Search

Aims To compare the safety and efficacy of antithrombotic regimens following transcatheter aortic valve replacement (TAVR) in patients without having an indication for chronic oral anticoagulation Methods and results We conducted a Prospero-registered systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVR antithrombotic regimens up to March 2021. We estimated the relative risk and 95% confidence intervals using a fixed effect model in a frequentist pairwise and network metanalytic approach. We included 6 studies comprising of 3,777 patients with a mean weighted follow-up of 13.3 months. Single antiplatelet therapy (SAPT) was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95% confidence interval [CI]: 0.28–0.69), apixaban (RR: 0.47, 95% CI 0.26–0.84) and low-dose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI: 0.16–0.57). Risk of all-cause death was significantly reduced with DAPT compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI: 0.41–0.88) and a consistent reduction was observed with SAPT and DAPT compared to apixaban (RR: 0.60, 95% CI: 0.31–1.16 and RR: 0.58, 95% CI: 0.32–1.04, respectively). There were no differences between the various regimens with respect to myocardial infarction and stroke. Apixaban significantly reduced the risk of pulmonary embolism, valve thrombosis and grade 3 or 4 reduced leaflet motion. Conclusion Following TAVR in patients without an indication for chronic oral anticoagulant, SAPT was associated with the lowest risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset. Funding Acknowledgement Type of funding sources: None.

Objective: To describe the incidence, clinical features and perinatal outcome of late onset growth restriction (FGR) associated with genetic syndromes or aneuploidy, structural malformation, or congenital infection. Methods: Retrospective multicenter cohort study conducted at four tertiary maternity hospitals in Italy. We included singleton pregnancies between 32+0 and 36+6 weeks of gestation with either abdominal circumference or estimated fetal weight

Background The rapid mode feature implemented in the latest version of the laser balloon system (LB3, HeartLight, X3, Cardiofocus) offers an automated continuous 360° lesion for pulmonary vein isolation (PVI). However, data on its clinical applicability and the potential reduction of procedural times are not yet available. Purpose To explore the use of the rapid mode and its association with PV total and fluoroscopy times in our initial experience with LB3. Methods This analysis included consecutive patients who underwent PVI procedure with LB3. We attempted to perform a complete circular ablation line using the rapid mode at 13 W, but if needed to achieve successful isolation, rapid mode was interrupted and manual mode (5.5–8.5 W) applications were used. The percentage of rapid mode use on the 360° lesion was measured for each PV. Total and fluoroscopy times to complete PVI were also collected. Results A total of 110 PVs were identified in 27 LB3 procedures and successfully isolated with a mean procedural time of 85±31 min. Sixty (55%) PVs were treated by using rapid mode for more than 50% (180°) lesion and 13 (12%) of them had a pure rapid mode ablation (without necessity of manual mode applications). Right inferior PV had the highest use of rapid mode (median value 70%). The main reasons for manual applications were poor PV occlusion, imperfect ostium visualization and presence of blood. PVs with >50% rapid mode use were treated in a significantly shorter time (21.2±13.7 vs 26.8±12.4, p=0.043). Fluoroscopy time did not differ significantly (4.7±4.2 vs 5.4±4.9, p=0.48). Three pinhole balloon ruptures were observed during rapid mode energy application in the second, third and twenty-fifth procedure. No other complications occurred. Conclusions Few PVs could be isolated using pure rapid mode; however, its applicability for more than 50% lesion was observed more frequently and significantly reduced the time to isolation. Funding Acknowledgement Type of funding sources: None. Time to isolation using Rapid Mode

