Gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve.

AIM: The aim of this paper was to evaluate gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve. METHODS: During a 20 year period, 629 patients (median age 60 years) underwent mechanical aortic valve replacement with the CarboMedics valve. Of these, 215 patients were female (34%). The median follow-up for the entire cohort was 10.2 ± 6.2 years. RESULTS: In-hospital mortality for the entire cohort was 9% (male 7.3% vs. female 11.0%, P=0.005). Cox regression analysis revealed redo-surgery (HR=2.35, CI 1.35-4.08), LVEF<30% (HR=2.31, CI 1.36-3.93), age (HR=1.60, CI 1.27-2.02), as well as female gender (HR=2.07, CI 1.28-3.35) as independent predictors of survival. For male gender LVEF<30% (HR=2.47, CI 1.23-4.93) and age (HR=1.75, CI 1.25-2.43) were independent predictors of survival. For female gender, additional CABG (HR=2.15, CI 1.08-4.28), redo surgery (HR=3.64, CI 1.78-7.46) as well as age (HR=1.48, CI 1.06-2.06) were independent predictors of survival. CONCLUSION: Gender per se is an independent risk factor of survival after mechanical aortic valve replacement. Severely impaired LVEF independently predicts survival in males whereas additional CABG and redo surgery do in females. Age affects survival in both sexes. These findings may serve as a basis for further improving gender related outcome.

Cryogenic pellet launcher adapted for controlling of tokamak plasma edge instabilities.

One of the main challenges posed recently on pellet launcher systems in fusion-oriented plasma physics is the control of the plasma edge region. Strong energy bursts ejected from the plasma due to edge localized modes (ELMs) can form a severe threat for in-vessel components but can be mitigated by sufficiently frequent triggering of the underlying instabilities using hydrogen isotope pellet injection. However, pellet injection systems developed mainly for the task of ELM control, keeping the unwanted pellet fueling minimized, are still missing. Here, we report on a novel system developed under the premise of its suitability for control and mitigation of plasma edge instabilities. The system is based on the blower gun principle and is capable of combining high repetition rates up to 143 Hz with low pellet velocities. Thus, the flexibility of the accessible injection geometry can be maximized and the pellet size kept low. As a result the new system allows for an enhancement in the tokamak operation as well as for more sophisticated experiments investigating the underlying physics of the plasma edge instabilities. This article reports on the design of the new system, its main operational characteristics as determined in extensive test bed runs, and also its first test at the tokamak experiment ASDEX Upgrade.

Fine structure of type-I edge-localized modes in the steep gradient region.

Fast, high resolution multichannel Thomson scattering is used to quantitatively determine plasma perturbations induced by type-I edge-localized modes (ELMs) in the low-field side edge of ASDEX Upgrade H-mode plasmas. 2D snapshots of temperature and density, deduced from the laser light scattered in a vertically elongated, poloidal array of 5 x 10 scattering volumes, are obtained in the hot, steep edge gradient zone, which is difficult to access by other diagnostics. Local maxima and minima with large amplitude are identified during ELMs and even in the precursor phase, both in density and temperature. Interpreting these structures as footprints of approximately field aligned helical modes in accordance with previous experimental and theoretical work, toroidal mode numbers between 8 and 20 are obtained, roughly consistent with corresponding scrape-off layer and divertor measurements.

Nonaxisymmetric energy deposition pattern on ASDEX upgrade divertor target plates during type-I edge-localized modes.

In the ASDEX Upgrade tokamak, complex power deposition structures on the divertor target plates during type-I edge-localized modes (ELMs) have been discovered by fast (few microseconds), two-dimensional (40 x 40 cm(2)) infrared thermography. In addition to the usual axisymmetric power deposition line near the separatrix, there appear, statistically distributed, several laterally displaced and inclined stripes, mostly well separated from each other and from the main strike zone. These structures are interpreted as footprints of approximately field aligned, helical perturbations at the low field side of the main plasma edge related to the nonlinear ELM evolution. Based on this picture, the ELM related mode structure can be derived from the target load pattern, yielding on average toroidal mode numbers in a range of 8-24.

Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success.

