Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement

BackgroundLeft ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). We hypothesized that there would be differences in myocardial mechanics, measured by global longitudinal strain (GLS) recovery in patients with four subtypes of severe AS after transcatheter aortic valve replacement (TAVR), stratified based upon flow and gradient.MethodsWe retrospectively evaluated 204 patients with severe AS who underwent TAVR and were followed post-TAVR at our institution for clinical outcomes. Speckle-tracking transthoracic echocardiography was performed pre- and post-TAVR. Patients were classified as: (1) normal-flow and high-gradient, (2) normal-flow and high-gradient with reduced LV ejection fraction (LVEF), (3) classical low-flow and low-gradient, or (4) paradoxical low-flow and low-gradient.ResultsBoth GLS (−13.9 ± 4.3 to −14.8 ± 4.3, P < 0.0001) and LVEF (55 ± 15 to 57 ± 14%, P = 0.0001) improved immediately post-TAVR. Patients with low-flow AS had similar improvements in LVEF (+2.6 ± 9%) and aortic valve mean gradient (−23.95 ± 8.34 mmHg) as patients with normal-flow AS. GLS was significantly improved in patients with normal-flow (−0.93 ± 3.10, P = 0.0004) compared to low-flow AS. Across all types of AS, improvement in GLS was associated with a survival benefit, with GLS recovery in alive patients (mean GLS improvement of −1.07 ± 3.10, P < 0.0001).ConclusionsLV mechanics are abnormal in all patients with subtypes of severe AS and improve immediately post-TAVR. Recovery of GLS was associated with a survival benefit. Patients with both types of low-flow AS showed significantly improved, but still impaired, GLS post-TAVR, suggesting underlying myopathy that does not correct post-TAVR.

Schrodinger’s Narratives: Denis Diderot’s and Laurence Sterne’s Manipulations of Time and Space

This article proposes connections between literature and science through the relatively recent scientific concept of chaos. I examine Laurence Sterne’s The Life and Opinions of Tristram Shandy, Gentleman and Denis Diderot’s Jacques the Fatalist and His Master to show how these authors contradict the scientific thinkers of their time by creating narrative structures that disrupt the normal flow of time and bend the typically absolute space between reader and fictional story. Though the physical books of Jacques and Tristram Shandy have a final page, the two authors leave it to their readers to finish the stories for themselves. The narrators of both novels interact with their readers, creating a space that allows their audience to fill in the narrator’s and author's blanks. In doing this, these texts become simultaneously complete and incomplete. Thus, a narrative styled similarly to the thought experiment of Schrodinger's cat is created. In this sense these novels can be perceived as precursors to scientific thought of the twentieth and twenty-first century.

NUMERICAL METHOD APPROACH TO ANALYSIS OF DRAINAGE CHANNELS OF PIT-3 WEST BANKO TANJUNG ENIM

The drainage network system should be designed to accommodate normal flow rates, especially during the rainy season. This means that the capacity of the drainage channel has been calculated to accommodate the water discharge that occurs so that the area in question does not experience puddles or the channel can to be function properly. For this reason, research is needed to analyze the ability of the ex-coal mine drainage channel in PIT-3 West Banko Tanjung Enim. The research was carried out with the help of the HEC-RAS software program to see the changes in the water level in the drainage channel where the water was overflowing from the channel body. The results showed that all the section profiles of the drainage channel (P1) till (P10) were still in the safe condition or the channel was still stable (stable channel).

Classification and Approach to Movement Disorders

Movement disorders are conventionally divided into 2 major categories. Hyperkinetic movement disorders (also called dyskinesias) are excessive, often repetitive, involuntary movements that intrude into the normal flow of motor activity. This category includes chorea, dystonia, myoclonus, stereotypies, tics, and tremor. Hypokinetic movement disorders are akinesia (lack of movement), hypokinesia (reduced amplitude of movement), bradykinesia (slow movement), and rigidity. Parkinsonism is the most common hypokinetic movement disorder. In childhood, hyperkinetic disorders are common, whereas hypokinetic movement disorders are relatively uncommon.

Prevalence and Outcomes of Low‐Gradient Severe Aortic Stenosis—From the National Echo Database of Australia