Background Electric isolation of the pulmonary veins (PVs) can successfully treat patients with atrial fibrillation (AF). Isolation of pulmonary veins can be achieved by several methods: radiofrequency, cryoballoon or laser balloon ablation (LBA). The main procedural challenge with either method is to achieve a continuous circumferential lesion at the left atrium-PVs junction, with the persistence of functional gaps. Purpose A novel endoscopic ablation system equipped with a precise motor control system (MCS) has been evaluated. The balloon is used with an endoscope to directly visualize and ablate tissue at the left atrial-PVs junction with laser energy. This system enables uninterrupted, high-speed, circumferential lesion creation under direct control of the physician. The MCS is intended to reduce procedure time and to ensure continuity of ablation lesions. The feasibility of the motorized ablation in terms of extent of applicability along each PV-left atrium junction and time of use of the manual point-by-point mode has been investigated. Methods 27 consecutive patients (male 70.3%, age 61.2±8.7 years) with paroxysmal or persistent AF who underwent LBA were enrolled in our institution. Exclusion criteria were any contraindication for the procedure including the presence of intracavitary thrombosis and contraindications to general anesthesia or deep sedation. After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and laser energy were projected onto the target. Results A total of 110 PVs were treated with LBA; in 9 patients there was a redundant right intermediate pulmonary vein; in 4 patients there was a right common ostium and in 2 a left common ostium. MCS was used for 82 PVs (74.5%): in particular, MCS was used continuously between 180° and 325° degrees (50 to 90% of PV circumference) for 35 PVs (31.8%) and between 326° and 359° degrees (91 to 99% of PV circumference) for 25 veins (22.7%). In 13 PVs (12%) MCS was used for the entire circumference. During 8508 (19.6%) seconds out of a total of 43.368 seconds, laser energy delivery occurred in the rapid mode by MCS. No clinical complications, either local or systemic (stroke or TIA, pericardial effusion, pericardial tamponade, pulmonary vein stenosis, esophageal injury, temporary or permanent phrenic nerve palsy), were observed neither during the use of MSC nor during the use of manual point-by-point mode. Of note, a pinhole rupture of the balloon occurred in 3 cases of our series, during the use of MCS, without harm to the patient and requiring only replacement of the LBA. Conclusions In our case series, laser balloon ablation with the help of motor control system appears safe and feasible in most cases for large portions of pulmonary vein circumference, providing considerable time sparing (74.5% of total ablation extent in 19.6% of total ablation time). Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter defibrillator (ICD) is an effective therapy for sudden cardiac death (SCD). 2015 HRS/EHRA/APHRS/SOLAECE expert consensus document suggests long VT detection, above 185 bpm, as optimal ICD programming to reduce unnecessary therapies in primary prevention (PP). Purpose The aim of our study is to evaluate incidence, safety and efficacy of ICD treatment for VT arrhythmias below 185 bpm, in a contemporary population of PP ICD recipients with long detection intervals (LDI), morphological discrimination algorithm and antitachycardia pacing therapies (ATP) before shock. Methods We conducted a single centre retrospective study enrolling 236 patients implanted with a primary-prevention indication from January 2013 to June 2019. Patients were implanted with single or dual chamber single-lead transvenous ICD. All patients had standard device setting with long (at least 20 s in VT and 7 s in VF) VT/VF detection above 150 bpm and therapies starting from 171 with up to 5 ATP and multiple shocks. PainFREE-like bursts and Schaumann-like ramps ATP were always set in VT zone. Of each patient we collected a detailed report of up to five appropriate events and three inappropriate events. Arrhythmia diagnosis was confirmed from 3 independent expert physicians. Date of the event, cycle length, type of morphology (polymorphic or monomorphic), therapies with their effect were collected. Results During a mean follow-up of 42 months, 47 (20 %) and 18 (8%) patients had at least one appropriate and inappropriate activation, respectively. The detailed-events analysis shows that 16 (7%) patients had 38 (30%) appropriate events with rate Conclusions One third of detected arrhythmias had a rate below 188 bpm and 73% were true VT. In this slow VT zone, ATP had a high success rate with low percentage of acceleration.

