Search

ObjectiveA cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident.MethodsProspectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients.ResultsThirty-one patients (25%) had 48 cerebrovascular accidents. The mean ventricular assist device support period was 228 and 89 days in patients with and without cerebrovascular accidents, respectively (P < .0001). Sixty-six percent of cerebrovascular accidents occurred within 4 months after implantation. Actuarial freedom from cerebrovascular accident at 6 months was 75%, 64%, 63%, and 33% with the HeartMate device (Thoratec Corp, Pleasanton, Calif), Thoratec biventricular ventricular assist device (Thoratec Corp), Thoratec left ventricular assist device (Thoratec), and Novacor device (WorldHeart, Oakland, Calif), respectively. Twenty cerebrovascular accidents (42%) occurred in patients with infections. The mean white blood cell count at the cerebrovascular accident was greater than the normal range in patients with infection (12,900/mm3) and without infection (9500/mm3). The mean maximum amplitude of the thrombelastogram in the presence of infection (63.6 mm) was higher than that in the absence of infection (60.7 mm) (P = .0309).ConclusionsThe risk of cerebrovascular accident increases with a longer ventricular assist device support period. Infection may activate platelet function and predispose the patient to a cerebrovascular accident. An elevation of the white blood cell count may also exacerbate the risk of cerebrovascular accident even in patients without infection. Selection of device type, prevention of infection, and meticulous control of anticoagulation are key to preventing cerebrovascular accident.

Background Despite the impact of medical regimen nonadherence on health outcomes after organ transplantation, there is mixed and conflicting evidence regarding the prevalence and predictors of posttransplant nonadherence. Clinicians require precise information on nonadherence rates in order to evaluate patients' risks for this problem. Methods A total of 147 studies of kidney, heart, liver, pancreas/kidney-pancreas, or lung/heart-lung recipients published between 1981 and 2005 were included in a meta-analysis. Average nonadherence rates were calculated for 10 areas of the medical regimen. Correlations between nonadherence and patient psychosocial risk factors were examined. Results Across all types of transplantation, average nonadherence rates ranged from 1 to 4 cases per 100 patients per year (PPY) for substance use (tobacco, alcohol, illicit drugs), to 19 to 25 cases per 100 PPY for nonadherence to immunosuppressants, diet, exercise, and other healthcare requirements. Rates varied significantly by transplant type in two areas: immunosuppressant nonadherence was highest in kidney recipients (36 cases per 100 PPY vs. 7 to 15 cases in other recipients). Failure to exercise was highest in heart recipients (34 cases per 100 PPY vs. 9 to 22 cases in other recipients). Demographics, social support, and perceived health showed little correlation with nonadherence. Pretransplant substance use predicted posttransplant use. Conclusions The estimated nonadherence rates, overall and by transplant type, allow clinicians to gauge patient risk and target resources accordingly. Nonadherence rates in some areas--including immunosuppressant use--appear unacceptably high. Weak correlations of most patient psychosocial factors with nonadherence suggest that attention should focus on other classes of variables (e.g., provider-related and systems-level factors), which may be more influential.

Cooperative interactions play an important role in recognition and binding in macromolecular systems. In this study, we find that cross-correlated atomic fluctuations can be used to identify cooperative networks in a protein-RNA system. The dynamics of the RRM-containing protein U1A-stem loop 2 RNA complex have been calculated theoretically from a 10 ns molecular dynamics (MD) simulation. The simulation was analyzed by calculating the covariance matrix of all atomic fluctuations. These matrix elements are then presented in the form of a two-dimensional grid, which displays fluctuations on a per residue basis. The results indicate the presence of strong, selective cross-correlated fluctuations throughout the RRM in U1A-RNA. The atomic fluctuations correspond well with previous biophysical studies in which a multiplicity of cooperative networks have been reported and indicate that the various networks identified in separate individual experiments are fluctuationally correlated into a hyper-network encompassing most of the RRM. The calculated results also correspond well with independent results from a statistical covariance analysis of 330 aligned RRM sequences. This method has significant implications as a predictive tool regarding cooperativity in the protein-nucleic acid recognition process.

We thank the J-PARC staff for superb accelerator performance and the CERN NA61 Collaboration for providing valuable particle production data. We acknowledge the support of MEXT, Japan; NSERC, NRC, and CFI, Canada; CEA and CNRS/IN2P3, France; DFG, Germany; INFN, Italy; National Science Centre (NCN), Poland; RSF, RFBR, and MES, Russia; MINECO and ERDF funds, Spain; SNSF and SER, Switzerland; STFC, UK; and DOE, USA. We also thank CERN for the UA1/NOMAD magnet, DESY for the HERA-B magnet mover system, NII for SINET4, the WestGrid and SciNet consortia in Compute Canada, GridPP, UK. In addition participation of individual researchers and institutions has been further supported by funds from ERC (FP7), EU; JSPS, Japan; Royal Society, UK; DOE Early Career program, USA.

Purpose: To evaluate the reliability and construct validity of measures from the Patient-Reported Outcomes Measurement Information System® (PROMIS®) for patients with heart failure before and after heart transplantation. Methods: We assessed reliability of the PROMIS short forms using Cronbach’s alpha and the average marginal reliability. To assess the construct validity of PROMIS computerized adaptive tests and short-form measures, we calculated Pearson product moment correlations between PROMIS measures of physical function, fatigue, depression, and social function and existing PRO measures of similar domains (i.e., convergent validity) as well as different domains (i.e., discriminate validity) in patients with heart failure awaiting heart transplant. We evaluated the responsiveness of these measures to change after heart transplant using effect sizes. Results: Forty-eight patients were included in the analyses. Across the many domains examined, correlations between conceptually similar domains were larger than correlations between different domains of health, demonstrating construct validity. Health status improved substantially after heart transplant (standardized effect sizes, 0.63–1.24), demonstrating the responsiveness of the PROMIS measures. Scores from the computerized adaptive tests and the short forms were similar. Conclusions: This study provides evidence for the reliability and construct validity (including responsiveness to change) of four PROMIS domains in patients with heart failure before and after heart transplant. PROMIS measures are a reasonable choice in this context and will facilitate comparisons across studies and health conditions.

