Mitral valve and left ventricular features in malignant mitral valve prolapse.

Objective: Mitral valve prolapse is a benign condition, however with occasional reports of sudden cardiac death or out-of-hospital cardiac arrest in the absence of severe mitral regurgitation or coronary artery disease, suggesting the existence of a malignant form. The objective of our study was to contribute to the characterisation of malignant mitral valve prolapse. Methods: We performed a retrospective analysis of pathology findings in 68 consecutive cases of sudden cardiac death with mitral valve prolapse as lone abnormal finding, reported as cause of death. Results: All mitral valve prolapse sudden death cases had mitral valve characteristics of Barlow disease, with extensive bileaflet multisegmental prolapse and dilatation of the annulus. The majority of cases (80.9%) had microscopic left ventricular fibrosis with associated hypertrophy and degenerative features of the myocytes, and some cases (10.9%) had right ventricular fibrosis as well. Conclusions: Malignant mitral valve prolapse is Barlow disease. Sudden cardiac death in mitral valve prolapse is due to Barlow disease, which besides the typical mitral valve degeneration may comprise a distinct Barlow disease cardiomyopathy, as suggested by myocyte degeneration and bi-ventricular involvement

LV Mechanics in Mitral and Aortic Valve Diseases: Value of Functional Assessment Beyond Ejection Fraction.

The assessment of myocardial function in the context of valvular heart disease remains highly challenging. The myocardium deforms simultaneously in 3 dimensions, and global left ventricular (LV) function parameters such as volume and ejection fraction may remain compensated despite the changes in myocardial deformation properties. Current guidelines recommend valve replacement/repair in the presence of symptoms or reduced LV ejection fraction, but the resolution of symptoms or recovery of LV function post-surgery may not be reliably predicted. A wealth of evidence currently suggests that LV dysfunction is frequently subclinical despite normal ejection fraction. It may precede the onset of symptoms and portend a poor outcome due to progressive myocardial remodeling and dysfunction during the post-operative period. The advent of novel tissue-tracking echocardiography techniques has unleashed new opportunities for the clinical identification of early abnormalities in LV function. This review gathers and summarizes current evidence regarding the use of these techniques to assess myocardial deformation in patients with valvular heart disease

Pumice and lapillus scraps: New national environmental-friendly chance for the production of ceramic tiles

Italian pumice and volcanic lapillus scraps have been used in different percentages as alternative raw materials to foreign feldspars in porcelain stoneware mixtures. The aim of this work was to create naturally colored support to limit the use of artificial dyes while maintaining the technical properties of the reference product. For this purpose, the significant presence of chromophores (Fe and Ti in particular) in by-products from extraction of Italian volcanic pumice and lapillus was exploited. The work was carried out in collaboration with a company: the products were made on a laboratory scale and then they were glazed and fired within the industrial production cycle (48 min, 1210 ◦C). The resulting slip and the fired samples were characterized by measuring the efflux time, density, linear shrinkage, water absorption and tensile strength to evaluate the technological performance. In addition, thermogravimetric analysis (TG), differential thermal analysis (DTA), and optical and mechanical dilatometry were performed to study the thermal behavior of the formulations. The obtained products could be classified as porcelain stoneware and belong to the BIa group (WA 0.5%, B. S.>35 MPa) in accordance with UNI EN 14411 ISO 13006

Randomized Load Balancing under Loosely Correlated State Information in Fog Computing

Fog computing infrastructures must support increasingly complex applications where a large number of sensors send data to intermediate fog nodes for processing. As the load in such applications (as in the case of a smart cities scenario) is subject to significant fluctuations both over time and space, load balancing is a fundamental task. In this paper we study a fully distributed algorithm for load balancing based on random probing of the neighbors' status. A qualifying point of our study is considering the impact of delay during the probe phase and analyzing the impact of stale load information. We propose a theoretical model for the loss of correlation between actual load on a node and stale information arriving to the neighbors. Furthermore, we analyze through simulation the performance of the proposed algorithm considering a wide set of parameters and comparing it with an approach from the literature based on random walks. Our analysis points out under which conditions the proposed algorithm can outperform the alternatives

Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review

Background: Intrapancreatic accessory spleen (IPAS) is an uncommon finding of pancreatic mass. Differential diagnosis with pancreatic tumor, especially with non-functional neuroendocrine tumor (NF-NET), may be very hard and sometimes it entails unnecessary surgery. A combination of CT scan, MRI, and nuclear medicine can confirm the diagnosis of IPAS. 68-Ga-Dotatoc PET/CT is the gold standard in NET diagnosis and it can allow to distinguish between IPAS and NET. Case presentation: A 69-year-old man was admitted to our hospital for an incidental nodule in the tail of the pancreas with focal uptake of 68-Ga-dotatate at PET/CT. NET was suspected and open distal splenopancreatectomy was performed. Pathologic examination revealed an IPAS. Conclusion: This is the second IPAS case in which a positive 68Ga-Dotatoc uptake led to a false diagnosis of pancreatic NET. Here is a proposal of a literature review

