The surgeon’s role in transcatheter aortic valve implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) has evolved into a routine procedure for elderly high-risk patients with severe aortic stenosis in specialised centres. It can be performed via a transfemoral or a transapical approach. Both approaches are truly minimally invasive and avoid the use of cardio-pulmonary bypass and cardioplegic arrest. TAVI is associated with good outcome and acceptable complication rates. The outcome of TAVI has improved over the last few years as centres became more experienced in the procedure. Up to now there is no clear evidence-based benefit for one or the other approach. A careful patient selection for each approach is therefore crucial for good results. Both procedures should be performed by a heart team of cardiologists, cardiac surgeons and cardiac anaesthetists.The knowledge the cardiac surgeons gained over the last decades by treating aortic stenosis with conventional aortic valve replacement is very important in TAVI procedures: Not only in terms of the procedure itself, but also for preoperative patient screening. TAVI must be approached as a team effort where cardiologists and cardiac surgeons play an equal role and should not be performed without a cardiac surgeon

Structural, magnetic and mechanical properties of 5 µm thick SmCo films for use in Micro-Electro-Mechanical-Systems

5µm thick SmCo films were deposited onto Si substrates using triode sputtering. A study of the influence of deposition temperature (Tdep ≤ 600°C) on the structural, magnetic and mechanical properties has shown that optimum properties (highest degree of in-plane texture, maximum in-plane coercivity and remanence (1.3 and 0.8 T, respectively), no film peel-off) are achieved for films deposited at the relatively low temperature of 350°C. This temperature is compatible with film integration into Micro-Electro-Mechanical-Systems (MEMS). The deposition rate was increased from 3.6 to 18 µm/h by increasing the surface area of the target from 7 to 81 cm2. Mechanically stable films could be prepared by deposition onto pre-patterned films or deposition through holes in a mask

High performance hard magnetic NdFeB thick films for integration into Micro-Electro-Mechanical-Systems

5$\mu$m thick NdFeB films have been sputtered onto 100 mm Si substrates using high rate sputtering (18 $\mu$m/h). Films were deposited at ≤ 500 C and then annealed at 750 C for 10 minutes. While films deposited at temperatures up to 450 C have equiaxed grains, the size of which decreases with increasing deposition temperature, the films deposited at 500 C have columnar grains. The out-of-plane remanent magnetization increases with deposition temperature, reaching a maximum value of 1.4 T, while the coercivity remains constant at about 1.6 T. The maximum energy product achieved (400 kJ/m3) is comparable to that of high-quality NdFeB sintered magnets

New planar nano-gauge detection microphone: Analytical and numerical acoustic modeling

International audienceThe miniaturization of microphones is of great interest for several fields, such as medical applications (audio implants), or consumer electronics (cell phones). Almost all existing miniature microphones rely on electrostatic transduction and offer good performances (sensitivity, frequency bandwidth). However, their sensitivity, proportional to the membranes area, would be dramatically reduced in case of extreme miniaturization. A new concept of microphones developed by CEA-LETI, which uses membranes moving in the plane of the substrate and inducing strain on piezoresistive Si nano-gauges (M&NEMS technology), seems promising for its miniaturization potential without significant decrease of sensitivity. The design and optimization of such planar piezo-resistive microphone require a deep understanding of its acoustic and vibroacoustic behavior. Regarding the small dimensions of the slits (1-100µm) and the sharp discontinuities in the microphones structure, viscous and thermal effects in the boundary layers and turbulent perturbations are of great importance, and must then be taken into account with high accuracy in device modeling. The aim of the present work is to provide accurate analytical and numerical (FEM) models able to gather all these effects in a consistent manner, and to suggest an experimental method to check their validity

Development and validation of explainable machine learning models for risk of mortality in transcatheter aortic valve implantation: TAVI risk machine scores.