The first annual report of the International Society for Heart and Lung Transplantation (ISHLT) Mechanically Assisted Circulatory Support (IMACS) registry provides global data on 5,942 patients from 31 countries. This initial report focuses on patient demographics, survival, device types, adverse events, competing outcomes, and a risk factor analysis.

The overwhelming majority of clinical research papers begin their Results section with a series of tables summarizing the distribution of significant demographics, clinical characteristics, and potential outcome variables within their study cohort. However, the presentation of these tables often leaves the reader confused or wanting different information than what is presented. One particularly vexing decision in the presentation of categoric variables is choosing to present the "row percentage" in preference to the "column percentage." This report provides a guide for clinical scientists, some of whom may not have access to statistical support, to summarize their descriptive results in the manner that provides the most clarity for the reader.

Artículo escrito por muchos autores, sólo se referencian el primero, los autores que firman como Universidad Autónoma de Madrid y el grupo de colaboración en el caso de que aparezca en el artículo, Hyper-Kamiokande will be a next-generation underground water Cherenkov detector with a total (fiducial) mass of 0.99 (0.56) million metric tons, approximately 20 (25) times larger than that of Super-Kamiokande. One of the main goals of Hyper-Kamiokande is the study of CP asymmetry in the lepton sector using accelerator neutrino and anti-neutrino beams. In this paper, the physics potential of a long-baseline neutrino experiment using the Hyper- Kamiokande detector and a neutrino beam from the J-PARC proton synchrotron is presented. The analysis uses the framework and systematic uncertainties derived from the ongoing T2K experiment. With a total exposure of 7.5 MW ×107 s integrated proton beam power (corresponding to 1.56 × 1022 protons on target with a 30 GeV proton beam) to a 2.5° off-axis neutrino beam, it is expected that the leptonic CP phase δCP can be determined to better than 19 degrees for all possible values of δCP, and CP violation can be established with a statistical significance of more than 3 σ (5 σ) for 76% (58%) of the δCP parameter space. Using both νeappearance and νμ disappearance data, the expected 1 σ uncertainty of sin2 Θ23 is 0.015(0.006) for sin2 Θ23= 0.5(0.45), This work was supported by a MEXT Grant-in-Aid for Scientific Research on Innovative Areas Number 25105004, titled “Unification and Development of the Neutrino Science Frontier.” In addition, the participation of individual researchers has been further supported by funds from JSPS, Japan; the European Union ERC-207282, H2020 RISE-GA644294-JENNIFER, and H2020 RISE-GA641540-SKPLUS; RSF, RFBR, and MES, Russia; and JSPS and RFBR under the Japan–Russia Research Cooperative Program

Right ventricular failure (RVF) increases morbidity and mortality. The RECOVER RIGHT study evaluated the safety and efficacy of a novel percutaneous right ventricular assist device, the Impella RP (Abiomed, Danvers, MA), in a prospective, multicenter trial.Thirty patients with RVF refractory to medical treatment received the Impella RP device at 15 United States institutions. The study population included 2 cohorts: 18 patients with RVF after left ventricular assist device (LVAD) implantation (Cohort A) and 12 patients with RVF after cardiotomy or myocardial infarction (Cohort B). The primary end point was survival to 30 days or hospital discharge (whichever was longer). Major secondary end points included indices of safety and efficacy.The patients (77% male) were a mean age of 59 ± 15 years, 53% had diabetes, 88.5% had a history of congestive heart failure, and 37.5% had renal dysfunction. Patients were on an average of 3.2 inotropes/pressors. Device delivery was achieved in all but 1 patient. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in cardiac index from 1.8 ± 0.2 to 3.3 ± 0.23 liters/min/m(2) (p0.001) and a decrease in central venous pressure from 19.2 ± 4 to 12.6 ± 1 mm Hg (p0.001). Patients were supported for an average of 3.0 ± 1.5 days (range, 0.5-7.8 days). The overall survival at 30 days was 73.3%. All patients discharged were alive at 180 days.In patients with life-threatening RVF, the novel percutaneous Impella RP device was safe, easy to deploy, and reliably resulted in immediate hemodynamic benefit. These data support its probable benefit in this gravely ill patient population.

8 pages.- 6 figures, The T2K experiment has performed a search for nu(e) disappearance due to sterile neutrinos using 5.9 x 10(20) protons on target for a baseline of 280 m in a neutrino beam peaked at about 500 MeV. A sample of nu(e) CC interactions in the off-axis near detector has been selected with a purity of 63% and an efficiency of 26%. The p-value for the null hypothesis is 0.085 and the excluded region at 95% C.L. is approximately sin(2)2 theta(ee) > 0.3 for Delta m(eff)(2) > 7 eV(2)/c(4)., We thank the J-PARC staff for superb accelerator performance and the CERN NA61 collaboration for providing valuable particle production data. We acknowledge the support of MEXT, Japan; NSERC, NRC and CFI, Canada; Commissariat 'a l'Energie Atomique and Centre National de la Recherche Scientifique-Institut National de Physique Nucleaire et de Physique des Particules, France; DFG, Germany; INFN, Italy; National Science Centre (NCN), Poland; Russian Science Foundation, RFBR and Ministry of Education and Science, Russia; MINECO and European Regional Development Fund, Spain; Swiss National Science Foundation and State Secretariat for Education, Research and Innovation, Switzerland; STFC, UK; and DOE, USA. We also thank CERN for the UA1/NOMAD magnet, DESY for the HERA-B magnet mover system, NII for SINET4, the WestGrid and SciNet consortia in Compute Canada, GridPP, UK. In addition participation of individual researchers and institutions has been further supported by funds from ERC (FP7), EU; JSPS, Japan; Royal Society, UK; DOE Early Career program, USA.

