Closure of patent foramen ovale for secondary prevention of cerebrovascular events

Stroke is the most debilitating cardiovascular event. It has a variety of causes that may be present simultaneously. In young or otherwise healthy people a patent foramen ovale (PFO) is increasingly searched for. In stroke of the elderly atherosclerosis and atrial fibrillation are in the foreground but the PFO should not be ignored. The risk of a PFO related stroke over time is controversial and so is its prevention by PFO closure. Percutaneous PFO closure is a minimally invasive procedure which can be performed with high success and low morbidity. We review the rationale for PFO closure for secondary prevention of embolic events.

Percutaneous closure of patent foramen ovale: safe and effective but underutilized.

With three recently published randomized trials on patent foramen ovale (PFO) closure, the concept of PFO closure to reduce recurrent strokes has been proven; however, PFO closure is currently only considered for secondary prevention. Given the potential devastating consequences of a PFO-related event, we advocate screening for and closure of a PFO for primary prevention in high-risk populations. Such populations include patients who are suffering from a disease that is associated with PFO (e.g., migraine) or patients with high-risk hobbies/professions (e.g., weight-lifters, frequent-flyers, and deep sea divers). Looking at young people with a remaining average life expectancy of 50 years, we have to close 2.4 PFOs to prevent one stroke. This should support a more proactive attitude toward PFO screening and closure.

Percutaneous closure of the patent foramen ovale, easy does it.

Closure of the patent foramen ovale does not benefit from echocardiographic guidance in the majority of cases. Guiding these procedures with fluoroscopy only reduces procedure time, radiation exposure, and amount of contrast medium. There is a clear trend to abandon echocardiographic guidance for this procedure over time and with growing experience.

Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography.

OBJECTIVES We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance. BACKGROUND Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs. METHODS Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group. RESULTS The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred. CONCLUSION According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.

On the Closure of the Tame Automorphism Group of Affine Three-Space

We provide explicit families of tame automorphisms of the complex affine three-space which degenerate to wild automorphisms. This shows that the tame subgroup of the group of polynomial automorphisms of C3 is not closed, when the latter is seen as an infinite-dimensional algebraic group.

Model-Driven Methodology for Rapid Deployment of Smart Spaces based on Resource-Oriented Architectures

Advances in electronics nowadays facilitate the design of smart spaces based on physical mash-ups of sensor and actuator devices. At the same time, software paradigms such as Internet of Things (IoT) and Web of Things (WoT) are motivating the creation of technology to support the development and deployment of web-enabled embedded sensor and actuator devices with two major objectives: (i) to integrate sensing and actuating functionalities into everyday objects, and (ii) to easily allow a diversity of devices to plug into the Internet. Currently, developers who are applying this Internet-oriented approach need to have solid understanding about specific platforms and web technologies. In order to alleviate this development process, this research proposes a Resource-Oriented and Ontology-Driven Development (ROOD) methodology based on the Model Driven Architecture (MDA). This methodology aims at enabling the development of smart spaces through a set of modeling tools and semantic technologies that support the definition of the smart space and the automatic generation of code at hardware level. ROOD feasibility is demonstrated by building an adaptive health monitoring service for a Smart Gym.

A Development Methodology to Facilitate the Integration of Smart Spaces into the Web of Things

How to create or integrate large Smart Spaces (considered as mash-ups of sensors and actuators) into the paradigm of ?Web of Things? has been the motivation of many recent works. A cutting-edge approach deals with developing and deploying web-enabled embedded devices with two major objectives: 1) to integrate sensor and actuator technologies into everyday objects, and 2) to allow a diversity of devices to plug to Internet. Currently, developers who want to use this Internet-oriented approach need have solid understanding about sensorial platforms and semantic technologies. In this paper we propose a Resource-Oriented and Ontology-Driven Development (ROOD) methodology, based on Model Driven Architecture (MDA), to facilitate to any developer the development and deployment of Smart Spaces. Early evaluations of the ROOD methodology have been successfully accomplished through a partial deployment of a Smart Hotel.

Influence of the semantic content of urban sounds in the identity of outer spaces

This paper shows the influence of the semantic content of urban sounds in the subjective evaluation of outer spaces. The study is based on the analysis conducted in three neighboring and integrated urban spaces with a different form of social ownership in the city of Cordoba, Argentina. It shows that the type of sound source present at each site influence, by its semantic content, in the user´s identification and permanence in the place. The noise present in a soundscape is able to have a high semantic content, and therefore the sound has a particular meaning for the perceiver. Every particular social group influences the production of their own sounds and how they perceive them. This allows to consider the sound as one of the factors that define the sense of "place" or "no place" of a certain urban space. Evidently the sounds, and their ability to evoke and characterize the environment, cannot be ignored in the construction and recovery of anthropological sites. This urban culture is unique and specific to every society. Thepublic spaces, with their soundscape, are part of the construction of the urban identity of a city. It is shown that for identical general sound levels present in each of the spaces, the level of annoyance or discomfort, in relation to the subjective acoustic quality, is different. This is the result of the influence of semantic content of the sounds present in each urban space. Coinciding with other similar research, the level of discomfort or annoyance decreases as the presence of natural sounds such as water, the wind in the trees or the birds singing increases, even when the objective values of noise level of natural sounds are higher.

Identification of pore spaces in 3D CT soil images using a PFCM partitional clustering

Recent advances in non-destructive imaging techniques, such as X-ray computed tomography (CT), make it possible to analyse pore space features from the direct visualisation from soil structures. A quantitative characterisation of the three-dimensional solid-pore architecture is important to understand soil mechanics, as they relate to the control of biological, chemical, and physical processes across scales. This analysis technique therefore offers an opportunity to better interpret soil strata, as new and relevant information can be obtained. In this work, we propose an approach to automatically identify the pore structure of a set of 200-2D images that represent slices of an original 3D CT image of a soil sample, which can be accomplished through non-linear enhancement of the pixel grey levels and an image segmentation based on a PFCM (Possibilistic Fuzzy C-Means) algorithm. Once the solids and pore spaces have been identified, the set of 200-2D images is then used to reconstruct an approximation of the soil sample by projecting only the pore spaces. This reconstruction shows the structure of the soil and its pores, which become more bounded, less bounded, or unbounded with changes in depth. If the soil sample image quality is sufficiently favourable in terms of contrast, noise and sharpness, the pore identification is less complicated, and the PFCM clustering algorithm can be used without additional processing; otherwise, images require pre-processing before using this algorithm. Promising results were obtained with four soil samples, the first of which was used to show the algorithm validity and the additional three were used to demonstrate the robustness of our proposal. The methodology we present here can better detect the solid soil and pore spaces on CT images, enabling the generation of better 2D?3D representations of pore structures from segmented 2D images.

Challenges for future of Natural Spaces of Canary Islands, Spain

The preservation of biodiversity is a fundamental objective of a ll policies related to a more sustainable development in any modern society. The rain forest and pine forests are two unique Canarian ecosystems with high importance to global biodiversity, holding a large number of endemic species and subspecies that is a priority to preserve. In this work the challenges that will face the natural areas of the Canary Islands are studied, as well as their fundamental value for economic and environmental development of the islands.

New lower bounds for the topological complexity of aspherical spaces

Date of Acceptance: 5/04/2015 15 pages, 4 figures