Perioperative Management of a Patient With Left Ventricular Free Wall Rupture After Myocardial Infarction: A Rare Case Scenario.

Myocardial infarction (MI) is typically followed by numerous lethal complications. One such complication is left ventricular free wall rupture (LVFWR). We present the case of a middle-aged hypertensive patient who had a history of unstable angina for seven days. He presented to the emergency room with chest pain, dyspnea, and unstable vital parameters. Clinical signs, electrocardiography, and echocardiography raised the suspicion of left ventricular free wall rupture with ST-segment elevation inferior wall and lateral wall MI. As a result, the patient received aggressive resuscitative measures. Later, he underwent surgical repair for cardiac rupture via cardiopulmonary bypass. Finally, the patient was discharged from the hospital on the 10th postoperative day. The window period from the onset of cardiac wall rupture to patient admission to the operating room is crucial. This case report highlights that a high index of suspicion for left ventricle free wall rupture should be considered for a patient presenting with MI and cardiogenic shock. Timely diagnosis and quick surgical intervention can deter complications and save the patient.

Annihilation and Control of Chiral Domain Walls with Magnetic Fields.

The control of domain walls is central to nearly all magnetic technologies, particularly for information storage and spintronics. Creative attempts to increase storage density need to overcome volatility due to thermal fluctuations of nanoscopic domains and heating limitations. Topological defects, such as solitons, skyrmions, and merons, may be much less susceptible to fluctuations, owing to topological constraints, while also being controllable with low current densities. Here, we present the first evidence for soliton/soliton and soliton/antisoliton domain walls in the hexagonal chiral magnet Mn1/3NbS2 that respond asymmetrically to magnetic fields and exhibit pair-annihilation. This is important because it suggests the possibility of controlling the occurrence of soliton pairs and the use of small fields or small currents to control nanoscopic magnetic domains. Specifically, our data suggest that either soliton/soliton or soliton/antisoliton pairs can be stabilized by tuning the balance between intrinsic exchange interactions and long-range magnetostatics in restricted geometries.

Prevalence of myocardial bridge in angiographic population-A study from rural part of western India.

INTRODUCTION: Intramural course of coronary artery is known as myocardial bridge (MB). Its prevalence is highly variable. Very few studies have been conducted in India, mostly from southern state and that too covering urban population. There are no studies from western India. In this study we aimed to estimate the prevalence of MB in coronary angiogram from rural part of western India. METHODS AND RESULTS: A total of 4,438 patients underwent coronary angiography for various indications during the study period of 69 months. Mean age of the study population was 53.6 ± 11.2 years. MB was found in 212 (4.77%) of patients, predominantly in males. Unstable angina was the most common presentation among males (28.7%), whereas chronic stable angina was being the most common presentation among females (22.6%). Majority of MBs were seen in left anterior descending artery in its mid part (61%). Mean diameter compression of the affected segment was 32.6% ± 11.8%, with no significant difference seen among males and females or between mid and distal left anterior descending artery. CONCLUSION: Our study showed the prevalence of MB similar to other Indian studies. Left anterior descending artery was most common artery involved. Mean compression was not statistically significant among either sex.

Electronic structure and lattice dynamics of Ba2CuTeO6 single crystals.

The electronic structure and lattice dynamics of Ba2CuTeO6 single crystals were investigated through spectroscopic ellipsometry and Raman scattering measurements. The room-temperature optical absorption spectrum of Ba2CuTeO6 presented a direct optical band gap at approximately 1.04 eV and exhibited four bands at approximately 1.45, 3.43, 4.65, and 5.79 eV. The optical absorption band at 1.45 eV was attributed to on-site Cu2+ d-d transition. The other bands were attributed to charge-transfer transitions between the O 2p and Cu 3d or Te 5p states. The room-temperature Raman scattering spectrum of Ba2CuTeO6 exhibited 16 phonon modes at approximately 85, 97, 104, 119, 160, 194, 380, 396, 404, 409, 492, 568, 574, 606, 679, and 751 cm-1. When the temperature decreased to less than 287 K, which is the temperature at which structural phase transition occurs from the monoclinic phase to the triclinic phase, additional phonon modes appeared at approximately 124, 128, 152, and 601 cm-1. On further cooling to lower than 75 and 15 K, which are the temperatures at which short- and long-range antiferromagnetic phase transitions occur, respectively, the phonon modes at approximately 97, 104, 124, 128, 152, 160, 194, 380, 396, 409, 568, 574, 606, and 679 cm-1 exhibited softening, which indicates a coupling between the magnetic and lattice degrees of freedom. The stretching vibration of CuO6 octahedra located at 679 cm-1 had the largest spin-phonon coupling constant (1.67 mRy Å-2).