Funding Acknowledgements Type of funding sources: None. Background Electric isolation of the pulmonary veins (PVs) can successfully treat patients with atrial fibrillation (AF). Isolation of pulmonary veins can be achieved by several methods: radiofrequency, cryoballoon or laser balloon ablation (LBA). The main procedural challenge with either method is to achieve a continuous circumferential lesion at the left atrium-PVs junction, with the persistence of functional gaps. Purpose A novel endoscopic ablation system equipped with a precise motor control system (MCS) has been evaluated. The balloon is used with an endoscope to directly visualize and ablate tissue at the left atrial-PVs junction with laser energy. This system enables uninterrupted, high-speed, circumferential lesion creation under direct control of the physician. The MCS is intended to reduce procedure time and to ensure continuity of ablation lesions. The feasibility of the motorized ablation in terms of extent of applicability along each PV-left atrium junction and time of use of the manual point-by-point mode has been investigated. Methods sixteen consecutive patients (male 68.7%, age 60.9 ± 7.8 years) with paroxysmal or persistent AF who underwent LBA were enrolled in our institution. Exclusion criteria were any contraindication for the procedure including the presence of intracavitary thrombosis and contraindications to general anesthesia or deep sedation. After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and laser energy were projected onto the target. Results A total of 62 PVs were treated with LBA; in 3 patients there was a redundant right intermediate pulmonary vein; in 4 patients there was a right common ostium and in one a left common ostium. MCS was used for 41 PVs (66.1%): in particular, MCS was used continuously between 180° and 325° degrees (50 to 90% of PV circumference) for 22 PVs (35.5%) and between 326° and 359° degrees (91 to 99% of PV circumference) for 16 veins (25.8%). In 3 PVs (4.8%) MCS was used for the entire circumference. During 5.659 (23.6%) seconds out of a total of 23.986 seconds, laser energy delivery occurred in the rapid mode by MCS. No clinical complications, either local or systemic (stroke or TIA, pericardial effusion, pericardial tamponade, pulmonary vein stenosis, esophageal injury, temporary or permanent phrenic nerve palsy), were observed neither during the use of MSC nor during the use of manual point-by-point mode. Of note, a pinhole rupture of the balloon occurred in the first 2 cases of our series, during the use of MCS, without harm to the patient and requiring only replacement of the LBA. Conclusions In our case series, laser balloon ablation with the help of motor control system appears safe and feasible in most cases for large portions of pulmonary vein circumference, providing considerable time sparing (66.1% of total ablation extent in 23.6% of total ablation time).

The World Health Organization (WHO) and other organizations report that the prevalence of human diseases during the past decade is rapidly increasing. Population growth and the pollution of water, air, and soil are contributing to the increasing number of human diseases worldwide. Currently an estimated 40% of world deaths are due to environmental degradation. The ecology of increasing diseases has complex factors of environmental degradation, population growth, and the current malnutrition of about 3.7 billion people in the world.

Background: Long-term outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention with a drug-eluting stent are unclear. Therefore, we aimed to evaluate long-term adverse events in HBR patients undergoing percutaneous coronary intervention with cobalt-chromium everolimus-eluting stent implantation. Methods: We analyzed stratified data from 4 all-comers postapproval registries. Patients with at least 1 of the following criteria were categorized as HBR: age ≥75 years, history of major bleeding (MB), history of stroke, chronic oral anticoagulant use, chronic kidney disease, anemia, or thrombocytopenia. Additionally, in a separate analysis, patients were categorized according to the recently published Academic Research Consortium HBR criteria. The Kaplan-Meier method was used for time-to-event analyses. Coronary thrombotic events (CTE) included myocardial infarction or definite/probable stent thrombosis. MB was defined according to the TIMI (Thrombolysis in Myocardial Infarction) or GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) scales. Impact of CTE and MB on subsequent risk of mortality was assessed using multivariable Cox regression with MB and CTE included as time-updated covariates. Results: Of the total 10 502 patients included, 3507 (33%) were identified as HBR. Compared with non-HBR patients, those at HBR had more comorbidities, higher lesion complexity, and a higher risk of 4-year mortality (Hazard Ratio [HR] 4.38 [95% CI, 3.76–5.11]). Results were qualitatively similar when using Academic Research Consortium criteria to define HBR. Risk of mortality was increased after CTE (HR 5.02 [95% CI, 3.93–6.41]), as well as after MB (HR 4.92 [95% CI, 3.82–6.35]). Of note, this effect was consistent across the spectrum of bleeding risk ( P -interaction test 0.97 and 0.06, respectively). Conclusions: Compared with the non-HBR population, HBR patients experienced worse 4-year outcomes after percutaneous coronary intervention with cobalt-chromium everolimus-eluting stent. Both CTE and MB had a significant impact on subsequent risk of mortality irrespective of bleeding risk.

