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AIMS To compare in vivo differences of two catheter systems for urodynamics to further discover their measurement properties. METHODS Side-by-side catheterization with two catheters for intravesical and abdominal pressure during full cystometry in 36 prospectively recruited patients with analysis of mean and absolute differences at urodynamic events and post hoc in-depth signal analysis comparing the full pressure traces of both systems. RESULTS The mean pressure differences at urodynamic events between air-filled and water-filled systems are small, however, with a large variation, without a systematic difference. The majority of the intersystem differences are significantly larger than 5 cmH2 O. Further analysis showed that urodynamic event pressure differences of both systems at the start of the test were carried forward throughout the remainder of the test without subsequent or additional tendency to differ. Post hoc whole test signal analysis with pressures equalized from the first sample shows high cross-correlation (>0.981) between the pressure signals per location (rectum and bladder) per test and almost zero-time shift (

Objectives This study sought to compare aortic stenosis (AS) progression rates, AS-related cardiac damage (AS-CD) indicator incidence and determinants, and survival between patients with tricuspid aortic valve (TAV)-AS and those with bicuspid aortic valve (BAV)-AS. Background Differences in AS progression and AS-CD between patients with BAV and patients with TAV are unknown. Methods We retrospectively studied consecutive patients with baseline peak aortic valve velocity (peakV) ≥2.5 m/s and left ventricular ejection fraction ≥50%. Follow-up echocardiograms (n = 4,818) provided multiparametric AS progression rates and AS-CD. Results The study included 330 BAV (age 54 ± 14 years) and 581 patients with TAV (age 72 ± 11 years). At last echocardiogram (median: 5.9 years; interquartile range: 3.9 to 8.5 years), BAV-AS exhibited similar peakV and mean pressure gradient (MPG) as TAV-AS, but larger calculated aortic valve area due to larger aortic annulus (p Conclusions In this cohort, TAV-AS and BAV-AS progression rates were similar. Rapid progression did not affect survival and was determined by cardiac risk factors for BAV-AS (particularly in patients with BAV

Hallux Valgus Surgery success depends not only on the operative technique, but also on the care of the foot during the postoperative period. Orthopedic shoes have been developed to decrease the weight load on the first ray, an excess of which might lead to a loss of fixation or pseudoarthrosis. The goal of this study was to determine how the load distribution changed as the forced applied to the foot increased, with and without an orthopedic shoe. Also, we compared to different shoe models.Pressure sensors were placed under the first metatarsal head and the heel of twenty specimens of fresh cadaveric adult feet. Two orthopedic shoes were chosen, a double padded (MS) and a reverse camber shoe (RCS). 10 kg loads were progressively applied, up to 60 kg. We first compared three instances: no shoe, MS and RCS. A secondary analysis comparing barefoot versus shoes was performed. A mean comparison was performed (ANOVA/T-student).The mean pressure of the heed and the first metatarsal showed that there were significant differences between groups (P.005). The secondary analysis (no shoe vs orthopedic shoes) showed that the pressure without shoe was significantly higher than with any orthopedic shoe (P.005). There were no statistically significant differences between models of shoes (P = .402).After a surgical procedure for hallux valgus fixation, postoperative shoes should be indicated to decrease the pressure on the first metatarsal head and heel in order to avoid an overload of the postoperative area.Cadaveric study. Level V.