De Winter Sign in Inferior Leads: A Rare Presentation.

De Winter pattern in anterior leads has been extensively described. However, there is only one case report of this pattern in inferior leads in English literature. Here, we describe a case of acute inferior wall myocardial infarction with thrombotic right coronary artery occlusion who presented with the classical De Winter sign in inferior leads.

Age-and-sex stratified prevalence of atrial fibrillation in rural Western India: Results of SMART-India, a population-based screening study.

BACKGROUND: Early detection of Atrial Fibrillation (AF) is a public health priority across the globe because AF-related strokes are preventable. Despite an ongoing stroke epidemic in India, a public health strategy for AF screening and treatment is missing because the epidemiology of AF in India remains poorly defined. METHODS: This population-based study used mobile technology to derive age and sex-stratified AF prevalence by screening 7 participants in each of six age and sex strata (age 40-55, 56-65, 65+, and male and female) from 50 villages (2100 participants). A health worker from each village used a handheld digital electrocardiogram (iECG) device (Kardia) to screen for AF on 3 separate days, and administered a questionnaire. All abnormal (AF or unclassified) iECGs were reviewed by the Indian cardiologist and AF determination confirmed by a US-based cardiac electrophysiologist. RESULTS: Of the 2100 individuals enrolled, iECGs were collected from 2074 participants (98.8%) and 1947 (92.7%) participants responded to the questionnaire. AF was identified in 33 participants (1.6%), two-thirds on the first iECG. AF prevalence was higher among males (2.3% vs 1.0%, p = 0.03) and in older people (0.6%, 0.9%, 2.1%, 5.6%; p < 0.01). CONCLUSIONS: The prevalence of AF observed in our population-based sample is comparable to rates found in studies from North America and Western Europe and increases similarly with age. AF screening using village health workers in rural India is feasible and presents an opportunity for a strategy to address the stroke epidemic in India through primary prevention.

Study protocol for Smartphone Monitoring for Atrial fibrillation in Real-Time in India (SMART-India): a community-based screening and referral programme.

INTRODUCTION: Atrial fibrillation (AF), the world's most common arrhythmia, often goes undetected and untreated in low-resource communities, including India, where AF epidemiology is undefined. AF is an important risk factor for stroke, which plagues an estimated 1.6 million Indians annually. As such, early detection of AF and management of high-risk patients is critically important to decrease stroke burden in individuals with AF. This study aims to describe the epidemiology of AF in Anand District, Gujarat, India, characterise the clinical profile of individuals who are diagnosed with AF and determine the performance of two mobile technologies for community-based AF screening. METHODS: This observational study builds on findings from a previous feasibility study and leverages two novel technologies as well as an existing community health programme to perform door-to-door AF screening for 2000 people from 60 villages of Anand District, Gujarat, India using local health workers. A single-lead ECG and a pulse-based application is used to screen each individual for AF three times over a period of 5 days. Participants with suspected arrhythmias are followed up by study cardiologist who makes final diagnoses. Participants diagnosed with AF are initiated on treatment based on current anticoagulation guidelines and clinical reasoning. ANALYTICAL PLAN: Age-stratified and sex-stratified prevalence of AF in the Anand District will be calculated for sample and estimated for Anand distribution using survey design weights. Sociodemographic and clinical factors associated with AF will be evaluated using multivariable regression methods. Performance of each mobile technology in detecting AF will be evaluated using a 12-lead ECG interpretation as the gold standard. ETHICS AND DISSEMINATION: This protocol was approved separately by the Institutional Review Board of University of Massachusetts Medical School and the Human Research Ethics Committee at Charutar Arogya Mandal. The findings of this study will be disseminated through peer-reviewed journals and scientific conferences.

Successive spin orderings of tungstate-bridged Li2Ni(WO4)2 of spin 1.

Magnetic, thermodynamic, and dielectric properties of Li2Ni(WO4)2 of S = 1 system have been studied using magnetic susceptibility, specific heat, and dielectric constant measurements. The magnetic orderings can be identified in three stages, including a short range magnetic ordering indicated by the rounded χ(T) peak with maximum at ∼20 K, and signatures of two successful antiferromagnetic long range orderings near T(N1) ~ 18 K and T(N2) ~ 13 K revealed by the d(χ(T)) /d(T) peaks. The successive long range magnetic orderings are related to the quasi triangular symmetry breaking in the ac- and bc-planes and to the change of the dielectric constant, suggesting the presence of spin-phonon coupling. The specific heat and magnetic entropy analysis for Li2Ni(WO4)2 shows the existence of a significant low dimensional magnetic correlations at high temperature and confirms the long range three-dimensional (3D) behavior of magnetic orderings below T(N1) and T(N2).

Large single crystal growth, transport property, and spectroscopic characterizations of three-dimensional Dirac semimetal Cd3As2.

