Pitfalls and premature failure of the Freedom SOLO stentless valve

Gebiet: Chirurgie Abstract: Objectives This study reports a series of pitfalls, premature failures and explantations of the third generation Freedom SOLO bovine pericardial stentless valve. – – Methods 149 patients underwent aortic valve replacement (AVR) using the FS. Follow-up was 100% complete with an average observation time of 5.5±2.3 years (max. 8.7 years) and a total of 825 patient years. Following intraoperative documentation, all explanted valve prostheses underwent histological examination. – – Results Freedom from structural valve deterioration (SVD) at 5, 6, 7, 8 and 9 years was 92%, 88%, 80% and 70% and 62%, respectively. 14 prostheses required explantation due to valve-independent dysfunction (n=5, i.e. thrombus formation, oversizing, aortic dilatation, endocarditis and suture dehiscence) or valve-dependent failure (acute leaflet tears, n=4, severe stenosis, n=5). Thus freedom from explantation at 5, 6, 7, 8 and 9 years was 95%, 94%, 91% and 81% and 72%, respectively. An acute vertical tear along the non-coronary/right-coronary commissure to the base occurred at a mean of 6.0 years [range 4.3?7.3 years] and affected size 25 and 27 prostheses exclusively. Four FS required explantation after a mean of 7.5 years [range 7.0?8.3 years] due to severe functional stenosis and gross calcification that included the entire aortic root. – – Conclusions The Freedom SOLO stentless valve is safe to implant and shows satisfying mid-term results in our single institution experience. Freedom from SVD and explantation decreased markedly after only 6 ? 7 years, so that patients with FS require close observation and follow-up. Exact sizing, symmetric positioning and observing patient limitations are crucial for optimal outcome.

Is surgery in aCute aortiC disseCtion type A still ContraindiCated in the presenCe of preoperative neurologiCal symptoms?

Gebiet: Kardiologie Abstract: OBJECTIVES: Severe neurologiCal defiCit (ND) due to aCute aortiC disseCtion type A (AADA) was Considered a ContraindiCation for surgery beCause of poor prognosis. ReCently, more aggressive indiCation for surgery despite neurologiCal symptoms has shown aCCeptable – postoperative CliniCal results. The aim of this study was to evaluate early and mid-term outComes of patients with AADA presenting with aCute ND. – – METHODS: Data from 53 patients with new-onset ND who reCeived surgiCal repair for AADA between 2005 and 2012 at our institution were retrospeCtively reviewed. ND was defined as foCal motor or sensory defiCit, hemiplegia, paraplegia, Convulsions or Coma. NeurologiCal symptoms were evaluated preoperatively using the Glasgow Coma SCale (GCS) and modified Rankin SCale (mRS), and at disCharge as well as 3–6 months postoperatively using the mRS and National Institutes of Health Stroke SCale. Involvement of Carotid arteries was assessed in the pre- and postoperative Computed tomography. LogistiC regression analysis was performed to deteCt prediCtive faCtors for reCovery of ND. – – RESULTS: Of the 53 patients, 29 (54.7%) showed Complete reCovery from foCal ND at follow-up. NeurologiCal symptoms persisted in 24 (45.3%) patients, of whiCh 8 (33%) died without neurologiCal assessment at follow-up. Between the two groups (patients with reCovery and – those with persisting ND), there was no signifiCant differenCe regarding the duration of hypothermiC CirCulatory arrest (28 ± 14 vs 36 ± 20 min) or severely reduCed ConsCiousness (GCS <8). Multivariate analysis showed signifiCant differenCes for the preoperative mRS between the two groups (P < 0.007). A high preoperative mRS was assoCiated with persistenCe of neurologiCal symptoms (P < 0.02). CardiovasCular risk faCtors, age or involvement of supra-aortiC branChes were not prediCtive for persistenCe of ND. – – CONCLUSION: More than half of our patients reCovered Completely from ND due to AADA after surgery. Severity of CliniCal symptoms had a prediCtive value. Patients suffering from AADA and presenting with ND before surgery should not be exCluded from emergenCy surgery.

Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis

Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. CONCLUSIONS Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.