Background The prescription of equation-based predicted pressure (Ppred) using mathematical equations has been proposed as a practical strategy for the determination of effective positive airway pressure (PAP). This study aimed at comparing the differences between therapeutic pressures obtained by auto-titrating positive airway pressure (APAP) and 10 predictive mathematical equations among Egyptian patients with obstructive sleep apnea (OSA). Patients and methods A retrospective cross-sectional study included 25 PAP-naive patients (23 males and two females) with polysomnographically confirmed OSA. The 95th percentile pressure (P95) of an APAP device during an attended successful titration study was selected as the effective reference PAP, against which PPred calculated from ten predictive equations was compared. Results Among the 25 patients included, four patients had mild, eight had moderate, whereas the remaining 13 patients had severe OSA. The mean P95 was higher than all predictive equations. A total of 24 (96%) of the 25 included patients experienced acceptable air leak during APAP titration. P95 correlated significantly and positively with pressures calculated by most of predictive equations except for those of equations 2, 6, and 7. Comparison between P95 and Ppred showed nonsignificant statistical difference for pressure calculated by Series equation, whereas Ppred of other equations were significantly lower than P95. Mean pressure difference between P95 and Ppred was around three in most of the equations with Series equation carrying the least mean pressure difference (0.7 cmH2O). Conclusion P95 is higher than Ppred, yet Series equation was the closest to P95. The utility of predictive equations for determining effective PAP level can serve a beneficial role during titration studies and can be used with caution as a practical alternative for PAP titration.

The open source code MFIX is used to perform CFD-DEM and TFM simulations based on the small scale challenge problem 1 fluidized bed set up. The basic flow features such as the core-annulus structure and slugging dynamics are well predicted by both modeling approaches. Similarly the first four statistical moments of the particle velocity distributions from HsPIV measurements are equally reproduced qualitatively by the models. The predicted mean pressure drop is independent of the drag correlation used in both modeling frameworks but the CFD-DEM model gives predictions closer to the experimental values. Predicted fluctuating quantities such as rms and granular temperature show sensitivity to the drag model used. The TFM demonstrates greater accuracy over the CFD-DEM in prediction of the particle granular temperature while the opposite is true for the bubble granular temperature. CFD-DEM simulations on average take twice the time required to perform a TFM simulation.

Objectives: Immediate result of PTMC in juvenile (5-12 years) rheumatic mitral stenosis. Study Design: Observational descriptive and retrospective study. Place and Duration of Study: Institute of Cardiology, Multan from 2009 to Jun 2020. Methodology: This is an observational descriptive and retrospective study carried out at Institute of Cardiology, Multan from 2009 to Jun 2020. Patients with clinical evidence of significant mitral stenosis were undergone transthoracic echocardiography. Mitral stenosis was defined as mitral valve area 8 were also excluded from the study. Variables recorded on a performa were age, weight, left atrial size, mean mitral valve gradient, preprocedure MR. Reduction of mitral valve mean pressure gradients to less than

OBJECTIVES To determine whether robotic mitral valve repair can be applied to more complex lesions compared with minimally invasive direct mitral valve repair through a right thoracotomy. METHODS We enrolled 335 patients over a 9-year period; 95% of the robotic surgeries were performed after experience performing direct mitral valve repair. RESULTS The mean age in the robotic versus thoracotomy repair groups was 61 ± 14 vs 55 ± 11 years, respectively (P CONCLUSIONS Robotic surgery can be applied to repair more complex mitral lesions, with excellent early outcomes.

In clinical studies, the effect of heart rate (HR) alone as feedback for maintaining homeostasis cannot be observed. Therefore, in this study, the effect of HR on pulse wave velocity (PWV) was investigated using a simulator without feedback. This was achieved via a one-tube model that simplifies the human arterial system and an arterial tree model similar to the human body, using a cardiovascular simulator. The one-tube model measured the pressure waveform at two measuring points 1.2 m apart, while the arterial tree model measured the pressure waveform in the carotid and femoral arteries. In the one-tube experiment, the effects of HR, mean pressure (MP), and stroke volume (SV) on PWV were independently investigated. PWV was found to increase as HR increased, but was not affected when MP and SV were changed. Further, in the arterial tree model experiment, it was observed that the PWV increased with an increase in HR. The results of this study showed that even in a simulator containing a human arterial model made of silicone material with no human feedback action, changes in HR alone affect the PWV.