Objectives This study sought to investigate the effect of different body mass index (BMI) categories on clinical outcomes in female patients treated with percutaneous coronary intervention (PCI) and drug-eluting stents. Background Patients with higher BMI might, paradoxically, have better long-term clinical outcomes after acute coronary syndrome treated with PCI. Methods We pooled patient-level data for female participants from 26 randomized trials on PCI with drug-eluting stents. Patients were stratified into underweight (BMI, Results Among 11,557 female patients included in the pooled database, 9,420 were treated with a drug-eluting stent and had BMI data available. Patients with higher BMI were significantly younger and with more cardiovascular risk factors. Only 139 patients were underweight and had significantly higher adjusted rates of cardiac mortality and all-cause mortality than the rest of the population (hazard ratio: 2.20 [1.31 to 3.71] compared with normoweight). There was a significantly lower frequency of unadjusted 3-year all-cause mortality in overweight, obese, and severely obese patients compared with normoweight. However, following multivariable analysis, a trend toward increased risk of death in severely obese patients was observed, describing an inverse “J”-shaped relation between BMI and 3-year mortality. Conversely, the relationship between BMI and other outcomes, such as major adverse cardiac events, was flat for normoweight and higher BMI. Conclusions The risk of 3-year adjusted cardiac events did not differ across BMI groups, whereas the risk of all-cause mortality compared with normoweight was significantly higher in underweight patients and lower in overweight patients with a trend toward increased risk in the severely obese population.

Background Available data on the long-term impact of coronary artery calcification (CAC) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) are limited. Purpose We evaluated the long-term impact of CAC on outcomes after PCI and the respective performance of first- and second-generation DES. Methods We pooled patient-level data from 18 randomized trials evaluating DES categorized according to the presence of angiographic core lab-confirmed moderate or severe CAC in any target lesion. Outcome measures of interest were the patient-oriented composite endpoint (POCE; death, myocardial infarction [MI], or any revascularization), the device-oriented composite endpoint of target lesion failure (TLF; cardiac death, target vessel MI or ischemia-driven target lesion revascularization), and definite or probable stent thrombosis (ST). Multivariable Cox proportional regression with study as a random effect was used to assess 5-year outcomes. Results A total of 19,833 patients were included. Moderate or severe CAC was present in 6211 (31.3%) patients and associated with increased 5-year risk of the POCE (adjHR 1.12, 95% CI 1.05–1.20, p Conclusion In this large-scale study, target lesion moderate or severe CAC was associated with adverse patient- and device-related outcomes at 5 years, risks that were reduced but not eliminated with second-generation DES. Acknowledgement/Funding This investigator-sponsored study was funded by Abbott Vascular.

