Selecting patients with nonischemic dilated cardiomyopathy for ICDs

No abstract available

Supply and demand for cereals in Nepal, 2010–2030:

This paper attempts to estimate the future supply and demand for cereals in Nepal. While there has been considerable research in the past examining the agricultural sector in Nepal, to the best of our knowledge there has been no analysis of the supply-demand scenario for food grains in the country. The analysis undertaken in this paper attempts to bridge this gap in the literature by estimating supply and demand models for the three most important cereals in Nepal's food basket: rice, wheat, and maize. The supply projections have been carried out on the basis of a single-crop production function model using data for the period 1995–2008. For estimating the demand function and projecting future demand, data from the Nepal Living Standards Survey II (NLSS II), undertaken in the year 2003/04, are used.cereal supply, cereal demand,

Recycling of RP Models by Solution - Casting Technique

Most of the Rapid Prototyping systems process polymeric materials for model making. Increased environmental concerns and waste minimization demands the recycle of these polymeric models. One way is to melt the models and cast it. However, in this method polymer degradation may occur leading to diminished functionality. In the present work a preliminary attempt has been made to reuse the polymer components by dissolving in a suitable solvent and casting the same into the required shape using soft tooling. Acrylonitrile Butadiene Styrene (ABS) polymer components, made by Fused Deposition Modeling (FDM) process were taken for the present studyMechanical Engineerin

Rapid Prototyping for Aerospace Launch Vehicles

Initial studies of the aerodynamic characteristics of proposed launch vehicles can be made more accurately if lower cost, high-fidelity aerodynamic models are available for wind tunnel testing early in design phase. Rapid Prototyping (RP) is an emerging key technology for producing accurate parts directly from CAD models quickly, with little need of human intervention. Use of RP models was studied at the NASA Marshall Space Flight Center (MSFC). It was concluded that RP methods and materials can be used only for preliminary design studies and limited configurations because of the RP material properties that allow bending of models under higher loading conditions. The reported results and analysis were based on wind tunnel balances. These balances give total load on the body. Thus, there is a need for studying the pressure distribution, the wave pattern and the system behavior under high-speed conditions. In order to study the above goals, a blunt nose cone of a launch vehicle/ missile was tested which was made using the solid based RP method FDM, with a Mach number of 2.0. It is concluded that RP models can take the load at the Mach number 2.0 and also can capture the pressure distribution and wave pattern.Mechanical Engineerin

Radiological and clinical evaluation of cockayne syndrome: A case report

Cockayne syndrome (CS) is a rare autosomal recessive disorder characterized by premature ageing (progeria), facial anomalies, cachectic dwarfism, mental retardation, cutaneous photosensitivity, and retinopathy, loss of adipose tissue and muscle, and neurological abnormality which are associated with the changes in the brain parenchyma. The findings of computed tomography scan and especially magnetic resonance imaging of the brain support the clinical diagnosis of CS. There is no permanent cure of this condition and death usually occurs in the 2nd or 3rd decade due to functional disability and multiple infections

Genetic Architecture of Acute Myocarditis and the Overlap With Inherited Cardiomyopathy.