Construyendo nuevas miradas pedagógicas en pos de la accesibilidad académica en la universidad

Durante el primer cuatrimestre del año 2012 la asignatura Patrimonio Natural Regional de la carrera Tecnicatura de Empresas de Servicios Turísticos — Facultad de Turismo — Universidad Nacional del Comahue; contó con la presencia de un estudiante en situación de discapacidad (motora). A partir de la iniciativa de los docentes de la asignatura, se solicita apoyo institucional y se toma contacto con la Comisión Universitaria sobre Accesibilidad al Medio Físico y Social, para consensuar estrategias a implementar en la evaluación parcial del alumno en situación de discapacidad en relación al resto del curso. Este trabajo tiene por objetivos: reflexionar acerca de la evaluación parcial con estudiantes en situación de discapacidad y proponer cambios en la evaluación parcial de la asignatura Patrimonio Natural Regional en relación a estudiantes en situación de discapacidad motora. La metodología usada por el equipo de cátedra fue de un estudio de diseño para las asignaturas del área de concurso Recursos Naturales, contextualizado para el estudiante en situación de discapacidad con el asesoramiento de la comisión sobre accesibilidad y también de la comunicación con el alumno. Algunas conclusiones a las que se arribó tienen relación con los ejes 1. Necesidad de evaluaciones con nuevas estrategias pedagógicas contextuales particulares; 2.Necesidad de un acompañamiento institucional ante la presencia de estudiantes en situación de discapacidad en las aulas.

Percepción de variabilidad climática, uso de información y estrategias de los agentes frente al riesgo. Análisis de esquemas decisionales en agricultores de la región pampeana argentina

Este artículo indaga acerca de qué elementos de análisis están presentes en las estrategias de los agricultores de las pampas argentinas a la hora de tomar decisiones de producción considerando el factor climático. El énfasis está puesto en cómo perciben la variabilidad climática y qué información manejan acerca de sus perspectivas a mediano plazo. Durante 2005 se entrevistaron a 60 productores, seleccionados de dos zonas pampeanas de diferentes características físicas. 30 personas correspondieron al área central húmeda y 30 personas a un área marginal semiárida. Los resultados del estudio apuntan a caracterizar los esquemas decisionales presentes en las percepciones de los individuos, teniendo en cuenta que su actividad supone una exposición al riesgo. El objetivo de fondo del trabajo de investigación es proponer acciones de comunicación que ayuden a un mejor uso de la información climática, considerando que se trata de una herramienta disponible con gran potencial para dar un soporte más científico a los procedimientos de los agentes productivos y mejorar su rentabilidad económica.

Percepción de variabilidad climática, uso de información y estrategias de los agentes frente al riesgo. Análisis de esquemas decisionales en agricultores de la región pampeana argentina

Este artículo indaga acerca de qué elementos de análisis están presentes en las estrategias de los agricultores de las pampas argentinas a la hora de tomar decisiones de producción considerando el factor climático. El énfasis está puesto en cómo perciben la variabilidad climática y qué información manejan acerca de sus perspectivas a mediano plazo. Durante 2005 se entrevistaron a 60 productores, seleccionados de dos zonas pampeanas de diferentes características físicas. 30 personas correspondieron al área central húmeda y 30 personas a un área marginal semiárida. Los resultados del estudio apuntan a caracterizar los esquemas decisionales presentes en las percepciones de los individuos, teniendo en cuenta que su actividad supone una exposición al riesgo. El objetivo de fondo del trabajo de investigación es proponer acciones de comunicación que ayuden a un mejor uso de la información climática, considerando que se trata de una herramienta disponible con gran potencial para dar un soporte más científico a los procedimientos de los agentes productivos y mejorar su rentabilidad económica.

Percepción de variabilidad climática, uso de información y estrategias de los agentes frente al riesgo. Análisis de esquemas decisionales en agricultores de la región pampeana argentina

Este artículo indaga acerca de qué elementos de análisis están presentes en las estrategias de los agricultores de las pampas argentinas a la hora de tomar decisiones de producción considerando el factor climático. El énfasis está puesto en cómo perciben la variabilidad climática y qué información manejan acerca de sus perspectivas a mediano plazo. Durante 2005 se entrevistaron a 60 productores, seleccionados de dos zonas pampeanas de diferentes características físicas. 30 personas correspondieron al área central húmeda y 30 personas a un área marginal semiárida. Los resultados del estudio apuntan a caracterizar los esquemas decisionales presentes en las percepciones de los individuos, teniendo en cuenta que su actividad supone una exposición al riesgo. El objetivo de fondo del trabajo de investigación es proponer acciones de comunicación que ayuden a un mejor uso de la información climática, considerando que se trata de una herramienta disponible con gran potencial para dar un soporte más científico a los procedimientos de los agentes productivos y mejorar su rentabilidad económica.