Background Heart failure with preserved ejection fraction (HFpEF) is a prevalent clinical condition in the aging population. HFpEF lacks specific therapies with a significant impact on survival, different therapeutic approaches have indeed failed, indicating a specific need in understanding the pathophysiology of the disease. Cardiac hypertrophy is one of the main features of HFpEF that contributes to impair diastolic function. Reducing ventricular stiffness associated with cardiomyocyte hypertrophy may indeed result in improved diastolic filling. Growth differentiation factor 11 (Gdf11), a TGF-β family factor, has been identified as a circulating factor able to reduce cardiac hypertrophy. Purpose Similar to myostatin (Gdf8), Gdf11 promotes the activation of atrophy pathways that induce ubiquitination of sarcomeric proteins. Gdf11 and Gdf8 activate both type I and II Tgf-β receptors, specifically by interacting with Acvr2a and Acvr2b (type II) and Alk 4/5/7 (type I), they activate Smad 3/4 pathway. Our data indicate a specific and more potent effect of Gdf11 in reducing cardiomyocytes size that is not recapitulated by Gdf8. Understanding the specific effect of Gdf11 on cardiomyocytes is crucial to develop therapeutic strategies to target the hypertrophic phenotype. Methods To investigate the effects of specific type I receptor KO on Smad signaling cascade we performed our preliminary experiment on HL-1 cells, a cardiac muscle cell line carrying a doxycycline inducible Cas9 transgene. Cell sensitivity of HL-1 to Gdf11 and Gdf8 was tested by performing a dose-response curve using a luciferase reporter for Smad 3/4 pathway activation (CAGA12). Selective Tgf-β type I receptor KO was induced using, for each receptor, two sgRNAs that have been designed to cleave the receptor coding sequence creating INDEL mutations and disrupt proper translation of the protein and confirmed by western blotting. Smad 3/4 activity was measured using a CAGA12-luciferase assay on HL-1-Cas9 transduced cells. Results Our data in HL-1 cells confirm a more potent effect of Gdf11 in activating Smad 3/4 pathway when compared to Gdf8 (Fig. 1A). Selective Alk4 and Alk5 KO induced a similar reduction in Smad 3/4 activation for both Gdf11 and Gdf8. Interestingly, Alk7 KO significantly reduced Gdf11 signaling that was not recapitulated when using Gdf8, suggesting that Alk7 receptor is crucial for Gdf11-dependent Smad 3/4 activation in HL-1 cells (Fig. 1B). Figure 1 Conclusions Our preliminary results indicate that part of Gdf11 cardiac specificity when compared to Gdf8 may reside in the usage of Alk7 for signaling. Alk7 has proposed as a protective factor for pathological cardiac hypertrophy by negatively regulating Mek-Erk1/2 signalling. Our results are now under investigation in vitro using mouse neonatal cardiomyocytes expressing Cas-9 and in vivo using cardiac-specific-Cas9-expressing C57 transgenic mice, in resting condition and after induction of pathological hypertrophy.

The original version of this article unfortunately contained a mistake. The following text was missing in the acknowledgements section. "This research is co-financed by Greece and the European Union (European Social Fund—ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project “Strengthening Human Resources Research Potential via Doctorate Research” (MIS-5000432), implemented by the State Scholarships Foundation (IKY).". © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Similar to manufacturing power plants using USC steels, fusion arc welding will be the key fabrication technology for A-USC materials, as well. The shape of semifinished products, welding details, and strategy of welded manufacturing are not expected to depart significantly from established concepts. In this field, as of today, welding technology and associated filler materials are sufficiently mature at least for some specific austenitic steels, nickel-based alloys, and limited types of arc welding methods. Difficulties still exist mainly for A-USC ferritic steels because promising base material candidates emerged only very recently (now commonly known as SAVE12AD and VM12-SHC, for thick- and thin-walled members, respectively). Also recently emerged are nickel-based alloys due to delicate weldability of the most performing grades (considered to be the alloys 617B and 740H). However, most A-USC austenitic steels are considered of good weldability and fabricability (the most promising grades are 304HCu and HR6W for tubing and thick components, respectively), and their use has been already introduced in USC designs. Control of the weld metal chemistry, its purity, and cleanliness requirements are often very tight and not easy to be consistently achieved during field welding; this is to say welding technologies for A-USC power plants require the highest care in the process and the selection of adequate filler material, which have to be carefully coordinated to the base materials as well as to the operation conditions. As consequence of this behavior, so far the gas tungsten arc method has been the main choice on all A-USC material classes, thus accepting compromises on the achievable deposition rates. Slag-forming methods have been confined to few specific alloys with more tolerant weldability. Also, dissimilar metal welding is an area of great complexity and concern, with qualification of the various solutions currently being undertaken. R&D in this sector has been intense in the last decade, but it is obviously needed to accumulate experience in large A-USC welded fabrication and long-time service at high temperature. This chapter presents recent developments for the most promising weldable A-USC materials, the challenges and the strategies for the proper control of the welding activity, the already mature welding methods suitable for the delicate weldability of such materials, and a selection of applications for different kinds of plant equipments already at a demonstrative stage.