17 pages.- 21 figures, We report a measurement of the nu(mu) charged current quasielastic cross-sections on carbon in the T2K on-axis neutrino beam. The measured charged current quasielastic cross-sections on carbon at mean neutrino energies of 1.94 GeV and 0.93 GeV are (11.95 +/- 0.19(stat)(-1.47)(+1.82)(syst)) x 10(-39) cm(2)/neutron, and (10.64 +/- 0.37(stat)(-1.65)(+2.03)(syst)) x 10(-39) cm(2)/neutron, respectively. These results agree well with the predictions of neutrino interaction models. In addition, we investigated the effects of the nuclear model and the multi-nucleon interaction., It is a pleasure to thank Mr. Taino from Mechanical Support Co. for helping with the construction of INGRID. We thank the J-PARC staff for superb accelerator performance and the CERN NA61 collaboration for providing valuable particle production data. We acknowledge the support of MEXT, Japan; NSERC, NRC and CFI, Canada; CEA and CNRS/IN2P3, France; DFG, Germany; INFN, Italy; National Science Centre (NCN), Poland; RSF, RFBR, and MES, Russia; MINECO and ERDF funds, Spain; SNSF and SER, Switzerland; STFC, UK; and DOE, USA. We also thank CERN for the UA1/NOMAD magnet, DESY for the HERA-B magnet mover system, NII for SINET4, the WestGrid and SciNet consortia in Compute Canada, GridPP, UK. In addition, participation of individual researchers and institutions has been further supported by funds from ERC (FP7), EU; JSPS, Japan; Royal Society, UK; DOE Early Career program, USA.

Background: The use of ventricular assist devices for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. Ventricular assist devices improve the longevity and the quality of life for these patients. In addition, they serve as a bridge to cardiac allograft transplantation until a donor heart is found. However, ventricular assist device-related infections remain a major problem complicating their long-term use. Clinical infection and sepsis can critically threaten these patients with ventricular assist devices. Infection can delay immediate transplantation and potentially require the removal of the device for definitive treatment of the problem. Methods: Patients who underwent insertion of a ventricular assist device at the University of Pittsburgh Medical Center were identified through accessing the medical records archives of the hospital. Review of patients' medical records was conducted to obtain patient demographics, preoperative diagnosis and disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, infectious organism identified, timing ofomental flap procedure after the initial insertion, duration of ventricular assist device support before cardiac transplantation, and patient follow-up. Results: There were 76 patients who underwent a ventricular assist device insertion procedure during the 4-year period between January of 2000 and January of 2004. Of the 76 patients who received a device, 11(14 percent) had evidence of clinical infection secondary to insertion. Two of these 11 patients died before surgical intervention, four had their devices explanted, and the remaining five underwent omental flap transposition with bilateral pectoralis major advancement flaps in surgically addressing their infections. Of the five patients with infections who received omental transposition flaps, two went on to undergo successful transplantation, two continue to await cardiac allograft transplantation, and one died as a result of an unknown cause. Conclusions: The authors present their experience with five patients who received omental transposition flaps to cover infected ventricular assist device pumps and the associated tubing in large, open sternoabdominal wounds. Treatment included the direct application of an omental transposition flap over the infected device with use of a bilateral pectoralis advancement flap to aid in complete sternal and skin closure of the sternal wound defect. In each of these cases, the use of the omental flap was followed by resolution of the mediastinal infection. In addition, the treatment with an omental flap prevented the removal of infected devices in patients who were otherwise pump dependent during their waiting periods for transplantation. The use of omental transposition flaps can be an effective technique in salvaging infected ventricular assist devices and preserving this valuable device for patients awaiting a cardiac transplant.

Ventricular assist devices (VADs) are approved for destination therapy because they improve survival in end-stage heart failure (HF). VADs are powered pneumatically or electrically. Pneumatic and electric left ventricular assist devices (LVADs) and biventricular assist devices (BiVADs) provide excellent hemodynamic support at rest, but differences in their effects on exercise tolerance are unclear. We sought to evaluate the effect of devices with varying operating parameters on exercise capacity.Exercise physiology data obtained during maximal exercise with on-line gas-exchange analysis were collected for 38 consecutive VAD-implanted HF patients referred for exercise testing.Electric LVADs were implanted in 18 patients, and pneumatic LVADs in 10 patients. Percent of predicted peak exercise oxygen consumption (VO2%) was significantly greater in pneumatic LVAD patients (52.1 +/- 11.1% vs 38.2 +/- 11.3%, p0.05). The 10 patients implanted with a pneumatically powered LVAD were compared to 10 patients implanted with a pneumatically powered BiVAD. LVAD-supported patients had a higher VO2% (52.1 +/- 11.1% vs 36.5 +/- 17.7%, p0.05).HF patients supported with a pneumatic LVAD appear to have better exercise tolerance than those receiving an electric LVAD. Patients on LVAD support have better exercise tolerance than BiVAD-supported patients. This highlights the importance of right ventricular function to exercise tolerance in HF patients, and may have implications for future VAD design.

Children with heart failure unresponsive to medical therapy are left with few options for survival. Pulsatile paracorporeal ventricular assist devices are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. From March 1997 to July 2004, 12 patients underwent implantation of Thoratec biventricular assist devices (BVADs) for refractory heart failure. Mean age was 14.9 (range 7-20) and mean BSA was 1.7 (range 1.1-1.9). Indications for support included end-stage cardiomyopathy (n=10), myocarditis (n=1), and postcardiotomy heart failure (n=1). Preimplant variables included 50% of patients requiring mechanical ventilation (mean 4.2 days), hyperbilirubinemia in 58%, and acute renal failure in 50%. Mean duration of support was 64.5 (range 2-175) days. Overall survival was 83%, with nine patients successfully bridged to transplantation (75%). One patient exhibited recovery allowing for device explantation, and two patients died while on BVADs. Complications included bleeding requiring reoperation in 25% (n=3), stroke in 8% (n=1), driveline infections in 17% (n=2), and device malfunction in one patient. Pulsatile paracorporeal BVADs can be used successfully in children and adolescents with heart failure. These results warrant consideration of using available miniaturized technology in the United States for the support of smaller children with intractable biventricular failure.