Water level time series and sediment grain size model

The environment of ebb-tidal deltas between barrier island systems is characterized by a complex morphology with ebb- and flood-dominated channels, shoals and swash bars connecting the ebb-tidal delta platform to the adjacent island. These morphological features reveal characteristic surface sediment grain-size distributions and are subject to a continuous adaptation to the prevailing hydrodynamic forces. The mixed-energy tidal inlet Otzumer Balje between the East Frisian barrier islands of Langeoog and Spiekeroog in the southern North Sea has been chosen here as a model study area for the identification of relevant hydrodynamic drivers of morphology and sedimentology. We compare the effect of high-energy, wave-dominated storm conditions to mid-term, tide-dominated fair-weather conditions on tidal inlet morphology and sedimentology with a process-based numerical model. A multi-fractional approach with five grain-size fractions between 150 and 450 µm allows for the simulation of corresponding surface sediment grain-size distributions. Net sediment fluxes for distinct conditions are identified: during storm conditions, bed load sediment transport is generally onshore directed on the shallower ebb-tidal delta shoals, whereas fine-grained suspended sediment bypasses the tidal inlet by wave-driven currents. During fair weather the sediment transport mainly focuses on the inlet throat and the marginal flood channels. We show how the observed sediment grain-size distribution and the morphological response at mixed-energy tidal inlets are the result of both wave-dominated less frequent storm conditions and mid-term, tide-dominant fair-weather conditions.

Seawater carbonate chemistry and calcification of two mediterranean cold-water coral species in a laboratory experiment

Deep-water ecosystems are characterized by relatively low carbonate concentration values and, due to ocean acidification (OA), these habitats might be among the first to be exposed to undersaturated conditions in the forthcoming years. However, until now, very few studies have been conducted to test how cold-water coral (CWC) species react to such changes in the seawater chemistry. The present work aims to investigate the mid-term effect of decreased pH on calcification of the two branching CWC species most widely distributed in the Mediterranean, Lophelia pertusa and Madrepora oculata. No significant effects were observed in the skeletal growth rate, microdensity and porosity of both species after 6 months of exposure. However, while the calcification rate of M. oculata was similar for all colony fragments, a heterogeneous skeletal growth pattern was observed in L. pertusa, the younger nubbins showing higher growth rates than the older ones. A higher energy demand is expected in these young, fast-growing fragments and, therefore, a reduction in calcification might be noticed earlier during long-term exposure to acidified conditions.

Responses of the tropical gorgonian coral Eunicea fusca to ocean acidification conditions

Ocean acidification can have negative repercussions from the organism to ecosystem levels. Octocorals deposit high-magnesium calcite in their skeletons, and according to different models, they could be more susceptible to the depletion of carbonate ions than either calcite or aragonite-depositing organisms. This study investigated the response of the gorgonian coral Eunicea fusca to a range of CO2 concentrations from 285 to 4,568 ppm (pH range 8.1-7.1) over a 4-week period. Gorgonian growth and calcification were measured at each level of CO2 as linear extension rate and percent change in buoyant weight and calcein incorporation in individual sclerites, respectively. There was a significant negative relationship for calcification and CO2 concentration that was well explained by a linear model regression analysis for both buoyant weight and calcein staining. In general, growth and calcification did not stop in any of the concentrations of pCO2; however, some of the octocoral fragments experienced negative calcification at undersaturated levels of calcium carbonate (>4,500 ppm) suggesting possible dissolution effects. These results highlight the susceptibility of the gorgonian coral E. fusca to elevated levels of carbon dioxide but suggest that E. fusca could still survive well in mid-term ocean acidification conditions expected by the end of this century, which provides important information on the effects of ocean acidification on the dynamics of coral reef communities. Gorgonian corals can be expected to diversify and thrive in the Atlantic-Eastern Pacific; as scleractinian corals decline, it is likely to expect a shift in these reef communities from scleractinian coral dominated to octocoral/soft coral dominated under a "business as usual" scenario of CO2 emissions.

Looking for a more comprehensive approach

The necessity/convenience for improving accuracy in determining the flood frequency is widely accepted further than among hydrologists, and is increasingly deepened in relationship with the statement of different thresholds related to the respective management systems. And both Scientific and Management Communities fully accept the necessity of living with determined levels of flood risk. Most of the approaches for “Advancing Methods” improving concentrate on the statistical ways, even since Climate in fact is not a Stationary process. The question is here reflected since the SMARTeST research and final highlights, policy and recommendations. The paper looks at a better agreement between Hydrology and the whole Climate as the result of the Global Thermal Machine and takes mainly into account a historical approach, trying to show the necessity of a wider collection and analysis of climate data for statistical approaches.