Fusion arc welding is the main fabrication technology for a variety of metallic products (like tubes, pipes, castings, and forgings) and components used in ultra-supercritical (USC) power plants. The basic aspects pertain the ability to develop weldments mechanical and technological properties matching the relevant base materials being joined, with creep rupture and oxidation resistance properties of the greatest importance. Most common fusion welding methods (Manual Metal Arc, Gas Tungsten Arc, Submerged Arc and Flux Cored Arc predominate) are successfully employed to match different demands for productivity and manufacturing situations on a wide range of welded details, either at the shop or during plant erection. The ability of a material to be welded is a key selection aspect for usage in USC plants, and the performance of the area affected by the weld thermal cycle may limit the full exploitation of the finely tuned base metal properties. This typically concerns the creep rupture strength of welded members stressed transversally made of high-Cr martensitic steels, where the occurrence of Type IV service cracking has to be taken into account at the design stage. Successful fabrication is achievable only with tight control of the material selection and the welding manufacturing cycle, especially due to the prevailing extensive use of the sophisticated precipitation-strengthened creep strength–enhanced ferritic steels that replaced the traditional Cr-Mo grades. The latter includes the management of the heating cycle and the precise control of the post-weld heat treatment. Filler metals used for joining USC steels have a similar alloy system for developing adequate creep strength, and their composition allows the exploitation of the full base materials (BMs) mechanical properties at both short- and long-term service. Anyway, the altered microstructure in the heat affected zone may limit the performance of the joints especially for longer lives and relatively low stress. This chapter aims to give a detailed overview of the welding methods, the USC base materials weldability and relevant welding metallurgy, the joints design, the mechanical properties and filler metal selection. The most productive methods used today for the classes of bainitic low-alloyed steels, the martensitic high-Cr steels and specific austenitic grades are given. The influence of the welding fabrication cycle on highly sophisticated materials used currently in USC fossil power plants is presented together the degradation and damage mechanisms acting during welding, the heat treatment strategies, and the service at high temperature. Topics recently attracting increased attention are also shortly addressed, like dissimilar metal welding (due to the even stronger tendency to tailor the BM placement to the specific plant service conditions) and the welding repair of members for alteration or after damage has occurred.

The ITER magnetic system includes 18 Toroidal Field (TF) Coils constructed using Nb3Sn cable-in-conduit superconductor. Each TF coil comprises a Winding Pack (WP) composed of 7 Double Pancake (DP) modules stacked together, impregnated and inserted into a stainless steel coil case. Fusion for Energy [the European Domestic Agency (DA)] is responsible for the procurement of the ten while the Japanese DA is responsible for remaining nine coils. The conductors are being produced by 6 different DAs, while the coil cases only by the Japanese DA. F4E has implemented a procurement strategy aimed to minimize costs and risks, consisting of subdividing the procurement into three main procurement packages, each foreseeing first an R&D and qualification phase. One procurement package is related to the construction of 72 radial plates (RP), another to the fabrication of the ten WP, and a third to the cold test and coil-case insertion of ten WP. In collaboration with industry, F4E has successfully produced two RP prototypes. Regarding the DP, the construction of the first DP prototype has started. In this paper, we will report on the results achieved so far and the status of each of the procurement packages.

