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Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is associated with increased morbidity and mortality, but the identification of LVAD candidates at risk for RVF remains challenging. We undertook a systematic review and meta-analysis of observational studies of risk factors associated with RVF after LVAD implant. Thirty-six studies published between 1 January 1995 and 30 April 2015, comprising 995 RVF patients out of a pooled final population of 4428 patients, were identified. Meta-analysed prevalence of post-LVAD RVF was 35%. A need for mechanical ventilation [odds ratio (OR) 2.99], or continuous renal replacement therapy (CRRT; OR 4.61, area under the curve 0.78, specificity 0.91) were the clinical variables with the highest effect size (ES) in predicting RVF. International normalized ratio [INR; standardized mean difference (SMD) 0.49] and N-terminal pro-brain natriuretic peptide (NT-proBNP) (SMD 0.52) were the biochemical markers that best discriminated between RVF and No-RVF populations, though NT-proBNP was highly heterogeneous. Right ventricular stroke work index (RVSWI) and central venous pressure (CVP) (SMD -0.58 and 0.47, respectively) were the haemodynamic measures with the highest ES in identifying patients at risk of post-LVAD RVF; CVP was particularly useful in risk stratifying patients undergoing continuous-flow LVAD implant (SMD 0.59, P < 0.001, I2 = 20.9%). Finally, pre-implant moderate to severe right ventricular (RV) dysfunction, as assessed qualitatively (OR 2.82), or a greater RV/LV diameter ratio (SMD 0.51) were the standard echocardiographic measurements with the highest ES in comparing RVF with No-RVF patients. Longitudinal systolic strain of the RV free wall had the highest ES (SMD 0.73) but also the greatest heterogeneity (I2 = 74%) and was thus only marginally significant (P = 0.05). Patients on ventilatory support or CRRT are at high risk for post-LVAD RVF, similarly to patients with slightly increased INR, high NT-proBNP or leukocytosis. High CVP, low RVSWI, an enlarged right ventricle with concomitant low RV strain also identify patients at higher risk.

Surfactants are specific functional materials that form various types of self-assemblies and affect local water ordering alongside solution properties. Such surface active agents are used extensively in gas hydrate based applications as kinetic hydrate promoters. To understand the effect of surfactant micelles on hydrate formation kinetics, a novel surfactant system capable of producing micelles at hydrate forming temperature was developed. The presence of surfactant micelles in this new system (a combination of anionic surfactant SDS and zwitterionic surfactant CAPB) was determined through DLS measurements. Pure methane and a coal bed methane mixture were individually used to assess the efficacy of the surfactant mixture for hydrate formation. This study conclusively proves for the first time that the presence of surfactant micelles enhances hydrate formation kinetics. The findings reported here can contribute significantly toward improving the utility of surfactants in gas hydrate based technological ap...

Aim: The aim of the study is to understand the role of anxiety and depression in obstructive sleep apnea (OSA) patients. Patients and Methods: This prospective, observational study was conducted at King George's Medical University, Lucknow, Uttar Pradesh, India, from September 2011 to August 2012. Seventy-one patients were enrolled in the study after obtaining informed written consent. Polysomnography (PSG) was performed to confirm OSA, and the psychiatric features were determined using the Hospital Anxiety and Depression Scale score. Results: A total of 71 individuals were enrolled in the study, and after exclusion, 48 individuals had participated in PSG. Of the 48 patients, 44 (91.67%) had shown OSA with PSG. From 44 OSA-diagnosed patients, 10 (22.73%) patients were diagnosed of having psychiatric manifestations (50% with depression, 30% with anxiety, and 20% having features of both depression and anxiety). No significant difference was found in between those with psychiatric features than that those without in body mass index (mean ± standard deviation [SD]: 32.38 ± 7.17 and 31.64 ± 3.93, P = 0.610), Epworth's sleepiness scale score (mean ± SD: 13.20 ± 4.71 and 11.88 ± 5.63, P = 0.505), apnea/hypopnea index (mean ± SD: 48.01 ± 31.71 and 37.81 ± 22.84, P = 0.263), average saturation (mean ± SD: 92.19 ± 4.37 and 91.74 ± 4.38, P = 0.774), and lowest saturation (mean ± SD: 74.50 ± 11.97 and 74.32 ± 11.97, P = 0.968), respectively. Conclusion: Although patients with OSA must be screened for psychiatric manifestations, the severity of OSA is not directly related to the severity of psychiatric features.

HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p

Cellular polymer foams find extensive applications as energy absorbers under static, impact and blast loads due to their capacity to absorb energy under constant stress up to full densification strain (Ashby et al. Metal foams: a design guide. Butterworth-Heinemann, Oxford, 2000 [1]; Gibson and Ashby, Cellular solids: structure and properties. Cambridge University Press, Cambridge, 1999 [2]). In the present paper, the material characterization of natural latex cellular polymer foam used in the field air blast experiments (Venkataramana et al. Proc Eng 173:547–554, 2017 [3]; Venkataramana et al. Numerical simulation of blast wave mitigation using foam impregnated with water. DAE BRNS Symposium on Multiscale Modeling of Materials and Devices (MMMD-2014), 2014 [4]) performed to assess the blast mitigation effect of fluid-filled open-cell pin-core polymer foam is presented. Static compression tests were performed to study the quasi-static behavior of the pin-core latex polymer foam. The Ogden hyper-elastic material parameters are determined from the analysis of static compression test data using ADINA (automatic dynamic incremental nonlinear analysis) v 9.2, ADINA R&D, Inc., Watertown [5]). Further, results of the static compression tests on dry foam and water-saturated foam are compared and discussed. In addition, the dynamic behavior of the pin-core latex cellular foam is investigated by conducting drop tower impact experiment and numerical simulation of the drop tower experiment using LS-DYNA (LS-DYNA v971, Livermore Software Technology Corporation, Livermore [6]). The stress–time history from the drop tower experiment is compared with that of simulation, and good correlation is found between the two sets of results.

Reversal of pulmonary hypertension has been observed in patients during a bridge to transplant with a left ventricular assist device. Total artificial heart (TAH) implant prevents subsequent right heart catheterization. Consequently, controversy exists over whether the prosthetic right ventricle improves or exacerbates pulmonary hypertension. A pulmonary artery (PA) pressure monitor was placed in two patients undergoing TAH implant, as a bridge to transplant. One patient had pulmonary hypertension at implant; the other had normal pulmonary pressures. Daily measurements were taken of systolic, diastolic, and mean PA pressures throughout support. Patient 1 received successful transplant after TAH support of 91 days. Systolic/diastolic (mean) PA pressures steadily decreased from 55/39 (28) mm Hg at implant to 29/18 (7) mm Hg currently. Patient 2 received support for 101 days before death due to abdominal ischemic complications. Pulmonary arterial pressures stayed consistent throughout this period, from 26/17 (20) mm Hg at implant to 23/13 (17) mm Hg at the time of death. These findings suggest that an implantable PA pressure monitor may be useful in optimizing hemodynamics and planning appropriate timing of transplant with TAH support.