AIMS Identification of high-risk patients and individualized decision support based on objective criteria for rapid discharge after transcatheter aortic valve implantation (TAVI) are key requirements in the context of contemporary TAVI treatment. This study aimed to predict 30-day mortality following TAVI based on machine learning (ML) using data from the German Aortic Valve Registry. METHODS AND RESULTS Mortality risk was determined using a random forest ML model that was condensed in the newly developed TAVI Risk Machine (TRIM) scores, designed to represent clinically meaningful risk modelling before (TRIMpre) and in particular after (TRIMpost) TAVI. Algorithm was trained and cross-validated on data of 22 283 patients (729 died within 30 days post-TAVI) and generalisation was examined on data of 5864 patients (146 died). TRIMpost demonstrated significantly better performance than traditional scores [C-statistics value, 0.79; 95% confidence interval (CI)] [0.74; 0.83] compared to Society of Thoracic Surgeons (STS) with C-statistics value 0.69; 95%-CI [0.65; 0.74]). An abridged (aTRIMpost) score comprising 25 features (calculated using a web interface) exhibited significantly higher performance than traditional scores (C-statistics value, 0.74; 95%-CI [0.70; 0.78]). Validation on external data of 6693 patients (205 died within 30 days post-TAVI) of the Swiss TAVI Registry confirmed significantly better performance for the TRIMpost (C-statistics value 0.75, 95%-CI [0.72; 0.79]) compared to STS (C-statistics value 0.67, CI [0.63; 0.70]). CONCLUSION TRIM scores demonstrate good performance for risk estimation before and after TAVI. Together with clinical judgement, they may support standardised and objective decision-making before and after TAVI

Bone autografting of the calvaria and craniofacial skeleton: Historical background, surgical results in a series of 15 patients, and review of the literature

BACKGROUND Although the use of autologous bone for reconstruction of the cranial and facial skeleton underwent a partial reappraisal following the introduction of a vast range of alloplastic materials for this purpose, it has demonstrated definite advantages over the last century and, particularly, during the last decade. METHODS Fifteen patients underwent cranial and/or cranio-facial reconstruction using autologous bone grafting in the Department of Neurologic Sciences-Neurosurgery and the Division of Maxillo-Facial Surgery of the Rome "La Sapienza" University between 1987 and 1995. This group of patients consisted of 8 females and 7 males whose average age was 29.5 years (range 7.5 to 59 years, mean age 30). In all these patients cranioplasty and/or cranio-facial reconstruction had been performed to repair bone defects secondary to benign tumors or tumor-like lesions (12 cases), trauma (2 cases), or, in the remaining case, to wound infection after craniotomy for a neurosurgical operation. RESULTS The results obtained in a series of 15 patients treated using this method are described with reference to the abundant data published on this topic. CONCLUSION The mechanical, immunologic, and technical-grafting properties of autologous bone, together with its superior esthetic and psychological effects, probably make it the best material for cranioplasty

Orbital effects of a monochromatic plane gravitational wave with ultra-low frequency incident on a gravitationally bound two-body system

We analytically compute the long-term orbital variations of a test particle orbiting a central body acted upon by an incident monochromatic plane gravitational wave. We assume that the characteristic size of the perturbed two-body system is much smaller than the wavelength of the wave. Moreover, we also suppose that the wave's frequency is much smaller than the particle's orbital one. We make neither a priori assumptions about the direction of the wavevector nor on the orbital geometry of the planet. We find that, while the semi-major axis is left unaffected, the eccentricity, the inclination, the longitude of the ascending node, the longitude of pericenter and the mean anomaly undergo non-vanishing long-term changes. They are not secular trends because of the slow modulation introduced by the tidal matrix coefficients and by the orbital elements themselves. They could be useful to indepenedently constrain the ultra-low frequency waves which may have been indirectly detected in the BICEP2 experiment. Our calculation holds, in general, for any gravitationally bound two-body system whose characteristic frequency is much larger than the frequency of the external wave. It is also valid for a generic perturbation of tidal type with constant coefficients over timescales of the order of the orbital period of the perturbed particle.Comment: LaTex2e, 24 pages, no figures, no tables. Changes suggested by the referees include

