We present results from pulsed-power driven differentially rotating plasma experiments designed to simulate physics relevant to astrophysical disks and jets. In these experiments, angular momentum is ...injected by the ram pressure of the ablation flows from a wire array Z pinch. In contrast to previous liquid metal and plasma experiments, rotation is not driven by boundary forces. Axial pressure gradients launch a rotating plasma jet upward, which is confined by a combination of ram, thermal, and magnetic pressure of a surrounding plasma halo. The jet has subsonic rotation, with a maximum rotation velocity 23±3 km/s. The rotational velocity profile is quasi-Keplerian with a positive Rayleigh discriminant κ^{2}∝r^{-2.8±0.8} rad^{2}/s^{2}. The plasma completes 0.5-2 full rotations in the experimental time frame (∼150 ns).
The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to ...evaluate their clinical outcome over the mid to long term.
Although a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.
The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010.
Survival at 30 days was 92.9%, and it was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.
Midterm to long-term survival after TAVI was encouraging in this high-risk patient population, although a substantial proportion of patients died within the first year.
We present the analysis of the event OGLE-2017-BLG-1186 from the 2017 Spitzer microlensing campaign. This is a remarkable microlensing event because its source is photometrically bright and variable, ...which makes it possible to perform an asteroseismic analysis using ground-based data. We find that the source star is an oscillating red giant with average timescale of ∼9 d. The asteroseismic analysis also provides us source properties including the source angular size (∼27 μas) and distance (∼11.5 kpc), which are essential for inferring the properties of the lens. When fitting the light curve, we test the feasibility of Gaussian processes (GPs) in handling the correlated noise caused by the variable source. We find that the parameters from the GP model are generally more loosely constrained than those from the traditional χ(exp 2) minimization method. We note that this event is the first microlensing system for which asteroseismology and GPs have been used to account for the variable source. With both finite-source effect and microlens parallax measured, we find that the lens is likely a ∼0.045 Mʘ brown dwarf at distance ∼9.0 kpc, or a ∼0.073 Mʘ ultracool dwarf at distance ∼9.8 kpc. Combining the estimated lens properties with a Bayesian analysis using a Galactic model, we find a ∼ 35 per cent probability for the lens to be a bulge object and ∼ 65 per cent to be a background disc object.
Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve ...implantation and formulated an anatomic and electrophysiological model.
Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM.
One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
This analysis presents the first report of 1-year outcomes of the 120 patients enrolled in the REPRISE II (Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus ...Valve System-Evaluation of Safety and Performance) study.
The fully repositionable and retrievable Lotus Valve (Boston Scientific, Marlborough, Massachusetts) was designed to facilitate accurate positioning, early valve function, and hemodynamic stability during deployment and to minimize paravalvular regurgitation in patients undergoing transcatheter aortic valve replacement.
The study enrolled 120 symptomatic patients 70 years of age or older at 14 centers in Australia and Europe. Patients had severe calcific aortic stenosis and were deemed to be at high or extreme risk of surgery based on assessment by the heart team.
The mean age was 84.4 ± 5.3 years, 57% (68 of 120) of patients were women, and the mean Society of Thoracic Surgeons score was 7.1 ± 4.6. The mean baseline aortic valve area was 0.7 ± 0.2 cm(2), and the mean transvalvular pressure gradient was 46.4 ± 15.0 mm Hg. All patients were successfully implanted with a Lotus Valve, and 1-year clinical follow-up was available for 99.2% (119 of 120 of patients). The mean 1-year transvalvular aortic pressure gradient was 12.6 ± 5.7 mm Hg, and the mean valve area was 1.7 ± 0.5 cm(2). A total of 88.6% patients had no or trivial paravalvular aortic regurgitation at 1 year by independent core lab adjudication, and 97.1% of patients were New York Heart Association functional class I or II. At 1 year, the all-cause mortality rate was 10.9% (13 of 119 patients), disabling stroke rate was 3.4% (4 of 119 patients), disabling bleeding rate was 5.9% (7 of 119 patients), with no repeat procedures for valve-related dysfunction. A total of 31.9% (38 of 119 patients) underwent new permanent pacemaker implantation at 1 year.
At 1 year of follow-up, the Lotus Valve demonstrated excellent valve hemodynamics, no moderate or severe paravalvular regurgitation, and significant and sustained improvement in New York Heart Association functional class status, with good clinical outcomes. (Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Evaluation of Safety and Performance REPRISE II; NCT01627691).
We present X-ray spectral analysis of 20 point-like X-ray sources detected in Chandra Planetary Nebula Survey observations of 59 planetary nebulae (PNe) in the solar neighborhood. Most of these 20 ...detections are associated with luminous central stars within relatively young, compact nebulae. The vast majority of these point-like X-ray-emitting sources at PN cores display relatively "hard" (> or =, slanted0.5 keV) X-ray emission components that are unlikely to be due to photospheric emission from the hot central stars (CSPN). Instead, we demonstrate that these sources are well modeled by optically thin thermal plasmas. From the plasma properties, we identify two classes of CSPN X-ray emission: (1) high-temperature plasmas with X-ray luminosities, LX, that appear uncorrelated with the CSPN bolometric luminosity, L sub(bol) and (2) lower-temperature plasmas with L sub(X)/L sub(bol) ~ 10 super(-7). We suggest these two classes correspond to the physical processes of magnetically active binary companions and self-shocking stellar winds, respectively. In many cases this conclusion is supported by corroborative multiwavelength evidence for the wind and binary properties of the PN central stars. By thus honing in on the origins of X-ray emission from PN central stars, we enhance the ability of CSPN X-ray sources to constrain models of PN shaping that invoke wind interactions and binarity.