Monitoring and assessment of vegetation phenology at the regional to global scale are essential to understand the characteristics of various biophysical parameters in terrestrial ecosystems. Passive optical remote sensing data have been used extensively in the recent past to study phenology of vegetation, also called land surface phenology, at diverse landscapes across the globe. In the present study, the moderate resolution imaging spectroradiometer (MODIS)-derived enhanced vegetation index (EVI) time series data (2000–2013) was used to study the phenology of dry and moist teak (Tectona grandis) forests of different biogeographic provinces of India. Four phenology metrics, viz., start of season (SOS), end of season (EOS), peak of season (POS) and length of season (LOS) were derived using the TIMESAT tool. The SOSs’ of dry and moist teak were found during July–August. LOS of moist teak was found to be much longer (~ 48 days) than dry teak. Also, a significant difference of leaf area index (LAI) (~ 2.8) of dry and moist teak forests was noticed during peak season from MODIS LAI product (MOD15A2). Vegetation phenology is greatly responsive to the fluctuation of climatic parameters such as rainfall. Hence, pre-season cumulative rainfall data were analysed to understand the control of rainfall over phenological variations in natural teak forests of India. It was noticed that rainfall was reasonably well correlated with SOS (R2 = 0.57–0.72) for both types of teak forests. The study highlighted the efficacy of time series MODIS EVI data to study the phenological variations in different teak forest types of India in a data-limited situation.

Background The presence of a durable left ventricular assist device ( LVAD ) is associated with increased risk of vasoplegia in the early postoperative period following heart transplantation ( HT ). However, preoperative predictors of vasoplegia and its impact on survival after HT are unknown. We sought to examine predictors and outcomes of patients who develop vasoplegia after HT following bridging therapy with an LVAD . Methods and Results We identified 94 patients who underwent HT after bridging with continuous‐flow LVAD from 2008 to 2018 at a single institution. Vasoplegia was defined as persistent low vascular resistance requiring ≥2 intravenous vasopressors within 48 hours after HT for >24 hours to maintain mean arterial pressure >70 mm Hg. Overall, 44 patients (46.8%) developed vasoplegia after HT . Patients with and without vasoplegia had similar preoperative LVAD , echocardiographic, and hemodynamic parameters. Patients with vasoplegia were significantly older; had longer LVAD support, higher preoperative creatinine, longer cardiopulmonary bypass time, and higher Charlson comorbidity index; and more often underwent combined organ transplantation. In a multivariate logistic regression model, older age (odds ratio: 1.08 per year; P =0.010), longer LVAD support (odds ratio: 1.06 per month; P =0.007), higher creatinine (odds ratio: 3.9 per 1 mg/dL; P =0.039), and longer cardiopulmonary bypass time (odds ratio: 1.83 per hour; P =0.044) were independent predictors of vasoplegia. After mean follow‐up of 4.0 years after HT , vasoplegia was associated with increased risk of all‐cause mortality (hazard ratio: 5.20; 95% CI, 1.71–19.28; P =0.003). Conclusions Older age, longer LVAD support, impaired renal function, and prolonged intraoperative CPB time are independent predictors of vasoplegia in patients undergoing HT after LVAD bridging. Vasoplegia is associated with worse prognosis; therefore, detailed assessment of these predictors can be clinically important.

Purpose Following implantation of continuous-flow left ventricular assist devices (CF-LVADs), mechanical offloading results in improved resting hemodynamics ; however peak exercise capacity generally does not increase substantially. The present study evaluated CF-LVAD supported patients who were invasively monitored during exercise to define parameters that underpin exercise capacity and outcomes. Methods A review of all CF-LVAD patients who underwent supine cycle ergometry exercise testing with measurement of pulmonary gas exchange during right heart catheterization (RHC) for evaluation of dyspnea at one institution between 2007 and 2018 was performed (n=22). In addition to the complete resting and exercise RHC data, additional data was extracted from the medical record including: baseline demographics, echocardiographic data, cardiopulmonary exercise testing (CPET) data, six-minute walk test (6MWT) distances, and pulmonary function test data (PFT). Results The primary outcome was death or heart failure hospitalization. Although resting filling pressures were relatively preserved, resting cardiac index (Fick) was low (2.1 ± 0.5 mL/kg/min). An impaired cardiac output reserve was present in 75% of patients. On univariate modeling, patients with exercise-induced hypoxemia (arterial oxygen saturation event-free survival (unadjusted HR 11.0, CI 2.4-57.2, p=0.003), which persisted after adjustment for RHC peak VO 2 and peak cardiac output (adjusted HR 25, CI 3.6-322, p=0.001). Conclusion Our findings suggest that exercise RHC provides additional prognostic utility over resting RHC in the CF-LVAD population.

Forest fringes are the outer reach of the forests which witness majority of the extraction pressure from the community living near to it. For a country like India, where most of the lands are rainfed and lack sufficient irrigation facilities for the agricultural activities, the dependence of the communities is significantly high on the forests for meeting their subsistence needs. When compared to the overall area of the forests, the fringe areas are more vulnerable to extraction pressure. Fringe forests safeguard the interior core forests as long as the anthropogenic pressure does not exceed their resilience. However, the phenomenal increase in human and cattle populations over time and lack of effective management interventions is acting as a barrier in meeting the goals of sustainable development. Over-exploitation of the forest resources had led to the diminishing supply of goods and services. A quantitative assessment of the dependence of the fringe communities on forests is essential for formulating the sustainable actions. We present here a national perspective of the current status of fringes in meeting the goals of sustainable development. We emphasise that forest fringes demand an urgent site-specific prioritised intervention to improve livelihood as well as the ecological health for addressing the goals of sustainable development.

Ayurveda based nanomaterials are recently conceptualized phenomena for biomedical applications especially for imaging and treatment of in vitro cancer cell. Wide range florescent (blue to red emission) quantum dots are versatile materials for imaging and sensing applications. Various procedures and precursors of fluorescent carbon quantum dots (CQDs) are well established and documented in the literature. However, expensive precursors and production, and time consuming process limit their economical design that need to be addressed. Herein, we report a cost effective simple route for fluorescent CQDs by using affordable ayurvedic plant's precursors such as Azadirachta Indica, OcimumTenuiflorum and Tridax Procumbens. Obtained quantum dots from ayurvedic plant leaves namely CQDs-1 (AzadirachtaIndica), CQDs-2 (OcimumTenuiflorum) and CQDs-3 (TridaxProcumbens) showed homogeneous size distribution (∼6–12 nm) and green fluorescent nature, average photo-stability, biocompatibility (more than 85 %), cancer cell imaging and promising phototherapy for cancer and bacterial cell lines.

