The use of donation after circulatory death (DCD) has increased significantly during the past decade. However, warm ischemia results in a greater risk for transplantation. Indeed, controlled DCD ...(cDCD) was associated with inferior outcomes compared with donation after brain death. The use of abdominal normothermic regional perfusion (nRP) to restore blood flow before organ recovery in cDCD has been proposed as better than rapid recovery to reverse the effect of ischemia and improve recipients’ outcome. Here, the first Spanish series using abdominal nRP as an in situ conditioning method is reported. A specific methodology to avoid restoring circulation to the brain after death determination is described. Twenty‐seven cDCD donors underwent abdominal nRP during at least 60 min. Thirty‐seven kidneys, 11 livers, six bilateral lungs, and one pancreas were transplanted. The 1‐year death‐censored kidney survival was 91%, and delayed graft function rate was 27%. The 1‐year liver survival rate was 90.1% with no cases of ischemic cholangiopathy. Transplanted lungs and pancreas exhibited primary function. The use of nRP may represent an advance to increase the number and quality of grafts in cDCD. Poor results in cDCD livers could be reversed with nRP. Concerns about restoring brain circulation after death are easily solved.
Abdominal normothermic regional perfusion with premortem interventions represents an advance to increase the number and quality of grafts recovered in controlled donation after circulatory death.
ABSTRACT
Stellar magnetic activity produces time-varying distortions in the photospheric line profiles of solar-type stars. These lead to systematic errors in high-precision radial-velocity ...measurements, which limit efforts to discover and measure the masses of low-mass exoplanets with orbital periods of more than a few tens of days. We present a new data-driven method for separating Doppler shifts of dynamical origin from apparent velocity variations arising from variability-induced changes in the stellar spectrum. We show that the autocorrelation function (ACF) of the cross-correlation function used to measure radial velocities is effectively invariant to translation. By projecting the radial velocities on to a subspace labelled by the observation identifiers and spanned by the amplitude coefficients of the ACF’s principal components, we can isolate and subtract velocity perturbations caused by stellar magnetic activity. We test the method on a 5-yr time sequence of 853 daily 15-min observations of the solar spectrum from the HARPS-N instrument and solar-telescope feed on the 3.58-m Telescopio Nazionale Galileo. After removal of the activity signals, the heliocentric solar velocity residuals are found to be Gaussian and nearly uncorrelated. We inject synthetic low-mass planet signals with amplitude K = 40 cm s−1 into the solar observations at a wide range of orbital periods. Projection into the orthogonal complement of the ACF subspace isolates these signals effectively from solar activity signals. Their semi-amplitudes are recovered with a precision of ∼ 6.6 cm s−1, opening the door to Doppler detection and characterization of terrestrial-mass planets around well-observed, bright main-sequence stars across a wide range of orbital periods.
Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy ...has been related to worse prognosis.
The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR).
Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed.
A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions.
Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation RASTAVI; NCT03201185)
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The most common approach to optically generate and manipulate bubbles in liquids involves temperature gradients induced by CW lasers. In this work, we present a method to accomplish both the ...generation of microbubbles and their 3D manipulation in ethanol through optothermal forces. These forces are triggered by light absorption from a nanosecond pulsed laser (λ = 532 nm) at silver nanoparticles photodeposited at the distal end of a multimode optical fiber. Light absorbed from each laser pulse quickly heats up the silver-ethanol interface beyond the ethanol critical-point (∼ 243 °C) before the heat diffuses through the liquid. Therefore, the liquid achieves a metastable state and owing to spontaneous nucleation converted to a vapor bubble attached to the optical fiber. The bubble grows with semi-spherical shape producing a counterjet in the final stage of the collapse. This jet reaches the hot nanoparticles vaporizing almost immediately and ejecting a microbubble. This microbubble-generation mechanism takes place with every laser pulse (10 kHz repetition rate) leading to the generation of a microbubbles stream. The microbubbles' velocities decrease as they move away from the optical fiber and eventually coalesce forming a larger bubble. The larger bubble is attracted to the optical fiber by the Marangoni force once it reaches a critical size while being continuously fed with each bubble of the microbubbles stream. The balance of the optothermal forces owing to the laser-pulse drives the 3D manipulation of the main bubble. A complete characterization of the trapping conditions is provided in this paper.
Superelasticity and shape memory down to the nanometer scale are successfully demonstrated in micro‐ and nanometer‐scale pillars of a Cu‐Al‐Ni shape memory alloy. Microcompression tests show ...superelastic behavior with recoverable strains above 5 % during more than 100 cycles. In addition, shape memory behavior with complete shape recovery at both the micro‐ and nanometer scales is also observed, opening the door to a new generation of smart micro and nano devices.