Mitral stenosis (MS) is associated with left atrial (LA) functional and morphological changes as a result of chronic increase in LA pressure. Relieving the mitral obstruction via balloon mitral valvuloplasty (BMV) might be associated with LA structural and functional remodeling. To study alterations of LA volume and functions 1 year following successful BMV in patients with isolated rheumatic severe mitral stenosis. Thirty patients (median age 33 years, 22 women) with severe rheumatic MS were included in the study. Using biplane method, trans-thoracic 2D echocardiography was used to estimate LA volume indexed to body surface area (BSA). Maximal, minimal and pre-A left atrial volumes were measured and indexed to BSA. LA volumetric functions were then assessed and the measurements were repeated 6 months and 1 year after successful valvuloplasty. At baseline, median mitral valve area (MVA) was 0.9 (0.6–1.3) cm2 measured by planimetry with a mean pressure gradient of 12.5 (8–24) mmHg. Following BMV, a significant regression of left atrial volume index was noticed at 6 months compared to baseline (51 vs. 60 ml/m2, p = 0.001) with a further decrease at 1 year (48 vs. 51 ml/m2, p = 0.03). At 6 months, volumetric assessment of left atrial functions showed a significant improvement in LA total emptying fraction (42% vs 30%, p = 0.001) as well as in LA passive emptying fraction (26% vs 14%, p = 0.033) and LA active emptying fraction (20% vs. 18%, p = 0.016). All these indices showed further improvement at 1 year [47% (P = 0.02), 29% (p = 0.03) and 31% (p = 0.001) respectively]. In patients with isolated rheumatic MS, mitral valvuloplasty was associated with a significant decline of LA volume accompanied by a significant improvement of its volumetric functions.

We present the results of experimental investigations of the distribution of deformation indicators and rolling forces along the length of brass (L63) strips in a 150 × 235 two-roll mill equipped with a microcontroller system for high-precision measurements of loads acting upon the rolls. The results of the quantitative analyses of changes in the sizes of strips and rolling forces on stationary and nonstationary sections along the strip length are presented. A significant effect of the outer parts of the strip on the rolling force and the pressure of the metal upon the rolls is established. On the basis of the experimental results, we propose an equation for the evaluation of the influence of the outer parts of the strip on the rolling force and pressure. The equation for the mean pressure of the metal upon the rolls is improved with regard for the influence of the outer parts and the stiffness of the strip on the site of deformation in the process of thin-sheet rolling. It is shown that the proposed equations make it possible to increase the accuracy of evaluation of pressure and determination of rolling forces along the length of thin strips.

The aim of this meta-analysis was to compare the clinical outcomes in patients who underwent rapid deployment aortic valve replacement (RDAVR) and conventional bio prosthetic aortic valve replacement (CAVR).We performed a literature search by August 2018. The primary outcomes were hospital and 1-year mortality, and the secondary endpoints included the aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and postoperative and valve-related complications.Two randomized controlled trials and 13 propensity score-matched studies were included. There was no difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%; risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR significantly reduced the ACC time ( (mean difference (MD) -24.33 [95% CI -28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The pooled analysis showed that RDAVR doubled the occurrence of permanent pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]). Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86]) and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI 0.69-0.99]) was reduced. The difference of paravalvular leakage frequency between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P = 0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI 0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58 to -0.28]).The hospital and 1-year survival rates between RDAVR and CAVR are comparable. RDAVR reduces POAF occurrence and blood transfusion but is associated with a higher occurrence of pacemaker implantation.