A field experiment was conducted during kharif season of 2016 at Mahatma Gandhi Chitrakoot Gramodaya Vishwavidyalaya, Chitrakoot, Satna (M.P.) to study the efficacy of different herbicides against weeds in mungbean. The weed density recorded at 30 and 60 DAS was significantly lower under pendimethalin 30 EC + imazethapyr 2 EC (Ready mix) 0.75 kg/ha as pre-emergence (PE) followed by pendimethalin PE. However, significantly lower weed dry weight and statistically superior weed control efficiency were noted in twice hand weeding at 20 DAS and 40 DAS and pendimethalin + imazethapyr (R.mix.) 0.75 kg/ha at same stages of crop (30 and 60 DAS). While, yield attributes viz. pods/plant (21.8) was significantly higher in plot treated with imazethapyr 10 SL @ 40g/ha applied at 20 DAS and statistically at par with imazamox 35 WG+ imazethapyr 35 WG 60g/ha applied at 20 DAS and clodinafop - propargyl 8% + aciflourfen - sodium 16.5% (WP) 187.5 kg/ha applied at 20 DAS. Application of clodinafop - propargyl 8% + aciflourfen - sodium 16.5% (WP) 187.5 kg/ha at 20 DAS produced significantly maximum seed yield (531 kg/ha) of mungbean closely followed by imazethapyr 10 SL @ 40g/ha at (528 kg/ha) and pendimethalin 30 EC + imazethapyr 2 EC (R.mix) 0.75 kg/ha (521 kg/ha). However, stover yield (2699 kg/ha), gross returns (`58464/ha) and net returns (`43163/ha) were obtained significantly superior under clodinafop - propargyl 8% + aciflourfen - sodium 16.5% (WP) 187.5 g/ha.

Background Diastolic pulmonary gradient ( DPG ) was proposed as a better marker of pulmonary vascular remodeling compared with pulmonary vascular resistance ( PVR ) and transpulmonary gradient ( TPG ). The prognostic significance of DPG in patients requiring a left ventricular assist device ( LVAD ) remains unclear. We sought to investigate whether pre‐ LVAD DPG is a predictor of survival or right ventricular ( RV ) failure post‐ LVAD . Methods and Results We retrospectively reviewed 268 patients who underwent right heart catheterization before LVAD implantation from 2007 to 2017 and had pulmonary hypertension because of left heart disease. Patients were dichotomized using DPG ≥7 mm Hg, PVR ≥3 mm Hg, or TPG ≥12 mm Hg. The associations between these parameters and all‐cause mortality or RV failure post LVAD were assessed with Cox proportional hazards regression and Kaplan–Meier analyses. After a mean follow‐up time of 35 months, elevated DPG was associated with increased risk of RV failure (hazard ratio [ HR ]: 3.30; P =0.004, for DPG ≥7 versus DPG PVR ( HR 1.85, P =0.13 for PVR ≥3 versus PVR TPG ( HR 1.47, P =0.35, for TPG ≥12 versus TPG RV failure. Elevated DPG was not associated with mortality risk ( HR 1.16, P =0.54, for DPG ≥7 versus DPG PVR , but not TPG , was associated with higher mortality risk ( HR 1.55; P =0.026, for PVR ≥3 versus PVR Conclusions Among patients with pulmonary hypertension because of left heart disease requiring LVAD support, elevated DPG was associated with RV failure but not survival, while elevated PVR predicted mortality post LVAD implantation.

Urban sprawl is synonymous with the urbanization. It characterizes the expansion of human population away from central urban areas into peri-urban areas, migration of a people into low-density residential areas in the outskirts of the city with more use of the personal automobiles for transport.

Sr2TiMnO6 (STMO) double perovskite was synthesized by a solid-state technique, and STMO-rGO (reduced graphene oxide) composite was prepared by a hydrothermal method. BET, XRD, XPS, TEM, SEM, and FT-IR techniques were used to investigate the properties and structures of the composite material. The characterization results depict that this material is an extremely efficient catalyst, which shows an excellent photocatalytic activity. The material has a direct bandgap of 1.30 ​eV, which makes it suitable for the photocatalytic wastewater treatment. The photocatalytic efficiency of STMO-rGO powder was tested in Rhodamine B dye. The complete degradation of dye has occurred only in 5 ​min. The first-order kinetic reaction was observed in Visible light, whereas the second-order kinetic response observed in UV light.

In India Doctorate of Medicine (MD) pharmacology is primarily knowledge oriented based on teaching, seminars, lectures and research related activities including animals and paper-based experiments and day to day management of undergraduate classes. MD pharmacology student should be competent of both clinical and experimental pharmacology. So, the postgraduate pharmacology curriculum should be competent to meet all the job requirements. Therefore, medical council of India (MCI) has introduced new post graduate curriculum which is based on knowledge, practical, clinical skills, thesis skills, and attitudes including communication and training in research. In India demand for skilled clinical research professionals is increasing day by day for growing pharma industries and good academician. So, there is an urgent need for the experienced and skilled pharmacologist to fulfil the requirements. MD pharmacology students should get posting in different clinical departments and observatory posting in industry, clinical research organization (CRO), regulatory body and research organisations. The course of MD Pharmacology should be like that fulfil all the skills that a pharmacologist must have.

Purpose Myocardial fibrosis is an important contributor for development of diastolic dysfunction (DD) following heart transplantation (HT). Small studies have reported superiority of sirolimus (SRL) over calcineurin inhibitor (CNI) in mitigating DD assessed by echocardiography. However, data on invasive hemodynamic assessment is lacking, and the impact of SRL on myocardial fibrosis progression remains unclear. We aimed to investigate the impact of SRL on DD and fibrosis progression among HT recipients. Methods A cohort of 100 HT recipients who were either treated with CNI alone (n =51) or converted from CNI to SRL (n=49) as primary immunosuppression was analyzed. Diastolic function parameters were assessed using serial echocardiograms and right heart catheterizations (RHC). Myocardial fibrosis was quantified on serial myocardial biopsies by automated digital analysis, blinded to the type of therapy. Results After 3 years, left ventricular end diastolic diameter (LVEDD) increased in the SRL group (45.7 ± 5.1 to 48.3 ± 5.5 mm, paired p Conclusion Early conversion to SRL is associated with improvement in DD and LV filling pressures which can be partially explained by attenuation of myocardial fibrosis progression as compared to CNI therapy.