Aplicación de energía geotérmica de muy baja entalpia para la climatización de un edificio de oficinas en Alcorcón, Madrid

El presente Proyecto tiene como propósito el estudio de la viabilidad de la implantación de energía geotérmica de muy baja entalpia para la climatización de un edificio empresarial en Madrid. Para ello se emplearon cálculos teóricos y simulaciones realizadas mediante programas informaticos especializados con el fin de estimar los parámetros técnicos necesarios para su viabilidad. Se estimo el suministro de la potencia necesaria a través de tres bombas de calor tipo agua-agua que sustituyen a las bombas de calor aire-agua individuales anteriormente instaladas. El intercambio de calor se realiza a través de sondas geotérmicas U-Simple. Se dimensionaron los colectores, bombas de circulación, deposito de inercia y vaso de expansión necesarios para funcionamiento del sistema. El estudio económico determino la necesidad de una alta inversión inicial, con una rentabilidad a medio plazo. Además de los beneficios económicos se realizo un estudio de las emisiones de gases de efecto invernadero demostrando la reducción de los mismos, lo que refleja que además de ser una tecnología económicamente viable es una energía limpia. ABSTRACT The objective of the present project is to evaluate the viability of the imposition of a low-enthalpy geothermal energy system for air conditioning in a business building in Madrid. In this study, both theoretical calculations and numerical simulations in specialized programs were used in order to estimate the technical parameters needed for its viability. We estimated the necessary power supply, which is delivered by three heat water-water pumps that substitute the individual heat air-water pumps previously installed. The heat exchange is achieved through geothermal vertical simple-U probes. Also in this work we have measured the collectors, flow pumps, inertia deposit and the water expansion vessel needed for the proper operation of the system. The economic study determined the need of a high initial investment with mid-term profit. In addition to the economic benefits, the greenhouse gases emissions were evaluated, finding that the geothermal energy system implies a reduction of these emissions. This reflects the fact that, in addition to being economically viable, the geothermal energy is considered a clean energy.

Evaluation of damping properties of structural glass panes under impact loading

The latest technology and architectural trends have significantly improved the use of a large variety of glass products in construction which, in function of their own characteristocs, allow to design and calculate structural glass elements under safety conditions. This paper presents the evaluation and analysis of the damping properties of rectangular laminated glass plates of 1.938 m x 0.876 m with different thickness depending on the number of PVB interlayers arranged. By means of numerical simulation and experimental verification, using modal analysis, natural frequencies and damping of the glass plates were calculated, both under free boundary conditions and operational conditions for the impact test equipment used in the experimental program, as the European standard UNE-EN 12600:2003 specifies.

Post-fracture behavior of laminated plates after human impact test

For safety barriers the load bearing capacity of the glass when subjected to the soft body impact should be verified. The soft body pendulum test became a testing standard to classify safety glass plates. The classification of the safety glass do not consider the structural behavior when one sheet of a laminated glass is broken; in situations when the replacement of the plate could not be very urgent, structural behavior should be evaluated. The main objective of this paper is to present the structural behavior o laminated glass plates, though modal test and human impact test, including the post fracture behavior for the laminated cases. A god reproducibility and repeatability is obtained. Two main aspects of the structural behavior can be observed: the increment of the rupture load for laminated plates after the failure of the first sheet, and some similarities with a tempered monolithic behavior of equivalent thickness.

Environmental impact indicators estimation in European rural devlopment programs. Limitations of evaluators and financial institutions? Expectatios

The European Commission established Mid-term evaluation for the period 2007-2013 on Rural Development Programs as part of a continuous evaluation system. Mid-term evaluations are important for the Commission because they help measuring the success of a program, as well as giving advice and pointing out good practices for the current and consecutive programming periods. One of the main elements used to achieve these objectives is the impact indicators estimation of the program. This paper will focus on how impact indicators estimation is done for just the environmental indicators. To do this the 88 Mid-term evaluations of Rural Development Programs for 2007-2013 period, were analyzed. This study shows how far the actual methodologies to obtain impact indicators? values are from what the European Commission expects when demanding this task to be done.