In turbulent premixed flames at low Karlovitz number, combustion heat release can have a significant impact on turbulence. Thermal expansion in flame induces dilatation, and the corresponding pressure–dilatation correlation acts as a primary source of turbulent kinetic energy (TKE). As a consequence, the flame-normal component of the normal Reynolds stresses significantly increases. Additionally, for sheared flames, typical of jet flames, the shear component of the Reynolds stresses exhibits counter-Boussinesq behavior. For flames at low Karlovitz number, where these effects dominate, no models have successfully predicted all Reynolds stress components. To develop more complete turbulence models, heat release effects on the evolution of all Reynolds stress components need to be analyzed. In this work, Reynolds stress budgets are evaluated from Direct Numerical Simulation (DNS) databases of spatially-evolving turbulent premixed planar jet flames at low and high Karlovitz numbers. In the Reynolds stress budgets, the velocity–pressure gradient correlation term is important at both Karlovitz numbers but serves fundamentally different roles in each case. In the budgets for the normal components, the velocity–pressure gradient correlation term is decomposed into a redistribution term and an isotropic term, where the redistribution term acts to redistribute energy between the Reynolds stress components and the isotropic term is the pressure–dilatation source term of turbulent kinetic energy. At high Karlovitz number, the isotropic term is negligible, and the redistribution term acts to isotropize the turbulence as in non-reacting flows. Conversely, at low Karlovitz number, the isotropic term acts as a large source, and the redistribution term preferentially injects energy into the flame-normal component at the expense of other components which acts to make the turbulence less isotropic. In the budget for the shear component, the shear production term dominates the velocity–pressure gradient correlation term at high Karlovitz number, but the opposite is observed at low Karlovitz number. The dominance of the velocity–pressure gradient correlation term at low Karlovitz number is primarily induced by the flame-generated mean pressure gradient and ultimately leads to the counter-Boussinesq behavior of the shear component. The overall analysis indicates that any turbulence model that relies on small-scale isotropy and/or rapid isotropization will fail to capture the heat release effects on turbulence at low Karlovitz number.

Background The aim of this study was to evaluate the hemodynamic effect of different suturing techniques for aortic valve replacement (AVR) in vitro. Whether or not the applied suturing technique impacts the outflow tract diameter by narrowing the annulus diameter was examined. Methods The commonly applied non-everting pledget forced suture technique (NE, n=13) was compared with an everting pledget forced suture (ET, n=13) for AVR using the 25 mm St. Jude Trifecta aortic valve. Hemodynamic parameters were obtained in a pulsatile flow simulator. A high speed camera captured the visual aspects of the suturing technique. Results Despite some kind of left ventricular outflow narrowing due to protruding pledgets using the NE suture technique, mean pressure gradients of both techniques were nearly similar (NE 5.88±2.7 mmHg, ET 5.23±1.31 mmHg, P=0.44). Closing volume (NE 3.16±0.48 mL; ET 3.51±0.68 mL; P=0.14) and the leakage volume (NE: 8.09±2.53 mL; ET: 8.35±3.65 mL; P=0.83) also showed no differences. Conclusions AVR using either suturing techniques leads to a similar hemodynamic performance in vitro. The impact of the suturing technique may be higher in a smaller annulus. Therefore, further studies using smaller prostheses are necessary.

The purpose of this study was to investigate the differences in plantar pressure under the lead and trail foot between two lunge tasks to the net in the dominant (LD) and non-dominant (LND) directions, and to explore how fatigue affects the plantar pressure patterns whilst performing movements before and after a competitive match. Peak and mean pressure were measured with the Biofoot-IBV in-shoe system from five repetitions of each task, with sensors positioned under the calcaneus, midfoot and phalanges on the lead and trail foot. Data were collected pre and immediately post-playing an official first national league competition match. The study was conducted with a sample of thirteen first league badminton players. A 2 × 2 repeated ANOVA found significant differences between the two tasks and between pre- and post-match (fatigued state). Players also had different foot pressure distributions for the LD and LND tasks, which indicated a difference in loading strategy. In a fatigued state, the plantar pressure shifted to the medial aspect of the midfoot in the trail limb, indicating a reduction in control and a higher injury risk during non-dominant lunge tasks.