Background: Acute myocarditis is an inflammatory condition that may herald the onset of dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM). We investigated the frequency and clinical consequences of DCM and ACM genetic variants in a population-based cohort of patients with acute myocarditis. Methods: This was a population-based cohort of 336 consecutive patients with acute myocarditis enrolled in London and Maastricht. All participants underwent targeted DNA sequencing for well-characterized cardiomyopathy-associated genes with comparison to healthy controls (n=1053) sequenced on the same platform. Case ascertainment in England was assessed against national hospital admission data. The primary outcome was all-cause mortality. Results: Variants that would be considered pathogenic if found in a patient with DCM or ACM were identified in 8% of myocarditis cases compared with <1% of healthy controls (P=0.0097). In the London cohort (n=230; median age, 33 years; 84% men), patients were representative of national myocarditis admissions (median age, 32 years; 71% men; 66% case ascertainment), and there was enrichment of rare truncating variants (tv) in ACM-associated genes (3.1% of cases versus 0.4% of controls; odds ratio, 8.2; P=0.001). This was driven predominantly by DSP-tv in patients with normal LV ejection fraction and ventricular arrhythmia. In Maastricht (n=106; median age, 54 years; 61% men), there was enrichment of rare truncating variants in DCM-associated genes, particularly TTN-tv, found in 7% (all with left ventricular ejection fraction <50%) compared with 1% in controls (odds ratio, 3.6; P=0.0116). Across both cohorts over a median of 5.0 years (interquartile range, 3.9–7.8 years), all-cause mortality was 5.4%. Two-thirds of deaths were cardiovascular, attributable to worsening heart failure (92%) or sudden cardiac death (8%). The 5-year mortality risk was 3.3% in genotype-negative patients versus 11.1% for genotype-positive patients (Padjusted=0.08). Conclusions: We identified DCM- or ACM-associated genetic variants in 8% of patients with acute myocarditis. This was dominated by the identification of DSP-tv in those with normal left ventricular ejection fraction and TTN-tv in those with reduced left ventricular ejection fraction. Despite differences between cohorts, these variants have clinical implications for treatment, risk stratification, and family screening. Genetic counseling and testing should be considered in patients with acute myocarditis to help reassure the majority while improving the management of those with an underlying genetic variant.post-print738 K

A model based on clinical parameters to identify myocardial late gadolinium enhancement by magnetic resonance in patients with aortic stenosis: An observational study

Objective With increasing age, the prevalence of aortic stenosis grows exponentially, increasing left heart pressures and potentially leading to myocardial hypertrophy, myocardial fibrosis and adverse outcomes. To identify patients who are at greatest risk, an outpatient model for risk stratification would be of value to better direct patient imaging, frequency of monitoring and expeditious management of aortic stenosis with possible earlier surgical intervention. In this study, a relatively simple model is proposed to identify myocardial fibrosis in patients with a diagnosis of moderate or severe aortic stenosis. Design Patients with moderate to severe aortic stenosis were enrolled into the study; patient characteristics, blood work, medications as well as transthoracic echocardiography and cardiovascular magnetic resonance were used to determine potential identifiers of myocardial fibrosis. Setting The Royal Brompton Hospital, London, UK Participants One hundred and thirteen patients in derivation cohort and 26 patients in validation cohort. Main outcome measures Identification of myocardial fibrosis. Results Three blood biomarkers (serum platelets, serum urea, N-terminal pro-B-type natriuretic peptide) and left ventricular ejection fraction were shown to be capable of identifying myocardial fibrosis. The model was validated in a separate cohort of 26 patients. Conclusions Although further external validation of the model is necessary prior to its use in clinical practice, the proposed clinical model may direct patient care with respect to earlier magnetic resonance imagining, frequency of monitoring and may help in risk stratification for surgical intervention for myocardial fibrosis in patients with aortic stenosis

When can heart failure treatment be stopped safely? – Authors' reply

No abstract available

Hypertrophic cardiomyopathy and ultra-endurance running - two incompatible entities?

Regular and prolonged exercise is associated with increased left ventricular wall thickness that can overlap with hypertrophic cardiomyopathy (HCM). Differentiating physiological from pathological hypertrophy has important implications, since HCM is the commonest cause of exercise-related sudden cardiac death in young individuals. Most deaths have been reported in intermittent 'start-stop' sports such as football (soccer) and basketball. The theory is that individuals with HCM are unable to augment stroke volume sufficiently to meet the demands of endurance sports and are accordingly 'selected-out' of participation in such events. We report the case of an ultra-endurance athlete with 25 years of > 50 km competitive running experience, with genetically confirmed HCM; thereby demonstrating that these can be two compatible entities

Magnetic resonance imaging: Physics basics for the cardiologist

Magnetic resonance imaging physics can be a complex and challenging topic for the practising cardiologist. Its evolving nature and the increasing number of novel sequences used in clinical scanning have been topics of excellent reviews; however, the basic understanding of physics underlying the creation of images remains difficult for many cardiologists. In this review, we go back to the basic physics theories underpinning magnetic resonance and explain their application and use in achieving good quality cardiac imaging, whilst describing established and novel magnetic resonance sequences. By understanding these basic principles, it is anticipated that cardiologists and other health professionals will then appreciate more advanced physics manuscripts on cardiac scanning and novel sequences