valve and the aortic root has to be accepted. Root reconstruction using GRF-glue is the method of choice and is superior to suture resuspension, with a significantly better reoperation-free and event-free surviva

Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery?

Background: Following mitral valve replacement, surgical closure of paravalvular leaks is usually advised in severely symptomatic patients and in those requiring blood transfusions for persisting haemolysis. However, the long-term prognosis of less symptomatic patients or those not needing blood transfusions is unknown. Methods: Between 1987 and 1997, we observed 96 patients with mitral paravalvular leakage. A paraprosthetic leak was diagnosed after a median time of 119 days (range: 1 day-23 years) after primary mitral valve replacement. During an average follow-up of 5 years (range: 1-23 years), 50/96 patients were referred for surgical closure. Results: Compared with patients who received conservative treatment, those referred for surgery had a significantly lower mean preoperative haematocrit (P=0.002) with a higher proportion of patients being in the NYHA class III/IV (P=0.03). Age, gender, left ventricular function and number and size of leaks did not differ between the groups. The 30-day postoperative mortality for valve reoperation was 6% (3/50); during follow-up three further patients died, resulting in an overall mortality rate of 12%. In the group treated conservatively there was a mortality rate of 26% (12/46). Thus, the actuarial survival for patients referred for surgery was 98, 90 and 88% after 1, 5 and 10 years, compared with 90, 75 and 68% for patients treated conservatively (long-rank P=0.03). In addition, there was a significant increase in mean haematocrit levels (P=0.0001) and an improvement in NYHA class III/IV symptoms (P=0.002), vertigo (P=0.001) and fatigue (P=0.001) after surgery. Conclusions: Following mitral valve replacement, a more aggressive surgical treatment is recommended for patients with paraprosthetic leaks. Surgery should be offered to less symptomatic patients, as well as those not requiring blood transfusio

Area-Constrained Planar Elastica

We determine the equilibria of a rigid loop in the plane, subject to the constraints of fixed length and fixed enclosed area. Rigidity is characterized by an energy functional quadratic in the curvature of the loop. We find that the area constraint gives rise to equilibria with remarkable geometrical properties: not only can the Euler-Lagrange equation be integrated to provide a quadrature for the curvature but, in addition, the embedding itself can be expressed as a local function of the curvature. The configuration space is shown to be essentially one-dimensional, with surprisingly rich structure. Distinct branches of integer-indexed equilibria exhibit self-intersections and bifurcations -- a gallery of plots is provided to highlight these findings. Perturbations connecting equilibria are shown to satisfy a first order ODE which is readily solved. We also obtain analytical expressions for the energy as a function of the area in some limiting regimes.Comment: 23 pages, several figures. Version 2: New title. Changes in the introduction, addition of a new section with conclusions. Figure 14 corrected and one reference added. Version to appear in PR