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve)

Impact of contractile reserve on acute response to cardiac resynchronization therapy

Background: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation. Methods: Fifty-one consecutive patients with heart failure (LV ejection fraction 27% ± 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume ≥15% after CRT. Results: Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p<0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p<0.0001). Conclusions: Heart failure patients referred to CRT have less chance of improving under therapy if they have no significant mitral regurgitation, no LV dyssynchrony and no contractile myocardial recruitment at exercise

Optical Performance of Ag-based Back Reflectors with different Spacers in Thin Film Si Solar Cells

Abstract We have compared different Ag-based back reflectors (BRs) applied to superstrate-type microcrystalline Si devices grown on Asahi U glass. In particular, substitution of the conventional ZnO:Al layer by MgF 2 , with lower refractive index and no free-carrier absorption, has been investigated. As electrical issues can mask the optical performance of the BR when evaluated by EQE measurements, a purely optical method that compares the intensity of Raman spectra generated with long wavelength excitation light has been applied. Based on this investigation, MgF 2 /Ag is potentially superior to ZnO:Al/Ag, even when MgF 2 is used in the form of ultrathin layer (few nm, likely island-like). Nevertheless, the novel dual-function n-SiO x /Ag BR outperforms all the other BRs

The value of adding sub-valvular procedures for chronic ischemic mitral regurgitation surgery: a meta-analysis.

BACKGROUND: The most performed repair technique for the treatment of chronic ischemic mitral regurgitation in patients referred for bypass grafting remains restricted annuloplasty. However, it is associated with a high rate of failure, especially if severe tenting exists. OBJECTIVES: To understand if adjunctive sub-valvular mitral procedures may provide better repair performance. METHODS: A systematic literature review identified six studies of which five fulfilled the criteria for meta-analysis. Outcomes for a total of 404 patients (214 had adjunctive sub-valvular procedures and 190 restricted annuloplasty) were meta-analyzed using random effects modeling. Heterogeneity and subgroup sensitivity analysis were assessed. Primary endpoints were: late recurrence of moderate mitral regurgitation, left ventricle remodeling and coaptation depth at follow-up. Secondary endpoints were: early mortality, mid-term survival and operative outcomes. RESULTS: Sub-valvular procedure technique was associated with a significantly lower late recurrence of mitral regurgitation (Odds ratio (OR) 0.34, 95% Confidence Interval (CI) [0.18, 0.65], p=0.0009), smaller left ventricle end-systolic diameter (Weighted Mean Difference (WMD) -4.06, 95% CI [-6.10, -2.03], p=0.0001) and reduced coaptation depth (WMD -2.36, 95% CI [-5.01, -0.71], p=0.009). These findings were consistent, even in studies that included patients at high risk for repair failure (coaptation depth >10 mm and tenting area >2.5 cm2). A low degree of heterogeneity was observed. There was no difference in terms of early mortality and mid-term survival; sub-valvular technique was associated with prolonged cardiopulmonary and cross-clamp time. CONCLUSIONS: Adding sub-valvular procedures when repairing ischemic chronic mitral valve regurgitation may be associated with better durability, even in the case of the presence of predictors for late failure. PERSPECTIVE: Surgical sub-valvular adjunctive procedures have to be considered in the case of the presence of echocardiographic predictors for late failure

Collapses and explosions in self-gravitating systems

Collapse and reverse to collapse explosion transition in self-gravitating systems are studied by molecular dynamics simulations. A microcanonical ensemble of point particles confined to a spherical box is considered; the particles interact via an attractive soft Coulomb potential. It is observed that the collapse in the particle system indeed takes place when the energy of the uniform state is put near or below the metastability-instability threshold (collapse energy), predicted by the mean-field theory. Similarly, the explosion in the particle system occurs when the energy of the core-halo state is increased above the explosion energy, where according to the mean field predictions the core-halo state becomes unstable. For a system consisting of 125 -- 500 particles, the collapse takes about $10^5$ single particle crossing times to complete, while a typical explosion is by an order of magnitude faster. A finite lifetime of metastable states is observed. It is also found that the mean-field description of the uniform and the core-halo states is exact within the statistical uncertainty of the molecular dynamics data.Comment: 9 pages, 14 figure