Many patients have iliofemoral vessel anatomy unsuitable for conventional transfemoral (TF) transcatheter aortic valve implantation (TAVI). Safe and practical alternatives to the TF approach are, ...therefore, needed. This study compared outcomes of alternative nonfemoral routes, transapical (TA), direct aortic (DA), and subclavian (SC), with standard femoral access. In this retrospective study, data from 3,962 patients in the UK TAVI registry were analyzed. All patients who received TAVI through a femoral, subclavian, TA, or DA approach were eligible for inclusion. The primary outcome measure was survival up to 2 years. Median Logistic EuroSCORE was similar for SC, DA, and TA but significantly lower in the TF cohort (22.1% vs 20.3% vs 21.2% vs 17.0%, respectively, p <0.0001). Estimated 1-year survival rate was similar for TF (84.6 ± 0.7%) and SC (80.5 ± 3%, p = 0.27) but significantly worse for TA (74.7 ± 1.6%, p <0.001) and DA (75.2 ± 3.3%, p <0.001). A Cox proportional hazard model was used to analyze survival up to 2 years. Survival in the SC group was not significantly different from the TF group (hazard ratio HR 1.22, 95% confidence interval CI 0.88 to 1.70, p = 0.24). In contrast, survival in the TA (HR 1.74, 95% CI 1.43 to 2.11; p <0.001) and DA (HR 1.55, 95% CI 1.13 to 2.14; p <0.01) cohorts was significantly reduced compared with TF. In conclusion, TA and DA TAVI were associated with similar survival, both significantly worse than with the TF route. In contrast, subclavian access was not significantly different from TF and may represent the safest nonfemoral access route for TAVI.
In vitro primary hepatocyte systems typically elicit drug induction and toxicity responses at concentrations much higher than corresponding in vivo or clinical plasma C(max) levels, contributing to ...poor in vitro-in vivo correlations. This may be partly due to the absence of physiological parameters that maintain metabolic phenotype in vivo. We hypothesized that restoring hemodynamics and media transport would improve hepatocyte architecture and metabolic function in vitro compared with nonflow cultures. Rat hepatocytes were cultured for 2 wk either in nonflow collagen gel sandwiches with 48-h media changes or under controlled hemodynamics mimicking sinusoidal circulation within a perfused Transwell device. Phenotypic, functional, and metabolic parameters were assessed at multiple times. Hepatocytes in the devices exhibited polarized morphology, retention of differentiation markers E-cadherin and hepatocyte nuclear factor-4α (HNF-4α), the canalicular transporter multidrug-resistant protein-2 (Mrp-2), and significantly higher levels of liver function compared with nonflow cultures over 2 wk (albumin ~4-fold and urea ~5-fold). Gene expression of cytochrome P450 (CYP) enzymes was significantly higher (fold increase over nonflow: CYP1A1: 53.5 ± 10.3; CYP1A2: 64.0 ± 15.1; CYP2B1: 15.2 ± 2.9; CYP2B2: 2.7 ± 0.8; CYP3A2: 4.0 ± 1.4) and translated to significantly higher basal enzyme activity (device vs. nonflow: CYP1A: 6.26 ± 2.41 vs. 0.42 ± 0.015; CYP1B: 3.47 ± 1.66 vs. 0.4 ± 0.09; CYP3A: 11.65 ± 4.70 vs. 2.43 ± 0.56) while retaining inducibility by 3-methylcholanthrene and dexamethasone (fold increase over DMSO: CYP1A = 27.33 and CYP3A = 4.94). These responses were observed at concentrations closer to plasma levels documented in vivo in rats. The retention of in vivo-like hepatocyte phenotype and metabolic function coupled with drug response at more physiological concentrations emphasizes the importance of restoring in vivo physiological transport parameters in vitro.
The wear and friction behavior of ultralow wear polytetrafluoroethylene (PTFE)/α-alumina composites first described by Burris and Sawyer in 2006 has been heavily studied, but the mechanisms ...responsible for the 4 orders of magnitude improvement in wear over unfilled PTFE are still not fully understood. It has been shown that the formation of a polymeric transfer film is crucial to achieving ultralow wear on a metal countersurface. However, the detailed chemical mechanism of transfer film formation and its role in the exceptional wear performance has yet to be described. There has been much debate about the role of chemical interactions between the PTFE, the filler, and the metal countersurface, and some researchers have even concluded that chemical changes are not an important part of the ultralow wear mechanism in these materials. Here, a “stripe” test allowed detailed spectroscopic studies of PTFE/α-alumina transfer films in various stages of development, which led to a proposed mechanism which accounts for the creation of chemically distinct films formed on both surfaces of the wear couple. PTFE chains are broken during sliding and undergo a series of reactions to produce carboxylate chain ends, which have been shown to chelate to both the metal surface and to the surface of the alumina filler particles. These tribochemical reactions form a robust polymer-on-polymer system that protects the steel countersurface and is able to withstand hundreds of thousands of cycles of sliding with almost no wear of the polymer composite after the initial run-in period. The mechanical scission of carbon–carbon bonds in the backbone of PTFE under conditions of sliding contact is supported mathematically using the Hamaker model for van der Waals interactions between polymer fibrils and the countersurface. The necessity for ambient moisture and oxygen is explained, and model experiments using small molecules confirm the reactions in the proposed mechanism.
For contact depths < 200 nm from the free surface of amorphous polymers, the apparent mechanical stiffness is in excess of bulk elastic properties. This enhanced stiffness can be attributed to the ...dynamic formation of a mechanically distinct interphase at synthetic and biological polymer interfaces. In “glassy” polymers such as polystyrene, this enhanced stiffness is independent of molecular weight, processing route, and environmental conditions.
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