Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance?

ObjectiveWe designed this study to evaluate the early hemodynamic performance of the recently introduced Carpentier-Edwards PERIMOUNT Magna bioprosthesis (Edwards Lifesciences, Irvine, Calif) and compare it with those of the conventional Carpentier-Edwards PERIMOUNT stented bioprosthesis (Edwards Lifesciences) and Edwards Prima Plus porcine stentless bioprosthesis (Edwards Lifesciences).MethodsSixty-three patients (>70 years old) were enrolled in this prospective, randomized study. At operation, once the annulus had been measured, the best size suitable was assessed for each of the three valves before random assignment. Transthoracic echocardiography was performed before discharge to evaluate early postoperative hemodynamic performances of the different valves implanted.ResultsThe best size suitable of Edwards Prima Plus (24.3 ± 1.7 mm) was significantly superior to those of both the Carpentier-Edwards PERIMOUNT Magna (23.4 ± 2.1 mm) and Carpentier-Edwards PERIMOUNT (22.4 ± 1.8 mm). The best size suitable of the Carpentier-Edwards PERIMOUNT Magna, however, was significantly superior to that of the Carpentier-Edwards PERIMOUNT. Furthermore the best size suitable of the Carpentier-Edwards PERIMOUNT Magna was equal to the measured annulus in 55% of patients, as opposed to 25% for the Carpentier-Edwards PERIMOUNT (P < .001). Mean implanted labeled size of the Edwards Prima Plus was significantly higher than those of both the Carpentier-Edwards PERIMOUNT Magna and the Carpentier-Edwards PERIMOUNT (24.6 ± 1.9 mm, 23.1 ± 1.9 mm, and 22.5 ± 1.8 mm, respectively). Early postoperative hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna, however, was superior to those of both the Edwards Prima Plus and the Carpentier-Edwards PERIMOUNT in both effective orifice area index (1.07 ± 0.4 cm2/m2, 0.87 ± 0.3 cm2/m2, and 0.80 ± 0.2 cm2/m2, respectively) and mean peak gradient (20 ± 6 mm Hg, 27 ± 8 mm Hg, and 28 ± 12 mm Hg, respectively).ConclusionThe improved design of the recently introduced third-generation stented bioprosthesis Carpentier-Edwards PERIMOUNT Magna allows implantation of a significantly bigger valve than with the old generation. Furthermore, the improved hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna compares favorably with both the Carpentier-Edwards PERIMOUNT and the Edwards Prima Plus

The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome

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Linked-Stick: Conveying a Physical Experience using a Shape-Shifting Stick

We use sticks as tools for a variety of activities, everything from conducting music to playing sports or even engage in combat. However, these experiences are inherently physical and are poorly conveyed through traditional digital mediums such as video. Linked-Stick is a shape-changing stick that can mirror the movements of another person's stick-shape tool. We explore how this can be used to experience and learn music, sports and fiction in a more authentic manner. Our work attempts to expand the ways in which we interact with and learn to use tools

Initial Testing of an Approximated, Fast Calculation Procedure for Personalized Dosimetry in Radionuclide Therapy Based on Planar Whole-Body Scan and Monte-Carlo Specific Dose Rates from the OpenDose Project

Individualized dosimetry in nuclear medicine is currently at least advisable in order to obtain the best risk–benefit balance in terms of the maximal dose to lesions and under-threshold doses to radiosensitive organs. This article aims to propose a procedure for fast dosimetric calculations based on planar whole-body scintigraphy (WBS) images and developed to be employed in everyday clinical practice. Methods: For simplicity and legacy reasons, the method is based on planar imaging dosimetry, complemented with some assumptions on the radiopharmaceutical kinetics empirically derived from single-photon emission tomography/computed tomography (SPECT/CT) image analysis. The idea is to exploit a rough estimate of the time-integrated activity as has been suggested for SPECT/CT dosimetry but using planar images. The resulting further reduction in dose estimation accuracy is moderated by the use of a high-precision Monte-Carlo S-factor, such as those available within the OpenDose project. Results: We moved the problem of individualized dosimetry to a transformed space where comparing doses was imparted to the ICRP Average Male/Female computational phantom, resulting from an activity distribution related to patient’s pharmaceutical uptake. This is a fast method for the personalized dosimetric evaluation of radionuclide therapy, bearing in mind that the resulting doses are meaningful in comparison with thresholds calculated in the same framework. Conclusion: The simplified scheme proposed here can help the community, or even the single physician, establish a quantitative guide-for-the-eye approach to individualized dosimetry

Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

Purpose The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade &gt;= 2).Methods This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients.Results 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naive (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p &lt; 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG &gt;= 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS &gt;= 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively.Conclusions Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions.Trial registration The present study was registered at ClinicalTrials.gov number: NCT05078359

Data monitoring roadmap. The experience of the Italian Multiple Sclerosis and Related Disorders Register

Introduction Over the years, disease registers have been increasingly considered a source of reliable and valuable population studies. However, the validity and reliability of data from registers may be limited by missing data, selection bias or data quality not adequately evaluated or checked.This study reports the analysis of the consistency and completeness of the data in the Italian Multiple Sclerosis and Related Disorders Register.MethodsThe Register collects, through a standardized Web-based Application, unique patients.Data are exported bimonthly and evaluated to assess the updating and completeness, and to check the quality and consistency. Eight clinical indicators are evaluated.ResultsThe Register counts 77,628 patients registered by 126 centres. The number of centres has increased over time, as their capacity to collect patients.The percentages of updated patients (with at least one visit in the last 24 months) have increased from 33% (enrolment period 2000-2015) to 60% (enrolment period 2016-2022). In the cohort of patients registered after 2016, there were &gt;= 75% updated patients in 30% of the small centres (33), in 9% of the medium centres (11), and in all the large centres (2).Clinical indicators show significant improvement for the active patients, expanded disability status scale every 6 months or once every 12 months, visits every 6 months, first visit within 1 year and MRI every 12 months.ConclusionsData from disease registers provide guidance for evidence-based health policies and research, so methods and strategies ensuring their quality and reliability are crucial and have several potential applications

Modeling piston secondary motion and skirt lubrication with applications

Thesis: S.M., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2014.Cataloged from PDF version of thesis.Includes bibliographical references (pages 97-100).The interest in reducing emission and improving engine efficiency has become a major push in industry, due to upcoming stricter regulations. A great deal of attention has been given to the frictional losses due to piston and liner interaction, as they represent a significant portion of the total mechanical losses. This thesis work focuses on further development and application of an existing model for the piston's secondary motion and skirt lubrication. Model development has been focused on introducing liner dynamic deformation, temperature and shear-thinning effect on viscosity, and arbitrary skirt's shape definition. The theory behind the inclusion of these components is discussed and the modifications to the existing model are explained. In regards to the model's applications, an important topic is the model validation, for which friction results from simulations are compared with experimental results obtained on a floating liner engine. The analysis covers the running condition of 1000 rpm, at partial and full load. This study is, however, not concluded and more cases need to be studied in order to complete the validation of the model. The second application focuses on the effects of geometrical patterns on the skirt on friction and secondary motion of the piston. First, some regular patterns were studied and found to have negative effects on friction due to their inability to build sufficient hydrodynamic pressure, compared to the baseline design. Then, a different sets of patterns were proposed to more effectively utilize available oil and to maximize the hydrodynamic pressure generation in the skirt region. The results show that new strategy can significantly reduce friction of the skirt without introducing negative impact on the secondary motion. This thesis work aims to make the model a more complete and powerful tool to understand piston's secondary motion and the applications are meant to show the capabilities of the model, as an instrument to approach piston's design and inspire new ways and ideas to reduce frictional losses.by Pasquale Totaro.S.M