First upper limits from LIGO on gravitational wave bursts

We report on a search for gravitational wave bursts using data from the first science run of the LIGO detectors. Our search focuses on bursts with durations ranging from 4 ms to 100 ms, and with significant power in the LIGO sensitivity band of 150 to 3000 Hz. We bound the rate for such detected bursts at less than 1.6 events per day at 90% confidence level. This result is interpreted in terms of the detection efficiency for ad hoc waveforms (Gaussians and sine-Gaussians) as a function of their root-sum-square strain h_{rss}; typical sensitivities lie in the range h_{rss} ~ 10^{-19} - 10^{-17} strain/rtHz, depending on waveform. We discuss improvements in the search method that will be applied to future science data from LIGO and other gravitational wave detectors.Comment: 21 pages, 15 figures, accepted by Phys Rev D. Fixed a few small typos and updated a few reference

Neural Correlates of Ongoing Conscious Experience: Both Task-Unrelatedness and Stimulus-Independence Are Related to Default Network Activity

The default mode network (DMN) is a set of brain regions that consistently shows higher activity at rest compared to tasks requiring sustained focused attention toward externally presented stimuli. The cognitive processes that the DMN possibly underlies remain a matter of debate. It has alternately been proposed that DMN activity reflects unfocused attention toward external stimuli or the occurrence of internally generated thoughts. The present study aimed at clarifying this issue by investigating the neural correlates of the various kinds of conscious experiences that can occur during task performance. Four classes of conscious experiences (i.e., being fully focused on the task, distractions by irrelevant sensations/perceptions, interfering thoughts related to the appraisal of the task, and mind-wandering) that varied along two dimensions (“task-relatedness” and “stimulus-dependency”) were sampled using thought-probes while the participants performed a go/no-go task. Analyses performed on the intervals preceding each probe according to the reported subjective experience revealed that both dimensions are relevant to explain activity in several regions of the DMN, namely the medial prefrontal cortex, posterior cingulate cortex/precuneus, and posterior inferior parietal lobe. Notably, an additive effect of the two dimensions was demonstrated for midline DMN regions. On the other hand, lateral temporal regions (also part of the DMN) were specifically related to stimulus-independent reports. These results suggest that midline DMN regions underlie cognitive processes that are active during both internal thoughts and external unfocused attention. They also strengthen the view that the DMN can be fractionated into different subcomponents and reveal the necessity to consider both the stimulus-dependent and the task-related dimensions of conscious experiences when studying the possible functional roles of the DMN

PrfA regulation offsets the cost of Listeria virulence outside the host.

Virulence traits are essential for pathogen fitness, but whether they affect microbial performance in the environment, where they are not needed, remains experimentally unconfirmed. We investigated this question with the facultative pathogen L isteria monocytogenes and its PrfA virulence regulon. PrfA‐regulated genes are activated intracellularly (PrfA ‘ON’) but shut down outside the host (PrfA ‘OFF’). Using a mutant PrfA regulator locked ON (PrfA*) and thus causing PrfA‐controlled genes to be constitutively activated, we show that virulence gene expression significantly impairs the listerial growth rate (μ) and maximum growth (A) in rich medium. Deletion analysis of the PrfA regulon and complementation of a L. monocytogenes mutant lacking all PrfA‐regulated genes with PrfA* indicated that the growth reduction was specifically due to the unneeded virulence determinants and not to pleiotropic regulatory effects of PrfA ON. No PrfA*‐associated fitness disadvantage was observed in infected eukaryotic cells, where PrfA‐regulated virulence gene expression is critical for survival. Microcosm experiments demonstrated that the constitutively virulent state strongly impaired L . monocytogenes performance in soil, the natural habitat of these bacteria. Our findings provide empirical proof that virulence carries a significant cost to the pathogen. They also experimentally substantiate the assumed, although not proven, key role of virulence gene regulation systems in suppressing the cost of bacterial virulence outside the host