The three dimensional (3D) Dirac semimetal is a new quantum state of matter that has attracted much attention recently in physics and material science. Here, we report on the growth of large plate-like single crystals of Cd3As2 in two major orientations by a self-selecting vapor growth (SSVG) method, and the optimum growth conditions have been experimentally determined. The crystalline imperfections and electrical properties of the crystals were examined with transmission electron microscopy (TEM), scanning tunneling microscopy (STM), and transport property measurements. This SSVG method makes it possible to control the as-grown crystal compositions with excess Cd or As leading to mobilities near 5-10(5) cm(2)V(-1)s(-1). Zn-doping can effectively reduce the carrier density to reach the maximum residual resistivity ratio (RRRρ300K/ρ5K) of 7.6. A vacuum-cleaved single crystal has been investigated using angle-resolved photoemission spectroscopy (ARPES) to reveal a single Dirac cone near the center of the surface Brillouin zone with a binding energy of approximately 200 meV.

Development of a ferromagnetic component in the superconducting state of Fe-excess Fe1.12Te(1-x)Sex by electronic charge redistribution.

The general picture established so far for the links between superconductivity and magnetic ordering in iron chalcogenide Fe1+y(Te(1-x)Sex) is that the substitution of Se for Te directly drives the system from the antiferromagnetic end into the superconducting regime. Here, we report on the observation of a ferromagnetic component that developed together with the superconducting transition in Fe-excess Fe1.12Te(1-x)Sex crystals using neutron and x-ray diffractions, resistivity, magnetic susceptibility and magnetization measurements. The superconducting transition is accompanied by a negative thermal expansion of the crystalline unit cell and an electronic charge redistribution, where a small portion of the electronic charge flows from around the Fe sites toward the Te/Se sites. First-principles calculations show consistent results, revealing that the excess Fe ions play a more significant role in affecting the magnetic property in the superconducting state than in the normal state and the occurrence of an electronic charge redistribution through the superconducting transition.

Large magnetoresistance and charge transfer between the conduction and magnetic electrons in layered oxyselenide BiOCu(0.96)Se.

The electrical and magnetic properties of slightly Cu-deficient BiOCu(0.96)Se have been investigated using neutron and X-ray diffraction, ac magnetic susceptibility, magnetization and electric resistivity measurements. The layered BiOCu(0.96)Se crystallizes into a tetragonal lattice with a P4/nmm symmetry. Thermal profiles of the electrical resistivity reveal a semiconductor type behavior, but depart from its course at low temperatures when antiferromagnetic coupling becomes thermally loosened at 140 K. Positive magnetoresistances are obtained at all temperatures studied. With an applied magnetic field of 0.5 kOe, the magnetoresistance reaches 235% at 2 K. It decreases with increasing temperature, but stabilizes to 70% above 60 K. Both ferromagnetic and antiferromagnetic coupling are detected between the Cu spins in the SeCu4 pyramidal blocks, which results in a non-collinear spin arrangement at low temperatures. The antiferromagnetic component becomes disordered above T(N) = 140 K, whereas the ferromagnetic moment persists up to T(C) = 300 K. Interlayer charge transfer between the conduction and magnetic electrons gives rise to an anomaly in the magnetic order parameter.

Spin polarization and quantum spins in Au nanoparticles.

The present study focuses on investigating the magnetic properties and the critical particle size for developing sizable spontaneous magnetic moment of bare Au nanoparticles. Seven sets of bare Au nanoparticle assemblies, with diameters from 3.5 to 17.5 nm, were fabricated with the gas condensation method. Line profiles of the X-ray diffraction peaks were used to determine the mean particle diameters and size distributions of the nanoparticle assemblies. The magnetization curves M(H(a)) reveal Langevin field profiles. Magnetic hysteresis was clearly revealed in the low field regime even at 300 K. Contributions to the magnetization from different size particles in the nanoparticle assemblies were considered when analyzing the M(H(a)) curves. The results show that the maximum particle moment will appear in 2.4 nm Au particles. A similar result of the maximum saturation magnetization appearing in 2.3 nm Au particles is also concluded through analysis of the dependency of the saturation magnetization M(P) on particle size. The M(P)(d) curve departs significantly from the 1/d dependence, but can be described by a log-normal function. Magnetization can be barely detected for Au particles larger than 27 nm. Magnetic field induced Zeeman magnetization from the quantum confined Kubo gap opening appears in Au nanoparticles smaller than 9.5 nm in diameter.

Spin, charge and lattice couplings in Cu-deficient oxysulphide BiOCu0.94S.