Purpose Stroke after heart transplantation (HT) is a major cause of morbidity and mortality. Less is known about the risk factors associated with stroke in the current era of increasing HT being performed in older patients and with advances in immunosuppressive (IS) therapies. We aimed to determine the incidence, predictors and outcomes of stroke after HT. Methods We examined the incidence of ischemic and hemorrhagic strokes and associated outcomes in all consecutive adults who underwent HT between 1994 and 2016 at a single institution. Logistic regression was used to examine predictors of stroke. The association of stroke with all-cause mortality were examined using Cox proportional hazards regression. Stroke events that occurred within 30 days postoperatively were excluded from the analysis. Results Of 530 patients who underwent HT, 44 (8.3%) developed stroke [37 (7%) had an ischemic events and 7 (1.3%) had a hemorrhagic stroke]. A multivariate logistic regression analysis showed that diabetes mellitus (DM) (odds ratio [OR] 2.5, p=0.02), renal dysfunction (OR 2.3 per unit increase in creatinine, p=0.01), azathioprine (vs. mycophenolate mofetil) use (OR 2.0, p=0.04), and longer course of steroids (OR 1.1, per year of treatment, p=0.009) were independent predictors of a composite outcome of ischemic or hemorrhagic strokes. Conversion from calcineurin inhibitor (CNI) to sirolimus-based IS was not found to be associated with a significant change in the risk of stroke (hazard ratio [HR] 1.6, CI: 0.79-3.05, p=0.20) compared with CNI maintenance therapy. After a median follow-up of 8.10 years, post-HT strokewas significantly associated with increased risk of death (adjusted HR 1.8, CI; 1.23-2.72, p=0.003). Conclusion Stroke after HT is not uncommon and is associated with increased mortality. HT recipients with DM, renal dysfunction, and those treated with azathioprine or with longer course of steroids were at greater risk of stroke.

The aim of this study was to evaluate the impact of continuous-flow left ventricular assist devices (CF-LVAD) on subsequent rejection after heart transplantation (HT) by using cellular rejection score and antibody-mediated rejection score (AMRS) and correlating with subsequent allograft outcomes. We retrospectively analyzed 108 consecutive patients who underwent HT without (n = 67) or with (n = 41) previous CF-LVAD in 2008 to 2014. The 24 months cumulative effect of rejection was calculated by using cellular rejection scores and AMRS, based on the total number of rejections divided by valid biopsy samples. Vasculopathy was assessed both by routine coronary angiogram and intravascular ultrasound. Patients who underwent pretransplant CF-LVAD demonstrated a significant increase in the number of cellular rejection episodes as compared with the nonbridged patients, for 1 and 2 years of follow-up (p = 0.026 and p = 0.016), respectively. There were no differences in AMRS (p >0.05) and allograft outcomes, such as vasculopathy and overall survival (p >0.05) over the period of follow-up. Implantation of a CF-LVAD before HT impacts cellular rejection during the post-transplant period. Despite these findings, CF-LVAD does not translate to differences in allograft outcomes after transplant, such as vasculopathy and overall survival over the period of the study. In conclusion, whether this affects longer term outcomes than studied remains to be determined.

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease, and optical coherence tomography (OCT) provides detailed microstructural information. The current study was designed to test the hypothesis that markers of plaque vulnerability derived from OCT could predict CAV progression after heart transplantation (HTx).In 34 consecutive patients (median 3.1 years from HTx), intravascular ultrasound (IVUS) and OCT were performed in the left anterior descending artery (LAD) during routine annual coronary angiography. The presence of vulnerability markers, such as lipid pools, thin-cap fibroatheroma, macrophages and microchannels, was assessed in 100 consecutive frames of OCT in 20-mm segments of proximal LAD. The total number of appearances of vulnerable markers was defined as the vulnerability score (VS). Plaque volume (PV) was measured in the same study segment using IVUS at baseline and at 1-year follow-up, and the association between the baseline VS and the subsequent change in percent PV (PV / vessel volume × 100 [%PV]) was evaluated.Follow-up IVUS study was conducted after 12.5 ± 1.3 months. The mean VS was 59.9 ± 44.6. Compared with the initial %PV, the follow-up %PV increased in the study segment (25.6 ± 13.7% to 31.8 ± 17.5%, p0.001). The correlations between baseline VS and Δ%PV were significant in the study segment (r = 0.757, p0.001). On multivariable analysis, only the VS correlated significantly with Δ%PV.Our results demonstrate that the markers of plaque vulnerability in OCT can predict the progression of CAV. Therefore, in patients with HTx, OCT may aid in determining prognosis and guiding therapy related to CAV.

Sirolimus used in transplantation is often associated with hypercholesterolemia. We measured serum lipid and PCSK9 levels in 51 heart transplant recipients who had their immunosuppressive therapy switched from calcineurin inhibitors to sirolimus. The switch resulted in a 23% increase in LDL cholesterol, and 46% increase in triglycerides and PCSK9 levels increased from 316 ± 105 ng/mL to 343 ± 107 ng/mL (p = 0.04), however the change in PCSK9 levels did not correlate with an increase in lipid levels (p = 0.2). To investigate the mechanism for the variability in the change in PCSK9 levels, lymphoblastoid cell lines were incubated with both sirolimus and everolimus, resulting in a 2-3 fold increase in PCSK9 expression and protein levels in mTOR inhibitor sensitive but not in mTOR inhibitor resistant cell lines. This first in human study demonstrates that sirolimus therapy is associated with elevation in PCSK9 levels which is not associated with sirolimus-induced hypercholesterolemia.

When transplanted simultaneously, the liver allograft has been thought to have an immunoprotective role on other organs; however, detailed analyses in simultaneous heart-liver transplantation (SHLT) have not been done to date. We analyzed patient outcomes and incidence of immune-mediated injury in 22 consecutive SHLT versus 223 isolated heart transplantation (IHT) recipients between January 2004 and December 2013, by reviewing 3912 protocol- and indication-specific cardiac allograft biopsy specimens. Overall survival was similar (86.4%, 86.4%, and 69.1% for SHLT and 93.3%, 84.7%, and 70.0% for IHT at 1, 5, and 10 years; p = 0.83). Despite similar immunosuppression, the incidence of T cell-mediated rejection (TCMR) was lower in SHLT (31.8%) than in IHT (84.8%) (p < 0.0001). Although more SHLT patients had preexisting donor-specific HLA antibody (22.7% versus 8.1%; p = 0.04), the incidence of antibody-mediated rejection was not different in SHLT compared with IHT (4.5% versus 14.8%, p = 0.33). While the left ventricular ejection fraction was comparable in both groups at 5 years, the incidence and severity of cardiac allograft vasculopathy were reduced in the SHLT recipients (42.9% versus 66.8%, p = 0.03). Simultaneously transplanted liver allograft was associated with reduced risk of TCMR (odds ratio [OR] 0.003, 95% confidence interval [CI] 0-0.02; p < 0.0001), antibody-mediated rejection (OR 0.04, 95% CI 0-0.46; p = 0.004), and cardiac allograft vasculopathy (OR 0.26, 95% CI 0.07-0.84; p = 0.02), after adjusting for other risk factors. These data suggest that the incidence of alloimmune injury in the heart allograft is reduced in SHLT recipients.

Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43–15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34–6%, p

Methane gas storage and transportation via clathrate hydrates is proposed to be a potential solution for large-scale energy storage. In this work, we study the formation and decomposition kinetics of methane hydrates (MH) in a laboratory-scale unstirred crystallizer. The present investigation demonstrates comparative studies of hydrate formation and dissociation kinetics in the presence of tetrahydrofuran (55.6 and 27.8 mmol/mol, 5.56 and 2.78 mol % THF) and sodium dodecyl sulphate (1 mg/g, 0.1 wt% SDS). Moreover, the storage capacity and hydrate formation kinetics in both the systems are discussed. In a recent work, enhanced methane hydrate growth in the presence of THF at close to atmospheric conditions was demonstrated. The emphasis of the current work is to study the stability of hydrates to understand dissociation kinetics by measuring the rate of hydrate decomposition at different temperatures. Hydrate stability measurements were performed at −8, −3, 2, 10, and 20 °C to study the decomposition rates of MH and self-preservation in presence of the two additives THF and SDS.

Carbon quantum dots (CQDs or C-dots, ≤10 nm in size) are tiny carbon nanoparticles being envisaged in biosensing, bio-imaging and biomolecular/drug delivery. In the present investigation, green fluorescent carbon quantum/nano dots (GCQDs, ∼3 nm in size) were synthesized through facile chemical slicing method. Further, folic acid (FA) functionalized GCQDs (GCQDs-FA) were obtained to enhance their targeting ability. FA is known to positively influence the binding potential and penetration into the cancer cells because of high abundance of folate receptors (FR) on various cancer cell membranes. We report high biocompatibility, photoluminescence stability and excellent in vitro cancer cell cytoplasm and nucleus targeting performance of GCQDs-FA on MCF-7 breast cancer cells.

The present work aims to provide first principles insights into the catalytic performance of composites based on BaTiO3 particles decorated over reduced graphene oxide (rGO). Examination regarding the orbital contributions of valence states, conduction states, interaction. surface and anchoring of perovskite over rGO have been carried out. Theoretical results thus obtained have been validated using experimental investigation. Further experiments have also been conducted to analyze the catalytic performance of composites with respect to multiple advanced oxidation processes. Charge separation has been improved due to rGO acting as macromolecular photosensitizer. Degradation of xanthene dye (Rhoda mine B) and methyl orange (MO) assisted in evaluation of the catalytic performance. Acoustic irradiation provides an additional route to improve degradation by ameliorating catalytic activity (from 0.036 min to 0.099 min in RhB especially). Synergistic effect obtained through conjugated benefits of oxidation processes with proposed composite, played a crucial role in improving the overall efficiency. The cumulative outcome of the results indicates superior performance of BaTiO3-rGO composites for green and sustainable water treatment applications. (C) 2016 Elsevier Ltd. All rights reserved.

Background Cardiac operations in high-risk adult congenital heart disease (ACHD) patients may require mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intraaortic balloon pump (IABP), to allow the cardiopulmonary system to recover. Methods We reviewed records for all ACHD patients who required MCS following cardiotomy at our institution from 1/2001 to 12/2013. Results During the study period, 2264 (mean age 39.1 years, females ∼54.1%) operations were performed in ACHD patients of whom 24 (1.1%) required postoperative MCS (14 males; median age 41 years, range 22–75). Preoperatively the 24 patients had a mean systemic ventricular ejection fraction of 47% (range 10–66%); 72% of these patients were in NYHA class III/IV heart failure. The common underlying diagnoses included pulmonary atresia with intact ventricular septum (20%), tetralogy of Fallot (16%), Ebstein anomaly (12%), cc-TGA (12%), septal defects (12%), and others (28%). Operations performed were valvular operations with/without maze (58.2%), Fontan conversion (21%), coronary bypass grafting with valvular operations (12.5%), and heart transplant (8.3%). Indications for MCS were left-sided (systemic) heart failure (32%), right-sided (subpulmonary) heart failure (24%), biventricular heart failure (36%), persistent arrhythmia (4%), and hypoxemia (4%). Forty-two percent were placed on ECMO only; in the second group, IABP was attempted and subsequently followed by ECMO initiation. The mean duration of MCS was 8.4 days (range 0.8–35.4). Common morbidities included coagulopathy (60%), renal failure (56%), and arrhythmia (48%). Overall, 46% of patients survived to hospital discharge. Deaths were due to either multi organ failure or the underlying cardiac disease; sepsis was the primary cause of death in one patient. Median follow-up for survivors was 41 months (maximum 106 months). NYHA functional class was I/II in all 8 late survivors. Conclusions Following complex operations in high-risk ACHD patients, MCS may be required. Despite significant morbidity, nearly half of patients survive to hospital discharge.

It has been suggested that lipoprotein abnormalities may contribute to the pulmonary arteriolar dysfunction observed in pulmonary arterial hypertension (PAH). High-density lipoprotein cholesterol (HDL) has vasodilatory, anti-inflammatory, and endothelial protective properties. We hypothesized that a higher serum HDL level may be advantageous for survival in PAH and that the serum HDL level at diagnosis would be an independent predictor of survival in PAH and be additive to previously validated predictors of survival. This study included all patients with PAH seen at the Mayo Clinic Pulmonary Hypertension Clinic from January 1, 1995, to December 31, 2009, who had a baseline HDL measurement. Mortality was analyzed over 5 years using the Kaplan-Meier method. Univariate and multivariable Cox proportional hazards ratios were calculated to evaluate the relation between baseline HDL level and survival. HDL levels were available for 227 patients. Higher HDL levels were associated with significantly lower mortality. Patients with an HDL54 mg/dl at diagnosis had a 5-year survival of 59%. By comparison those with an HDL34 mg/dl had a 5-year survival of 30%. On multivariate analysis, higher HDL was associated with an age-adjusted risk ratio for death of 0.78 (CI 0.67 to 0.91; p0.01) per 10 mg/dl increase. In conclusion, HDL was an independent predictor of survival in PAH.