Hybrid density functional calculations with effective core potential basis sets are performed for monomeric group 13/15 and group 14/14 analogues of cyclohexane, as well as for three different pseudo-two-dimensional structures that can be formed from expanding one and two concentric rings around the central one (trans-fused chairs, a rolling combination of trans- and cis-fused chairs, and cis-fused boats). Varying contributions from torsional strain, angle strain, electrostatics, and nontraditional H-H hydrogen bonding lead to different orderings and magnitudes of motif energies in the various systems: Homoatomic SiSi and GeGe systems prefer the trans-fused chair alternative and heteroatomic systems GaN, SiC, and GeC prefer the rolling chair. Decomposition of structure energies into characteristic fragment contributions indicates that pseudo-one-dimensional rods of poly(imidogallane) are thermodynamically more stable than any of the pseudo-two-dimensional structures.

Personality characteristics are clinically believed to predict posttransplant adherence and outcome; however, data, as to the prevalence and type of personality disorders (PDs) and distribution of personality traits among transplant (txp) populations, are sparse and inconclusive. This paper reports on the prevalence and type of PD and range of personality traits, according to the Five-Factor model, among 73 adult cardiothoracic txp recipients. It represents the first systematic assessment of PDs and traits in a sample of txp recipients. Personality disorders were assessed with a semistructured diagnostic interview; personality traits were assessed with a self-report instrument. Thirty-three percent of the sample met diagnostic criteria for a PD, approximately three times higher than prevalence of PD previously reported among nonpsychiatric populations. Mean values of personality traits for the sample were in the normative range but with wide variability; extreme values on four of the five traits were scored by subjects with a PD. This unexpectedly high prevalence of PD and the wide variability in traits among heart and lung recipients alert clinicians to consider personality characteristics when planning interventions to increase compliance and maximize quality of life after cardiothoracic transplantation.

Reaction of [RGa(NMe(2))(2)](2), where R = Me, Et, Bu, and Hx, with ammonia at 150 degrees C in an autoclave produced insoluble white powders formulated as oligomers of [RGaNH](n). The analogous reaction between NH(3) and MeGa[N(SiMe(3))(2)](2) at low temperature (

Experimentally measured 298 K enthalpies of formation are not well established for monofluoroalkanes. To supplement available experimental data, the multi-coefficient G3 (MCG3) quantum mechanical model has been applied toestimate this thermochemical quantity for methyl fluoride, ethyl fluoride, 2-fluoropropane (isopropyl fluoride) and 2-fluoro-2-methylpropane (tert-butyl fluoride). The following 298 K standard enthalpies of formation are suggested for these monofluoroalkanes: ΔH f \ , 2 9 8 (MeF) = -57.1′0.2 kcal mol - 1 , ΔH f \ , 2 9 8 (EtF) = -66.5 ′ 0.4 kcal mok - 1 , ΔH f \ , 2 9 8 (i-PrF) = -75.4 ′ 0.5 kcal mol - 1 , and ΔH f \ , 2 9 8 (t-BuF) = -86.0 ′ 2.0 kcal mol - 1 (1 kcal = 4.184 kJ).

OBJECTIVE To report the use of oral terbutaline for chronotropic support in a patient who had undergone heart transplantation. CASE SUMMARY A 54-year-old white man received a heart transplant secondary to ischemic dilated cardiomyopathy. His clinical course was uncomplicated until postoperative day 10, when he became hemodynamically compromised despite inotropic therapy (BP 88/53 mm Hg, mean HR 80 beats/min) secondary to stage IIIa rejection. Although a continuous intravenous infusion of dobutamine was maintained, therapy with oral terbutaline 2.5 mg every 6 hours was initiated. Because the patient remained bradycardic on postoperative day 11 (HR 64 beats/min; mean 75), terbutaline was titrated to a dosage of 5 mg every 8 hours. Subsequently, an improvement in the hemodynamic profile (BP 140/78 mm Hg, mean HR 91 beats/min) was noted. Treatment with terbutaline was continued for 13 days and was well tolerated. DISCUSSION As of February 11, 2004, this is the first case, to our knowledge, to describe the use of oral terbutaline therapy for chronotropic support in the setting of acute rejection after heart transplantation. Terbutaline is a β2-adrenergic agonist that may mediate its effects via direct β2-receptor stimulation, baroreceptor-mediated increases in sympathetic tone, or via presynaptic β2-stimulation. Although isoproterenol has been the mainstay of therapy for chronotropic support in this setting, its availability has been an issue in recent years. Terbutaline, therefore, may represent a useful alternative for chronotropic support in the setting of heart transplantation. CONCLUSIONS Terbutaline therapy did not appear to be associated with any significant adverse effects and warrants further application and study in this setting.

Select patients who have undergone orthotopic heart transplantation with proximal left anterior disease may be candidates for minimally invasive direct coronary artery bypass surgery. Combining left internal thoracic artery transthoracic Doppler flow assessment with wall motion assessment during dobutamine stress echocardiography adds to the utility of this test by focusing attention on the graft's status as well as detecting ischemia due to cardiac allograft vasculopathy.

A search for single production of doubly-charged Higgs bosons has been performed using 600.7 pb^-1 of e+e- collision data with sqrt(s)=189--209GeV collected by the OPAL detector at LEP. No evidence for the existence of H++/-- is observed. Upper limits on the Yukawa coupling of the H++/-- to like-signed electron pairs are derived. Additionally, indirect constraints on the Yukawa coupling from Bhabha scattering, where the H++/-- would contribute via t-channel exchange, are derived for M(H++/--) < 2TeV. These are the first results for both a single production search and constraints from Bhabha scattering reported from LEP., 20 pages, 9 figures, Submitted to Phys. Lett. B