The electrical and magnetic properties of slightly Cu-deficient BiOCu(0.94)S are investigated using neutron diffraction, ac magnetic susceptibility, magnetization and electrical resistivity measurements. The Cu spins order in a ferromagnetic arrangement below T(C) = 250 K. An antiferromagnetic component develops below 180 K when the crystalline unit cell experiences a sharp thermal contraction upon cooling, resulting in a canted ferromagnetic spin arrangement at low temperatures. In the magnetically ordered state the electrical transport can be described using three-dimensional variable range hopping conduction. An applied magnetic field can effectively reduce the hopping barrier. Spin-charge couplings are clearly revealed when the resistivity departs from the hopping conduction and begins to increase with increasing temperatures above 250 K where the Cu spins become disordered.

Effect of percutaneous transvenous mitral commissurotomy on left atrial appendage function: an immediate and 6-month follow-up transesophageal Doppler study.

BACKGROUND: The left atrial appendage (LAA) is a common site of thrombus formation and is the source of systemic thromboembolism in patients with rheumatic mitral stenosis. LAA contractile dysfunction is a common finding in these patients. The aim of this study was to assess immediate and 6-month follow-up LAA function by transesophageal Doppler echocardiography in patients who underwent percutaneous transvenous mitral commissurotomy (PTMC). METHODS: Forty-seven consecutive patients with symptomatic critical mitral stenosis who underwent PTMC were enrolled. All had underwent transthoracic and transesophageal echocardiography before, 24 hours after, and 6 months after PTMC. Pulse Doppler velocities of the LAA were measured, including peak early diastolic (E wave), peak late diastolic (A wave), and peak systolic (S wave). The corresponding tissue Doppler velocities of the LAA, including peak early diastolic (E(LAA)), peak late diastolic (A(LAA)), and peak systolic (S(LAA)), were also measured. LAA ejection fraction was measured using the modified Simpson's method. RESULTS: The mean age of the 47 enrolled patients was 31.7 ± 10.26 years. Thirty-eight patients were in sinus rhythm, and the remaining nine were in atrial fibrillation. PTMC was successful in all patients. The pulse Doppler velocities of the LAA at baseline, after PTMC, and at 6-month follow-up were as follows: for the E wave, 15.29 ± 2.26, 17.02 ± 2.25, and 17.97 ± 2.55 cm/sec, respectively (P < .001); for the A wave 22.45 ± 4.11, 24.19 ± 4.21, and 25.99 ± 4.51 cm/sec, respectively (P < .001); and for the S wave, 28.52 ± 4.37, 31.45 ± 5.37, and 33.06 ± 4.99 cm/sec, respectively (P < .001). The corresponding tissue Doppler velocities of LAA were as follows: for E(LAA), 4.65 ± 0.91, 5.28 ± 0.85, and 5.80 ± 0.84 cm/sec, respectively (P < .001); for A(LAA), 6.67 ± 1.12, 7.33 ± 1.17, and 7.88 ± 1.22 cm/sec, respectively (P < .001); and for S(LAA), 4.67 ± 1.12, 5.52 ± 1.18, 6.07 ± 1.11 cm/sec, respectively (P < .001). There was a nonsignificant increase in LAA ejection fraction (48.97 ± 8.14% vs 52.3 ± 13.76% vs 52.11 ± 16.3%, respectively, P = .052). On subgroup analysis between patients in sinus rhythm and those with atrial fibrillation, there was no significant difference for LAA ejection fraction and pulse and tissue Doppler velocities. Very good intraclass correlation of the LAA parameters was also observed for the reproducibility of the data. CONCLUSIONS: The present study shows contractile dysfunction of the LAA in patients with critical mitral stenosis, which significantly improved after PTMC, and a further improvement was observed at 6-month follow-up. Favorable 6-month improvements in LAA parameters suggest continuous structural remodeling of the LAA after PTMC, which is clinically attributed to the absence of thromboembolism. Although there was an improvement in LAA function, it was far below the normal range, suggesting a need for continuous long-term monitoring and management of thromboembolism in these patients.

Short range magnetic correlations induced by La substitution in Ho(1-x)La(x)Mn(2)O(5).

Magnetic susceptibility, x-ray diffraction, neutron diffraction and Raman scattering measurements are employed to study the effects of La substitution on the magnetic properties of multiferroic HoMn(2)O(5). 9% and 18% La-substituted compounds crystallize into the same orthorhombic Pbam symmetry as the parent compound. The magnetic responses to an ac driving magnetic field between 40 and 140 K are greatly enhanced by 18% La substitution. The neutron magnetic diffraction patterns reveal the development of short range magnetic correlations below 140 K. In addition, two Raman peaks and a series of new x-ray diffraction peaks suddenly develop below this temperature. Incommensurate long range antiferromagnetic order appears below 38 K. Magnetic frustration could be the main mechanism governing the present observations.