SummaryStudy Objectives Sleep disruption is increasingly recognized in hospitalized patients. Impaired sleep is associated with measureable alterations in neurodevelopment. The neonatal intensive care unit (NICU) environment has the potential to affect sleep quality and quantity. We aimed: (i) to determine the frequency and duration of hands-on care, and its impact on sleep, for NICU patients; and (ii) to assess the incidence of respiratory events associated with handling for a cohort of sick neonates. Methods Term and near-term neonates admitted to the NICU and at risk for cerebral dysfunction due to severity of illness or clinical suspicion for seizures underwent attended, bedside polysomnography. Continuous polysomnogram segments were analyzed and data on handling, infant behavioral state, and associated respiratory events were recorded. Results Video and polysomnography data were evaluated for 25 infants (gestational age 39.4 ± 1.6 weeks). The maximum duration between handling episodes for each infant was 50.9 ± 26.2 min, with a median of 2.3 min between contacts. Handling occurred across all behavioral states (active sleep 29.5%; quiet sleep 23.1%; awake 29.9%; indeterminate 17.4%; P = 0.99). Arousals or awakenings occurred in 57% of contacts with a sleeping infant. Hypopnea, apnea, and oxygen desaturation occurred with 16%, 8%, and 19.5% of contacts, respectively. Hypopnea was most likely to occur following contact with infants in active sleep (28%; P

In the present work, we report enhanced kinetics of hydrate formation in the presence of kinetic and thermodynamic promoters, SDS (sodium dodecyl sulphate) and THF (tetrahydrofuran) respectively. Hydrate formation was carried out in a fixed bed reactor for post-combustion capture of CO 2 . Silica sand was used as a fixed bed medium to capture CO 2 from a CO 2 /N 2 /SO 2 (17.7 mol% CO 2 , 1.05 mol% SO 2 and balance N 2 ) gas mixture by hydrate crystallisation. Experiments were performed at a constant temperature (273.65 K) and at different pressures (9.5 and 2.45 MPa) in batch mode. It was found that the addition of SDS enhances the rate and gas uptake of gas hydrate formation. A higher gas consumption was achieved by using 5.56 mol% THF compared to 1.0 and 3.0 mol% THF.

Background In this study we examined the impact of continuous-flow left ventricular assist device (CF-LVAD) support on proximal thoracic aorta dimensions. Methods Aortic root and ascending aorta diameter were measured from serial echocardiograms before and after CF-LVAD implantation in patients with ≥6 months of support, and correlated with the development of >mild aortic valve insufficiency (AI). Results Of 162 patients included, mean age was 58 ± 11 years and 128 (79%) were male. Seventy-nine (63%) were destination therapy patients. Mean aortic root and ascending aorta diameters at baseline, 1 month, 6 months, 12 months and long-term follow-up (mean 2.0 ± 1.4 years) were 3.5 ± 0.4, 3.5 ± 0.3, 3.9 ± 0.3, 3.9 ± 0.2 and 4.0 ± 0.3, and 3.3 ± 0.2, 3.3 ± 0.3, 3.6 ± 0.2, 3.6 ± 0.3 and 3.6 ± 0.3 cm, respectively. Only change in aortic root diameter from 1-month to 6-month follow-up reached statistical significance ( p = 0.03). Nine (6%) patients had accelerated proximal thoracic aorta expansion (>0.5 cm/year), occurring predominantly in the first 6 months after implantation. These patients were older and more likely to have hypertension and baseline proximal thoracic aorta dilation. Forty-five (28%) patients developed >mild AI at long-term follow-up, including 7 of 9 (78%) of those with accelerated proximal thoracic aorta expansion. All 7 had aortic valves that remained closed throughout the cardiac cycle, and this, along with duration of CF-LVAD support and increase in aortic root diameter, were significantly associated with developing >mild AI. Conclusion CF-LVAD patients have small increases in proximal thoracic aorta dimensions that predominantly occur within the first 6 months after implantation and then stabilize. Increasing aortic root diameter was associated with AI development.

Gross primary production (GPP) is the basic biophysical parameter of an ecosystem. The quantification of GPP has been a major challenge in understanding the global carbon cycle. Eddy covariance (EC) measurements at flux tower provide valuable direct information on seasonal dynamics of GPP and allow model optimization. In this paper, the GPP of forest plantation was estimated using light use efficiency (LUE-based) model and validated with flux tower GPP observations in Terai Central Forest Division, Nainital, India. The LUE model is mainly based upon the photosynthetically active radiation (PAR), satellite-derived normalized difference vegetation index (NDVI), land surface wetness index (LSWI), and the air temperature. The simulation of the model was carried out using vegetation indices generated from Landsat imagery and the meteorological data from flux tower. The predicted GPP showed distinct significance of spatio-temporal dynamics of GPP. The environmental variables, viz., PAR and NDVI showed distinct effect on the GPP prediction. Comparison between predicted and the measured GPP on flux tower site showed good agreement (R 2 = 0.626, RMSE = 2.08 and MAPE = 18.46). The study demonstrated the potential of LUE model for estimating GPP and scaling up of GPP over large areas, which is a major parameter in the study of the carbon cycle on regional to global scales.

The concept of biventricular support with durable centrifugal pumps is evolving, and the surgical strategy and best practice guidelines for implantation of right-sided devices are still unknown. We present optimal strategy for bilateral HeartWare continuous-flow ventricular assist device (HVAD) implantation in a series of four patients. Patients were implanted with the HVAD pumps simultaneously or sequentially. This report offers a perspective on surgical considerations such as right ventricular positioning, implications related to potential risks of obstruction from the tricuspid apparatus, the role if any of downsizing the outflow anastomosis, and considerations for speed adjustments. In this series, one patient died on support and three patients experienced pump thrombosis requiring device revision. All other patients survived until orthotopic heart transplantation, although one of these patients died from perioperative complications, 2 days posttransplantation. Surgical management of patients with medically refractory biventricular heart failure remains challenging and associated with a high incidence of pump thrombosis. Best practice guidelines from experts' consensus are still needed to address this challenging population.