Myocardial recovery may occur in patients with heart failure who are receiving left ventricular assist-device support, but identification of candidates for device removal remains challenging. We hypothesized that on-line quantitative echocardiography during trials of decreased device support alone or in combination with exercise cardiopulmonary testing can assess cardiac recovery to predict successful device removal.We studied 18 patients with severe heart failure, aged 45 +/- 19 years, who received 234 +/- 169 days of assist-device support as a bridge to transplantation. We used echocardiographic automated border detection from mid-ventricular short-axis images and non-invasive arterial pressure to measure beat-to-beat responses in 2 to 5 minute trials of decreased device flow. We also assessed maximal oxygen consumption in 14 patients who could exercise.Six patients experienced myocardial recovery and underwent successful device removal; 12 remained device dependent. With transient, low assist-device flow, patients with device removal had increased echocardiographic stroke area of 27% +/- 36% vs -24% +/- 12% (p0.05) and fractional area change of 51% +/- 13% vs 23% +/- 11% (p0.05) in the patients who were device dependent. Estimates of pre-load-adjusted maximal power, a relatively load-independent index, were 6.7 +/- 2.1 mW/cm(4) in patients with successful device removal vs 1.2 +/- 1.2 mW/cm(4) in patients who were device dependent (p0.005). Maximal oxygen consumption was 17.2 +/- 1.4 ml/kg/min in patients with myocardial recovery vs 13.1 +/- 1.9 ml/kg/min in patients who were device dependent (p0.005) and correlated with pre-load-adjusted maximal power (r = 0.89, p0.001). Maximal oxygen consumption16 ml/kg/min, increased stroke area,40% increase in fractional area change, or pre-load-adjusted maximal power4.0 mW/cm(4) with low device flow were associated with successful device removal (p0.05).On-line quantitative echocardiography alone or combined with exercise cardiopulmonary testing can assess myocardial recovery of patients receiving left ventricular assist-device support and has the potential to identify patients who are clinical candidates for device removal.

A search for stable and long-lived massive particles of electric charge |Q/e|=1 or fractional charges of 2/3, 4/3, and 5/3 is reported using data collected by the OPAL detector at LEP, at centre-of-mass energies from 130 to 209 GeV. These particles are assumed to be pair-produced in e+e- collisions and not to interact strongly. No evidence for the production of these particles was observed. Model-independent upper limits on the production cross-section between 0.005 and 0.028 pb have been derived for scalar and spin-1/2 particles with charge +-1. Within the framework of the Constrained Minimal Supersymmetric Standard Model (CMSSM), this implies a lower limit of 98.0 (98.5) GeV on the mass of long-lived right (left)- handed scalar muons and scalar taus. Long-lived charged heavy leptons and charginos are excluded for masses below 102.0 GeV. For particles with fractional charge +-2/3, +-4/3, and +-5/3, the upper limit on the production cross-section varies between 0.005 and 0.020 pb. All mass and cross-section limits are derived at the 95% confidence level and are valid for particles with lifetimes longer than 10-6s. A search for stable and long-lived massive particles of electric charge | Q / e |=1 or fractional charges of 2/3, 4/3, and 5/3 is reported using data collected by the OPAL detector at LEP, at centre-of-mass energies from 130 to 209 GeV. These particles are assumed to be pair-produced in e + e − collisions and not to interact strongly. No evidence for the production of these particles was observed. Model-independent upper limits on the production cross-section between 0.005 and 0.028 pb have been derived for scalar and spin-1/2 particles with charge ±1. Within the framework of the Constrained Minimal Supersymmetric Standard Model (CMSSM), this implies a lower limit of 98.0 (98.5) GeV on the mass of long-lived right- (left-)handed scalar muons and scalar taus. Long-lived charged heavy leptons and charginos are excluded for masses below 102.0 GeV. For particles with fractional charge ±2/3, ±4/3 and ±5/3, the upper limit on the production cross-section varies between 0.005 and 0.020 pb. All mass and cross-section limits are derived at the 95% confidence level and are valid for particles with lifetimes longer than 10 −6 s. A search for stable and long-lived massive particles of electric charge |Q/e|=1 or fractional charges of 2/3, 4/3, and 5/3 is reported using data collected by the OPAL detector at LEP, at centre-of-mass energies from 130 to 209 GeV. These particles are assumed to be pair-produced in e+e- collisions and not to interact strongly. No evidence for the production of these particles was observed. Model-independent upper limits on the production cross-section between 0.005 and 0.028 pb have been derived for scalar and spin-1/2 particles with charge +-1. Within the framework of the Constrained Minimal Supersymmetric Standard Model (CMSSM), this implies a lower limit of 98.0 (98.5) GeV on the mass of long-lived right (left)- handed scalar muons and scalar taus. Long-lived charged heavy leptons and charginos are excluded for masses below 102.0 GeV. For particles with fractional charge +-2/3, +-4/3, and +-5/3, the upper limit on the production cross-section varies between 0.005 and 0.020 pb. All mass and cross-section limits are derived at the 95% confidence level and are valid for particles with lifetimes longer than 10-6s.

A systematic quantum chemical investigation of mono-, di-, and triaminoborane, -alane, -gallane, and -indane is carried out to determine quantitatively the effects of pi bonding and negative hyperconjugation on structures, energetics, and rotational barriers in these systems. Pi bonding plays a significant role in the aminoborane compounds, but becomes rapidly less significant in the aminoalanes, -gallanes, and -indanes. For each main-group metal X investigated, X-N rotational barriers are found to be essentially equal depending only on the number of remaining in-plane amino groups. The contribution of negative hyperconjugation to reducing rotational barriers, as assessed from natural bond orbital (NBO) delocalization energies, is independent of the pyramidalization of the out-of-plane amino group, and is also dependent only on the number of rotated groups. Optimized tris[bis(trimethylsilyl)amino]-substituted structures of boron, aluminum, gallium, and indium are found to compare quite well with available experimental structural data, and exhibit X-N torsion angles that are independent of the central metal atom.

Liver, small intestine, and heart allografts in residence for 4 days to 16 years were analyzed by simultaneous XY fluorescent in situ hybridization to search for evidence of the recently described process of transdifferentiation of recipient bone marrow stem cells to allograft parenchymal cells. These studies were carried out in an effort to find conditions associated with maximal levels of engraftment or expansion of the recipient parenchymal cells. Despite prolonged survival up to 16 years, regeneration after severe preservation injury or use of split livers, only rare, isolated and tentatively identified recipient hepatocytes were detected in liver allografts. In intestinal allografts, despite survival of up to 8 years and extensive mucosal regeneration because of severe damage from acute rejection, there was no crypt replacement by recipient epithelial cells. In cardiac allografts, no recipient myocytes were detected despite recipient survival for 2-3 days and 3-4 weeks after myocardial infarcts at 5 and 8 years after transplantation. Parenchymal cell transdifferentiation from recipient bone marrow stem cells was rare to nonexistent in severely injured, regenerating, and long-surviving allografts. The rare isolated recipient parenchymal cells tentatively identified did not appear to behave as stem cells: they did not form clusters and did not increase with time after transplantation. Because of the extremely low frequency, interpretation was difficult. Regardless of these results, a more vigorous search for conditions that promote transdifferentiation is warranted.

