The majority of gas giants (planets of masses 102 M⊕) are found to reside at distances beyond ∼1 au from their host stars. Within 1 au, the planetary population is dominated by super-Earths of 2-20 ...M⊕. We show that this dichotomy between inner super-Earths and outer gas giants can be naturally explained should they form in nearly inviscid disks. In laminar disks, a planet can more easily repel disk gas away from its orbit. The feedback torque from the pile-up of gas inside the planet's orbit slows down and eventually halts migration. A pressure bump outside the planet's orbit traps pebbles and solids, starving the core. Gas giants are born cold and stay cold: more massive cores are preferentially formed at larger distances, and they barely migrate under disk feedback. We demonstrate this using two-dimensional hydrodynamical simulations of disk-planet interaction lasting up to 105 years: we track planet migration and pebble accretion until both come to an end by disk feedback. Whether cores undergo runaway gas accretion to become gas giants or not is determined by computing one-dimensional gas accretion models. Our simulations show that in an inviscid minimum mass solar nebula, gas giants do not form inside ∼0.5 au, nor can they migrate there while the disk is present. We also explore the dependence on disk mass and find that gas giants form further out in less massive disks.
Protoplanets can produce structures in protoplanetary disks via gravitational disk-planet interactions. Once detected, such structures serve as signposts of planet formation. Here we investigate the ...kinematic signatures in disks produced by multi-Jupiter mass (MJ) planets using 3D hydrodynamics and radiative transfer simulations. Such a planet opens a deep gap, and drives transonic vertical motions inside. Such motions include both a bulk motion of the entire half-disk column, and turbulence on scales comparable to and smaller than the scale height. They significantly broaden molecular lines from the gap, producing double-peaked line profiles at certain locations, and a kinematic velocity dispersion comparable to thermal after azimuthal averaging. The same planet does not drive fast vertical motions outside the gap, except at the inner spiral arms and the disk surface. Searching for line broadening induced by multi-MJ planets inside gaps requires an angular resolution comparable to the gap width, an assessment of the gap gas temperature to within a factor of 2, and a high sensitivity needed to detect line emission from the gap.
ABSTRACT Direct imaging observations of protoplanetary disks at near-infrared (NIR) wavelengths have revealed structures of potentially planetary origin. Investigations of observational signatures ...from planet-induced features have so far focused on disks viewed face-on. Combining 3D hydrodynamics and radiative transfer simulations, we study how the appearance of the spiral arms and the gap produced in a disk by a companion varies with inclination and position angle in NIR scattered light. We compare the cases of a 3MJ and a 0.1M companion, and make predictions suitable for testing with Gemini/GPI, Very Large Telescope/NACO/SPHERE, and Subaru/HiCIAO/SCExAO. We find that the two trailing arms produced by an external perturber can have a variety of morphologies in inclined systems-they may appear as one trailing arm; two trailing arms on the same side of the disk; or two arms winding in opposite directions. The disk ring outside a planetary gap may also mimic spiral arms when viewed at high inclinations. We suggest potential explanations for the features observed in HH 30, HD 141569 A, AK Sco, HD 100546, and AB Aur. We emphasize that inclined views of companion-induced features cannot be converted into face-on views using simple and commonly practiced image deprojections.
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been ...published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
Spatially resolved structures in protoplanetary disks hint at unseen planets. Previous imaging observations of the transitional disk around MWC 758 revealed an inner cavity, a ring-like outer disk, ...emission clumps, and spiral arms, all possibly generated by companions. We present ALMA dust continuum observations of MWC 758 at 0.87 mm wavelength with 43 × 39 mas angular resolution (6.9 × 6.2 au) and 20 Jy beam−1 rms. The central submillimeter emission cavity is revealed to be eccentric; once deprojected, its outer edge can be well fitted by an ellipse with an eccentricity of 0.1 and one focus on the star. The broad ring-like outer disk is resolved into three narrow rings with two gaps in between. The outer two rings tentatively show the same eccentricity and orientation as the innermost ring bounding the inner cavity. The two previously known dust emission clumps are resolved in both the radial and azimuthal directions, with radial widths equal to ∼4× the local scale height. Only one of the two spiral arms previously imaged in near-infrared (NIR) scattered light is revealed in ALMA dust emission, at a slightly larger stellocentric distance owing to projection effects. We also submit evidence of disk truncation at ∼100 au based on comparing NIR imaging observations with models. The spirals, the north clump, and the truncated disk edge are all broadly consistent with the presence of one companion exterior to the spirals at roughly 100 au.