Ocular trauma is the leading cause of acquired monocular blindness, accounting for 1.97-6% of such cases. Particularly, penetrating ocular injuries are among the most common eye injuries with this kind of outcome. Early diagnosis and prompt management are crucial to avoid complications, and the especially dreaded enucleation. In this article, the authors describe the clinical management, and evaluate the visual and anatomical results obtained in a case of ocular injury with retained intraocular foreign body (IOFB) in a 20-year old female patient. The course of treatment involved a combination of penetrating keratoplasty with a temporary keratoprosthesis, phacoemulsification with intraocular lens implantation and pars plana vitrectomy. At three years from the initial injury, the patient was able to count fingers at 30 centimetres and anatomical restitutio ad integrum of the globe had been achieved.

Current guidelines recommend high intensity lipid lowering (HILL) for treatment of established coronary artery disease (CAD). Adherence to and predictors of HILL use in usual-care setting remains unknown. We analyzed 8,976 consecutive patients with CAD undergoing PCI from Jan 2010 to May 2016 in

The aim of the project ‘Bridgeplex’, partly supported by the European Research Fund for Coal and Steel, was to explore the suitability of austenitic-ferritic (duplex) stainless steel for the construction of large welded bridges. Using duplex stainless steels for bridge decks would be a major step forward in providing durable, low maintenance structures, exploiting both their corrosion resistance and high mechanical properties, while fulfilling the required structural safety performances. In this work, beyond the Bridgeplex planned activities, it was investigated the possibility to replace the longitudinal welded joint between the deck plate and the girder trapezoidal stiffeners, performed by SAW, with a comparable one fabricated by hybrid laser welding (LB-GMAW). Potential advantages that could be achieved are, among others, productivity improvement, better detail fatigue resistance and lower distortion of the welded structure. The main differences obtained using SAW and LB-GMAW for the specific structura...

In reducing the costs associated with the fabrication of new pipelines for transporting hydrocarbons (pipelines), circumferential joint welding activities have a significant impact on total cost per km. LASER–MIG hybrid welding (LB–GMAW), with fibre-optic LASER beam delivery, offers the opportunity for reducing fabrication costs, thanks to increased productivity, despite the higher initial investment. The aim of this work is to demonstrate the feasibility of pipeline fabrication using LB–GMAW hybrid welding technology for the circumferential welding of large diameter pipes (36″) for gas pipelines, on X100 high-grade steel with nominal thickness of 16 mm. Solid-state LASER systems with fibre-delivered LASER beam (Nd:YAG and Yb:SiO2) have been used in this study. The hybrid welding system has been shown to be of potential interest since, by guaranteeing adequate mechanical properties, it ensures increased productivity (reduced number of passes and increased welding speed).

The final oscillation analysis of the complete set of data collected by CHORUS in the years 1994-1997 is presented. Reconstruction algorithms of data extracted by electronic detectors were improved and the data recorded in the emulsion target were analysed by new automated scanning systems, allowing the use of a new method for event reconstruction in emulsion. CHORUS has applied these new techniques to the sample of 1996-1997 events for which no muons were observed in the electronic detectors. Combining the new sample with the data analysed in previous papers, the overall sensitivity of the experiment to the ?? appearance is thus improved. In a two-neutrino mixing scheme, a 90% C.L. upper limit of sin2 2 ?µ ? < 4.4 × 10-4 is set for large ? m2, improving by a factor 1.5 the previously published CHORUS result. © 2007 Elsevier B.V. All rights reserved. Bundesministerium für Bildung und Forschung: 05 7MS12P, 05 6BU11P Grant Foundation: KRF-2003-005-C00014 Promotion and Mutual Aid Corporation for Private Schools of Japan CERN Israel Science Foundation: 328/94 Brussels Instituut voor Milieubeheer Istituto Nazionale di Fisica Nucleare Foundation for Fundamental Research on Matter Korean Foundation for Cancer Research Walter Burke Institute for Theoretical Physics We gratefully acknowledge the help and support of the neutrino beam staff and of the numerous technical collaborators who contributed to the detector construction, operation, emulsion pouring, development, and scanning. The experiment has been made possible by grants from the Institut Interuniversitaire des Sciences Nucléaires and the Interuniversitair Instituut voor Kernwetenschappen (Belgium), the Israel Science Foundation (grant 328/94) and the Technion Vice President Fund for the Promotion of Research (Israel), CERN (Geneva, Switzerland), the German Bundesministerium für Bildung und Forschung (contract numbers 05 6BU11P and 05 7MS12P) (Germany), the Institute of Theoretical and Experimental Physics (Moscow, Russia), the Istituto Nazionale di Fisica Nucleare (Italy), the Promotion and Mutual Aid Corporation for Private Schools of Japan and Japan Society for the Promotion of Science (Japan), the Korea Research Foundation Grant (KRF-2003-005-C00014) (Republic of Korea), the Foundation for Fundamental Research on Matter FOM and the National Scientific Research Organization NWO (The Netherlands), and the Scientific and Technical Research Council of Turkey (Turkey). We gratefully acknowledge their support.