Context Lung transplant candidates face numerous health-related stressors. Although previous work has described the range of coping strategies candidates may use, whether those strategies are related to quality of life in physical functioning, emotional, and social domains has rarely been examined. Methods Adult lung transplant candidates (N=128) participated in semistructured interviews that included questions regarding global and domain-specific quality of life and a multidimensional assessment of coping with health-related problems. Demographic characteristics, health status, and other psychosocial variables were also assessed, and their effects were examined and controlled in multivariate analyses of the coping–quality-of-life relationship. Results Respondents were most likely to use active, acceptance, and support-seeking strategies to cope with health problems. Self-blame or avoidance were rarely used. Although used least often, avoidant coping was the most strongly and consistently related to quality of life. With demographic and psychosocial variables controlled, higher avoidant coping remained associated with significantly poorer global quality of life, bodily pain, difficulty with daily work or activities as a function of emotional problems, and depressive symptomatology. Avoidant coping accentuated the association of poor health status and lower quality of life. Among respondents with lower health status, using more avoidant coping was associated with greater difficulty functioning in daily activities as a result of emotional problems. Those with higher health status had less difficulty functioning in daily activities as a result of emotional problems. Conclusions Transplant team members are encouraged to be aware of and help patients refrain from using avoidant coping strategies.

The area of flotation testing of drill core is important in the business plan of most mining companies. Metallurgical information derived from this practice can be used to advantage in strategic decision-making. Sampling, flotation testing and subsequent QemSCAN (Quantitative Evaluation of Minerals by Scanning Electron Microscopy) analysis of a mineral resource is one example of this approach. A new resource, located in Sudbury, Ontario, is being assessed for the Sudbury Operations of Falconbridge Limited, which includes the Strathcona Mill. In this case, it was possible to improve the value of information from sampling and flotation testwork by using an improved, statistically-based test design, by sampling the resource by generic end-member ore type, and by integrating the Mineral Processing and Mineral Science disciplines into a Process Mineralogy team. In addition to producing standard metal grade and recovery information, this new approach provides more reproducible information from representative samples and flotation testing in a replicate format. QemSCAN technology is used to produce a size by size mineral balance, including both modal percentages and liberation, from which flotation models for each ore type can be developed. As a result, a key understanding of the potential behaviour of a given ore type, if mined and then processed at the current mill operation, is gained at the 95% confidence level. The three ore types of this mineral resource were shown to have different flotation characteristics. Quantifying the mineralogy and liberation in each of the three ore types, has shown that this difference is due to changes in modal percentages of ferro-magnesium and magnesium silicate minerals such as pyroxene, talc and serpentine. Liberation across the three ore types is very similar and is therefore not responsible for variation in flotation performance.

A search was performed for charginos with masses close to the mass of the lightest neutralino in e+e- collisions at centre-of-mass energies of 189-209 GeV recorded by the OPAL detector at LEP. Events were selected if they had an observed high-energy photon from initial state radiation, reducing the dominant background from two-photon scattering to a negligible level. No significant excess over Standard Model expectations has been observed in the analysed data set corresponding to an integrated luminosity of 570pb-1. Upper limits were derived on the chargino pair-productin cross-section, and lower limits on the chargino mass were derived in the context of the Minimal Supersymmetric Extension of the Standard Model for the gravity and anomaly mediated Supersymmetry breaking scenarios., 26 pages, 9 figures

An adiabatic connection method, mPW1PW91(0.581)/6-31G(d), was employed in conjunction with the continuum solvation model SM5.42 to study the effects of solvation on the S(N)1, S(N)2, and syn and anti S(N)2' nucleophilic substitution reactions of chloride anion with allyl chloride and its gamma-methylated analogues Z- and E-crotyl chloride and isoprenyl chloride. The impact of equilibrium solvation on the potential energy surfaces of these systems is large and leads to significant changes in both the geometries and the relative energetics of different reaction pathways for different species. The predicted effects of increased solvent dielectric constant are consistent with available experimental data and provide semiquantitative insights into the relative influence of different solvents on particular properties.

The tau -> mu nu nu branching ratio has been measured using data collected from 1990 to 1995 by the OPAL detector at the LEP collider. The resulting value of B(tau->mu nu nu) = 0.1734 +/- 0.0009(stat) +/- 0.0005(syst) has been used in conjunction with other OPAL measurements to test lepton universality, yielding the coupling constant ratios g(mu)/g(e) = 1.0005 +/- 0.0043 and g(tau)/g(e) = 1.0031 +/- 0.0047, in good agreement with the Standard Model prediction of unity, and also to determine a value for the Michel parameter eta = 0.004 +/- 0.036. This is subsequently used to find a model-dependent limit of the mass for the charged Higgs boson, m(Higgs) > 1.30 tan(beta), in the Minimal Supersymmetric Standard Model.

While studies in kidney recipients have found meningitis to be the most common clinical manifestation of cryptococcosis (Cry), it is unclear if the clinical presentation of Cry differs among various solid-organ transplant (SOT) recipients and whether the serum cryptococcal antigen (SCA) might predict the site of infection. We report the clinical manifestations and the correlation with a positive SCA among 55 consecutive SOT recipients diagnosed with Cry at the University of Pittsburgh Medical Center. These included: heart (n=13), lung (n=4), liver (n=28), kidney (n=9) and small bowel (n=1) recipients. While there were no significant differences in the manifestations of Cry in heart and lung recipients, kidney recipients had disseminated disease as the most common presentation (P=0.02). In contrast, pneumonia (P=0.003) and meningitis (P=0.02) were more frequent than disseminated disease in liver recipients. Positive SCA was higher in patients with disseminated disease and meningitis than in patients with isolated pneumonia (P=0.0001). Significant differences in the manifestations of Cry were observed among types of SOT populations. A positive SCA may be predictive of dissemination and meningitis, but it may not be sensitive for pulmonary disease.

