Treatment of mitral stenosis

In patients with mitral stenosis the need for therapeutic intervention can be assessed by clinical and non-invasive data. Mitral valve replacement is indicated when marked dyspnoea on mild exertion, dyspnoea at rest or pulmonray oedema, haemoptpis, atrial fibrillation, recurrent systemic emboli or right ventricular failure occur in a patient with a mitral valve area of <1·5cm2, as memured by Doppler echocardiography. This treatment will entail life-long anticoagulation in the majoriv of patients. Closed commissurotomy is no longer considered a valid therapeutic alternative due to its limited success rate but open cormmissurotomy and balloon valvotomy may be performed in patients with no significant calcification of valve cusps and no major concomitant mitral regurgitation. Preservation of the subvalvular apparatus and left ventricular geometry can be comidered the most important advantages of these techniques. More severe chronic symptom are generally required m indication for mitral valve replacement because of the additional long-term imponderabilities imposed by an implanted artrficial device. Therefore, in patienb with mitral stenosis different symptom and clinical findings will eventually lead to different intervention

Displacements by Successive rotations for Vehicles Subject to Given Constraints

The displacements of a vehicle on a plane can be subject to constraints depending on the nature of the vehicle. One can, for instance, think of the existence of a smallest turning circle for a car. In this paper our purpose is to show, on a simple example, how such constraints can be handled. We, in fact, consider the case of a vehicle the motions of which consist of a finite sequence of rotations, each rotation being subject to the following constraints. 1) The radius of the circles along which the displacements of the vehicle take place are larger than a critical radius. 2) The centers of the successive rotations are located along a straight line defined by the geometry of the vehicle. The mathematical analysis of this problem relies on a suitable choice of frames of reference in which the expression of the constraints is particularly simple. It is then shown that, under the above constraints, an arbitrary displacement can always be achieved by three approriate rotation

Mechanical concept of the neurosurgical robot ‘Minerva'

We describe a robot capable of performing all procedures necessary to carry out a complete stereotactic neurosurgical operation under the control and supervision of a surgeon. The operation consists of the introduction of a small probe with diameter 2-3 mm through a hole without trepanation. The robot has been built and is now being tested and evaluated. The accompanying control software as well as various medical probes are either in development or partially tested. The installation will be able to carry out a complete intervention under the surveillance of a computed tomography scanner. In this article we emphasize the design choices required to eliminate gearing backlash in a crucial degree of freedo

On the Behaviour of General-Purpose Applications on Cloud Storages

Managing data over cloud infrastructures raises novel challenges with respect to existing and well studied approaches such as ACID and long running transactions. One of the main requirements is to provide availability and partition tolerance in a scenario with replicas and distributed control. This comes at the price of a weaker consistency, usually called eventual consistency. These weak memory models have proved to be suitable in a number of scenarios, such as the analysis of large data with Map-Reduce. However, due to the widespread availability of cloud infrastructures, weak storages are used not only by specialised applications but also by general purpose applications. We provide a formal approach, based on process calculi, to reason about the behaviour of programs that rely on cloud stores. For instance, one can check that the composition of a process with a cloud store ensures `strong' properties through a wise usage of asynchronous message-passing

Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls

Summary: This nested case-control analysis of a Swiss ambulatory cohort of elderly women assessed the discriminatory power of urinary markers of bone resorption and heel quantitative ultrasound for non-vertebral fractures. The tests all discriminated between cases and controls, but combining the two strategies yielded no additional relevant information. Introduction: Data are limited regarding the combination of bone resorption markers and heel quantitative bone ultrasound (QUS) in the detection of women at risk for fracture. Methods: In a nested case-control analysis, we studied 368 women (mean age 76.2 ± 3.2years), 195 with low-trauma non-vertebral fractures and 173 without, matched for age, BMI, medical center, and follow-up duration, from a prospective study designed to predict fractures. Urinary total pyridinolines (PYD) and deoxypyridinolines (DPD) were measured by high performance liquid chromatography. All women underwent bone evaluations using Achilles+ and Sahara heel QUS. Results: Areas under the receiver operating-characteristic curve (AUC) for discriminative models of the fracture group, with 95% confidence intervals, were 0.62 (0.56-0.68) and 0.59 (0.53-0.65) for PYD and DPD, and 0.64 (0.58-0.69) and 0.65 (0.59-0.71) for Achilles+ and Sahara QUS, respectively. The combination of resorption markers and QUS added no significant discriminatory information to either measurement alone with an AUC of 0.66 (0.60-0.71) for Achilles+ with PYD and 0.68 (0.62-0.73) for Sahara with PYD. Conclusions: Urinary bone resorption markers and QUS are equally discriminatory between non-vertebral fracture patients and controls. However, the combination of bone resorption markers and QUS is not better than either test used alon

New country, Brazilian states and host records of the eucalypt shoot psyllid Blastopsylla occidentalis.