During the years 1994–1997, the emulsion target of the CHORUS detector was exposed to the wide-band neutrino beam of the CERN SPS of 27 GeV average neutrino energy. In total about 100 000 charged-current neutrino interactions were located in the nuclear emulsion target and fully reconstructed. From this sample of events which was based on the data acquired by new automatic scanning systems, 1048 charged-current interactions with a D 0 in the final state were selected by a pattern recognition program and confirmed as neutral-particle decays through visual inspection. The ratio of decay branching fractions of the D 0 into four charged particles to two charged particles was measured to be B ( D 0 → V 4 ) / B ( D 0 → V 2 ) = 0.207 ± 0.016 ± 0.004 . The inclusive measurement of the observed production rate of the D 0 with a decay into four charged prongs in combination with external measurements of this topological branching ratio was used to determine the total D 0 production rate by neutrinos without additional assumption on the branching fractions. The value of this rate relative to the charged-current cross-section was found to be σ ( D 0 ) / σ ( CC ) = 0.0269 ± 0.0018 ± 0.0013 . In addition, the same normalization method was used to deduce the inclusive topological decay rate into final states with neutral particles only. A value of 0.218 ± 0.049 ± 0.036 was found for this branching fraction. From an observed number of three charged six-prong events the branching ratio into six charged particles was determined to be ( 1.2 −0.9 +1.3 ± 0.2 ) × 10 −3 . A measurement of the energy dependence of the D 0 production by neutrinos relative to the total charged-current cross-section is also reported. This measurement was used to deduce for m c , the effective charm-quark mass, a value of ( 1.42 ± 0.08 ) GeV / c 2 .

During the years 1994–1997, the emulsion target of the CHORUS detector was exposed to the wide-band neutrino beam of the CERN SPS of 27 GeV average neutrino energy. In total about 100 000 charged-current neutrino interactions were located in the nuclear emulsion target and fully reconstructed. A high-statistics sample of neutrino interactions with a D 0 in the final state was collected. Using the decay mode D * + → D 0 π + a production cross-section measurement of the D * + in neutrino–nucleon charged-current interactions was performed. The low Q-value of the decay was used to isolate a sample of candidate events containing a positive hadron with a small p T with respect to the D 0 direction. A signal of 22.1 ± 5.5 D * + events was obtained. The D * + production cross-section relative to the D 0 production cross-section, σ ( D * + ) / σ ( D 0 ) , was estimated to be 0.38 ± 0.09 ( stat ) ± 0.05 ( syst ) . From this result, the fraction of D 0 's produced via the decay of a D * was deduced to be 0.63 ± 0.17 . The D * + production cross-section relative to the ν μ charged-current interaction, σ ( D * + ) / σ ( CC ) , was estimated to be [ 1.02 ± 0.25 ( stat ) ± 0.15 ( syst ) ] % .

Background: Both Impella and Intra-aortic balloon pump (IABP) are used to provide hemodynamic support in high risk patients undergoing complex percutaneous coronary intervention (PCI). However, patterns of use and selection strategies for these devices in routine clinical practice are unclear