Waste heat is an environmental issue in the world. There are some technologies that can be used to recovery the waste heat, one of which is thermoacoustic cooler technology. Thermoacoustic technology can be divided into two parts: one is thermoacoustic engine and cooler. To design the cooler system having high efficiency and lower onset heating temperature, the effect of mean pressure is investigated. By increasing mean pressure from 0.5 to 3 MPa, the heating temperature generating acoustic power can be decreased from 831 to 580 K. Moreover, 15% of Thermodynamic upper limit value of the whole cooler system is achieved.

Controlling cavitation occurrence is one of the most important factors in chute spillways designing due to high velocity and the negative pressure of flow. A probabilistic design approach was implemented in the present study to estimate the probability of cavitation occurrence on chute spillways. In addition, the uncertainty presence of the effective parameters in the limit state function related to the cavitation occurrence was highlighted in the present design. The probability of cavitation occurrence was studied based on the reliability of first order reliable method (FORM) and it was controlled by Monte Carlo simulation method. The data was extracted from eighteen spillways laboratory models built by the Iranian Water Research Institute, among which ten were aerated and eight were without aerator. Accordingly, as a result of the performance of these spillways and the cavitation occurrence in the prototype, a graph and its relationship was found for controlling the cavitation occurrence and its failure probability based on the mean velocity and flow mean pressure along the chute spillway. According to the results of this study as a new method for designing based on reliability, it could be controlled the probability of cavitation occurrence.

Abdominal compartment syndrome is a sustained intra-abdominal pressure (IAP) >20 mm Hg associated with new organ dysfunction. In order to prevent its development and related complications, IAP monitoring should be performed in patients with risk factors. Although techniques for its monitoring have been developed, they are of high cost and not always available in low- and lower–middle-income countries. Therefore, we aim to develop and validate in a bench model a handcrafted catheter to be used as an alternative method to measure the intra-gastric pressure (IGP) as a surrogate of the IAP. We used an acrylic water container as a model of the abdomen and four handcrafted catheters made of a 16 Fr Levin tube with a globe finger tied with silk in the distal end, inflated with 1 cm of air. They were placed on the bottom of the container where the water pressure was directly measured as a gold standard. The agreement between the two measures was assessed with the Bland–Altman method. We performed 120 simultaneous measures. The mean pressure difference was 0.218 (95% CI 0.074 to 0.363). The handcrafted prototype catheter and the direct measure were highly correlated. The new catheter is a reliable and reproducible tool for pressure monitoring. However, before it can be used in the clinical setting for IAP monitoring, validation in human models in a real clinical setting needs to be performed.

Summary The purpose of this study was to assess plantar pressure and static balance alterations after jumping and landing. According to the importance of devastating impact of improper distribution of plantar forces on the incidence of abnormal movements and stresses in the foot structure of volleyball players, studying the effect of fatigue on plantar pressure and static balance can lead to significant achievements in the evaluation of this organ's performance. In this study, 12 male adolescent volleyball players with a history of unilateral ankle injury and 12 male adolescent volleyball players without a history of unilateral ankle injury was participated. Plantar pressure characteristics and static balance in volleyball players with and without history of unilateral ankle injury was recorded before and after a fatigue from consecutive jumping and landing protocol while standing static on foot pressure. maximum pressure, mean pressure, pressure distribution, surface and romberg open and close eyes balance registered. There was a significant difference between the maximum and the mean plantar pressure and the contact surface of the right foot before and after fatigue and significant difference between the mean pressure and the pressure distribution of the healthy foot and the injured leg in individuals with a history of ankle injury also fatigue cause reduce balance in adolescent volleyball players without history of unilateral ankle injury in open eyes mode and reduce balance in adolescent volleyball players with history of unilateral ankle injury in open and closed eyes. These changes could lead to lower limb injuries.