Mechanical circulatory support device (MCSDs) have evolved during the past 2 decades to become accepted bridging therapy for patients with irreversible hemodynamic deterioration while awaiting cardiac transplantation. More recently, based on the results of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, MCSD therapy has become available as permanent or destination therapy for a restricted population of patients with advanced heart failure (AHF) not thought to be appropriate transplant candidates. The potential proliferation of new devices and the possible expansion of the target populations bring new responsibilities. Unlike pharmaceutical trials that have included thousands of patients, trials with MCSDs will continue to be performed on a relatively small scale because equipoise for randomization can be undermined by the unmasked nature of mechanical support, the logistics of study finances, and the continuous device improvements—all of which constrain trial size and duration. Currently, insufficient evidence beyond REMATCH criteria exists for refining potential long-term MCSD therapy candidate cohorts, and application of this challenging therapy is complicated further by the degree of institutional commitment, surgical expertise, multidisciplinary skills, available devices, and overall experience required for the successful application of mechanical circulatory support. The REMATCH trial was a landmark study that demonstrated the benefit of MCSDs in patients with AHF not eligible for transplantation. Patients supported with MCSDs had significantly better survival at 1 year than did patients with advanced end-stage heart failure who were treated medically (many with long-term parenteral inotropes). Although a survival benefit was clear, it was only over a 2-year time period, and morbidity was substantial, particularly with respect to infections, neurologic events, and pump malfunctions. These observations force us to consider carefully patient selection and the infrastructure of centers with strategies developed to provide this type of care. In the United States, the Food and Drug Administration (FDA) approval of the HeartMate From Columbia University, New York, New York; Cleveland Clinic Foundation, Cleveland, Ohio; Harvard University, Boston, Massachusetts; Stanford University, Stanford, California; University of Alabama at Birmingham, Birmingham, Alabama; University of California at Los Angeles, Los Angeles, California; University of Minneapolis, Minneapolis, Minnesota; Midwest Heart Specialists, Downers Grove, Illinois; Tufts–Northeast Medical Center, Boston, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania. Submitted February 7, 2002. Reprint requests: Mario C. Deng, MD, The Heart Failure Center and Division of Circulatory Physiology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Milstein Hospital Building, Room 5-407, 177 Fort Washington Avenue, New York, New York 10032. Telephone: 212-305-0200. Fax: 212-305-7439. E-mail: md785@columbia. edu J Heart Lung Transplant 2003;22:365–369 Copyright © 2003 by the International Society for Heart and Lung Transplantation. 1053-2498/03/$–see front matter doi:10.1016/S1053-2498(03)00073-1

The tau -> mu nu nu branching ratio has been measured using data collected from 1990 to 1995 by the OPAL detector at the LEP collider. The resulting value of B(tau -> mu nu nu) = 0.1734 +- 0.0009(stat) +- 0.0006(syst) has been used in conjunction with other OPAL measurements to test lepton universality, yielding the coupling constant ratios gmu/ge=1.0005+-0.0044 and gt/ge=1.0031+-0.0048, in good agreement with the Standard Model prediction of unity. A value for the Michel parameter eta = 0.004 +- 0.037 has also been determined and used to find a limit for the mass of the charged Higgs boson mH+- > 1.25 tan beta, in the Minimal Supersymmetric Standard Model.

Objective: We developed “EVAHEARTTM”: a compact centrifugal blood pump system as an implantable left ventricular assist device for long-term circulatory support. The 55×64 mm pump is made from pure titanium, and weighs 370 g. The entire blood-contacting surface is covered with an anti-thrombogenic coating of diamond like carbon (DLC) or 2-methacryloyloxyethyl phosphorylcholine (MPC) to improve blood compatibility. Flows exceeding 12 L/min against 100 mmHg pressure at 2600 rpm was measured. A low-temperature mechanical seal with recirculating cooling system is used to seal the shaft. EVAHEARTTM demonstrated an acceptably low hemolysis rate with normalized index of hemolysis of 0.005±0.002 g/100 L.Methods: We evaluated the pump in long-term in-vivo experiments with seven calves. Via left thoracotomy, we conducted left ventricular apex-descending aorta bypass, placing the pump in the left thoracic cavity.Results: Pump flow rates was maintained at 5–9 L/min, pump power consumption remained stable at 9–10 W in all cases, plasma free Hb levels were less than 15 mg/dl, and the seal system showed good seal capability throughout the experiments. The calves were sacrificed on schedule on postoperative day 200, 222, 142, 90, 151, 155, and 133. No thrombi formed on the blood contacting surface with either the DLC or MPC coating, and no major organ thromboembolisms occurred except for a few small renal infarcts.Conclusion: EVAHEARTTM centrifugal blood pump demonstrated excellent performance in long-term in-vivo experiments.

Background: In certain forms of severe heart failure there is sufficient improvement in cardiac function during ventricular assist device (VAD) support to allow removal of the device. However, it is critical to know whether there is sustained recovery of the heart and long-term patient survival if VAD bridging to recovery is to be considered over the option of transplantation. Methods: To determine long-term outcome of survivors of VAD bridge-to-recovery procedures, we retrospectively evaluated 22 patients with non-ischemic heart failure successfully weaned from the Thoratec left ventricular assist device (LVAD) or biventricular assist device (BVAD) after recovery of ventricular function at 14 medical centers. All patients were in imminent risk of dying and were selected for VAD support using standard bridge-to-transplant requirements. There were 12 females and 10 males with an average age of 32 (range, 12-49). The etiologies were 12 with myocarditis, 7 with cardiomyopathies (4 post-partum [PPCM], 1 viral [VCM], and 2 idiopathic [IDCM]), and 3 with a combination of myocarditis and cardiomyopathy. BVADs were used in 13 patients and isolated LVADs in 9 patients, for an average duration of 57 days (range, 11-190 days), before return of ventricular function and successful weaning from the device. Post-VAD survival was compared with 43 VAD bridge-to-transplant patients with the same etiologies who underwent cardiac transplantation instead of device weaning. Results: Nineteen of the 22 patients are currently alive. Three patients required heart transplantation, 1 within 1 day, 2 at 12 and 13 months post-weaning, and 2 died at 2.5 and 6 months. The remaining 17 patients are alive with their native hearts after an average of 3.2 years (range, 1.2-10 years). The actuarial survival of native hearts (transplant-free survival) post-VAD support is 86% at 1 year and 77% at 5 years, which was not significantly different (p = 0.94) from that of post-VAD transplanted patients, also at 86% and 77%, respectively. Conclusion: Long-term survival for bridge-to-recovery with VADs for acute cardiomyopathies and myocarditis is equivalent to that for cardiac transplantation. Recovery of the native heart, which can take weeks to months of VAD support, is the most desirable clinical outcome and should be actively sought, with transplantation used only after recovery of ventricular function has been ruled out.

