Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only

The objective of our study was to assess the long-term outcome of patients with prosthetic valve endocarditis. We used a multicenter, prospective, observational study design. Six university teaching hospitals with high volume cardiothoracic surgery participated. Seventy-four patients with prosthetic valve endocarditis as defined by explicit, objective criteria were selected for participation. All patients were followed up prospectively for 1 year. Thirty-one percent and 69% had development of endocarditis within 60 days of valve insertion ("early") and after 60 days ("late"), respectively. The most common causes were Staphylococcus epidermidis (40%), Staphylococcus aureus (20%), streptococcal species (18%), and aerobic gram-negative bacilli (11%). Physical signs of endocarditis (new or changing murmur, stigmata, emboli) were seen in 58%. At 6 months and 12 months, mortality was 46% and 47%, respectively. Surgical replacement of the infected valve led to significantly lower mortality (23%) as compared with medical therapy alone (56%), as assessed by both univariate and multivariate analyses (p < 0.05). Improved outcome was seen for the surgical group even when controlling for severity of illness at time of diagnosis. From these findings we conclude that accurate assessment of outcome in prosthetic valve endocarditis requires long-term follow-up of at least 6 months following diagnosis. Surgical therapy warrants greater scrutiny; evaluation in controlled clinical trials is appropriate.     

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.     

Investigation of machining characteristics in rotary ultrasonic machining of alumina ceramic

Alumina ceramic is well documented as a much-demanded advanced ceramic in the present competitive structure of manufacturing and industrial applications owing to its excellent and superior properties. The current article aimed to experimentally investigate the influence of several process variables, namely: spindle speed, feed rate, coolant pressure, and ultrasonic power, on considered machining characteristics of interest, i.e., chipping size and material removal rate in the rotary ultrasonic machining of alumina ceramic. Response surface methodology has been employed in the form of a central composite rotatable design to design the experiments. Variance analysis testing has also been performed with a view to observing the consequence of the considered parameters. The microstructure of machined rod samples was evaluated and analyzed using a scanning electron microscope. This analysis has revealed and confirmed the presence of plastic deformation that caused removal of material along with brittle fractures in rotary ultrasonic machining of alumina ceramic. The validity and competence of the developed mathematical model have been verified with test results. The multi-response optimization of machining responses (material removal rate and chipping size) has also been attempted by employing a desirability approach, and at an optimized parametric setting the obtained experimental values for material removal rate and chipping size were 0.4166?mm³/s and 0.5134?mm, respectively, with a combined desirability index value of 0.849.     

Intelligent System Application to Monitor the Smart City Building Lighting

A smart city incorporates infrastructure methods that are environmentally responsible, such as smart communications, smart grids, smart energy, and smart buildings. The city administration has prioritized the use of cutting-edge technology and informatics as the primary strategy for enhancing service quality, with energy resources taking precedence. To achieve optimal energy management in the multidimensional system of a city tribe, it is necessary not only to identify and study the vast majority of energy elements, but also to define their implicit interdependencies. This is because optimal energy management is required to reach this objective. The lighting index is an essential consideration when evaluating the comfort indicators. In order to realize the concept of a smart city, the primary objective of this research is to create a system for managing and monitoring the lighting index. It is possible to identify two distinct phases within the intelligent system. Once data collection concludes, the monitoring system will be activated. In the second step, the operation of the control system is analyzed and its effect on the performance of the numerical model is determined. This evaluation is based on the proposed methodology. The optimized results were deemed satisfactory because they maintained the brightness index value (79%) while consuming less energy. The intelligent implementation system generated satisfactory outcomes, which were observed 1.75 times on average.     

磁盘空间占用“大户”查看我最行

当计算机系统长时间运行之后,很多人或许会感觉到系统速度会越来越慢,硬盘剩余空间也越来越小了。特别是一些喜欢下载软件或欣赏视频的用户,常常会感觉到硬盘空间就像是被病毒侵蚀一样不知不觉就被消耗光了。     

识别并管理企业的应用个性

很多时候,IT预算只是用来管理并运行企业的基础设施,而不是推动业务创新。不能适应当今迅速变化步伐的老旧系统和应用更加剧了这一问题。这种方式往往会导致企业发展停滞不前,且难以满足不断变化的业务需求。将现代化应用组合进行整合并转换到全新架构将能促进企业发展,能显著提高其敏捷性及创新能力。     

Atropine and exercise-induced bronchoconstriction

Six asthmatic children were studied to determine whether supplemental, parenteral atropine would increase the effects of bronchodilation and protection against exercise-induced bronchoconstriction after maximal effects had been achieved by inhalation. First, we determined the amount of inhaled atropine sulfate that would give maximal bronchodilation for each patient at rest. This quantity of atropine was designated as "A." Then all subjects exercised for five sessions with the following pre-exercise treatments in a random order: (a) inhaled distilled water plus intramuscular (IM) saline solution; (b) inhaled A dose of atropine plus IM saline solution; (c) inhaled distilled water plus 0.35 mg IM atropine; (d) inhaled A dose of atropine plus 0.35 mg IM atropine; and (e) inhaled double the A dose plus IM saline solution. The results showed that the combination of inhaled and IM atropine had the greatest bronchodilation effect and the greatest protection against exercise-induced bronchoconstriction. Atropine inhalation alone (A dose) or IM injection (0.35 mg) was not as effective in bronchodilation or in alleviation of exercise-induced bronchoconstriction. Doubling the dose of inhalation (2A) did not increase the effects of the A dose. These results support the hypothesis that inhaled atropine does not reach all the airways where cholinergic receptors are present.     

低VOC涂料用成膜助剂

随着环保法规的日益严格和人们环境质量意识的增强,研发新型材料,采用新工艺是降低VOC的有效途径。本文介绍了新型油酸类无溶剂型成膜助剂,能有效降低涂料中的VOC含量以及提高涂料相应性能。     

Measurement of thrombus formation on intravascular catheters

War is a complex social situation due to the interplay of multiple factors. Economical and political ones are of utmost importance, but human attitudes and motivations must be also taken into account. Being desirable to modify human transactions in such a way that they do not interfere with the basic right of everyone to a condition of physical and mental well-being, war must be abolished. The author contends that an understanding of behaviour through Psychology can be helpful in that aim. Aggression is considered the principal psychological cause of war. It is worth while to differentiate between aggression as an instrument for attaining a special end, and as pure hostility. Only in the first form, it is held here, does it play an important role in war. Psychogists must deal also with a wide range of states of mind that can be "served" by aggression: feelings of inferiority or insecurity, fear, greed, projections, compensations, rationalizations, etc. Scientific approach is not the only one Physiology brings to war prevention. It is equally important the wide dissemination of its conclusions among the general public. Information on the dynamics that prompt people to decide war would make it easier to control. This applies not only to political or military leaders, but also to civil populations. Concerning those two possible contributions of psychologists, scientific and educative, it is suggested the extensive use of psychodramatic techniques. Their richness lie in the lifelike experiences they convey to the participants, and particular aptitude to promote changes of attitudes. Investigation and information on the psychological processes related to war should be undertaken by international organizations of social scientists, acting simultaneously in several countries. Some of the initial steps they could further: 1) that prevention of war be a current subject matter in psychological courses; 2) that the World Health Organization take interest in this subject; 3) that psychologists participate in international political and economical bodies in order to clarify the psychological factors leading to war.