Wind surface mean pressure coefficient (Cp) is an essential parameter for the assessment of wind induced forces that is a must input to all structural designs. An extensive experimentation is carried out to obtain pressure coefficient data over the surfaces of C-shaped building models of varying aspect ratio, corner curvature and angle of incidence in a sub-sonic wind tunnel. The studies also include models without corner curvature. In this study, a technique known as Gene-Expression Programming (GEP) is used to develop a model equation using experimental values of pressure coefficient data collected at the grid points of the frontal surface under varying conditions. And this developed model is used to predict surface mean pressure coefficients (Cp). The predicted values of Cp using the developed model are compared with the corresponding Cp values obtained by Swami and Chandra (S&C) equation and Muehleisen and Patrizi (M&P) equations. The prediction made by the developed GEP model is also validated with the actual building data of Tokyo Polytechnic University (TPU). The results signify the ability of the model to predict the Cp values for practical purposes. The error analysis of the results show that the predicted values of Cp using developed GEP correlation are more close to the experimental values than those obtained by using other two methods.

Introduction: We measured the peak pressure gradient (pPG) and mean pressure gradient (mPG) obtained by transesophageal echocardiography (TEE) after induction of anesthesia and compared it with the preoperative pPG and mPG by transthoracic echocardiography (TTE) in adults with aortic stenosis (AS). We also compared the aortic valve area (AVA) measurements as obtained preoperatively by TTE versus those by TEE following induction of general endotracheal anesthesia (GETA) during the inspiratory phase, expiratory phase of the ventilatory cycle and with incremental increases in tidal volume. Materials and Methods: All patients had preoperative TTE within 1 month of surgery and was reviewed 1 day before the surgery. After anesthetic induction, precardiopulmonary bypass (CPB) TEE evaluation was done to measure mPG and pPG across AV, under steady-state conditions. Three different controlled tidal volumes: 8 ml, 10 ml, and 12 ml per kg body weight were utilized during the TEE measurements. Results: A total of 90 adults underwent aortic valve replacement from 2017 to 2018. The preoperative pPG and mPG across the AV by TTE was 96.7 ± 23.27 mmHg and 60.7 ± 18.1 mmHg, respectively. Compared to preoperative TTE, pre-CPB TEE pressure gradient during both phases of ventilation under GETA was significantly lower. The pPG and mPG were higher during inspiration as compared to those in the expiratory cycle during mechanical ventilation under GETA (pPG during inspiration = 66.63 ± 22.15 mmHg; mPG during inspiration = 38.24 ± 13.65 mmHg; pPG during expiration = 52.49 ± 19.10 mmHg; mPG during expiration = 30.76 ± 12.66 mmHg). There were no significant changes in AVA between TTE/TEE and inspiration/expiration. Conclusions: The findings of this study demonstrate that the TEE pre-CPB PGs underestimated the severity of AS; hence, the severity of AS must be interpreted with caution during GETA and mechanical ventilation (MV). In addition, PGs must be done at similar points in the respiratory cycle.

For the first time, we analyzed the direct kinetic effects of concrete and rubber flooring on the soles of live dairy cows' claws while standing and walking. Ten adult dairy cows were equipped with foil-based pressure sensors (HoofSystem, Tekscan Inc., Boston, MA) under their left hind leg using a leather claw shoe. These sensors captured parameters of pressure distribution and vertical ground reaction forces while the cows walked on the 2 tested flooring types. The mean pressure was 15.1 to 21.1% lower on rubber flooring compared with concrete; mean pressure values (± standard deviation) were 36.32 ± 7.77 N/cm2 for static measures and 57.33 ± 11.77 N/cm2 for dynamic measures. We observed an even more obvious relief on rubber flooring in the maximum pressure loads, which were 30.1 to 32.7% lower on rubber flooring compared with concrete; mean pressure values (± standard deviation) were 98.79 ± 14.49 N/cm2 for static measures and 150.45 ± 20.87 N/cm2 for dynamic measures). The force–time curves of the dynamic measures essentially showed biphasic curve progression, with local peaks at 29 and 79% of the stance phase. However, we found considerable differences in curve progression between individuals and between the lateral and medial claws, which may be verified in further investigations with more animals. The study showed a noticeable reduction in mechanical load during standing and walking on rubber flooring compared with concrete.