Searches for first generation scalar and vector leptoquarks, and for squarks in R-parity violating SUSY models with the direct decay of the squark into Standard Model particles, have been performed using e+e- collisions collected with the OPAL detector at LEP at e+e- centre-of-mass energies between 189 and 209 GeV. No excess of events is found over the expectation from Standard Model background processes. Limits are computed on the leptoquark couplings for different values of the branching ratio to electron-quark final states.

A modified Perdew–Wang one-parameter hybrid density functional (mPW1N) was developed for nucleophilic substitution reactions by optimizing the fraction of exact exchange in vPW1PW91/6–31+G(d). Activation energies for 20 identity nucleophilic substitution and alkyl halide heterolysis reactions involving fluorine and chlorine were compared to values computed at the MCG3//MC-QCISD level to arrive at an optimal value of 40.6% HF exchange in mPW1N. This choice also leads to improved transition-state geometries over the training set. Results from mPW1N are compared with those from other common DFT methods, and some sources of error are explored. Copyright © 2002 John Wiley & Sons, Ltd.

BACKGROUND Patients requiring lung transplantation (LTx) may also have coronary artery disease (CAD). The peri-operative management and long-term outcomes of these patients are not well established. METHODS Patients referred for LTx from 2008 to 2014 were included in this study. CAD was defined by angiography as no CAD (stenosis

Background: Pre-LVAD analysis of RV function is critical for surgical planning and determines operative outcome. Current imaging techniques have yielded limited success at predicting RV failure (RVF). GBPS is count based without geometric assumption, and allows global and regional RV function

The purpose of this study was to determine the risk factors for ischemic in hemorrhage cerebrovascular events in patients supported by the HeartWare ventricular assist device (HVAD).Patients supported with left ventricular assist devices are at risk for both ischemic and hemorrhagic cerebrovascular events.Patients undergoing implantation with a HVAD as part of the bridge-to-transplant trial and subsequent continued access protocol were included. Neurological events (ischemic cerebrovascular accidents [ICVAs] and hemorrhagic cerebrovascular accidents [HCVAs]) were assessed, and the risk factors for these events were evaluated in a multivariable model.A total of 382 patients were included: 140 bridge-to-transplant patients from the ADVANCE (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure) clinical trial and 242 patients from the continued access protocol. Patients had a mean age of 53.2 years; 71.2% were male, and 68.1% were white. Thirty-eight percent had ischemic heart disease, and the mean duration of support was 422.7 days. The overall prevalence of ICVA was 6.8% (26 of 382); for HCVA, it was 8.4% (32 of 382). Pump design modifications and a protocol-driven change in the antiplatelet therapy reduced the prevalence of ICVA from 6.3% (17 of 272) to 2.7% (3 of 110; p = 0.21) but had a negligible effect on the prevalence of HVCA (8.8% [24 of 272] vs. 6.4% [7 of 110]; p = 0.69). Multivariable predictors of ICVA were aspirin ≤81 mg and atrial fibrillation; predictors of HCVA were mean arterial pressure90 mm Hg, aspirin ≤81 mg, and an international normalized ratio3.0. Eight of the 30 participating sites had established improved blood pressure management (IBPM) protocols. Although the prevalence of ICVA for those with and without IBPM protocols was similar (5.3% [6 of 114] vs. 5.2% [14 of 268]; p = 0.99), those with IBPM protocols had a significantly lower prevalence of HCVA (1.8% [2 of 114] vs. 10.8% [29 of 268]; p = 0.0078).Anticoagulation, antiplatelet therapy, and blood pressure management affected the prevalence of cerebrovascular events after implantation of the HVAD. Attention to these clinical parameters can have a substantial impact on the occurrence of serious neurological events. (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure [ADVANCE]; NCT00751972).

Right-sided circulatory failure has been defined by the International Right Heart FoundationWorkingGroup as a clinical syndrome, causedbyanalterationof structure and/or function of the right heart circulatory system, that leads to suboptimal delivery of blood flow (high or low) to the pulmonary circulation and/or to elevated venous pressures—at rest or with exercise. When taken in the context of postoperative rightsided failure, this encompasses the pulmonary circulation (main pulmonary artery, postpulmonic valve, secondary and tertiary branches of the pulmonary artery, and lung parenchyma), and the right ventricle (tricuspid valve, right ventricular [RV] free wall, RVoutflow tract, and pulmonary valve). Taking this broad approach is critical to our understanding ofwhy the right ventricle seems to fail in the setting of cardiac surgery and transplantation, but most vexingly in the setting of left ventricular assist device (LVAD) implantation. Right ventricular failure in the setting of left heart failure has been a challenge to quantify when deciding upon candidacy for an LVAD. When the LVAD is used as a bridge to cardiac transplantation, temporary or even longer-term RV failure can be tolerated and obviated by transplantation. The decision regarding RV tolerance is more critical when the LVAD is utilized for destination therapy. In this setting, chronic RV failure on an LVAD can be debilitating and results in recurrent rehospitalization, reduction in quality of life, and ultimately in renal and hepatic dysfunction or failure. It is no longer sufficient to have a right ventricle that supports the patient out of the operating room without an RV assist device (RVAD). The LVAD unloads the left ventricle and thereby reduces the right ventricle’s work against pressure by decompressing the left ventricle, and thus the pulmonary capillary wedge pressure, which in turn passively reduces pulmonary vascular resistance. On the other hand, an LVAD, by decompressing the left ventricle, can cause a leftward shift of the interventricular septum, which results in a more spherical