Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis

BACKGROUND: To identify predictors of long-term outcome after balloon aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78 +/- 9 years; 56% were women) undergoing this procedure at 24 clinical centers who had a mean initial increase in aortic valve area of 0.3 cm2. METHODS AND RESULTS: Baseline data included clinical, echocardiographic, and catheterization variables. Follow-up data included mortality, cause of death, rehospitalization, 6-month echocardiography, and functional status. Kaplan-Meier curves and log-rank tests were used to evaluate survival in subgroups. Multivariate Cox regression models were used to identify independent predictors of survival. Overall survival was 55% at 1 year, 35% at 2 years, and 23% at 3 years, with the majority of deaths (70%) classified as cardiac by an independent review committee. Rehospitalization was common (64%), although 61% of survivors at 2 years reported improved symptoms. Echocardiography at 6 months (n = 115) showed restenosis from the postprocedural valve area of 0.78 +/- 0.31 cm2 to 0.65 +/- 0.25 cm2 (P < .0001). With stepwise multivariate analysis, sequentially adding clinical, echocardiographic, and catheterization variables, the overall model identified independent predictors of survival as baseline functional status, baseline cardiac output, renal function, cachexia, female gender, left ventricular systolic function, and mitral regurgitation. Baseline and postprocedural variables were examined to identify which subgroup of patients has the best outcome after aortic valvuloplasty. A "lower-risk" subgroup (28% of the study population), defined by normal left ventricular systolic function and mild clinical functional limitation, had a 3-year survival of 36% compared with 17% in the remainder of the study group. CONCLUSIONS: Long-term survival after balloon aortic valvuloplasty is poor with 1- and 3-year survival rates of 55% and 23%, respectively. Although survivors report fewer symptoms, early restenosis and recurrent hospitalization are common.     

Synthesis,structural and optical properties of nanoparticles (Al,V) co-doped zinc oxide

The synthesis by the sol–gel method, structural and optical properties of ZnO, Zn_0.99Al_0.01O (AlZ), Zn_0.9V_0.1O (VZ) and Zn_0.89Al_0.01V_0.1O (AlVZ) nanoparticles was reported. The approach was slow release of water for hydrolysis by esterification reaction followed by a supercritical drying in ethyl alcohol. After thermal treatment at 500^°C in air, the obtained nanopowders were characterized by various techniques such as transmission electron microscopy, X-ray diffraction and photoluminescence (PL) spectroscopy. The structural properties showed that the ZnO nanoparticles with an average particle size of 25 nm exhibit hexagonal wurtzite structure. From the optical studies, it was found that the optical band gap was located between 2.97 and 3.17 eV. The obtained electrical properties showed the potential application of the samples in optoelectronic devices. The powder of AlVZ presented a strong luminescence band in the visible range. The PL band energy position presented a small blue shift with the increase of measurement temperature. Different possible attributions of this emission band will be discussed.     

Refining the level for anticipated hepatotoxicity in acetaminophen poisoning

Treatment of an acetaminophen overdose with N-acetyl cysteine usually is based on the position of the 4-h acetaminophen (APAP) level on the Rumack-Matthew nomogram; however, there is disagreement on the level at which clinically relevant hepatotoxicity occurs. A retrospective review of all acute adult formulation APAP exposures reported to our poison center between 1986 and 1993 was performed and cases corresponding to the "possible risk or toxicity" range on the nomogram were identified. Our current poison center protocol for APAP poisoning does not recommend treatment with N-acetylcysteine (NAC) in low-risk patients if the 4-h serum APAP level or the extrapolated equivalent falls within the possible toxicity range on the nomogram. Seventeen cases met the inclusion criteria for the study and received no NAC; six additional patients met inclusion criteria but received one or two doses of NAC before therapy was discontinued. No patients in either group demonstrated clinical evidence of hepatotoxicity. This pilot study suggests that patients with no risk factors and APAP levels in the "possible risk" range may not require NAC therapy.     

Intelligent security and access control framework for service-oriented architecture

One of the most significant difficulties with developing Service-Oriented Architecture (SOA) involves meeting its security challenges, since the responsibilities of SOA security are based on both the service providers and the consumers. In recent years, many solutions to these challenges have been implemented, such as the Web Services Security Standards, including WS-Security and WS-Policy. However, those standards are insufficient for the new generation of Web technologies, including Web 2.0 applications. In this research, we propose an intelligent SOA security framework by introducing its two most promising services: the Authentication and Security Service (NSS), and the Authorization Service (AS). The suggested autonomic and reusable services are constructed as an extension of WS-¹ security standards, with the addition of intelligent mining techniques, in order to improve performance and effectiveness. In this research, we apply three different mining techniques: the Association Rules, which helps to predict attacks, the Online Analytical Processing (OLAP) Cube, for authorization, and clustering mining algorithms, which facilitate access control rights representation and automation. Furthermore, a case study is explored to depict the behavior of the proposed services inside an SOA business environment. We believe that this work is a significant step towards achieving dynamic SOA security that automatically controls the access to new versions of Web applications, including analyzing and dropping suspicious SOAP messages and automatically managing authorization roles.     