Background: Pneumatic tourniquet is an effective tool to achieve hemostatic control of the surgical field in upper extremity (UE) operations. Elevated pressures have been associated with adverse effects despite various methods of pressure determination. We aim to demonstrate the usage of reduced tourniquet pressures and examine factors associated with achieving reduced pressures. Methods: A prospective study was conducted (2016–2018) at a Level 1 Trauma Center and an Outpatient Surgical Center, totaling 226 operations, involving a reduction of cuff pressures over time from a standard baseline of limb occlusion pressure for UE operations. Results: A gradual reduction of pressures was successfully achieved with a mean pressure of 187 mmHg and average time of tourniquet application being 25 minutes. We found chronological surgical number and patient BMI to be significantly associated with tourniquet pressure (p < 0.05). 4.5% of cases resulted in breakthrough bleeding, but did not reliably occur with any pressure thresholds, patient demographics, or operative factors (p > 0.05, for all). Conclusions: Reduced tourniquet pressures can mitigate complications associated with tourniquet use. Our research shows reduced pressures are successful in maintaining field visibility and we encourage an adoption of pressures below 200 mm Hg in most procedures that require a tourniquet.

Pulmonary hypertension has multiple etiologies and so can be difficult to diagnose, prognose, and treat. Diagnosis is typically made via invasive hemodynamic measurements in the main pulmonary artery and is based on observed elevation of mean pulmonary artery pressure. This static mean pressure enables diagnosis, but does not easily allow assessment of the severity of pulmonary hypertension, nor the etiology of the disease, which may impact treatment. Assessment of the dynamic properties of pressure and flow data obtained from catheterization potentially allows more meaningful assessment of the strain on the right heart and may help to distinguish between disease phenotypes. However, mechanistic understanding of how the distribution of disease in the lung leading to pulmonary hypertension impacts the dynamics of blood flow in the main pulmonary artery and/or the pulmonary capillaries is lacking. We present a computational model of the pulmonary vasculature, parameterized to characteristic features of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension to help understand how the two conditions differ in terms of pulmonary vascular response to disease. Our model incorporates key features known to contribute to pulmonary vascular function in health and disease, including anatomical structure and multiple contributions from gravity. The model suggests that dynamic measurements obtained from catheterization potentially distinguish between distal and proximal vasculopathy typical of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. However, the model suggests a non-linear relationship between these data and vascular structural changes typical of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension which may impede analysis of these metrics to distinguish between cohorts.

Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves.Methods: All consecutive patients undergoing ViV-TAVI for degenerated surgical valves at the Cleveland Clinic were analyzed. Data were extracted from our patient registry on baseline patient characteristics, echocardiographic parameters, and procedural details. To identify possible predictors of ViV-TAVI procedural success, we employed a multivariate logistic regression model.Results: A total of 186 patients who underwent ViV-TAVI were analyzed, with procedural success (VARC-2 device success and absence of periprocedural MACCE) reported in 165 (88.7%) patients. Patients with successful ViV-TAVI were significantly younger and had more frequent utilization of the transfemoral access than those with failed procedure. Other baseline and procedural characteristics were comparable between both groups. In terms of echocardiographic parameters, the procedural success group had a significantly lower AV peak pressure gradient (62.1 ± 24.7 vs. 74.1 ± 34.6 mmHg; p = 0.04) and lower incidence of moderate-to-severe aortic regurgitation [AR] (30.4 vs. 55%; p = 0.04). However, no significant differences between both groups were noted in terms of AV mean pressure gradient and left ventricular measurements. In multivariate analysis, lower AV peak pressure gradient (OR = 0.97, 95% CI: 0.95–0.99) and absence of moderate-to-severe AR (OR = 0.65, 95% CI: 0.44–0.95) at baseline emerged as independent predictors of ViV-TAVI procedural success.Conclusion: Valve-in-Valve TAVI for degenerated surgical valves is a feasible approach with high success rates, especially in those with lower AV peak pressure gradient and absence of moderate-to-severe AR. Studies with larger sample size and longer follow-up are required to further characterize the predictors of ViV-TAVI success and other clinical outcomes.