Background The prevalence and outcomes of the different subtypes of severe low‐gradient aortic stenosis (AS) in routine clinical cardiology practice have not been well characterized. Methods and Results Data were derived from the National Echocardiography Database of Australia. Of 192 060 adults (aged 62.8±17.8 [mean±SD] years) with native aortic valve profiling between 2000 and 2019, 12 013 (6.3%) had severe AS. Of these, 5601 patients (47%) had high‐gradient and 6412 patients (53%) had low‐gradient severe AS. The stroke volume index was documented in 2741 (42.7%) patients with low gradient; 1750 patients (64%) with low flow, low gradient (LFLG); and 991 patients with normal flow, low gradient. Of the patients with LFLG, 1570 (89.7%) had left ventricular ejection fraction recorded; 959 (61%) had paradoxical LFLG (preserved left ventricular ejection fraction), and 611 (39%) had classical LFLG (reduced left ventricular ejection fraction). All‐cause and cardiovascular‐related mortality were assessed in the 8162 patients with classifiable severe AS subtype during a mean±SD follow‐up of 88±45 months. Actual 1‐year and 5‐year all‐cause mortality rates varied across these groups and were 15.8% and 49.2% among patients with high‐gradient severe AS, 11.6% and 53.6% in patients with normal‐flow, low‐gradient severe AS, 16.9% and 58.8% in patients with paradoxical LFLG severe AS, and 30.5% and 72.9% in patients with classical LFLG severe AS. Compared with patients with high‐gradient severe AS, the 5‐year age‐adjusted and sex‐adjusted mortality risk hazard ratios were 0.94 (95% CI, 0.85–1.03) in patients with normal‐flow, low‐gradient severe AS; 1.01 (95% CI, 0.92–1.12) in patients with paradoxical LFLG severe AS; and 1.65 (95% CI, 1.48–1.84) in patients with classical LFLG severe AS. Conclusions Approximately half of those patients with echocardiographic features of severe AS in routine clinical practice have low‐gradient hemodynamics, which is associated with long‐term mortality comparable with or worse than high‐gradient severe AS. The poorest survival was associated with classical LFLG severe AS.

Vitamin D level predicts angiographic no-reflow phenomenon after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p < 0.001). 25(OH)D3 level was significantly negatively correlated with Neutrophil/lymphocyte (N/L) ratio. In multivariate analysis, 25(OH)D3 level on admission (OR: 0.738; 95% CI: 0.584–0.878; p = 0.001) was found an independent predictor of NRP together with N/L ratio, N-Terminal-proBNP, balloon pre dilatation and syntax score I. On receiver operating curve analysis (ROC), the cut-off value of admission 25(OH)D3 level was 10.5 ng/ml for the prediction of NRP with a sensitivity of 93% and specificity of 68%. The area under the ROC curve (AUC) was 0.772 (95% CI: 0.697–0.846; p < 0.001). Conclusion: We have shown that lower 25(OH)D3 level on admission is associated with higher NRP frequency and may be used as a predictor for NRP in STEMI patients undergoing PPCI.

The problem of demarcation of modernity and social reality after modernity philosophical dialogue)

This article discusses the conditions for delimitation of modernity and futureculture, as well as the concept of modernity. Vadim Belyaev claims that what the author refers to as futureculture, in fact does not go beyond the boundaries of modernity; these are rather the processes of promodernity and countermodernity. Vyacheslav Maracha polemicizes with Belyaev&rsquo;s statements. Belyaev substantiates his critical rhetoric, gives characteristics to his interpretation of modernity, and claims that the author did not explain the thesis on the completion of modernity and the establishment of futureculture. The author partially agrees with the criticism and provides additional arguments: characterizes the definition of modernity used by him; distinguishes between the new worldview, semantic reality of culture, and projects of modernity, realization of these projects and objective reality results from implementation of the projects of modernity and responses to new challenges of the time, as well as construction of the social institutions of modernity. The latter statement is illustrated on the example of the formation of state institution, the study by Martin van Creveld &ldquo;The Rise and Fall of the State&rdquo;. The conclusion is made that all plans and fundamental structures of modernity (worldview, semantic reality of culture, projects of modernity, social institutions) can no longer ensure normal flow of modern life, but rather generate problems and social destructions. Objectively, modernity has been reborn and is nearing completion. The author formulates certain ideas and meaning that reveal the formation of the future culture.

Lockdown: A Commentary

The Collins dictionary has elected lockdown as its word-of-the-yearn 2020. Defined as “the imposition of stringent restrictions on travel, social interaction and access to public spaces”, decided by governments “to mitigate the spread of COVID-19”, for Collins’ lexicographers “lockdown” took the top spot because it is a unifying experience for billions of people across the world, who have had, collectively, to play their part in combating the spread of the virus. Faced with the unknown of a brand-new virus, governments all over the world reacted in a rather familiar way, by suspending the normal flow of social life through the implementation of measures that are usually categorised as a state of exception. This article is a commentary that aims at placing the practice of lockdown (as a governmental administrative measure) in the context of the theory of state and government. To the extent that emergencies are always revelatory, this paper will argue that the state of exception – of which the lockdown is a sub-category – in displaying state’s sovereign power is exposing the radical impotence in which it is grounded, and from which it takes its ultimate meaning and function.

A Review of Factors to Consider for Permanent Cordon Establishment and Maintenance

Decisions made during the establishment and reworking of permanent cordon arms may have long-term consequences on vineyard health and longevity. This review aims to summarise several of the important considerations that must be taken into account during cordon establishment and maintenance. Commonly practiced cordon training techniques such as wrapping developing arms tightly around the cordon wire may result in a constriction of the vascular system, becoming worse over time and disrupting the normal flow of water and nutrients. Studies have shown that other factors of cordon decline such as the onset of vascular diseases may be influenced by pre-existing stress conditions. Such conditions could be further exacerbated by water and heat stress events, an important consideration as these scenarios become more common under the influence of climate change. Vineyard sustainability may be improved by adopting cordon training techniques which promote long-term vitality and avoid a reduction in vine defence response and the costly, premature reworking of vines.