Observational studies suggest that conventional right ventricular apical pacing may have a deleterious effect on left ventricular function. In this study, we examined whether biventricular pacing is ...superior to right ventricular apical pacing in preventing deterioration of left ventricular systolic function and cardiac remodeling in patients with bradycardia and a normal ejection fraction.
In this prospective, double-blind, multicenter study, we randomly assigned 177 patients in whom a biventricular pacemaker had been successfully implanted to receive biventricular pacing (89 patients) or right ventricular apical pacing (88 patients). The primary end points were the left ventricular ejection fraction and left ventricular end-systolic volume at 12 months.
At 12 months, the mean left ventricular ejection fraction was significantly lower in the right-ventricular-pacing group than in the biventricular-pacing group (54.8+/-9.1% vs. 62.2+/-7.0%, P<0.001), with an absolute difference of 7.4 percentage points, whereas the left ventricular end-systolic volume was significantly higher in the right-ventricular-pacing group than in the biventricular-pacing group (35.7+/-16.3 ml vs. 27.6+/-10.4 ml, P<0.001), with a relative difference between the groups in the change from baseline of 25% (P<0.001). The deleterious effect of right ventricular apical pacing occurred in prespecified subgroups, including patients with and patients without preexisting left ventricular diastolic dysfunction. Eight patients in the right-ventricular-pacing group (9%) and one in the biventricular-pacing group (1%) had ejection fractions of less than 45% (P=0.02). There was one death in the right-ventricular-pacing group, and six patients in the right-ventricular-pacing group and five in the biventricular-pacing group were hospitalized for heart failure (P=0.74).
In patients with normal systolic function, conventional right ventricular apical pacing resulted in adverse left ventricular remodeling and in a reduction in the left ventricular ejection fraction; these effects were prevented by biventricular pacing. (Centre for Clinical Trials number, CUHK_CCT00037.)
ABSTRACT Recent VLT/SPHERE near-infrared imaging observations revealed two spiral arms with a near m = 2 rotational symmetry in the protoplanetary disk around the ∼1.7 M Herbig star HD 100453. A ∼0.3 ...M M dwarf companion, HD 100453 B, was also identified at a projected separation of 120 AU from the primary. In this Letter, we carry out hydrodynamic and radiative transfer simulations to examine the scattered light morphology of the HD 100453 disk as perturbed by the companion on a circular and coplanar orbit. We find that the companion truncates the disk at ∼45 AU in scattered light images, and excites two spiral arms in the remaining (circumprimary) disk with a near m = 2 rotational symmetry. Both the truncated disk size and the morphology of the spirals are in excellent agreement with the SPHERE observations at Y, J, H, and K1-bands, suggesting that the M dwarf companion is indeed responsible for the observed double-spiral-arm pattern. Our model suggests that the disk is close to face on (inclination angle ∼5°), and that the entire disk-companion system rotates counterclockwise on the sky. The HD 100453 observations, along with our modeling work, demonstrate that double spiral arm patterns in near-infrared scattered light images can be generically produced by companions, and support future observations to identify the companions responsible for the arms observed in the MWC 758 and SAO 206462 systems.
Background
Left ventricular lead (LVL) implant success rates have historically ranged between 70.5% and 95.5%. To date, there are few large studies that evaluate LVL implant success utilizing a ...single family of delivery catheters and leads. The Attain Success study was a prospective nonrandomized multicenter global study with the main objectives of assessing single‐system LVL implant success and complication rates.
Methods
Patients undergoing cardiac resynchronization therapy implantation were eligible for enrollment. There was no prespecified level of experience for investigator participation. LVL implant success and complication rates were assessed though 3 months of follow‐up.
Results
A total of 2,014 patients (69.1 ± 12.0 years, 71% male and 38% atrial fibrillation) were enrolled from 114 centers with a follow‐up of 3.5 ± 2.1 months. Coronary sinus cannulation success rate was 96.4% with Attain Family delivery catheters. Implant success rate for Attain Family leads using Attain Family catheters was 94.0%; overall LVL implant success rate was 97.1%. Median procedure time was 4 minutes for cannulation and 9 minutes for LVL placement. Median fluoroscopy time was 17 minutes and median contrast used was 25 cc. There were 55 catheter or LVL‐related complications in 53 subjects; the majority were LVL dislodgements (34, 1.7%) and extracardiac stimulation (11, 0.5%). The Kaplan‐Meier estimate of the 3‐month complication probability was 2.6%.
Conclusion
This study represents the largest prospective evaluation of LVL implantation to date, revealing a high LVL implant success rate and low complication rate using a single family of leads and delivery catheters.
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been ...identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
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