Background The criteria to define the grade of aortic stenosis (AS)—aortic valve area (AVA) and mean gradient (MG) or peak jet velocity—do not always coincide into one grade. Although in severe AS, this discrepancy is well characterised, in moderate AS, the phenomenon of discordant grading has not been investigated and its prognostic implications are unknown. Objectives To investigate the occurrence of discordant grading in patients with moderate AS (defined by an AVA between 1.0 cm² and 1.5 cm² but with an MG

The aerodynamic performance of a roof depends significantly on its shape and size, among other factors. For instance, large roofs of industrial low-rise buildings may behave differently compared to those of residential homes. The main objective of this study is to experimentally investigate how perimeter solid parapets can alter the flow pattern around a low-rise building with a large aspect ratio of width/height of about 7.6, the case of industrial buildings/shopping centers. Solid parapets of varied sizes are added to the roof and tested in an open-jet simulator in a comparative study to understand their impact on roof pressure coefficients. Roof pressures were measured in the laboratory for cases with and without parapets under different wind direction angles (representative of straight-line winds under open terrain conditions). The results show that using a parapet can alter wind pressures on large roofs. Parapets can modify the flow pattern around buildings and change the mean and peak pressures. The mean pressure pattern shows a reduction in the length of the separation bubble due to the parapet. The parapet of 14% of the building’s roof height is the most efficient at reducing mean and peak pressures compared to other parapet heights.

El objetivo del presente estudio fue establecer las diferencias que se presentan en la huella plantar tras aplicar un protocolo de fatiga neuromuscular. Un total de 10 deportistas varones sanos con una edad aproximada de 21 años fueron evaluados para el componente morfológico, con el equipo Tanita BC585F® (variables: kg de peso, kg de grasa, kg de músculo y kg de hueso). En el protocolo de fatiga se utilizó el equipo isoinercial Squat RSP®. Para la prueba de baropodometría, tanto en el pre-test como en el post-test, se utilizó el equipo EcoWalk. Se tomaron variables de presión R-Type® para ambos pies, como presión media, superficie de contacto, distribución anterior, posterior, lateral derecha y lateral izquierda. No se encontraron diferencias significativas en el pre y post test de la prueba de baropodometría con una p>0.05. Se encontraron correlaciones significativas entre el componente morfológico y la baropodometría con una p The objective of the present study sought to establish the differences presented in the plantar footprint after applying a neuromuscular fatigue protocol. A total of 10 healthy male athletes with an approximate age of 21 years were evaluated for the morphological component, with the Tanita BC585F® equipment (variables: weight Kg, fat KG, muscle Kg and bone Kg). In the fatigue protocol, the isoinertial Squat RSP® equipment was used. For the baropodometry test, both in the pre-test and in the post-test, the EcoWalk equipment was used. R-Type® pressure variables were taken for both feet, such as mean pressure, contact surface, anterior, posterior, right lateral and left lateral distribution. No significant differences were found in the pre and post test of the baropodometry test with a p> 0.05. Significant correlations were found between the morphological component and the baropodometry with a p

We report a case of a 25-year-old man diagnosed with an unusual case of cor triatriatum sinister with a mobile left atrial thrombus. He was hospitalised with aggravating dyspnoea. Transthoracic echocardiography revealed a membrane-like structure traversing the left atrial and a small orifice of about 7.1 mm. The mean pressure gradient was 12.94 mmHg across the orifice of the membrane-like structure and there was a mobile mass in the post-erosuperior chamber. The anomaly was rectified by a surgical resection. Timely diagnosis and surgical repair may prevent stroke in patients with unusual cor triatriatum sinister.