This study investigates BaTiO3 decorated reduced graphene oxide sheets as a potential visible light active catalyst for dye degradation (Rhodamine B). The composites were prepared through conventional hydrothermal synthesis technique using hydrazine as a reducing agent. A number of techniques have been employed to affirm the morphology, composition and photocatalytic properties of the composites; these include UV-visible spectrophotoscopy that assisted in quantifying the concentration difference of Rhodamine B. The phase homogeneity of the composites was examined through x-ray powder diffraction (XRD) and high resolution transmission electron microscopy (HRTEM) was employed to confirm the orientation of the BaTiO3 particles over the reduced graphene oxide sheets. Photoluminescence (PL) emission spectra assisted in determining the surface structure and excited state of the catalyst. Fourier transformed-infrared (FTIR) spectra investigated the vibrations and adsorption peak of the composites, thereby ascertaining the formation of reduced graphene oxide. In addition, diffuse reflectance spectroscopy (DRS) demonstrated an enhanced absorption in the visible region. The experimental investigations revealed that graphene oxide acted as charge collector and simultaneously facilitated surface adsorption and photo-sensitization. It could be deduced that BaTiO3-reduced graphene oxide composites are of significant interest the field of water purification through solar photocatalysis.

The significance of de novo donor-specific antibodies (dnDSAs) after heart transplantation (HTx) on alloimmune injury, including acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy, remains unclear. In this study, we examined the importance of routine solid-phase arrays in detecting dnDSA during long-term follow-up of recipients of HTx. The study protocol was approved by the Mayo Clinic Institutional Review Board, and patients gave informed consent. Between January 2009 and December 2013, 86 of 101 consecutive adult recipients of HTx underwent routine serial antihuman leukocyte antigen (HLA) antibody monitoring before and 1 week, 4 months, 1 year, and annually after HTx using a panel of single-antigen beads (LABScreen, One Lambda, Inc.) read on a Luminex (Luminex Corp.) platform. Mean fluorescence intensity levels ≥2000 were considered positive. According to the International Society for Heart and Lung Transplantation classification, 1546 endomyocardial biopsies scored with severe ACR defined as grade 2R or 3R. Serial 3-dimensional intravascular ultrasound examinations were performed as previously published.1 Cumulative incidences were estimated using the Kaplan-Meier method. Cox-proportional hazard models were used for analysis of time-to-event data. Variables with a P value

Background Invasive fungal infection (IFI) in heart transplant recipients is associated with increased mortality and poor outcome. Reports have estimated the risk of 1-year IFI to be 3.4-8.6% with renal replacement therapy, delayed chest closure, and reoperation suggested as risk factors. However, the role of antifungal prophylaxis is unclear, though previous studies have suggested a reduced incidence of invasive Aspergillosis. The transplant program in Mayo Arizona provides 6 months of universal azole prophylaxis for Coccidioides, while Rochester and Florida only provide prophylaxis to high risk patients. We sought to define epidemiology and risk factors for 1-year IFI and determine the effect of antifungal prophylaxis. Methods We conducted a retrospective cohort study of patients undergoing single-organ heart transplantation at Mayo Rochester, Florida, or Arizona from January 2000 to March 2019. We identified baseline characteristics, details of transplant hospitalization such as need for renal replacement therapy, open chest, reoperation, and operative time, receipt of antifungal prophylaxis, and diagnosis of IFI. Multivariable Cox analysis was performed to identify risk factors of time to 1-year IFI. Results A total of 966 heart transplant recipients were identified with a median age of 56 years (IQR 47, 62) and 72% male. 444 patients received antifungal prophylaxis which included 32% fluconazole, 34% itraconazole, 18% voriconazole, 15% echinocandin, and < 1% amphotericin or posaconazole. Over 1-year follow-up, 62 patients developed IFI with a cumulative prevalence of 6.4%. The most common organisms were Aspergillus (50%) and Candida (27%). In a multivariable model, factors associated with 1-year IFI were post-transplant renal replacement therapy (HR 3.34, 95% CI 1.69-6.60; P < 0.001) and antifungal prophylaxis (HR 0.32, 95% CI 0.11-0.96; P=0.042). Operative time, recent hospitalization, open chest, and post-transplant mechanical circulatory support were not associated with 1-year IFI. Conclusion Renal replacement therapy after transplantation is associated with 1-year IFI. Antifungal prophylaxis appears to be protective and further prospective study is warranted to verify this finding. Disclosures All Authors: No reported disclosures

India is well known for its broad spectrum diversity concerning cultural, lingual, and ethnic, aligned with caste, tribes, and community segments. Serving for the passage of human migration in history has been reported as the reason for this wide genetic variability in the Indian populations. With the aim to unravel the genetic structure of Kahar and Tharu people of India, 23 Y chromosomal paternal lineage markers were analyzed in 147 unrelated male Individuals (Kahar = 78 and Tharu = 69). The cumulative probability of matching for the Kahar and Tharu people was observed to be 2.94 × 10‐12 and 5.06 × 1012, respectively. Both the studied populations belong to the same geographical region but showed minute genetic distance between each other in population cross-comparison study. Haplogroup R was observed most frequently in the studied populations which are also reported to be the most prevalent in North Indian populations. The genetic distance between the studied and previously published populations was analyzed using the Analysis of Molecular Variance (AMOVA) and Multi-Dimensional Scaling (MDS) tool from the Y Chromosome Haplotype Reference Database (YHRD). The Studied populations come up with the genetically close Indian populations from Uttarakhand, Karnataka, Andhra Pradesh and Singapore, and Bangladeshi populations from Dhaka, which might be a result of genetic relatedness.

A study was undertaken to evaluate the genetic link of Tharu community with South and East Asian populations. Tharu is an intriguing community that lives in the Terai region of Himalayas. The folklore claims that they originally came from Rajasthan. Previous studies have analyzed uniparental and biparental markers to access their origin and affinity. This is first genetic study based on 20 autosomal STR genetic markers included in the PowerPlex® 21 multiplex system in the Tharu population of India. The wide range of heterozygosity (0.61963 to 0.92025) indicates multidirectional gene flow in the studied population. The locus Penta E was most polymorphic and discriminatory with a value of 0.907 and 0.979 respectively, whereas the locus TPOX was least polymorphic and discriminatory with a value of 0.578 and 0.798 respectively among all the studied loci. The combined value of matching probability and paternity index was observed as 4.2 × 10−24 and 6.01 × 108 respectively. The results showed no deviation from Hardy–Weinberg equilibrium. All the studied loci showed significant genetic variation when compared with previously reported populations. This study suggests that the studied population has an admixed origin with more inclination towards the populations having a higher genetic relationship with East Asian rather than South Asian populations.