BACKGROUND: Typical atrial flutter (AFL) results from right atrial reentry by propagation through an isthmus between the inferior vena cava (IVC) and tricuspid annulus (TA). We postulated that the eustachian valve and ridge (EVR) forms a line of conduction block between the IVC and coronary sinus (CS) ostium and forms a second isthmus (septal isthmus) between the TA and CS ostium. METHODS AND RESULTS: Endocardial mapping in 30 patients with AFL demonstrated atrial activation around the TA in the counter-clockwise direction (left anterior oblique projection). Double atrial potentials were recorded along the EVR in all patients during AFL. Pacing either side of the EVR during sinus rhythm also produced double potentials, which indicated fixed anatomic block across EVR. Entrainment pacing at the septal isthmus and multiple sites around the TA produced a delta return interval < or = 8 ms in 14 of 15 patients tested. Catheter ablation eliminated AFL in all patients by ablation of the septal isthmus in 26 patients and the posterior isthmus in 4. AFL recurred in 2 of 12 patients (mean follow-up, 33.9 +/- 16.3 months) in whom ablation success was defined by the inability to reinduce AFL, compared with none of 18 patients (mean follow-up, 10.3 +/- 8.3 months) in whom success required formation of a complete line of conduction block between the TA and the EVR, identified by CS pacing that produced atrial activation around the TA only in the counterclockwise direction and by pacing the posterior TA with only clockwise atrial activation. CONCLUSIONS: (1) The EVR forms a line of fixed conduction block between the IVC and the CS; (2) the EVR and the TA provide boundaries for the AFL reentrant circuit; and (3) verification of a complete line of block between the TA and the EVR is a more reliable criterion for long-term ablation success.

Sequential histamine inhalations cause increased bronchial histamine reactivity in guinea pigs: role of platelets, thromboxanes and prostacyclin.

Groups of 6-15 guinea pigs sensitized to ovalbumin were challenged by repeated inhalations of a constant histamine dose at time 0, 10, 20, 60 and 70 min. Bronchial obstruction was measured by whole body plethysmography. The degree of bronchial obstruction increased from one challenge to the other reaching maximal values after 70 min. This increase of bronchial responsiveness to histamine after repeated histamine challenges was reduced by pretreatment with clemastine (histamine H1-receptor antagonist, 0.12 mg/kg i.p., n = 7, P less than 0.05) and more effectively by combined clemastine/cimetidine pretreatment (combined H1-H2-receptor antagonists, 0.12 resp. 10 mg/kg, n = 7, P less than 0.001); pretreatment with acetylsalicylic acid (10 mg/kg orally) accelerated the increase of bronchial responsiveness to histamine (n = 9, P less than 0.01 at the second challenge), inhalation of prostacyclin (1 microgram) prior to each histamine inhalation prevented the increase of bronchial histamine sensitivity totally (n = 10, P less than 0.001), whereas inhibition of thromboxane biosynthesis (imidazol, 10 mg/kg i.p., n = 6; 4-[2-(1H-imidazol-1-yl)ethoxy]benzoic acid, 10 mg/kg i.p., n = 9; imidazo(1,5-a)pyridine-5-hexanoic acid, 1 mg/kg i.p., n = 8) as well as immunologic platelet depletion were ineffective in our test system. We conclude that prostacyclin inhibits the increase of bronchial responsiveness to histamine after sequential histamine inhalation challenges by a platelet independent mechanism. 1-(3-phenyl-2-propenyl)-1H-imidazol, the fourth type of thromboxane synthetase inhibitor tested (10 mg/kg i.p., n = 15) showed specific effects which may be attributed to antihistamine functions.

Histamine1--histamine2 antagonism: effect of combined clemastine and cimetidine pretreatment on allergen and histamine-induced reactions of the guinea pig lung in vivo and in vitro.

In a preliminary study high doses of the H1-antagonist clemastine (clem) and the H2-antagonist cimetidine (cim) were used in order to detect the side effects of both drugs on allergic reactions. After pretreatment with clem or clem/cim different guinea pigs were challenged with either OA or histamine. Bronchial obstruction was measured by body plethysmography using a new parameter ('compressed air'). Pretreatment with clem/cim in high doses protected guinea pigs against OA-induced bronchial obstruction much more effectively than H1-receptor antagonism alone; lower cim doses produced insignificant effects. In histamine-challenged animals cim showed no protective effects. In vitro clem/cim caused a marked reduction of histamine release measured in perfused lungs from 16.9 +/- 4.2 ng/ml (eight control cases) to 2.8 +/- 1.7 ng/ml (n = 8). Our preliminary data suggest that high doses of clem/cim can protect sensitized guinea pigs against allergen-induced bronchial obstruction by inhibiting histamine release.

Caffeine resistance of Saccharomyces cerevisiae.

Four caffeine-resistant haploid isolates, two resistant to 50 mM caffeine and two resistant to 100 mM caffeine, were genetically analyzed. Complementation and tetrad analysis indicated that all four mutations are alleles of the same locus. All four isolates demonstrated incomplete dominance when hybridized to the wild-type strain and dominance of high to low resistance when hybridized to one another. Differences in caffeine resistance were found between wild-type grande cells and its petite derivative.