Collection and transfusion of blood and blood components in the United States, 1989

A poor response to L-DOPA in addition to parkinsonian, cerebellar, and autonomic signs is commonly regarded as indicative of clinical multiple system atrophy (MSA). We compared the motor response to a single oral administration of 250 mg L-DOPA/25 mg carbidopa in eight MSA patients and eight Parkinson's disease (PD) patients with the "on-off" phenomenon, evaluating L-DOPA peripheral pharmacokinetics. Motor response was consistently good in all PD patients, but only four MSA patients had a (moderate) response. Pharmacokinetic parameters did not differ between the groups. The varying extent of putaminal damage could be responsible for the differing motor response to L-DOPA in MSA patients.     

弃武从文的卡司克

<正>不必质疑卡司克的精密、耐用和可靠程度,因为孕育它的母体可是战争中那把直接致命的武器——左轮手枪。"我打赌你以前没有拿过枪。"面对着正在把玩.32口径左轮手枪的乔恩·索洛萨巴尔(Jon Solozabal),很难相信这句话竟是一位文具制造商的开场白。对乔恩和他的这座超过90岁的企业王国而言,手枪所代表的不仅是一段历史,更是一笔宝贵的遗产。     

Sensors and observers in distributed parameter systems

Luenberger observer theory is extended to distributed parameter systems. This extension is based on the consideration of sensors. For systems with infinite dimensional state spaces, it is possible to construct the state vector asymptotically (or a part of the state vector) by a ‘good’ choice of sensors. We show that the link between detectability and sensor structure may be of some interest in the construction of observers.     

Multi-laboratory evaluations of the performance of Catellicoccus marimammalium PCR assays developed to target gull fecal sources

Here we report results from a multi-laboratory (n = 11) evaluation of four different PCR methods targeting the 16S rRNA gene of Catellicoccus marimammalium originally developed to detect gull fecal contamination in coastal environments. The methods included a conventional end-point PCR method, a SYBR^® Green qPCR method, and two TaqMan^® qPCR methods. Different techniques for data normalization and analysis were tested. Data analysis methods had a pronounced impact on assay sensitivity and specificity calculations. Across-laboratory standardization of metrics including the lower limit of quantification (LLOQ), target detected but not quantifiable (DNQ), and target not detected (ND) significantly improved results compared to results submitted by individual laboratories prior to definition standardization. The unit of measure used for data normalization also had a pronounced effect on measured assay performance. Data normalization to DNA mass improved quantitative method performance as compared to enterococcus normalization. The MST methods tested here were originally designed for gulls but were found in this study to also detect feces from other birds, particularly feces composited from pigeons. Sequencing efforts showed that some pigeon feces from California contained sequences similar to C. marimammalium found in gull feces. These data suggest that the prevalence, geographic scope, and ecology of C. marimammalium in host birds other than gulls require further investigation. This study represents an important first step in the multi-laboratory assessment of these methods and highlights the need to broaden and standardize additional evaluations, including environmentally relevant target concentrations in ambient waters from diverse geographic regions.     

Plasma ignition threshold disparity between silver nanoparticle-based target and bulk silver target at different laser wavelengths

Plasma ignition threshold of nanoparticle-based and bulk silver targets was measured in air. The plasma was initiated by a Nd:YAG laser at wavelengths of 355, 532, and 1064 nm. The plasma ignition was monitored utilizing the prominent Ag I line at 546.5 nm. Lower ignition thresholds of the nanoparticle-based silver target were estimated at 0.4?±?0.02, 0.34?±?0.04, and 0.27?±?0.035 J cm~(-2) coupled with the different laser wavelengths, respectively. In contrast, the bulk silver target plasma exhibited an order of magnitude higher ignition threshold. A three orders of magnitude enhanced emission intensity from the nano-based target over the bulk target was achieved at lower levels of laser irradiation. A reduction of the thermal diffusion length of the nanosilver was assumed in order to theoretically predict this reduction in the plasma threshold. In addition, the effect of self-reversal on the resonance lines was taken into consideration.