The design of the next generation of β-stabilized γ-TiAl based alloys as structural materials for high-temperature applications in aircraft engines requires the precise knowledge of the mobility of ...defects in the ordered βo phase. To reach this goal a Mo-rich prototype alloy has been specifically produced and investigated. The mobility of defects, between 600K and 1635K, has been studied by mechanical spectroscopy. The internal friction spectra show a relaxation peak P1 (at 1130K for 1Hz) superimposed to a high-temperature background. We demonstrate that the relaxation peak is taking place inside the βo phase and measure an activation energy of EP1 = 3.55 ± 0.05eV. An atomistic model is additionally proposed to explain this relaxation peak, which is attributed to a Zener-like mechanism of stress-induced Mo-Mo dipoles reorientation by exchange with a vacancy, and consequently the measured activation energy corresponds to the one for Mo diffusion in the βo phase.
Electric-arc furnace slag is proposed as a substitute for the conventional aggregate used in classical structural concrete. In the present research is studied the durability of these slag aggregate ...concretes and their resistance to both physical (freeze–thaw, high temperature and relative humidity) and chemical degradation (sulfate attack, alkali–aggregate reaction and marine environment), as well as their resistance to the corrosion of steel reinforcement bars (an assessment of the risks of corrosion) embedded in the concrete matrix. This approach requires laboratory studies. The main objective of this work focuses on evaluating the durability of slag concrete under the conditions specified in the Spanish structural concrete code. In general terms, the behavior of the concrete with slag aggregate was similar to or better than the reference concrete (natural aggregate), except in case of exposure to marine environments and seawater, which resulted in quicker chloride penetration. The study confirms the viability of producing steel-reinforced concrete with slag aggregate.
•Concrete containing two slag aggregates as an alternative raw material.•Contributes to knowledge of the durability of slag concretes.•Assesses the durability of slag concrete subjected to chemical and physical attacks.•Assesses the durability of reinforced slag concrete in marine environments.•Assesses the corrosive behavior of steel bars embedded in slag concrete.
Advanced γ-TiAl based intermetallics Mo-bearing have been developed to obtain the fine-grained microstructure required for superplastic deformation to be used during further processing. In the ...present work we have studied an alloy of Ti–46.8Al–1Mo–0.2Si (at%) with two different microstructures, as-cast material with a coarse grain size above 300 μm, and the hot extruded material exhibiting a grain size smaller than 20 μm. We have used a mechanical spectrometer especially developed for high temperature internal friction measurements to study the defect mobility processes taking place at high temperature. The internal friction spectra at different frequencies has been studied and analyzed up to 1360 K in order to characterize the relaxation processes appearing in this temperature range. A relaxation peak, with a maximum in between 900 K and 1080 K, depending on the oscillating frequency, has been attributed to Ti-atoms diffusion by the stress-induced reorientation of Al–VTi–Al elastic dipoles. The high temperature background in both microstructural states, as-cast and extruded, has been analyzed, measuring the apparent activation parameters, in particular the apparent energies of Ecast(IF) = 4.4 ± 0.05 eV and Eext(IF) = 4.75 ± 0.05 eV respectively. These results have been compared to those obtained on the same materials by creep deformation. We may conclude that the activation parameters obtained by internal friction analysis, are consistent with the ones measured by creep. Furthermore, the analysis of the high temperature background allows establish the difference on creep resistance for both microstructural states.
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Context.
The solar telescope connected to HARPS-N has been observing the Sun since the summer of 2015. Such a high-cadence, long-baseline data set is crucial for understanding spurious ...radial-velocity signals induced by our Sun and by the instrument. On the instrumental side, this data set allowed us to detect sub- m s
−1
systematics that needed to be corrected for.
Aims.
The goals of this manuscript are to (i) present a new data reduction software for HARPS-N, (ii) demonstrate the improvement brought by this new software during the first three years of the HARPS-N solar data set, and (iii) release all the obtained solar products, from extracted spectra to precise radial velocities.
Methods.
To correct for the instrumental systematics observed in the data reduced with the current version of the HARPS-N data reduction software (DRS version 3.7), we adapted the newly available ESPRESSO DRS (version 2.2.3) to HARPS-N and developed new optimised recipes for the spectrograph. We then compared the first three years of HARPS-N solar data reduced with the current and new DRS.
Results.
The most significant improvement brought by the new DRS is a strong decrease in the day-to-day radial-velocity scatter, from 1.27 to 1.07 m s
−1
; this is thanks to a more robust method to derive wavelength solutions, but also to the use of calibrations closer in time. The newly derived solar radial-velocities are also better correlated with the chromospheric activity level of the Sun in the long term, with a Pearson correlation coefficient of 0.93 compared to 0.77 before, which is expected from our understanding of stellar signals. Finally, we also discuss how HARPS-N spectral ghosts contaminate the measurement of the calcium activity index, and we present an efficient technique to derive an index free of instrumental systematics.
Conclusions.
This paper presents a new data reduction software for HARPS-N and demonstrates its improvements, mainly in terms of radial-velocity precision, when applied to the first three years of the HARPS-N solar data set. Those newly reduced solar data, representing an unprecedented time series of 34 550 high-resolution spectra and precise radial velocities, are released alongside this paper. Those data are crucial to understand stellar activity signals in solar-type stars further and develop the mitigating techniques that will allow us to detect other Earths.
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