Background Left ventricular (LV) hemodynamic assessment has been sparsely performed in patients supported on continuous‐flow LV assist devices (cf LVADs ). Insight into dynamic changes of left heart parameters during ramp studies may improve LV assist device optimization and evaluate pathology. Methods and Results To complement right heart catheterization, a novel technique for left heart catheterization in patients with a cf LVAD was developed. Patients implanted with cf LVAD s underwent hemodynamic ramp left heart catheterization and right heart catheterization with transthoracic echocardiography. Continuous aortic and LV pressures were measured along with right atrial, pulmonary artery, and pulmonary capillary wedge pressures. A novel index, the transaortic gradient ( TAG ) was established. Thirty eight patients with cf LVADs were evaluated at a median of 446 days (interquartile range, 183–742) after device implant. During left heart catheterization performed for hemodynamic optimization, drop‐in LV end‐diastolic pressure and pulmonary capillary wedge pressure were associated with a rise in TAG . A range was identified for TAG (20–40 mm Hg) as providing the most optimal level of hemodynamic offloading. Pathologic states deviated from normal responses to ramp. LV assist device thrombosis was associated with an inability to increase in TAG during speed ramp. Significant aortic insufficiency was associated with a marked increase in LV end‐diastolic pressure despite a concomitant decrease in pulmonary capillary wedge pressure with increasing LV assist device speeds. Conclusions Inclusion of left heart catheterization to a typical right heart catheterization LV assist device ramp protocol imparted unique insights to optimize cf LVAD speeds in different clinical scenarios. A novel index, the TAG was defined and provided additional resolution to optimized offloading.

The gold standard for noninvasive blood pressure (BP) measurement, the Doppler technique, does not provide systolic blood pressure (SBP) and diastolic blood pressure (DBP) and may limit therapy outcomes. To improve patient care, we tested specifically designed experimental BP (ExpBP) monitor and the Doppler technique by comparing noninvasive measures to the intraarterial (I-A) BP in 31 patients with end-stage heart failure (4 females) 2.6 ± 3.4 days post-LVAD implantation (20 HeartMate II and 11 HeartWare). Bland-Altman plots revealed that the ExpBP monitor overestimated mean arterial pressure (MAP) by 1.2 (4.8) mm Hg (mean difference [standard deviation]), whereas the Doppler by 6.7 (5.8) mm Hg. The ExpBP SBP was overestimated by 0.8 (6.1) mm Hg and DBP by 1.9 (5.3) mm Hg compared with the respective I-A pressures. Both techniques achieved similar measurement reliability. In the measurement "success rate" expressed as a frequency (percent) of readable BP values per measurement attempts, Doppler accomplished 100% vs. 97%, 97%, and 94% of successful detections of MAP, SBP, and DBP provided by the ExpBP monitor. The ExpBP monitor demonstrated higher accuracy in the MAP assessment than the Doppler in addition to providing SBP and DBP in majority of subjects. Improved BP control may help to mitigate related neurologic adverse event rates.

Quantum wires occupy a unique status among the semiconducting nanostructures with reduced dimensionality -- no other system seems to have engaged researchers with as many appealing features to pursue. This paper aims at a core issue related with the magnetoplasmon excitations in the quantum wires characterized by the confining harmonic potential and subjected to a longitudinal electric field and a perpendicular magnetic field in the symmetric gauge. Despite the substantive complexity, we obtain the exact analytical expressions for the eigenfunction and eigenenergy, using the scheme of ladder operators, which fundamentally characterize the quantal system. Crucial to this inquiry is an intersubband collective excitation that evolves into a magnetoroton -- above a threshold value of magnetic field -- which observes a negative group velocity between the maxon and the roton. The evidence of negative group velocity implies anomalous dispersion in a gain medium with the population inversion that forms the basis for the lasing action of lasers. Thus, the technological pathway that unfolds is the route to devices exploiting the magnetoroton features for designing the novel optical amplifiers at nanoscale and hence paving the way to a new generation of lasers., Comment: 10 Figures

Purpose For optimization of the pump setting, there is currently a lack of non-invasive diagnostic methods capable to sensitively reflect the altered right-to-left ventricle relationship following the Left Ventricle Assist Device (LVAD) implantation. It was hypothesized that novel measures derived from the re-breath diffusing lung capacity for carbon monoxide (DLCO) technique may become a viable alternative to invasive hemodynamic studies. The present pilot study demonstrates feasibility and quantification of dynamic pulmonary variables including lung blood flow (Q) in the face of a device derived and clinical data. Methods 6 patients with LVAD participated in the present study (tab 1). Oxygen consumption and DLCO with its components were assessed pre- and during 12-15 min of low intensity (0.3 Watts/kg) exercise on a semi-recumbent ergometer. At constant LVAD speed, nitric oxide analyzer and mass spectrometer connected to a subject via a mouthpiece were used. Results During exercise, each patient demonstrated different patterns and magnitude of alterations in respiratory gas exchange (fig 1A). Moreover, variability of alteration in DLCO measures among patients was more prominent after correction for Q (fig 2B). Conclusion Distinct inter-personal responses in DLCO components and respiratory gas exchange to low intensity exercise may indicate that the re-breath DLCO technique can be utilized for a non-invasive LVAD speed optimization.

Purpose Enhanced platelet reactivity may play a role in the development and progression of cardiac allograft vasculopathy (CAV). Although aspirin is often a part of the medication regimen after heart transplantation (HT), limited evidence is available on its effects on CAV and related outcomes. In this large study, we sought to investigate whether aspirin treatment has an independent impact on CAV progression using coronary intravascular ultrasound (IVUS) follow-up studies and clinical outcomes after long-term follow-up post HT. Methods CAV progression, all-cause and cardiac mortality were compared between HT patients taking and those not taking aspirin from 1994 to 2016 at a single institution. CAV progression was assessed by measuring the log ratio of the last to first plaque index (PI, ratio of plaque volume to vessel volume) between last follow-up and baseline coronary IVUS after adjustment for age, time to first IVUS, conversion to sirolimus, and time between IVUS studies. Survival analyses were performed using Cox regression models with aspirin treated as a time-dependent predictor conditional on patients being alive at 6 months post HT. Results Overall, 530 HT recipients (308 patients received sirolimus-based and 222 received calcineurin inhibitor-based immunosuppression) were retrospectively analyzed, among which 323 patients underwent at least 2 IVUS studies post HT. Length of aspirin use was modestly associated with attenuated progression of plaque index ratio (r=-0.14, p=0.02) (Figure 1A). Cox regression with adjustment for clinically relevant characteristics, including conversion to sirolimus, and CAV grade at 1 year post HT did not suggest any difference in all-cause mortality (hazard ratio [HR] 0.9; 95% confidence interval [CI] 0.6 to 1.3, p=0.45) (Figure 1B) or cardiac death (HR 1.5, 95% CI 0.7 to 3.2, p = 0.33) (Figure 1C) after a median follow-up time of 10 years post HT. Conclusion Aspirin use may delay CAV progression but does not affect long-term survival after HT.