O psilídeo das ponteiras do eucalipto, Blastopsylla occidentalis Taylor, 1985 (Hemiptera: Psylloidea) é relatado aqui pela primeira vez para o Burundi, Indonésia (Sumatra), Nicarágua, Filipinas e Iêmen. O registro desta para o Paraguai mostrou ser um erro. Novos registros são dados para os estados brasileiros Bahia, Ceará, Piauí e Rio Grande do Sul. Eucalyptus viminalis é listado pela primeira vez como hospedeiro de B. occidentalis.Nota científica

An annotated checklist of the jumping plant-lice (Insecta: Hemiptera: Psylloidea) from the Mercantour National Park, with seven new records for France and one new synonymy

A total of 68 psyllid species are listed from the Mercantour National Park in Southeast France, where a targeted collecting campaign was conducted between 2009 and 2012, as part of the project "ATBI+M" Mercantour. The insects were collected using Malaise traps, flight intercept traps and sweep nets to sample in the vegetation. Additional information on distribution, biology and host-plants is provided for each species. Seven species are recorded for the first time from France: Craspedolepta artemisiae (Foerster, 1848), Craspedolepta nebulosa (Zetterstedt, 1828), Cacopsylla propinqua (Schaefer, 1949), Cyamophila prohaskai (Priesner, 1927), Eryngiofaga cf. refuga (Loginova, 1966), Bactericera parastriola Conci, Ossiannilsson & Tamanini, 1988 and Trioza flixiana Burckhardt & Lauterer, 2002. Trioza (Trioza) rapisardai Conci & Tamanini, 1984 is a new subjective synonym of Trioza brachyceraea Hodkinson & White, 1979, which was previously known only from the male holotype. The abundance, distribution and introduction status of some species are discussed

Heart valve replacement with the Björk-Shiley and St Jude Medical prostheses: A randomized comparison in 178 patients

In 178 patients, a randomized prospective comparison between the 60° spherical disc Björk-Shiley (BS) and the St Jude Medical (SJM) heart valve prostheses was performed. Four-week perioperative mortality was zero in the BS (n = 84) and 4.3% in the SJM group (n = 94). During a mean ( ± SD) follow-up of 52 ± 20 months or 778 patient-years, late cardiac mortality per year was 2.4% in the BS and 2.2% in the SJM group. The yearly thromboembolic rates were 1.4% in the BS and 2.0% in the SJM group. There was no mechanical valve failure or haemolytic anaemia. Paravalvular leaks and major bleeding complications occurred at low rates in both groups (1.1% and2.2% per year in BS; 0.7% and 1.7% per year in SJM). Functional results were similarly good with 96% of patients with BS valves and 95% of patients with SJM prostheses being in NYHA classes I and II, respectively. We conclude that heart valve replacement with mechanical prostheses can be performed with equally good results using either the Björk-Shiley spherical disc valve or the St Jude Medical bileaflet prosthesi

Effects of anti-ischaemic drug therapy in silent myocardial ischaemia type I: the Swiss Interventional Study on Silent Ischaemia type I (SWISSI I): a randomized, controlled pilot study

Aims To determine the effect of anti-ischaemic drug therapy on long-term outcomes of asymptomatic patients without coronary artery disease (CAD) history but silent exercise ST-depression. Methods and results In a randomized multicentre trial, 263 of 522 asymptomatic subjects without CAD but at least one CAD risk factor in whom silent ischaemia by exercise ECG was confirmed by stress imaging were asked to participate. The 54 (21%) consenting patients were randomized to anti-anginal drug therapy in addition to risk factor control (MED, n = 26) or risk factor control-only (RFC, n = 28). They were followed yearly for 11.2 ± 2.2 years. During 483 patient-years, cardiac death, non-fatal myocardial infarction, or acute coronary syndrome requiring hospitalization or revascularization occurred in 3 (12%) of MED vs. 17 (61%) of RFC patients (P < 0.001). In addition, MED patients had consistently lower rates of exercise-induced ischaemia during follow-up, and left ventricular ejection fraction remained unchanged (−0.7%, P = 0.597) in contrast to RFC patients in whom it decreased over time (−6.0%, P = 0.006). Conclusion Anti-ischaemic drug therapy and aspirin seem to reduce cardiac events in subjects with asymptomatic ischaemia type I. In such patients, exercise-induced ST-segment depression should be verified by stress imaging; if silent ischaemia is documented, anti-ischaemic drug therapy and aspirin should be considere

Material tipo de insectos en el Laboratorio de Sanidad Vegetal, SENASA, Lima, Perú

A list of the type material of Insecta deposited in the Laboratorio de Sanidad Vegetal, Servicio Nacional de Sanidad Agraria (SENASA), Lima, Peru, presented here includes 21 species of Psylloidea (Hemiptera), 4 of Cicadellidae (Hemiptera), 4 of Curculionidae (Coleoptera), and 2 of Tachinidae (Diptera), all of them from Peruvian localities. The types of Tachinidae described by Charles Townsend have not been included in this list.Se presenta la lista de material tipo de Insecta depositado en la colección del Laboratorio de Sanidad Vegetal, Servicio Nacional de Sanidad Agraria (SENASA), Lima, Perú, comprendiendo 21 especies de Psylloidea (Hemiptera), 4 de Cicadellidae (Hemiptera), 4 de Curculionidae (Coleoptera) y 2 de Tachinidae (Diptera), todas provenientes de localidades peruanas. Los tipos de Tachinidae descritos por Charles Townsend no han sido incluidos en esta relación