Surgical treatment of ventricular tachycardia after surgical repair of tetralogy of Fallot. Relation between intraoperative mapping and histological findings

BACKGROUND: The mechanism of ventricular tachycardia (VT) after correction of tetralogy of Fallot (TF) is poorly understood. The purpose of this study was to examine the histopathology of the arrhythmogenic area detected by intraoperative mapping. METHODS AND RESULTS: The patients were three men who underwent radical surgery for TF at age 3, 3, or 5 years, respectively. VT developed at 8, 9, or 11 years, respectively, after surgery, and shock developed during VT in every case. The ECG revealed monomorphic VT in two cases and polymorphic VT in one case. Induction of VT resulted in a wide left-axis deviation-pattern QRS with cycle lengths varying between 260 and 330 milliseconds. The VT origin was identified at the right ventricular outflow tract (RVOT). A radical operation was performed with the patient under cardiopulmonary bypass. On epicardial mapping, delayed activation of the RVOT was recorded during sinus rhythm, and clockwise circus movement of the macroreentry current during VT on the right ventricular free wall was documented in each case. The VTs were treated successfully by surgical resection and cryoablation of the myocardium. In every patient, histology of the myocardial specimens showed degeneration, adiposis, fibrosis, inflammatory cell infiltration, and scattered myocyte islets. These lesions corresponded anatomically to the area of myocardium in which delayed activation was evident during epicardial mapping. CONCLUSIONS: The results of this study indicate that patients with VT after radical correction of the TF have abnormal histopathological findings at the site of the prior right ventriculotomy scar. These lesions were noted within the region of delayed activation found during epicardial mapping and were found to be a part of the reentrant circuit.     

Properties of networks obtained by internal plasticization of epoxy resin with aromatic and aliphatic glycidyl compounds

In order to improve the fracture properties of p, p′-diaminodiphenylmethane-cured epoxy resin, various kinds of aromatic and aliphatic glycidyl compounds were investigated as a modifier at an amount of 30 wt %. Several compounds promoted the fracture toughness. In any glycidyl compounds, however, heat resistance was decreased by the modification. The dynamic mechanical properties of the modified epoxy resins were measured. The crosslinking density ρ was calculated from the theory of rubber elasticity, and the mechanical properties of the resins were discussed in regard to the crosslinking density. Tensile strength was scarcely affected by the crosslinking density. Elongation at break and Izod impact strength increased remarkably with decrease in crosslinking density. The fracture toughness K_Ic- increased with decrease in crosslinking density except at small ρ.     

Curvature continuous path generation for autonomous vehicle using B-spline curves

In this paper we introduce a roadmap algorithm for generating collision-free paths in terms of cubic B-spline curves for unmanned vehicles used in mining operations. The algorithm automatically generates collision-free paths that are curvature continuous with an upper bounded curvature and a small slope discontinuity of curvature at knots, when we are given the locations of the obstacles, the boundary geometry of the working area, positions and directions of the vehicle at the start, loading, and the goal points. Our algorithm also allows us to find a switch back point where the vehicle reverses its direction to enter the loading area. Examples are provided to demonstrate the effectiveness of the proposed algorithms.     

Tricuspid annuloplasty with Carpentier''s prosthetic ring in tricuspid insufficiency combined with mitral valve insufficiency

A case of bilateral hypernephroma treated by right heminephrectomy in situ and "benchwork" excision of two tumors from the left kidney followed by autotransplantation is presented. Follow-up examination has demonstrated good renal function with no evidence of tumor recurrence or metastasis. This case illustrates the feasibility of benchwork operation and its application to renal tumors, particularly when these tumors are bilateral and preservation of renal tissue is imperative. Long-term follow-up of patients managed by this technique is mandatory.     

Human behavior in a staircase during a total evacuation drill in a high‐rise building

Many studies have been conducted on the evacuation behavior on the staircases of buildings, but very little data are available for a situation with many occupants in a crowded high‐rise building. Therefore, this study investigated the evacuation behavior of a large number of evacuees on the staircase of a 25‐story high‐rise building. A total evacuation drill was conducted with 2088 evacuees, and the behavior of 1136 evacuees on the landings of the south staircase was recorded by a video recorder on the ceiling. The relationship between the density and speed of the evacuees on the landings was analyzed from the evacuation data for two situations: without and with merging in the stair flow. The evacuation stair flow in this drill had merging occupants entering from the floors, but no one entered from the lower floors during the latter period of the drill. Therefore, the flow during the latter period was treated as non‐merging flow, for which it was observed that, when the staircase was fully crowded, the density on the landings in the moving situation was different from that in the stopped situation. Moreover, the density on the landings was different from that on the treads. Furthermore, in the merging flow, a merging ratio of approximately 50:50 occurred during the congested evacuation. Copyright © 2016 John Wiley & Sons, Ltd.     

Enhanced crystallization of poly(lactide) stereocomplex by xylan propionate

The effect of xylan propionate (XylPr) as a novel biomass‐derived nucleating agent on the poly(lactide) sterecomplex was investigated. Addition of XylPr to an enantiomeric blend of poly(l ‐lactide) (PLLA) and poly(d ‐lactide) (PDLA) was performed in either the solution state or molten state. The solution blend of PLLA/PDLA with XylPr was prepared by mixing equal volumes of 1 wt% XylPr/PLLA and 1 wt% XylPr/PDLA solutions in chloroform and precipitating in methanol. The solution blend with XylPr showed shorter half‐time crystallization than the solution blend without XylPr in isothermal crystallization between 80 and 140 °C, although homocrystallization occurred. Enhanced stereocomplex crystallization in the solution blend with XylPr was observed at 180 °C, where no crystallization occurred in the solution blend without XylPr. Addition of XylPr to PLLA/PDLA blend in the molten state was performed at 240 °C. Thereafter, the melt blend of PLLA/PDLA with or without XylPr was either quenched in iced water or isothermally crystallized directly from the melt. Isothermal crystallization of the melt‐quenched blend with XylPr gave a similar result to the solution blend with XylPr. In contrast, the melt‐crystallized blend with XylPr formed only stereocomplex crystals after crystallization above 140 °C. Furthermore, the melt‐crystallized blend with XylPr showed a higher crystallinity index and melting temperature than the melt‐crystallized blend without XylPr. This shows that XylPr promotes stereocomplex crystallization only when the blend of PLLA/PDLA with XylPr is directly crystallized from the molten state just after blending. © 2016 Society of Chemical Industry     

Experimental study of bubbly swirling flow in a vertical tube using ultrasonic velocity profiler (UVP) and wire mesh sensor (WMS)

Two-phase air-water bubbly swirling flow through a pipe is a complex turbulent flow and its prediction is still challenging. The present paper describes the experimental investigation of the air-water bubbly swirling flow in vertical co-current flow. Swirling flow is induced by a twisted tape in a 20 mm inner diameter pipe. The flow is investigated using Ultrasonic velocity profiler (UVP), which allows the measurement of liquid and gas velocities simultaneously. Furthermore, simultaneous measurement of void fraction is performed using Wire mesh sensor (WMS). The experimental results reveal that swirling flow has significant impact on bubbles’ distribution. In low liquid flow rate, the average bubble velocity is fairly uniform along the radial position and void fraction increases in the near wall region. However, increasing liquid flow rate at constant gas flow rate leads to increase in void fraction in the core region, this is mainly due to drift velocity which is affected by centrifugal force. Experimental findings and parametric trends based on the effects of swirling flow are summarized and discussed.